Mikami, Yukiko; Takagi, Kenjiro; Itaya, Yukiko; Ono, Yoshihisa; Matsumura, Hideyoshi; Takai, Yasushi; Seki, Hiroyuki
We examined the post-partum recovery course in patients with pre-eclampsia (PE) and gestational hypertension (GH) and evaluated the associated factors. In a retrospective review of 145 patients with GH or PE who gave birth between 1 January 2008 and 30 October 2011 at our institution, there were 125 PE and 20 GH cases. Data collected included the gestational age at initial examination and delivery, delivery mode, time for normalization of blood pressure (BP), and time until resolution of proteinuria in PE patients. Comparisons were made between singleton and multiple pregnancies, onset (early, hypertension and proteinuria, respectively. The time for BP normalization was longer in the early-onset group. The time for resolution of proteinuria was not affected by any factor examined. A post-partum observation period of 12 weeks is acceptable for differentiating PE and GH from chronic hypertension or renal disease. GH severity did not affect the recovery period, but proteinuria severity did. Onset time was a factor influencing the recovery from PE and GH. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.
Ginex, Valeria; Veronelli, Laura; Vanacore, Nicola; Lacorte, Eleonora; Monti, Alessia; Corbo, Massimo
Aphasia is a serious consequence of stroke but aphasics patients have been routinely excluded from participation in some areas of stroke research. To assess the role of specific linguistic and non-verbal cognitive abilities on the short-term motor recovery of patients with aphasia due to first-ever stroke to the left hemisphere after an intensive rehabilitation treatment. 48 post-acute aphasic patients, who underwent physiotherapy and speech language therapy, were enrolled for this retrospective cohort-study. Four types of possible predictive factors were taken into account: clinical variables, functional status, language and non-verbal cognitive abilities. The motor FIM at discharge was used as the main dependent variable. Patients were classified as follows: 6 amnestic, 9 Broca's, 7 Wernicke's, and 26 global aphasics. Motor FIM at admission (p = 0.003) and at discharge (p = 0.042), all linguistic subtests of Aachener AphasieTest (p = 0.001), and non-verbal reasoning abilities (Raven's CPM, p = 0.006) resulted significantly different across different types of aphasia. Post-hoc analyses showed differences only between global aphasia and the other groups. A Multiple Linear Regression shows that admission motor FIM (p = 0.001) and Token test (p = 0.040), adjusted for clinical, language, and non-verbal reasoning variables, resulted as independent predictors of motor FIM scores at discharge, while Raven's CPM resulted close to statistical significance. Motor function at admission resulted as the variable that most affects the motor recovery of post-stroke patients with aphasia after rehabilitation. A linguistic test requiring also non-linguistic abilities, including attention and working memory (i.e. Token test) is an independent predictor as well.
Vukovic, Mile; Vuksanovic, Jasmina; Vukovic, Irena
In this study we investigated the recovery patterns of language and cognitive functions in patients with post-traumatic language processing deficits and in patients with aphasia following a stroke. The correlation of specific language functions and cognitive functions was analyzed in the acute phase and 6 months later. Significant recovery of the…
Veiga, Mariana B; Lam, Melanie; Gemeinhardt, Carla; Houlihan, Edwina; Fitzsimmons, Brian P; Hodgson, Zoë G
The benefits of social support in post-surgical recovery are well documented; social support decreases preoperative stress and postoperative recovery time. However, a paucity of studies have examined the effect of social support in the context of pregnancy termination. This study is the first to examine the effect of postoperative accompaniment from the patient, support person and nurses' perspective. This study was carried out in two phases. In Phase I, no accompaniment was allowed in the post-anesthesia recovery room (PAR); in Phase II, accompaniment was permitted. All participants completed pre- and postoperative questionnaires. The perception of accompaniment was overwhelmingly positive in patients and support people. Patients in Phase II demonstrated a high (over 95%) acceptance of accompaniment in the recovery room. It was found that 96.8% reported they would choose to be accompanied in the recovery room again if they had to have another abortion. Support persons felt very strongly that their presence was helpful to the patient. The decrease in pre- to postoperative anxiety levels was significantly greater in those women who were accompanied. However, overall, nurses demonstrated a negative attitude towards accompaniment in the recovery room. In summary, the presence of a support person in the PAR was perceived in a positive manner by patients and support people. However, the reasoning behind the negative opinion of nurses requires further study before PAR accompaniment can be considered a possibility in the context of pregnancy termination. Copyright © 2011 Elsevier Inc. All rights reserved.
Vukovic, Mile; Vuksanovic, Jasmina; Vukovic, Irena
In this study we investigated the recovery patterns of language and cognitive functions in patients with post-traumatic language processing deficits and in patients with aphasia following a stroke. The correlation of specific language functions and cognitive functions was analyzed in the acute phase and 6 months later. Significant recovery of the tested functions was observed in both groups. However, in patients with post-traumatic language processing deficits the degree of recovery of most language functions and some cognitive functions was higher. A significantly greater correlation was revealed within language and cognitive functions, as well as between language functions and other aspects of cognition in patients with post-traumatic language processing deficits than in patients with aphasia following a stroke. Our results show that patients with post-traumatic language processing deficits have a different recovery pattern and a different pattern of correlation between language and cognitive functions compared to patients with aphasia following a stroke. (1) Better understanding of the differences in recovery of language and cognitive functions in patients who have suffered strokes and those who have experienced traumatic brain injury. (2) Better understanding of the relationship between language and cognitive functions in patients with post-traumatic language processing deficits and in patients with aphasia following a stroke. (3) Better understanding of the factors influencing recovery.
Otter, A.R. den; Geurts, A.C.H.; Mulder, T.; Duysens, J.E.J.
OBJECTIVE: To establish whether functional recovery of gait in patients with post-stroke hemiparesis coincides with changes in the temporal patterning of lower extremity muscle activity and coactivity during treadmill walking. METHODS: Electromyographic (EMG) data from both legs, maximum walking
Den Otter, AR; Mulder, T; Duysens, J
Objective: To establish whether functional recovery of gait in patients with post-stroke hemiparesis coincides with changes in the temporal patterning of lower extremity muscle activity and coactivity during treadmill walking. Methods: Electromyographic (EMG) data from both legs, maximum walking
Prolonged, strenuous exercise results in muscle glycogen depletion. Recovery of these stores prior to the next training session or competition is crucial to optimise exercise performance. Nutrition plays an important role during the post-exercise recovery period when processes such as muscle regeneration, glycogen and ...
Wei, Jun; Wang, Yan; Xu, Jiayuan; Zhang, Chunfang; Zhou, Helen; Liu, Guoli
The aim of this study was to investigate the post-partum recovery of blood pressure (BP) in women with hypertensive disorders of pregnancy (HDP) and to evaluate HDP risk factors. A total of 124 patients with gestational hypertension (n = 63) or pre-eclampsia (n = 61) who gave birth at Peking University People's Hospital between January and December 2013 were included in this study. The recorded clinical and laboratory parameters included the patients' general information, maternal pre-pregnancy body mass index, gestational weight gain, gestational age at onset and delivery, delivery mode and time taken for BP to return to normal level. Logistic regression analysis was performed to evaluate the influence of various risk factors on post-partum BP recovery. The mean interval for BP normalization was 24.1 ± 22.8 days (median, 7 days). Forty-six percent of the patients recovered from hypertension within three days, and 75% recovered within six weeks of delivery. About 90% of the patients required 60 days for BP to normalize after delivery. After adjusting for confounding factors, post-partum recovery from hypertension was found to be influenced by hypertension severity, maternal serum albumin level, a family history of hypertension and gestational week at delivery. The BP of the majority of the patients with gestational hypertension or pre-eclampsia returned to normal within 60 days of delivery. Hypertension severity, maternal serum albumin level, a family history of family hypertension and gestational week at delivery influenced the time required for BP normalization. © 2016 Japan Society of Obstetrics and Gynecology.
Langkilde, A; Jakobsen, T L; Bandholm, T Q
OBJECTIVE: Reduced function persists for many patients after total knee arthroplasty (TKA). Inflammation is part of osteoarthritis' pathophysiology, and surgery induces a marked inflammatory response. We therefore wanted to explore the role of inflammation in long-term recovery after TKA, and thus...... conducted this secondary analysis of our randomized controlled trial (RCT) of physical rehabilitation ± progressive strength training (PST). We aimed to investigate whether (1) inflammation is associated with functional performance, knee-extension strength, and knee pain before TKA; (2) PST affects...... factor (TNF)-α at baseline; day 1, week 4, 8, and 26 after TKA. RESULTS: At baseline, suPAR (P = 006) was negatively associated with 6MWT. Neither baseline nor surgery-induced inflammation modified the response to rehabilitation ± PST. Only surgery-induced IL-10 was associated with Δ6MWT26 weeks...
Duffy, Paul; Baldwin, Helen
The increasing focus on achieving a sustained recovery from substance use brings with it a need to better understand the factors (recovery capital) that contribute to recovery following treatment. This work examined the factors those in recovery perceive to be barriers to (lack of capital) or facilitators of (presence of capital) sustained recovery post treatment. A purposive sample of 45 participants was recruited from 11 drug treatment services in northern England. Semi-structured qualitative interviews lasting between 30 and 90 minutes were conducted one to three months after participants completed treatment. Interviews examined key themes identified through previous literature but focused on allowing participants to explore their unique recovery journey. Interviews were transcribed and analysed thematically using a combination of deductive and inductive approaches. Participants generally reported high levels of confidence in maintaining their recovery with most planning to remain abstinent. There were indications of high levels of recovery capital. Aftercare engagement was high, often through self referral, with non substance use related activity felt to be particularly positive. Supported housing was critical and concerns were raised about the ability to afford to live independently with financial stability and welfare availability a key concern in general. Employment, often in the substance use treatment field, was a desire. However, it was a long term goal, with substantial risks associated with pursuing this too early. Positive social support was almost exclusively from within the recovery community although the re-building of relationships with family (children in particular) was a key motivator post treatment. Addressing internal factors and underlying issues i.e. 'human capital', provided confidence for continued recovery whilst motivators focused on external factors such as family and maintaining aspects of a 'normal' life i.e. 'social and physical
Full Text Available Abstract Background The increasing focus on achieving a sustained recovery from substance use brings with it a need to better understand the factors (recovery capital that contribute to recovery following treatment. This work examined the factors those in recovery perceive to be barriers to (lack of capital or facilitators of (presence of capital sustained recovery post treatment. Methods A purposive sample of 45 participants was recruited from 11 drug treatment services in northern England. Semi-structured qualitative interviews lasting between 30 and 90 minutes were conducted one to three months after participants completed treatment. Interviews examined key themes identified through previous literature but focused on allowing participants to explore their unique recovery journey. Interviews were transcribed and analysed thematically using a combination of deductive and inductive approaches. Results Participants generally reported high levels of confidence in maintaining their recovery with most planning to remain abstinent. There were indications of high levels of recovery capital. Aftercare engagement was high, often through self referral, with non substance use related activity felt to be particularly positive. Supported housing was critical and concerns were raised about the ability to afford to live independently with financial stability and welfare availability a key concern in general. Employment, often in the substance use treatment field, was a desire. However, it was a long term goal, with substantial risks associated with pursuing this too early. Positive social support was almost exclusively from within the recovery community although the re-building of relationships with family (children in particular was a key motivator post treatment. Conclusions Addressing internal factors and underlying issues i.e. ‘human capital’, provided confidence for continued recovery whilst motivators focused on external factors such as family and
Cardoso-Moreno, M J; Tomás-Aragones, L
The objective of this work was to investigate the possible relationship between perceived family support, levels of cortisol and post surgery recovery. The study sample comprised 42 patients that were due to undergo open cholecystectomy surgery in a Regional Health Authority Reference Centre of the Autonomous Community of Extremadura in Spain. The FACES-II questionnaire was used for the evaluation of perceived family support and to measure the three fundamental dimensions of perceived family behaviour: cohesion, adaptability and family type. The day before surgery, a sample of saliva was taken from each subject in order to determine the level of cortisol. Results showed a clear relationship between family support and recovery. Patients with higher scores on the Cohesion Scale demonstrated better post surgery recovery (F = 8.8; gl = 40; p = .005). A relationship between levels of cortisol, perceived family support and recovery was also revealed. Patients with lower scores on the Cohesion scale and higher cortisol levels demonstrated poorer post surgery recovery (F = 10.96; gl = 40; p = .006). These results are coherent with other studies that have highlighted the beneficial effects of perceived family support on mental and physical health.
Gouveia, Celia; Bastos, Ana; DaCamara, Carlos; Trigo, Ricardo M.
Fires in Portugal, as in the Mediterranean ecosystems, have a complex effect on vegetation regeneration due to the different responses of vegetation to the variety of fire regimes and to the complexity of landscape structures. A thorough evaluation of vegetation recovery after fire events becomes therefore crucial in land management. In 2005, Portugal suffered a strong damage from forest fires that damaged an area of 300 000 ha of forest and shrub. This year are particularly interesting because it is associated the severe drought of 2005. The aim of the present study is to identify large burnt scars in Portugal during the 2005 fire seasons and monitoring vegetation behaviour throughout the pre and the post fire periods. The mono-parametric model developed by Gouveia et al. (2010), based on monthly values of NDVI, at the 1km×1km spatial scale, as obtained from the VEGETATION-SPOT5 instrument, from 1999 to 2009, was used.
Full Text Available Background: Environment and its ecosystems are affected by various natural and man-made disasters. The environmental management in disasters tries to protect ecosystems, sustain development, reduce disaster risk, and adapt to or decrease the impact of climate change. This study aimed to investigate the impact of disasters on the environment and methods of reducing these effects. Materials and Methods: This review study was conducted by searching PubMed, Google Scholar, Elsevier, UNEP, SID, and Magiran databases using keywords of “environment”, “disasters”, “recovery”, and “lessons learned” from 1999 to 2015. Results: Decrease in surface and groundwater resources, pollution of water resources, deforestation, desertification, soil erosion, air pollution and extinction of animal species are among post-disaster environmental damages. As a result of such changes in the environment and ecosystem, water shortage and drought, loss of vegetation, and food insecurity will ensue. Due to these destructive incidents, the people’s ability to provide necessary resources for living decreases and their very lives are threatened. Consequently, they are forced to immigrate to save their lives. Conclusion: Environmental recovery is one of the effective strategies for achieving sustainable development. In this regard, public and private organizations as well as international ones and people should work together. Responsible organizations, the stakeholders at different levels, and the public must be trained in this area and introduced to the latest international standards. Rules and policies should be reviewed and revised in accordance with today’s needs and international standards.
Engelund Luna, Iben; Peterson, Barry; Kehlet, Henrik
time. The aim of this study was to describe a novel methodology using actigraphy data to describe specific activity-intensities potentially affected by surgery and patients with poor rehabilitation trajectories. Actigraphy data from 10 patients scheduled for primary unilateral TKA were recorded...... recovery trajectories were described by the gradient of the regression line of post- versus pre-operative physical activity over the study period. TKA had a negative impact on all activity intensities with gradual improvement towards preoperative values during the study period. The inter......-individual variation increased with intensified activity. Identification of individual patients with positive, neutral or negative activity trajectories was possible. The methodology should be considered in future interventional studies to improve rehabilitation strategies....
Impact of Salivary Gland Dosimetry on Post-IMRT Recovery of Saliva Output and Xerostomia Grade for Head-and-Neck Cancer Patients Treated With or Without Contralateral Submandibular Gland Sparing: A Longitudinal Study
Wang Zhonghe; Yan Chao; Zhang Zhiyuan; Zhang Chenping; Hu Haisheng; Tu Wenyong; Kirwan, Jessica; Mendenhall, William M.
Purpose: To observe the recovery of saliva output and effect on xerostomia grade after intensity-modulated radiotherapy (IMRT) with or without contralateral submandibular gland (cSMG) sparing and to assess the impact of salivary gland dosimetry on this recovery among patients with head-and-neck cancer. Methods and Materials: Between May 2007 and May 2008, 52 patients with head-and-neck cancer received definitive (n = 5 patients) and postoperative (n = 47 patients) IMRT at our institution, with at least one parotid gland spared. Of these patients, 26 patients with a low risk of recurrence in the cSMG region underwent IMRT and had their cSMGs spared (cSMG-sparing group). The remaining 26 high-risk patients had no cSMGs spared (cSMG-unspared group). Xerostomia grades and salivary flow rates were monitored at five time points (before IMRT and at 2, 6, 12, and 18 months after IMRT). Results: Average mean doses and mean volumes receiving 30 Gy (V30) of the cSMGs were lower in the cSMG-sparing group than in the cSMG-unspared group (mean dose, 20.4 Gy vs. 57.4 Gy; mean V30, 14.7% vs. 99.8%, respectively). Xerostomia grades at 2 and 6 months post-IMRT were also significantly lower among patients in the cSMG-sparing group than in the cSMG-unspared group, but differences were not significant at 12 and 18 months after IMRT. Patients in the cSMG-sparing group had significantly better mean unstimulated salivary flow rates at each time point post- IMRT as well as better mean stimulated salivary flow rates at 2 months post-IMRT. Conclusions: Recovery of saliva output and grade of xerostomia post-IMRT in patients whose cSMGs were spared were much better than in patients whose cSMGs were not spared. The influence of the mean doses to the cSMG and parotid gland on the recovery of saliva output was equivalent to that of the mean V30 to the glands.
Impact of Salivary Gland Dosimetry on Post-IMRT Recovery of Saliva Output and Xerostomia Grade for Head-and-Neck Cancer Patients Treated With or Without Contralateral Submandibular Gland Sparing: A Longitudinal Study
Wang Zhonghe; Yan Chao [Division of Radiation Oncology, the Shanghai Ninth Peoples Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai (China); Zhang Zhiyuan; Zhang Chenping [Department of Oral and Maxillofacial Surgery, the Shanghai Ninth Peoples Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai (China); Hu Haisheng; Tu Wenyong [Division of Radiation Oncology, the Shanghai Ninth Peoples Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai (China); Kirwan, Jessica [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida (United States); Mendenhall, William M., E-mail: firstname.lastname@example.org [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida (United States)
Purpose: To observe the recovery of saliva output and effect on xerostomia grade after intensity-modulated radiotherapy (IMRT) with or without contralateral submandibular gland (cSMG) sparing and to assess the impact of salivary gland dosimetry on this recovery among patients with head-and-neck cancer. Methods and Materials: Between May 2007 and May 2008, 52 patients with head-and-neck cancer received definitive (n = 5 patients) and postoperative (n = 47 patients) IMRT at our institution, with at least one parotid gland spared. Of these patients, 26 patients with a low risk of recurrence in the cSMG region underwent IMRT and had their cSMGs spared (cSMG-sparing group). The remaining 26 high-risk patients had no cSMGs spared (cSMG-unspared group). Xerostomia grades and salivary flow rates were monitored at five time points (before IMRT and at 2, 6, 12, and 18 months after IMRT). Results: Average mean doses and mean volumes receiving 30 Gy (V30) of the cSMGs were lower in the cSMG-sparing group than in the cSMG-unspared group (mean dose, 20.4 Gy vs. 57.4 Gy; mean V30, 14.7% vs. 99.8%, respectively). Xerostomia grades at 2 and 6 months post-IMRT were also significantly lower among patients in the cSMG-sparing group than in the cSMG-unspared group, but differences were not significant at 12 and 18 months after IMRT. Patients in the cSMG-sparing group had significantly better mean unstimulated salivary flow rates at each time point post- IMRT as well as better mean stimulated salivary flow rates at 2 months post-IMRT. Conclusions: Recovery of saliva output and grade of xerostomia post-IMRT in patients whose cSMGs were spared were much better than in patients whose cSMGs were not spared. The influence of the mean doses to the cSMG and parotid gland on the recovery of saliva output was equivalent to that of the mean V30 to the glands.
Frolov, A. A.; Húsek, Dušan; Biryukova, E. V.; Bobrov, P.; Mokienko, O.; Alexandrov, A.V.
Roč. 27, č. 1 (2017), s. 107-137 ISSN 1210-0552 Grant - others:Russian Ministry of Education and Science(RU) RFMEFI60715X0128 Institutional support: RVO:67985807 Keywords : brain computer interface * motor imagery * post-stroke and post-traumatic patients * arm and hand exoskeleton * proportional derivative controller * motor synergy * clinical application Subject RIV: IN - Informatics, Computer Science OBOR OECD: Computer sciences, information science, bioinformathics (hardware development to be 2.2, social aspect to be 5.8) Impact factor: 0.394, year: 2016
Partanen, Anu; Valtola, Jaakko; Silvennoinen, Raija; Ropponen, Antti; Siitonen, Timo; Putkonen, Mervi; Sankelo, Marja; Pelkonen, Jukka; Mäntymaa, Pentti; Varmavuo, Ville; Jantunen, Esa
Lenalidomide is an immunomodulatory drug that is also currently used in transplant-eligible patients with multiple myeloma. Previous studies have suggested a negative impact of lenalidomide on the mobilization of CD34 + cells. No data are available regarding the more detailed composition of blood grafts after lenalidomide. In a multicenter, prospective study, we analyzed the mobilization of CD34 + cells, graft cellular composition, and post-transplant hematologic recovery in 26 patients with multiple myeloma after lenalidomide-based induction and in 34 lenalidomide-naive controls with multiple myeloma. All patients were mobilized with low-dose cyclophosphamide plus granulocyte-colony-stimulating factor. The cellular composition of the grafts was analyzed from thawed, cryopreserved samples with flow cytometry. Graft function was evaluated by engraftment data and by complete blood counts until 12 months after the graft infusion. Patients in the lenalidomide arm had lower median peak CD34 + counts and approximately 40% lower CD34 + cell yields from the first apheresis session, but these differences were not significant. The median total number of CD34 + cells collected was comparable (6.4 vs. 7.5 × 10 6 /kg). The number of apheresis sessions was higher in the lenalidomide group (2 vs. 1; p = 0.039). The blood graft composition was comparable between the groups. Hematologic recovery within 12 months post-transplant did not differ between the groups. Lenalidomide-based induction seems to have an impact on the number of aphereses performed, but not on the total yields of the CD34 + cells in the graft. Neither cellular composition of the grafts nor post-transplant recovery was affected by the limited pre-transplant exposure to lenalidomide. © 2017 AABB.
Mucek, Adonara E; Danišík, Martin; de Silva, Shanaka L; Schmitt, Axel K; Pratomo, Indyo; Coble, Matthew A
Large calderas, or supervolcanoes, are sites of the most catastrophic and hazardous events on Earth, yet the temporal details of post-supereruption activity, or resurgence, remain largely unknown, limiting our ability to understand how supervolcanoes work and address their hazards. Toba Caldera, Indonesia, caused the greatest volcanic catastrophe of the last 100 kyr, climactically erupting ∼74 ka. Since the supereruption, Toba has been in a state of resurgence but its magmatic and uplift history has remained unclear. Here we reveal that new 14 C, zircon U-Th crystallization and (U-Th)/He ages show resurgence commenced at 69.7±4.5 ka and continued until at least ∼2.7 ka, progressing westward across the caldera, as reflected by post-caldera effusive lava eruptions and uplifted lake sediment. The major stratovolcano north of Toba, Sinabung, shows strong geochemical kinship with Toba, and zircons from recent eruption products suggest Toba's climactic magma reservoir extends beneath Sinabung and is being tapped during eruptions.
Maniar, Rajesh N; Maniar, Parul R; Singhi, Tushar; Gangaraju, Bharat Kumar
No study in the literature has compared early functional recovery following total knee arthroplasty (TKA) in the obese with the nonobese using World Health Organization (WHO) classes of obesity. Our aim was to compare functional scores and flexion post-TKA in each class of obesity as per WHO classification against a matched control group of nonobese patients. Records of 885 consecutive primary TKA patients (919 knees) operated by a single surgeon were reviewed. The first 35 knees in each class I, class II and class III obesity group during the study period were then matched with a similar number of knees in nonobese TKA patients during the same period. Functional scores recorded pre- and postoperatively at 3 months and 1 year were Western Ontario and McMaster Osteoarthritis Index (WOMAC), Short-Form Health Survey (SF-12) score, and Knee Society Score (KSS). There was no difference in any parameter between the class I obese and matched nonobese at any assessment point. In the class II obese, as compared to the nonobese, there was no difference in any parameter preoperatively and 3 months postoperatively. However, 1 year postoperatively, the SF-12 physical subscore was lower in the class II obese than the nonobese (44.7 vs. 48.6, p = 0.047) and the WOMAC score was significantly higher (15.8 vs. 9.7, p = 0.04). In the class III obese, the WOMAC score was significantly higher than the nonobese (58.1 vs. 44.3, p lower (83.5 vs. 96.5, p = 0.049 preoperatively; 172 vs. 185; p = 0.003 at 1 year). Knee flexion was significantly lower in the class III obese than the nonobese (95 vs. 113; p class I obese can expect good early and late functional recovery as the nonobese. The class II obese can expect comparable early functional recovery as the nonobese but their late function may be lesser. The class III obese would have poorer functional scores and lesser knee flexion postoperatively compared to the nonobese. However, compared to their own preoperative status, there is
Rathburn, Sara L.; Shahverdian, Scott M.; Ryan, Sandra E.
Sediment recovery following disturbances is a measure of the time required to attain pre-disturbance sediment fluxes. Insight into the controls on recovery processes and pathways builds understanding of geomorphic resilience. We assess post-disturbance sediment recovery in three small (1.5-100 km2), largely unaltered watersheds within the northern Colorado Rocky Mountains affected by wildfires, floods, and debris flows. Disturbance regimes span 102 (floods, debris flows) to 103 years (wildfires). For all case studies, event sediment recovery followed a nonlinear pattern: initial high sediment flux during single precipitation events or high annual snowmelt runoff followed by decreasing sediment fluxes over time. Disturbance interactions were evaluated after a high-severity fire within the South Fork Cache la Poudre basin was followed by an extreme flood one year post-fire. This compound disturbance hastened suspended sediment recovery to pre-fire concentrations 3 years after the fire. Wildfires over the last 1900 YBP in the South Fork basin indicate fire recurrence intervals of 600 years. Debris flows within the upper Colorado River basin over the last two centuries have shifted the baseline of sediment recovery caused by anthropogenic activities that increased debris flow frequency. An extreme flood on North St. Vrain Creek with an impounding reservoir resulted in extreme sedimentation that led to a physical state change. We introduce an index of resilience as sediment recovery/disturbance recurrence interval, providing a relative comparison between sites. Sediment recovery and channel form resilience may be inversely related because of high or low physical complexity in streams. We propose management guidelines to enhance geomorphic resilience by promoting natural processes that maintain physical complexity. Finally, sediment connectivity within watersheds is an additional factor to consider when establishing restoration treatment priorities.
Zheng, W.B.; Liu, G.R.; Wu, R.H.; Li, L.P.
To determine whether diffusion-weighted magnetic resonance (MR) imaging findings combined with initial clinical factors indicate the depth of shearing lesions in the brain structure and therefore relate to coma duration in diffuse axonal injury (DAI). A total of 74 adult patients (48 male and 26 female) with DAI were examined with conventional MR imaging and diffusion-weighted MR imaging between 2 hours and 20 days after injury. Apparent diffusion coefficient (ADC) maps were obtained and the mean ADC values of each region of interest (ROI) were measured using MRI console software. The involvement of the brainstem, deep gray matter, and corpus callosum was determined for each sequence separately as well as for the combination of all sequences. The correlations between MR imaging findings indicating the presence of apparent brain injury combined with initial clinical factors were determined. Clinical characteristics, such as initial score on the Glasgow coma scale (GCS), age and number of all lesions, and ADC scores were predictive of the duration of coma. It was possible to predict post-traumatic coma duration in DAI from cerebral MR imaging findings combined with clinical prognostic factors in the acute to subacute stage after head injury. Age, ADC scores, GCS score and number of lesions were highly significant in predicting coma duration. The technique presented here might provide a tool for in vivo detection of DAI to allow the prediction of the coma duration during the early stages in patients with traumatic brain injury. (orig.)
Batcho, Sèbiyo Charles; Stoquart, Gaëtan; Thonnard, Jean-Louis
Objective: To determine whether regular brisk walking can promote functional recovery in community-dwelling stroke patients. Patients: A total of 44 chronic stroke patients, recruited in Belgium and Benin, respectively European high-income and African low-income countries. Methods: This longitudinal, single-cohort, observational study with 1 intervention period and 4 time-points of assessments (2 baseline, 1 post-intervention and 1 follow-up) was structured in 3 periods: pre-intervention peri...
Schneider, T; Andronopoulos, S; Camps, J; Duranova, T; Gallego, E; Gering, F; Isnard, O; Maître, M; Murith, C; Oughton, D; Raskob, W
NERIS is the European platform on preparedness for nuclear and radiological emergency response and recovery. Created in 2010 with 57 organisations from 28 different countries, the objectives of the platform are to: improve the effectiveness and coherency of current approaches to preparedness; identify further development needs; improve 'know how' and technical expertise; and establish a forum for dialogue and methodological development. The NERIS Strategic Research Agenda is now structured with three main challenges: (i) radiological impact assessments during all phases of nuclear and radiological events; (ii) countermeasures and countermeasure strategies in emergency and recovery, decision support, and disaster informatics; and (iii) setting up a multi-faceted framework for preparedness for emergency response and recovery. The Fukushima accident has highlighted some key issues for further consideration in NERIS research activities, including: the importance of transparency of decision-making processes at local, regional, and national levels; the key role of access to environmental monitoring; the importance of dealing with uncertainties in assessment and management of the different phases of the accident; the use of modern social media in the exchange of information; the role of stakeholder involvement processes in both emergency and recovery situations; considerations of societal, ethical, and economic aspects; and the reinforcement of education and training for various actors. This paper emphasises the main issues at stake for NERIS for post-accident management.
Joyce, L; Pandolph, P
The One Stop Post Op model for open heart surgery recovery is an innovative approach to post op care utilized in only a few facilities in the country. This model calls for an integration of acute ICU and step-down phases of care, thus changing the paradigm for nursing care of the open heart surgery patient. Typically, hospitals incur inefficiencies transferring the patient through multiple levels of care, thus resulting in a "disconnect" as new caregivers relearn the patient's care requirements and special needs. The construction of a "one stop" unit allows the patient to remain stationary while the service level changes to accommodate changing care needs. The cardiac "one stop" model is similar to the LDRP concept for obstetrical care. The One Stop Post Op patient rooms are designed to accommodate every level of patient acuity. All rooms meet the regulations for critical care room design, however this is where the aesthetic similarity ends. The patient environment looks more like hotel rooms rather than the traditional ICU setting. Cabinets designed to cover medical gases, in the room's private bathrooms and comfortable furnishings help to create a patient focused environment conducive to recovery. This model has been utilized by several facilities and has demonstrated clear clinical and economic advantages for patients, families, and health care providers. Implementing an open heart surgery (OHS) program presents the opportunity for several community based hospitals to challenge the way they have been providing patient care and establish an innovative approach to post surgery patient care. The One Stop Post Op cardiovascular recovery unit is designed to receive the OHS patient directly from the operating room and to be the "care unit" for the patient's entire stay. Patient flow, quality monitoring and caregiver acceptance in this unit requires new paradigms from the traditional two or three step post OHS care delivery process. The One Stop Post Op model focuses
Peris, Adriano; Bonizzoli, Manuela; Iozzelli, Dario; Migliaccio, Maria Luisa; Zagli, Giovanni; Bacchereti, Alberto; Debolini, Marta; Vannini, Elisetta; Solaro, Massimo; Balzi, Ilaria; Bendoni, Elisa; Bacchi, Ilaria; Trevisan, Monica; Giovannini, Valtere; Belloni, Laura
Critically ill patients who require intensive care unit (ICU) treatment may experience psychological distress with increasing development of psychological disorders and related morbidity. Our aim was to determine whether intra-ICU clinical psychologist interventions decrease the prevalence of anxiety, depression and posttraumatic stress disorder (PTSD) after 12 months from ICU discharge. Our observational study included critical patients admitted before clinical psychologist intervention (control group) and patients who were involved in a clinical psychologist program (intervention group). The Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale-Revised questionnaires were used to assess the level of posttraumatic stress, anxiety and depression symptoms. The control and intervention groups showed similar demographic and clinical characteristics. Patients in the intervention group showed lower rates of anxiety (8.9% vs. 17.4%) and depression (6.5% vs. 12.8%) than the control group on the basis of HADS scores, even if the differences were not statistically significant. High risk for PTSD was significantly lower in patients receiving early clinical psychologist support than in the control group (21.1% vs. 57%; P < 0.0001). The percentage of patients who needed psychiatric medications at 12 months was significantly higher in the control group than in the patient group (41.7% vs. 8.1%; P < 0.0001). Our results suggest that that early intra-ICU clinical psychologist intervention may help critically ill trauma patients recover from this stressful experience.
Edmiston, Elizabeth; Dolansky, Mary A; Zullo, Melissa; Forman, Daniel E
Octogenarians receiving cardiac valve surgery is increasing and recovery is challenging. Post-acute care (PAC) services assist with recovery, yet services provided in facilities do not provide adequate cardiac-focused care or long-term self-management support. The purpose of the paper was to report post-acute care discharge rates in octogenarians and propose clinical implications to improve PAC services. Using a 2003 Medicare Part A database, we studied post-acute care service use in octogenarians after cardiac valve surgery. We propose expansion of the Geriatric Cardiac Care model to include broader clinical therapy dynamics. The sample (n = 10,062) included patients over 80 years discharged from acute care following valve surgery. Post-acute care services were used by 68% of octagarians following cardiac valve surgery (1% intermediate rehabilitation, 35% skilled nursing facility, 32% home health). The large percentage of octagarians using PAC point to the importance of integrating geriatric cardiac care into post-acute services to optimize recovery outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.
Popov Kirill M
female than male non-hypertrophied hearts. Glucose oxidation was lower in female than male hearts and was unaffected by hypertrophy or ischemia. Consequently, non-oxidative catabolism of glucose after ischemia was lowest in male non-hypertrophied hearts and comparably elevated in hypertrophied hearts of both sexes. These differences in non-oxidative glucose catabolism were inversely related to post-ischemic functional recovery. Conclusion Gender does not significantly influence post-ischemic function of hypertrophied hearts, even though female sex is detrimental to post-ischemic function in non-hypertrophied hearts. Differences in glucose catabolism may contribute to hypertrophy-induced and gender-related differences in post-ischemic function.
Full Text Available Wildfires in Mediterranean Europe have been increasing in number and extension over the last decades and constitute one of the major disturbances of these ecosystems. Portugal is the country with more burnt area in the last decade and the years of 2003 and 2005 were particularly devastating, the total burned areas of 425 000 and 338 000 ha being several times higher than the corresponding average. The year of 2005 further coincided with one of the most severe droughts since early 20th century. Due to different responses of vegetation to diverse fire regimes and to the complexity of landscape structures, fires have complex effects on vegetation recovery. Remote sensing has revealed to be a powerful tool in studying vegetation dynamics and in monitoring post-fire vegetation recovery, which is crucial to land-management and to prevent erosion.
The main goals of the present work are (i to assess the accuracy of a vegetation recovery model previously developed by the authors; (ii to assess the model's performance, namely its sensitivity to initial conditions, to the temporal length of the input dataset and to missing data; (iii to study vegetation recovery over two selected areas that were affected by two large wildfire events in the fire seasons of 2003 and 2005, respectively.
The study relies on monthly values of NDVI over 11 years (1998–2009, at 1 km × 1 km spatial resolution, as obtained by the VEGETATION instrument. According to results from sensitivity analysis, the model is robust and able to provide good estimations of recovery times of vegetation when the regeneration process is regular, even when missing data is present. In respect to the two selected burnt scars, results indicate that fire damage is a determinant factor of regeneration, as less damaged vegetation recovers more rapidly, which is mainly justified by the high coverage of Pinus pinaster over the area, and by the fact that coniferous forests tend to
Bastos, A.; Gouveia, C. M.; Dacamara, C. C.; Trigo, R. M.
Wildfires in Mediterranean Europe have been increasing in number and extension over the last decades and constitute one of the major disturbances of these ecosystems. Portugal is the country with more burnt area in the last decade and the years of 2003 and 2005 were particularly devastating, the total burned areas of 425 000 and 338 000 ha being several times higher than the corresponding average. The year of 2005 further coincided with one of the most severe droughts since early 20th century. Due to different responses of vegetation to diverse fire regimes and to the complexity of landscape structures, fires have complex effects on vegetation recovery. Remote sensing has revealed to be a powerful tool in studying vegetation dynamics and in monitoring post-fire vegetation recovery, which is crucial to land-management and to prevent erosion. The main goals of the present work are (i) to assess the accuracy of a vegetation recovery model previously developed by the authors; (ii) to assess the model's performance, namely its sensitivity to initial conditions, to the temporal length of the input dataset and to missing data; (iii) to study vegetation recovery over two selected areas that were affected by two large wildfire events in the fire seasons of 2003 and 2005, respectively. The study relies on monthly values of NDVI over 11 years (1998-2009), at 1 km × 1 km spatial resolution, as obtained by the VEGETATION instrument. According to results from sensitivity analysis, the model is robust and able to provide good estimations of recovery times of vegetation when the regeneration process is regular, even when missing data is present. In respect to the two selected burnt scars, results indicate that fire damage is a determinant factor of regeneration, as less damaged vegetation recovers more rapidly, which is mainly justified by the high coverage of Pinus pinaster over the area, and by the fact that coniferous forests tend to recover slower than transitional woodland
Pritchett, Kelly; Pritchett, Robert
An optimal post-exercise nutrition regimen is fundamental for ensuring recovery. Therefore, research has aimed to examine post-exercise nutritional strategies for enhanced training stimuli. Chocolate milk has become an affordable recovery beverage for many athletes, taking the place of more expensive commercially available recovery beverages. Low-fat chocolate milk consists of a 4:1 carbohydrate:protein ratio (similar to many commercial recovery beverages) and provides fluids and sodium to aid in post-workout recovery. Consuming chocolate milk (1.0-1.5•g•kg(-1) h(-1)) immediately after exercise and again at 2 h post-exercise appears to be optimal for exercise recovery and may attenuate indices of muscle damage. Future research should examine the optimal amount, timing, and frequency of ingestion of chocolate milk on post-exercise recovery measures including performance, indices of muscle damage, and muscle glycogen resynthesis. Copyright © 2012 S. Karger AG, Basel.
Basu, Bhakti; Apte, Shree Kumar
An extremophile Deinococcus radiodurans is bestowed with an extraordinary DNA repair ability that renders it virtually resistant to all known forms of DNA damage caused by ionizing radiations (10 kGy of gamma rays), UV (1 kJ/m 2 ) or weeks of desiccation etc. The genome of D. radiodurans encodes a unique combination of DNA repair pathways such as prokaryotic type RecFOR mediated homologous recombination (HR) and nucleotide/base excision repair along with eukaryotic type strand annealing (SA) and non-homologous end joining (NHEJ), but is devoid of universal prokaryotic DNA repair pathways such as RecBCD mediated HR, photo-reactivation and SOS response. Collective evidence obtained so far from multiple approaches, have indicated (i) that all genes essential for DNA repair are not necessarily induced following radiation stress (ii) early RecA independent DNA assembly occurs, and (iii) absolute necessity of RecA dependent HR for final genome restitution. The 6 kGy gamma irradiation inducible proteome dynamics were mapped during the post-irradiation growth arrest phase by 2D protein electrophoresis coupled with mass spectrometry. Radiation inducible expression of at least 33 proteins was evident in the first 1h of post irradiation recovery
Pardue, J. E.; Stapp, P. R.
Sulfonated phenolic compounds as well as sulfomethylated phenolic compounds, surfactant systems containing such compound and the use of such surfactant systems in post primary oil recovery are disclosed.
Teece, Angela; Baker, John
This review aims to use thematic analysis to explore and synthesise evidence of the actual or potential reported effects of diaries on the psychological rehabilitation and recovery of discharged critical care patients. Evidence suggests that whilst admission to critical care may save patient lives, the psychological aftermath can damage a patient's recovery and these needs must be met. Patient diaries are one potential intervention to aid patients understand their critical illness and fill memory gaps caused by sedation, thus reducing psychological distress post-discharge. Prospective patient diaries are increasing in popularity amongst critical care units in the United Kingdom, however there is little evidence base to support their use or understand their effects. A literature review using systematic methods was undertaken of studies relating to the effects of diaries on discharged patients. Thematic analysis enabled the generation and synthesis of themes. Three themes arose from the generated codes: 1) Reclaiming ownership of lost time. 2) Emphasising personhood. 3) Fear and frustration. The diary intervention was shown to have a largely positive impact on survivors' psychological rehabilitation. However, caution should be exercised as recipients could find the contents painful and emotional. Diaries should be embedded within a robust critical care follow-up plan. This review suggests that diaries have the potential to form one aspect of rehabilitation and make a positive impact on patients' recovery. More research is indicated to fully evaluate the effects of diaries on their recipients. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.
periods of 4 hours or more suggests enhanced recovery and exercise performance which would be .... Total work RPE. CHOC milk, FR (Gato- rade) ..... high CHO recovery beverage consumed after exercise for a week in intercollegiate soccer ...
Full Text Available Brain plasticity after stroke remains poorly understood. Patients may improve spontaneously within the first 3 months and then more slowly in the coming year. The first days, decreased edema and reperfusion of the ischemic penumbra may possibly account for these phenomena, but the improvement during the next weeks suggests plasticity phenomena and cortical reorganization of the brain ischemic areas and of more remote areas. Indeed, the injured ischemic motor cortex has a reduced cortical excitability at the acute phase and a suspension of the topographic representation of affected muscles, whereas the contralateral motor cortex has an increased excitability and an enlarged somatomotor representation; furthermore, contralateral cortex exerts a transcallosal interhemispheric inhibition on the ischemic cortex. This results from the imbalance of the physiological reciprocal interhemispheric inhibition of each hemisphere on the other, contributing to worsening of neurological deficit. Cortical excitability is measurable through transcranial magnetic stimulation (TMS and prognosis has been established according to the presence of motor evoked potentials (MEP at the acute phase of stroke, which is predictive of better recovery. Conversely, the lack of response to early stimulation is associated with a poor functional outcome. Non-invasive stimulation techniques such as repetitive TMS (rTMS or transcranial direct current stimulation (tDCS have the potential to modulate brain cortical excitability with long lasting effects. In the setting of cerebrovascular disease, around 1000 stroke subjects have been included in placebo-controlled trials so far, most often with an objective of promoting motor recovery of the upper limb. High frequency repetitive stimulation (> 3 Hz rTMS, aiming to increase excitability of the ischemic cortex, or low frequency repetitive stimulation (≤ 1 Hz, aiming to reduce excitability of the contralateral homonymous cortex, or
Newingham, B. A.; Hudak, A. T.; Bright, B. C.; Smith, A.; Khalyani, A. H.
Climate change is predicted to affect plants at the margins of their distribution. Thus, ecosystem recovery after fire is likely to vary with climate and may be slowest in drier and hotter areas. However, fire regime characteristics, including burn severity, may also affect vegetation recovery. We assessed vegetation recovery one and 9-15 years post-fire in North American ponderosa pine ecosystems distributed across climate and burn severity gradients. Using climate predictors derived from downscaled 1993-2011 climate normals, we predicted vegetation recovery as indicated by Normalized Burn Ratio derived from 1984-2012 Landsat time series imagery. Additionally, we collected field vegetation measurements to examine local topographic controls on burn severity and post-fire vegetation recovery. At a regional scale, we hypothesized a positive relationship between precipitation and recovery time and a negative relationship between temperature and recovery time. At the local scale, we hypothesized southern aspects to recovery slower than northern aspects. We also predicted higher burn severity to slow recovery. Field data found attenuated ponderosa pine recovery in hotter and drier regions across all burn severity classes. We concluded that downscaled climate data and Landsat imagery collected at commensurate scales may provide insight into climate effects on post-fire vegetation recovery relevant to ponderosa pine forest managers.
Kooistra, C. M.; Hall, T. E.; Paveglio, T.; Carroll, M.; Smith, A. M.
), post-fire restoration/seeding efforts, and what the landscape was ';supposed to look like.' Participants with a stronger understanding of the ecological role of fire seemed less concerned about the long-term negative impacts of the fire on the ecological and aesthetic aspects of the changed landscape. Others seemed to focus on the negative aspects, namely that the landscape would never return to ';normal' within their lifetime. Several residents (not interviewed) reportedly moved away because the changes to the landscape were so severe. Of course, most residents stayed, though many mentioned how important the trees in the landscape were to them and that areas burnt by the fire had lost something special. Many respondents also discussed a severe flood shortly after the fire, as well as continued erosion problems due largely to the fire's impacts on the soil and vegetation. These insights about perceptions of changes in the landscape from the fire, floods, and erosion, in terms of expected recovery over spatial and temporal scales will be explored in more detail. We also discuss the implications of these insights for understanding people's attitudes about wildfire management and for communicating about wildfire issues with the public.
Jimenez-Zepeda, Victor H; Duggan, Peter; Neri, Paola; Chaudhry, Ahsan; Tay, Jason; Bahlis, Nizar
Immunoparesis and polyclonal immunoglobulin recovery have been recently described as common indicators of immune dysfunction in patients with multiple myeloma. In the present study, we aimed to assess the impact of immunoparesis and polyclonal immunoglobulin recovery at day-100 post autologous stem cell transplant (auto-SCT) on clinical outcomes. A total of 302 patients were included for the analysis of immunoparesis, and 197 were evaluable for polyclonal immunoglobulin recovery evaluation. Immunoparesis was observed in 93.5% of cases, with 47% of cases having polyclonal immunoglobulin recovery at 12 months post auto-SCT. Median overall and progression-free survival were longer in the group of patients with complete or partial normalization of polyclonal immunoglobulins. Patients receiving consolidation had a lower level of polyclonal reconstitution. In conclusion, polyclonal immunoglobulin recovery by 12 months post-auto-SCT is associated with superior overall and progression free survival in patients with MM. Efforts to better enhance polyclonal recovery deserve further investigation.
Kar, Nilamadhab; Barreto, Socorro
Relation between mental illness and creativity is intricate. While many creative people show signs of mental illness, persons with severe mental illness occasionally have creative output beyond the ordinary. We are presenting a patient with psychotic illness whose creative potential took a positive turn during the illness phase and grew further following symptomatic improvement and helped in her recovery process. Observing the contrast related to creative productivity pre and post psychotic phase raises the probability of whether psychotic illness or process might enhance creative potential. The case additionally illustrates how creativity can be a useful method supporting recovery from severe mental illnesses. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Small Business Administration — Reflects total post-charge off recovery rates, as a percent of the amounts charged off by charge off year, for the major loan programs and aggregate totals by charge...
Calleja-González, Julio; Terrados, Nicolás; Mielgo-Ayuso, Juan; Delextrat, Anne; Jukic, Igor; Vaquera, Alejandro; Torres, Lorena; Schelling, Xavier; Stojanovic, Marko; Ostojic, Sergej M
Basketball can be described as a moderate-to-long duration exercise including repeated bouts of high-intensity activity interspersed with periods of low to moderate active recovery or passive rest. A match is characterized by repeated explosive activities, such as sprints, jumps, shuffles and rapid changes in direction. In top-level modern basketball, players are frequently required to play consecutive matches with limited time to recover. To ensure adequate recovery after any basketball activity (i.e., match or training), it is necessary to know the type of fatigue induced and, if possible, its underlying mechanisms. Despite limited scientific evidence to support their effectiveness in facilitating optimal recovery, certain recovery strategies are commonly utilized in basketball. It is particularly important to optimize recovery because players spend a much greater proportion of their time recovering than they do in training. Therefore, the main aim of this report is to facilitate useful information that may lead to practical application, based on the scientific evidence and applied knowledge specifically in basketball.
Mankiw , Principles of Economics (Ft. Worth, Dryden Press, 1998), p556, and Robert J. Barro, “Are Government Bonds Net Wealth?” Journal of Political...CRS Report for Congress Prepared for Members and Committees of Congress Economic Recovery: Sustaining U.S. Economic Growth in a Post...2. REPORT TYPE 3. DATES COVERED 00-00-2010 to 00-00-2010 4. TITLE AND SUBTITLE Economic Recovery: Sustaining U.S. Economic Growth in a Post
This report describes recent developments in Liberia, a small, poor West African country that is undergoing a post-conflict transition and peace-building process after its second civil war in a decade...
.... It held elections in October 2005, with a presidential run-off vote in November -- a key step in a post-conflict transition and peace-building process that began following its second civil war in a decade...
Nov 20, 2015 ... ... challenges communities face in a post-conflict environment. ... Read the working paper (PDF, 2.36 MB ). ... Discover how IDRC supports research to make cities safer through our partnership – Safe and Inclusive Cities ...
Conclusion: There is a dose-dependent effect of rehabilitation on functional improvement of stroke patients for the first 6 months post-stroke, and earlier delivery of rehabilitation has lasting effects on the functional recovery of stroke patients up to 1 year.
Huang, Zhezhou; Zheng, Ying; Bao, Pingping; Cai, Hui; Hong, Zhen; Ding, Ding; Jackson, James; Shu, Xiao-Ou; Dai, Qi
Therapy-induced cognitive impairment is prevalent and long-lasting in cancer survivors, but factors affecting post-therapy cognitive recovery are unclear. We conducted this study to evaluate the associations of age, body mass index (BMI), waist-to-hip ratio (WHR), and physical activity (PA) with post-therapy cognitive changes in a population-based breast cancer (BC) survivor cohort. We collected information on PA, weight, height, waist and hip circumferences of 1286 BC survivors aged 20-75. We assessed their cognitive functions, including immediate memory, delayed memory, verbal fluency, and attention, at 18 and 36 months after cancer diagnosis. Linear regression models were used to examine the associations of age, BMI, WHR and PA with mean changes in cognitive scores from 18- to 36-month follow-up interview. We found that the post-therapy cognitive changes differed by age and obesity status. Verbal fluency and attention improved in younger patients aged therapy cognitive change. Due to the novelty of our findings and the limitations of our study, further research, including intervention trials, is warranted to confirm the causal relationship between obesity and cognitive impairments.
Steinthorsdottir, Kristin J; Kehlet, Henrik; Aasvang, Eske K
The immediate postoperative course in the post-anesthesia care unit (PACU) remains a challenge across surgical procedures. Postoperative pain, sedation/cognitive dysfunction, nausea and vomiting (PONV), circulatory and respiratory problems and orthostatic intolerance constitute the bulk of the di......-anesthesia care unit (PACU), but with a scarcity of intervention studies using glucocorticoids to control inflammation. We, therefore, suggest a future research focus on the role of inflammation and effect of glucocorticoids in the PACU setting to improve patient recovery....
Cashman, E C
This study was designed to evaluate health related quality of life post thyroidectomy for hyperthyroidism with respect to clinical benefit and patient satisfaction. This is one of the first such studies in the literature evaluating quality of life post thyroidectomy for hyperthyroidism.
Savitha, D; Mallikarjuna, Reddy N; Rao, Chythra
The role of music in increasing the exercise performance is well recognised. There is very little information about effect of music on time taken for post exercise recovery. We examined the effect of music and different musical tempo on post exercise recovery time, following treadmill work. 30 volunteers (15 male, 15 female) subjected to isotonic exercise (submaximal treadmill work) on three consecutive days. They were allowed to rest in silence on the first day, rest by hearing slow music on second day and rest with fast music on third day. Parameters such as Pulse rate, blood pressure, rating of perceived exertion (RPE) were measured at predetermined intervals. Repeated measures ANOVA test showed that with slow music, recovery time of systolic blood pressure (SBP) (7.9 +/- 2.5), diastolic blood pressure (DBP) (5.5 +/- 3.4) pulse rate recovery (PR) (8.0 +/- 2.3) and recovery from exertion (RPE) (7.7 +/- 2.5) were significantly faster when compared to both no music and fast music. The individual music preference made no significant difference in the relaxation time. The study concluded that music hastens post exercise recovery and slow music has greater relaxation effect than fast or no music, recovery time being independent of the gender and individual music preference.
Full Text Available Stroke victims tend to prioritize speaking, writing and walking as the three most important rehabilitation goals. Of note is that two of these goals involve communication. This underscores the significance of developing successful approaches to aphasia treatment for the several hundred thousand new aphasia patients each year and over 1 million stroke survivors with chronic aphasia in the U.S. alone. After several years of growth as a research tool, noninvasive brain stimulation (NBS is gradually entering the arena of clinical aphasiology. In this review, we first examine the current state of knowledge of post-stroke language recovery including the contributions from the dominant and non-dominant hemispheres. Next, we briefly discuss the methods and the physiologic basis of the use of inhibitory and excitatory repetitive transcranial magnetic stimulation (rTMS and transcranial direct current stimulation (tDCS as research tools in patients who experience post-stroke aphasia. Finally, we provide a critical review of the most influential evidence behind the potential use of these two brain stimulation methods as clinical rehabilitative tools.
Shah, Priyanka P; Szaflarski, Jerzy P; Allendorfer, Jane; Hamilton, Roy H
Stroke victims tend to prioritize speaking, writing, and walking as the three most important rehabilitation goals. Of note is that two of these goals involve communication. This underscores the significance of developing successful approaches to aphasia treatment for the several hundred thousand new aphasia patients each year and over 1 million stroke survivors with chronic aphasia in the U.S. alone. After several years of growth as a research tool, non-invasive brain stimulation (NBS) is gradually entering the arena of clinical aphasiology. In this review, we first examine the current state of knowledge of post-stroke language recovery including the contributions from the dominant and non-dominant hemispheres. Next, we briefly discuss the methods and the physiologic basis of the use of inhibitory and excitatory repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) as research tools in patients who experience post-stroke aphasia. Finally, we provide a critical review of the most influential evidence behind the potential use of these two brain stimulation methods as clinical rehabilitative tools.
Novick, Diego; Montgomery, William; Vorstenbosch, Ellen; Moneta, Maria Victoria; Dueñas, Héctor; Haro, Josep Maria
Not all individuals treated for major depressive disorder (MDD) achieve recovery. This observational study examined the recovery rates in MDD patients and the patient characteristics associated with achieving recovery in a naturalistic clinical setting. Recovery was defined as having both clinical and functional remission. Data for this post hoc analysis were taken from a 24-week prospective, observational study that involved 1,549 MDD patients. Clinical remission was assessed using the 16-item Quick Inventory of Depressive Symptomatology Self-Report and functional remission through the Sheehan Disability Scale and no days of reduced productivity in the previous week. Generalized estimating equation regression models were used to examine the baseline factors associated with recovery during follow-up. Clinical and functional remission was achieved in 70.6% and 56.1% of the MDD patients, respectively. MDD patients who achieved recovery (52.1%) were significantly less likely to have impaired levels of functioning, concurrent medical or psychiatric conditions, low levels of education, or nonadherence to therapy at follow-up. The level of functioning during the index episode seems to be a better predictor of recovery than symptom severity. Therefore, the level of functioning should be considered while determining recovery from depression.
Full Text Available BACKGROUND: Patients started on long term hemodialysis have typically had low rates of reported renal recovery with recent estimates ranging from 0.9-2.4% while higher rates of recovery have been reported in cohorts with higher percentages of patients with acute renal failure requiring dialysis. STUDY DESIGN: Our analysis followed approximately 194,000 patients who were initiated on hemodialysis during a 2-year period (2008 & 2009 with CMS-2728 forms submitted to CMS by dialysis facilities, cross-referenced with patient record updates through the end of 2010, and tracked through December 2010 in the CMS SIMS registry. RESULTS: We report a sustained renal recovery (i.e no return to ESRD during the available follow up period rate among Medicare ESRD patients of > 5% - much higher than previously reported. Recovery occurred primarily in the first 2 months post incident dialysis, and was more likely in cases with renal failure secondary to etiologies associated with acute kidney injury. Patients experiencing sustained recovery were markedly less likely than true long-term ESRD patients to have permanent vascular accesses in place at incident hemodialysis, while non-White patients, and patients with any prior nephrology care appeared to have significantly lower rates of renal recovery. We also found widespread geographic variation in the rates of renal recovery across the United States. CONCLUSIONS: Renal recovery rates in the US Medicare ESRD program are higher than previously reported and appear to have significant geographic variation. Patients with diagnoses associated with acute kidney injury who are initiated on long-term hemodialysis have significantly higher rates of renal recovery than the general ESRD population and lower rates of permanent access placement.
Jimenez M, L.
The objective of the work was to evaluate the recovery cardiac frequency like ischemia indicator, due to the immediate reactivity of the parasympathetic nervous system in the post-effort. It is obtained as conclusion that a slow descent of the cardiac frequency to the first minute of the post-effort is a predictor ischemia index when correlating it with the risk evaluated by cardiac SPECT with a high specificity; being this a marker of simple calculating in the daily practice. (Author)
Nathalie Kubis; Nathalie Kubis
Brain plasticity after stroke remains poorly understood. Patients may improve spontaneously within the first 3 months and then more slowly in the coming year. The first days, decreased edema and reperfusion of the ischemic penumbra may possibly account for these phenomena, but the improvement during the next weeks suggests plasticity phenomena and cortical reorganization of the brain ischemic areas and of more remote areas. Indeed, the injured ischemic motor cortex has a reduced cortical exci...
Dalimunthe, D. A.; Putra, I. B.; Jusuf, N. K.
Miliaria is a skin disorder due to blockage/interruption of the eccrine sweat glands that often caused by increased heat, humidity, and resident skin organism. Types of miliaria are miliariacrystalline, miliariarubra, and miliariaprofunda. Miliariapustulosa isarare variant of miliariarubra in which vesicles develop into pustules. Miliariapustulosa is often misdiagnosed because it has a similar appearance like other skin disorder with pustules as their main lesion. A 16-year-old female was consulted from Neurosurgeon Department H. Adam Malik General Hospital with reddish papules and pustules accompanied with pain and itchy at the back and chest since 12 days of hospitalization. They firstly rose in the back region then spread to chest, neck and became pustules. Dermatology status showed in interscapular, thoracic and collie region, miliary pustules and erythematous papules were found. Differential diagnoses were miliariapustulosa, steroid acne and drug allergic eruption with miliariapustulosa as working diagnosis. Lotiofaberi combined with gentamycin sulfate cream 0.1%, and cetirizine 10 mg tablet once daily were given as treatments. The patientwas advised to wear lightweight clothing and avoid exposure to conditions of high heat and humidity. After seven days of treatment, the patient showed good clinical improvement.
Warner, M. E.; Bhatia, U.; Sela, L.; Wang, R.; Kodra, E.; Ganguly, A. R.
A well-designed recovery strategy for lifeline infrastructure networks can lead to faster and more reliable restoration of essential services in the aftermath of natural catastrophes such as hurricanes or earthquakes. Urban and regional lifelines impact one another, while the recovery of urban lifelines in turn impacts regional infrastructural resilience, owing to the interdependence of lifelines across scales. Prior work by our team, often in collaboration, has led to the development of new recovery approaches based on network science and engineering, including centrality measures from network science, information theoretic metrics, and network optimization approaches. We have developed proof-of-concept demonstrations at both regional scales, such as for the Indian Railways Network and the US National Airspace System both subjected to multiple hazards, and to urban settings, such as the post-Hurricane recovery of combined power-subway system-of-systems in Boston and the New York City MTA after Hurricane Sandy. Here we make an attempt to understand how such methods may have been, or continue to be, applicable to the transportation network in Houston post-Harvey, and more broadly, how and to what extent lessons learned in urban and regional resilience may generalize across cases. We make an assessment of the state of the literature, process understanding, simulation models, data science methods, and best practices, necessary to address problems of this nature, with a particular focus on post-Harvey recovery of transportation services in Houston.
Many military veterans are seeking ways beyond conventional treatments to manage their stress injuries. An increasing number is turning to nature, including hiking and fishing, farming and gardening, and building relationships with dogs or horses. Many continue to benefit from medication and therapy, but find that nature provides an additional measure of support, relief and healing in their lives. This paper examines reciprocal interactions between humans and nature during post-conflict recovery, with a focus on the experiences of four North American veterans who regard their personal recovery from stressful and traumatic military experiences as intimately tied to their nature experiences. Experience-centered narrative inquiry often sheds light on details and experiences concealed or overlooked by other research paradigms. In-depth interviews about post-military experiences with recovery were conducted with four veterans who suffer from stress and/or post-traumatic distress; these experiences are further illuminated by supporting interviews, and theories and praxis in ecopsychology, cognitive science, neuroscience, biophilia, and ecological intelligence. Through exploring themes of sensory experience, safety, sense of purpose, and renewed relationships, this research gives space to former soldiers' stories of experience and to their individual realizations that their embodied interconnections with nature provide alternative experiences to their military training and combat exposure. The veterans' experiences with nature and recovery are pointing towards an avenue of recovery that is little acknowledged in the mainstream literature and praxis, but deserving of attention.
Full Text Available Coal mine spoil dumping grounds are present in the landscape of every mining region. Although the composition of waste material is in general safe for the environment (sedimentary rocks – sandstones, mudstones and siltstones, there may be up to 10% of coal particles in disposed wastes. The presence of organic material causes self-ignition processes and fire hazards. There is a need and the possibility of the recovery of coal, and which should be conducted according to legal regulations and environmental protection rules. The recovery should also be preceded by a feasibility study, a drilling campaign, laboratory tests and requires different environmental permissions. Recovery processes are connected with the work of a preparation plant, which is usually linked with protests from the local community and potential conflicts. This article presents the most significant hazards to the environment, health and human life connected with the functions associated with the installation of the recovery processes of coal from waste material deposited on the dumps. The methods of reducing these threats are described with regards to legal regulations, particularly law deeds concerning the safe recovery processes and further reclamation and restoration of degraded post-mining dumping grounds. The role and participation of interested community members at the preparation for investment stage as well as the period of realization of the preparation processes is described. The question of re-using and managing the post-mining dumping grounds after completion of the recovery processes is discussed.
Thomson, D.L.; Baillie, S.R.; Peach, W.J.
We present a method for studying post-fledging survival rates from data on national ringing recoveries. The approach extends the classical two-age-class models of Brownie et al. (1985) to include a third age-class of birds ringed as nestlings. The models can incorporate age-class-specific and
Zachary J. Nelson; Peter J. Weisberg; Stanley G. Kitchen
In arid and semi-arid landscapes around the world, wildfire plays a key role in maintaining species diversity. Dominant plant associations may depend upon particular fire regime characteristics for their persistence. Mountain shrub communities in high-elevation landscapes of the Intermountain West, USA, are strongly influenced by the post-fire recovery dynamics of the...
The aim of the study was to identify the most preferred post-match recovery methods utilized by U19 and U21 provincial rugby union players (n=97; Mean age: ± 20.2 years) in Gauteng Province of South Africa. Questionnaire-based data were collected from a purposive sample size of 97 rugby players. The findings ...
Full Text Available In order to develop evidence-based rehabilitation protocols post stroke, one must first reconcile the vast heterogeneity in the post-stroke population and develop protocols to facilitate motor learning in the various subgroups. The main purpose of this study is to show that auditory constraints interact with the stage of recovery post stroke to influence motor learning. We characterized the stages of upper limb recovery using task-based kinematic measures in twenty subjects with chronic hemiparesis, and used a bimanual wrist extension task using a custom-made wrist trainer to facilitate learning of wrist extension in the paretic hand under four auditory conditions: 1 without auditory cueing; 2 to non-musical happy sounds; 3 to self-selected music; and 4 to a metronome beat set at a comfortable tempo. Two bimanual trials (15 s each were followed by one unimanual trial with the paretic hand over six cycles under each condition. Clinical metrics, wrist and arm kinematics and electromyographic activity were recorded. Hierarchical cluster analysis with the Mahalanobis metric based on baseline speed and extent of wrist movement stratified subjects into three distinct groups which reflected their stage of recovery: spastic paresis, spastic co-contraction, and minimal paresis. In spastic paresis, the metronome beat increased wrist extension, but also increased muscle co-activation across the wrist. In contrast, in spastic co-contraction, no auditory stimulation increased wrist extension and reduced co-activation. In minimal paresis, wrist extension did not improve under any condition. The results suggest that auditory task constraints interact with stage of recovery during motor learning after stroke, perhaps due to recruitment of distinct neural substrates over the course of recovery. The findings advance our understanding of the mechanisms of progression of motor recovery and lay the foundation for personalized treatment algorithms post stroke.
Han, Shi-You; Hong, Zhi-You; Xie, Yu-Hua; Zhao, Yong; Xu, Xiao
Stroke is a condition with high morbidity and mortality, and 75% of stroke survivors lose their ability to work. Stroke is a burden to the family and society. The purpose of this study was to evaluate the effectiveness of Chinese herbal patent medicines in the treatment of patients after the acute phase of a stroke. We searched the following databases through August 2016: PubMed, Embase, Cochrane library, China Knowledge Resource Integrated Database (CNKI), China Science Periodical Database (CSPD), and China Biology Medicine disc (CBMdisc) for studies that evaluated Chinese herbal patent medicines for post stroke recovery. A random-effect model was used to pool therapeutic effects of Chinese herbal patent medicines on stroke recovery. Network meta-analysis was used to rank the treatment for each Chinese herbal patent medicine. In our meta-analysis, we evaluated 28 trials that included 2780 patients. Chinese herbal patent medicines were effective in promoting recovery after stroke (OR, 3.03; 95% CI: 2.53-3.64; P herbal patent medicines significantly improved neurological function defect scores when compared with the controls (standard mean difference [SMD], -0.89; 95% CI, -1.44 to -0.35; P = .001). Chinese herbal patent medicines significantly improved the Barthel index (SMD, 0.73; 95% CI, 0.53-0.94; P herbal medicines most likely to improve stroke recovery when combined with acupuncture. Our research suggests that the Chinese herbal patent medicines were effective for stroke recovery. The most effective treatments for stroke recovery were MLC601, Shuxuetong, and BuchangNaoxintong. However, to clarify the specific effective ingredients of Chinese herbal medicines, a well-designed study is warranted.
Grodzinskij, D.M.; Kolomiets, K.D.
The role of the molecular equation and self-assemblage in post-radiation chromatin recovery of meristematic cells of pea rootlets is shown. Found are the two repair types at the chromatin level by fractionating of the radiation dose. The first type comprises transient processes including DNA repair, the second type comprises processes including biosynthesis of the chromatin components and proteins, in the first place. The role of protein biosynthesis in the process of recovery of the chromatin supramolecular structure is shown. The improved radiostability of chromatin self-assemblage is characteristic for the level of its subunits. The supramolecular chromatin structure of the other levels has less radiostability
Batcho, Charles Sèbiyo; Stoquart, Gaëtan; Thonnard, Jean-Louis
To determine whether regular brisk walking can promote functional recovery in community-dwelling stroke patients. A total of 44 chronic stroke patients, recruited in Belgium and Benin, respectively European high-income and African low-income countries. This longitudinal, single-cohort, observational study with 1 intervention period and 4 time-points of assessments (2 baseline, 1 post-intervention and 1 follow-up) was structured in 3 periods: pre-intervention period (1 month), intervention period (3 months) and follow-up period (3 month). Intervention consisted of a 3 times/week group-based brisk walking programme. Primary outcome measures were ACTIVLIM-Stroke questionnaire and the 6-minute walk test (6MWT). Secondary outcome measures were the Stroke Impairment Assessment Set (SIAS), the Hospital Anxiety and Depression Scale (HADS), and the Berg Balance Scale (BBS). All outcome measures were stable during the pre-intervention period (p ≥ 0.16). They all improved significantly after intervention (p ≤ 0.01), except the HADS (p = 0.058). However, during the follow-up period, SIAS (p = 0.002) and BBS (p = 0.001) decreased, while ACTIVLIM-Stroke, 6MWT and HADS showed no significant change (p ≥ 0.13). This study suggests regular brisk walking as an effective approach to promote functional recovery in chronic stroke survivors. However, further studies are required before generalizing these results to the whole stroke population.
Khan, Mudassar Nawaz; Sakata, Katsumi; Hiraga, Susumu; Komatsu, Setsuko
Soybean is an important legume crop that exhibits markedly reduced growth and yields under flooding conditions. To unravel the mechanisms involved in recovery after flooding in soybean root, gel-free proteomic analysis was performed. Morphological analysis revealed that growth suppression was more severe with increased flooding duration. Out of a total of 1645 and 1707 identified proteins, 73 and 21 proteins were changed significantly during the recovery stage following 2 and 4 days flooding, respectively. Based on the proteomic, clustering, and in silico protein-protein interaction analyses, six key enzymes were analyzed at the mRNA level. Lipoxygenase 1, which was increased at the protein level during the recovery period, was steadily down-regulated at the mRNA level. The peroxidase superfamily protein continuously increased in abundance during the course of recovery and was up-regulated at the mRNA level. HAD acid phosphatase was decreased at the protein level and down-regulated at the transcript level, while isoflavone reductase and an unknown protein were increased at both the protein and mRNA levels. Consistent with these findings, the enzymatic activity of peroxidase was decreased under flooding stress but increased significantly during the recovery sage. These results suggest that peroxidases might play key roles in post-flooding recovery in soybean roots through the scavenging of toxic radicals.
Hawtree, Daniel; San Miguel, Jesus; Sedano, Fernando; Kempeneers, Pieter
The Mediterranean basin region is highly susceptible to wildfire, with approximately 60,000 individual fires and half a million ha of natural vegetation burnt per year. Of particular concern in this region is the impact of repeated wildfires on the ability of natural lands to return to a pre-fire state, and of the possibility of desertification of semi-arid areas. Given these concerns, understanding the temporal patterns of vegetation recovery is important for the management of environmental resources in the region. A valuable tool for evaluating these recovery patterns are vegetation indices derived from remote sensing data. Previous research on post-fire vegetation recovery conducted in this region has found significant variability in recovery times across different study sites. It is unclear what the primary variables are affecting the differences in the rates of recovery, and if any geographic patterns of behavior exist across the Mediterranean basin. This research has primarily been conducted using indices derived from Landsat imagery. However, no extensive analysis of vegetation regeneration for large regions has been published, and assessment of vegetation recovery on the basis of medium-spatial resolution imagery such as that of MODIS has not yet been analyzed. This study examines the temporal pattern of vegetation recovery in a number of fire sites in the Mediterranean basin, using data derived from MODIS 16 -day composite vegetation indices. The intent is to develop a more complete picture of the temporal sequence of vegetation recovery, and to evaluate what additional factors impact variations in the recovery sequence. In addition, this study evaluates the utility of using MODIS derived vegetation indices for regeneration studies, and compares the findings to earlier studies which rely on Landsat data. Wildfires occurring between the years 2000 and 2004 were considered as potential study sites for this research. Using the EFFIS dataset, all wildfires
Williams, Wesley; McKinney, Christopher; Martinez, Larry; Benson, Carmela
This study evaluated the effect of paliperidone palmitate long-acting injectable (LAI) antipsychotic on recovery-oriented mental health outcomes from the perspective of healthcare providers and patients during the treatment of patients with schizophrenia or schizoaffective disorders. Archival data for patients with a primary diagnosis of schizophrenia or schizoaffective disorder receiving ≥6 months of paliperidone palmitate LAI were retrieved from the electronic medical records system at the Mental Health Center of Denver. Mental health recovery was assessed from both a provider's (Recovery Markers Inventory [RMI]) and patient's (Consumer Recovery Measure [CRM]) perspective. A three-level hierarchical linear model (HLM) was utilized to determine changes in CRM and RMI scores by including independent variables in the models: intercept, months from treatment (slope), treatment time period (pretreatment and treatment), age, gender, primary diagnosis, substance abuse diagnosis, concurrent medications, and adherence to paliperidone palmitate LAI. A total of 219 patients were identified and included in the study. Results of the final three-level HLMs indicated an overall increase in CRM scores (p a retrospective, non-comparative design, and did not adjust for multiplicity Conclusions: The current study demonstrates that changes in recovery-oriented mental health outcomes can be detected following the administration of a specific antipsychotic treatment in persons with schizophrenia or schizoaffective disorders. Furthermore, patients receiving paliperidone palmitate LAI can effectively improve recovery-oriented outcomes, thereby supporting the drug's use as schizophrenia treatment from a recovery-oriented perspective.
Davidson, Larry; Schmutte, Timothy; Dinzeo, Thomas; Andres-Hyman, Raquel
Schizophrenia remains a complex, dynamic, multi-dimensional, and poorly understood condition. Although the concept of heterogeneity in outcome has conceptually overturned the post Kraepelinian legacy of progressive deterioration, a number of factors appear to contribute to perpetuating a pessimistic attitude toward outcome within the field. These include the limited access people with schizophrenia have to effective interventions and the phenomenon of the "clinician's illusion," which refers to the tendency of practitioners to assume that patients remain seriously ill when outside of the clinical care settings in which they are typically seen. Longitudinal studies, however, continue to point to a large number of people who experience improvements in their condition over time. Pressure from patients and their families, who experience periods of symptomatic relief and enhanced functioning first-hand, has led to the introduction of such concepts as "remission" and being "in" recovery with schizophrenia, in addition to the conventional notion of recovering "from" schizophrenia. These developments are consistent with recent policy initiatives by the U.S. and other governments around the world and aim to re-orient research and clinical practice from a traditional focus on effecting cure to exploring ways to encourage and assist people with schizophrenia to live meaningful lives in the face of an enduring illness.
This work has investigated the policy of wildfires, modeling techniques for post-fire assessment, and the influence of controlling variables on post-fire recovery. Post-fire mitigation and management require reliable predictions of immediate hydrologic consequences and long-term recovery to pre-fire conditions. This research shows that models used by agencies are not adaptable to all geographical and climatological conditions. Results show inconsistencies between model predictions for peak di...
DE LA Camara, Miguel A; Pardos, Ana I; Veiga, Óscar L
Whole-body electromyostimulation (WB-EMS) devices are now being used in health and sports training, although there are few studies investigating their benefits. The objective of this research was to evaluate the effectiveness of WB-EMS as a post-exercise recovery method, and compare it with other methods like active and passive recovery. The study included nine trained men (age = 21 ± 1years, height = 1.77 ± 0.4 m, mass = 62 ± 7 kg). Three trials were performed in three different sessions, 1 week apart. Each trial, the participants completed the same exercise protocol and a different recovery method each time. A repeated measures design was used to check the basal reestablishing on several physiological variables [lactate, heart rate, percentage of tissue hemoglobin saturation, temperature, and neuromuscular fatigue] and to evaluate the quality of recovery. The non-parametric Wilcoxon and Friedman ANOVA tests were used to examine the differences between recovery methods. The results showed no differences between methods in the physiological and psychological variables analyzed. Although, the blood lactate concentration showed borderline statistical significance between methods (P = 0.050). Likewise, WB-EMS failed to recover baseline blood lactate concentration (P = 0.021) and percentage of tissue hemoglobin saturation (P = 0.023), in contrast to the other two methods. These findings suggest that WB-EMS is not a good recovery method because the power of reestablishing of several physiological and psychological parameters is not superior to other recovery methods like active and passive recovery.
Gouveia, Célia M.; Bastos, Ana; DaCamara, Carlos; Trigo, Ricardo
Fire is a natural factor of Mediterranean ecosystems. However, fire regimes in the European Mediterranean areas have been changing in the last decades, mainly due to land-use changes and climate driven factors possibly associated with climatic warming (e.g. decline of precipitation, increasing temperatures but also higher frequency of heatwaves). In Greece, the fire season of 2007 was particularly devastating, achieving the new all-time record of estimated burnt area (225 734 ha), since 1980. Additionally, we must stress that prior to the summer fire season in 2007, Greece suffered an exceptional drought event. This severe drought had a strong negative impact in vegetation dynamics. Since water availability is a crucial factor in post-fire vegetation recovery, it is desirable to assess the impact that such water-stress conditions had on fire sensitivity and post-fire vegetation recovery. Based on monthly values of NDVI, at the 1km×1km spatial scale, as obtained from the VEGETATION-SPOT5 instrument, from 1999 to 2010, large burnt scars are identified in Greece, during 2007 fire season. Vegetation recovery is then assessed based on a mono parametric regression model originally developed by Gouveia et al. (2010) to identify large burnt scars in Portugal during the 2003 fire season and after applied to 2005 fire season (Bastos et al., 2012). Some large burnt areas are selected and the respective NDVI behaviour is monitored throughout the pre and the post fire period. The vegetation dynamics during the pre-fire period is analysed and related to the extreme climatic events that characterised the considered period. An analysis is made of the dependence of recovery rates on land cover types and fire damage. Finally results are compared to results already obtained for Portugal (Gouveia et al. 2010). This work emphasises the use of a simple methodology, when applied to low resolution satellite imagery in order to monitor vegetation recovery after large fires events over
Perry, C. T.; Morgan, K. M.
Given the severity of the 2016 global bleaching event, there are major questions about how quickly reef communities will recover. Here, we explore the ecological and physical structural changes that occurred across five atoll interior reefs in the southern Maldives using data collected at 6 and 12 months post-bleaching. Following initial severe coral mortality, further minor coral mortality had occurred by 12 months post-bleaching, and coral cover is now low (transitions to rubble-dominated states will occur in the near future. Juvenile coral densities in shallow fore-reef habitats are also exceptionally low (<6 individuals m-2), well below those measured 9-12 months following the 1998 bleaching event, and below recovery thresholds identified on other Indian Ocean reefs. Our findings suggest that the physical structure of these reefs will need to decline further before effective recruitment and recovery can begin.
Slavík, Ladislav; Carls, P.
Roč. 87, č. 4 (2012), s. 815-832 ISSN 1214-1119 R&D Projects: GA ČR GA205/09/0703 Institutional research plan: CEZ:AV0Z30130516 Institutional support: RVO:67985831 Keywords : late Silurian * Ludfordian * post-Lau Event, * conodont recovery * Lau Event, Prague Subject RIV: DB - Geology ; Mineralogy Impact factor: 1.141, year: 2012
Full Text Available Diego Novick,1 William Montgomery,2 Ellen Vorstenbosch,3 Maria Victoria Moneta,3 Héctor Dueñas,4 Josep Maria Haro3 1Eli Lilly and Company, Windlesham, Surrey, UK; 2Eli Lilly Australia Pty Ltd, West Ryde, NSW, Australia; 3Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain; 4Eli Lilly de Mexico, Mexico City, Mexico Abstract: Not all individuals treated for major depressive disorder (MDD achieve recovery. This observational study examined the recovery rates in MDD patients and the patient characteristics associated with achieving recovery in a naturalistic clinical setting. Recovery was defined as having both clinical and functional remission. Data for this post hoc analysis were taken from a 24-week prospective, observational study that involved 1,549 MDD patients. Clinical remission was assessed using the 16-item Quick Inventory of Depressive Symptomatology Self-Report and functional remission through the Sheehan Disability Scale and no days of reduced productivity in the previous week. Generalized estimating equation regression models were used to examine the baseline factors associated with recovery during follow-up. Clinical and functional remission was achieved in 70.6% and 56.1% of the MDD patients, respectively. MDD patients who achieved recovery (52.1% were significantly less likely to have impaired levels of functioning, concurrent medical or psychiatric conditions, low levels of education, or nonadherence to therapy at follow-up. The level of functioning during the index episode seems to be a better predictor of recovery than symptom severity. Therefore, the level of functioning should be considered while determining recovery from depression. Keywords: remission, functional impairment, clinical remission, course of illness, disability, predictors
Patient Data Protection (APDAPT) Eisenhower Medical Center (EMC) is attempting to lower the risk of losing patient data, as well as the risk...includes radiological images. EMC has made a multi-million dollar investment in the digitization of patient data; the Electronic Medical Record (EMR...storage and retrieval of the patient chart or EMR. The EMR is comprised of patient vital signs, nurse notes, medications administered, doctors
Full Text Available Post-exercise heart rate (HR recovery (HRR presents a biphasic pattern, which is mediated by parasympathetic reactivation and sympathetic withdrawal. Several mechanisms regulate these post-exercise autonomic responses and thermoregulation has been proposed to play an important role. The aim of this study was to test the effects of heat stress on HRR and HR variability (HRV after aerobic exercise in healthy subjects. Twelve healthy males (25 ± 1 years, 23.8 ± 0.5 kg/m2 performed 14 min of moderate-intensity cycling exercise (40–60% HRreserve followed by 5 min of loadless active recovery in two conditions: heat stress (HS and normothermia (NT. In HS, subjects dressed in a whole-body water-perfused tube-lined suit to increase internal temperature (Tc by ~1°C. In NT, subjects did not wear the suit. HR, core and skin temperatures (Tc and Tsk, mean arterial pressure (MAP skin blood flow (SKBF, and cutaneous vascular conductance (CVC were measured throughout and analyzed during post-exercise recovery. HRR was assessed through calculations of HR decay after 60 and 300 s of recovery (HRR60s and HRR300s, and the short- and long-term time constants of HRR (T30 and HRRt. Post-exercise HRV was examined via calculations of RMSSD (root mean square of successive RR intervals and RMS (root mean square residual of RR intervals. The HS protocol promoted significant thermal stress and hemodynamic adjustments during the recovery (HS-NT differences: Tc = +0.7 ± 0.3°C; Tsk = +3.2 ± 1.5°C; MAP = −12 ± 14 mmHg; SKBF = +90 ± 80 a.u; CVC = +1.5 ± 1.3 a.u./mmHg. HRR and post-exercise HRV were significantly delayed in HS (e.g., HRR60s = 27 ± 9 vs. 44 ± 12 bpm, P < 0.01; HRR300s = 39 ± 12 vs. 59 ± 16 bpm, P < 0.01. The effects of heat stress (e.g., the HS-NT differences on HRR were associated with its effects on thermal and hemodynamic responses. In conclusion, heat stress delays HRR, and this effect seems to be mediated by an attenuated parasympathetic
Full Text Available A procedure is presented that allows identifying large burned scars and the monitoring of vegetation recovery in the years following major fire episodes. The procedure relies on 10-day fields of Maximum Value Composites of Normalized Difference Vegetation Index (MVC-NDVI, with a 1 km×1 km spatial resolution obtained from the VEGETATION instrument. The identification of fire scars during the extremely severe 2003 fire season is performed based on cluster analysis of NDVI anomalies that persist during the vegetative cycle of the year following the fire event. Two regions containing very large burned scars were selected, located in Central and Southwestern Portugal, respectively, and time series of MVC-NDVI analysed before the fire events took place and throughout the post-fire period. It is shown that post-fire vegetation dynamics in the two selected regions may be characterised based on maps of recovery rates as estimated by fitting a monoparametric model of vegetation recovery to MVC-NDVI data over each burned scar. Results indicated that the recovery process in the region located in Central Portugal is mostly related to fire damage rather than to vegetation density before 2003, whereas the latter seems to have a more prominent role than vegetation conditions after the fire episode, e.g. in the case of the region in Southwestern Portugal. These differences are consistent with the respective predominant types of vegetation. The burned area located in Central Portugal is dominated by Pinus Pinaster whose natural regeneration crucially depends on the destruction of seeds present on the soil surface during the fire, whereas the burned scar in Southwestern Portugal was populated by Eucalyptus that may quickly re-sprout from buds after fire. Besides its simplicity, the monoparametric model of vegetation recovery has the advantage of being easily adapted to other low-resolution satellite data, as well as to other types of vegetation
Gouveia, C.; Dacamara, C. C.; Trigo, R. M.
A procedure is presented that allows identifying large burned scars and the monitoring of vegetation recovery in the years following major fire episodes. The procedure relies on 10-day fields of Maximum Value Composites of Normalized Difference Vegetation Index (MVC-NDVI), with a 1 km×1 km spatial resolution obtained from the VEGETATION instrument. The identification of fire scars during the extremely severe 2003 fire season is performed based on cluster analysis of NDVI anomalies that persist during the vegetative cycle of the year following the fire event. Two regions containing very large burned scars were selected, located in Central and Southwestern Portugal, respectively, and time series of MVC-NDVI analysed before the fire events took place and throughout the post-fire period. It is shown that post-fire vegetation dynamics in the two selected regions may be characterised based on maps of recovery rates as estimated by fitting a monoparametric model of vegetation recovery to MVC-NDVI data over each burned scar. Results indicated that the recovery process in the region located in Central Portugal is mostly related to fire damage rather than to vegetation density before 2003, whereas the latter seems to have a more prominent role than vegetation conditions after the fire episode, e.g. in the case of the region in Southwestern Portugal. These differences are consistent with the respective predominant types of vegetation. The burned area located in Central Portugal is dominated by Pinus Pinaster whose natural regeneration crucially depends on the destruction of seeds present on the soil surface during the fire, whereas the burned scar in Southwestern Portugal was populated by Eucalyptus that may quickly re-sprout from buds after fire. Besides its simplicity, the monoparametric model of vegetation recovery has the advantage of being easily adapted to other low-resolution satellite data, as well as to other types of vegetation indices.
Lopez, S. R.; Kinoshita, A. M.; Atchley, A. L.
Wildfires are naturally occurring hazards that can have catastrophic impacts. They can alter the natural processes within a watershed, such as surface runoff and subsurface water storage. Generally, post-fire hydrologic models are either one-dimensional, empirically-based models, or two-dimensional, conceptually-based models with lumped parameter distributions. These models are useful in providing runoff measurements at the watershed outlet; however, do not provide distributed hydrologic simulation at each point within the watershed. This research demonstrates how ParFlow, a three-dimensional, distributed hydrologic model can simulate post-fire hydrologic processes by representing soil burn severity (via hydrophobicity) and vegetation recovery as they vary both spatially and temporally. Using this approach, we are able to evaluate the change in post-fire water components (surface flow, lateral flow, baseflow, and evapotranspiration). This model is initially developed for a hillslope in Devil Canyon, burned in 2003 by the Old Fire in southern California (USA). The domain uses a 2m-cell size resolution over a 25 m by 25 m lateral extent. The subsurface reaches 2 m and is assigned a variable cell thickness, allowing an explicit consideration of the soil burn severity throughout the stages of recovery and vegetation regrowth. Vegetation regrowth is incorporated represented by satellite-based Enhanced Vegetation Index (EVI) products. The pre- and post-fire surface runoff, subsurface storage, and surface storage interactions are evaluated and will be used as a basis for developing a watershed-scale model. Long-term continuous simulations will advance our understanding of post-fire hydrological partitioning between water balance components and the spatial variability of watershed processes, providing improved guidance for post-fire watershed management.
Ferreira, Margarida; Firmino-Machado, João; Marques, Elisa A; Santos, Paula C; Simões, Ana Daniela; Duarte, José A
The main aim of this study was to identify the prognostic factors that contribute to complete recovery at 6 weeks and 6 months in patients with Bell's palsy. This is a prospective, longitudinal, and descriptive study that included 123 patients diagnosed with facial nerve palsy (FNP) at a hospital in Guimarães, Portugal. However, only 73 patients with Bell's palsy (BP) were included in the assessment of recovery at 6 weeks and 6 months. We analyzed the demographic and clinical characteristics of the patients, including sex, age, paralyzed side, occupation, previous and associated symptoms, seasonal occurrence, familial facial palsy, patient perception, intervention options, and baseline grade according to the House-Brackmann facial grading system (HB-FGS). Of the 123 cases with FNP, 79 (64.2%) patients had BP. Age, sex, and baseline HB-FGS grades were significant predictors of complete recovery at 6 weeks. Patients with HB-FGS grade III or lower (6 weeks baseline) had significant recovery of function at 6 months. Baseline severity of BP, elderly patients, and male sex were early predictors of poor prognosis. Patients with mild and moderate dysfunction according to the HB-FGS achieved significant normal facial function at 6 months. Further prospective studies with longer observation periods and larger samples are needed to verify the results.
Douiri, Abdel; Grace, Justin; Sarker, Shah-Jalal; Tilling, Kate; McKevitt, Christopher; Wolfe, Charles DA; Rudd, Anthony G
Background and aims Clinical predictive models for stroke recovery could offer the opportunity of targeted early intervention and more specific information for patients and carers. In this study, we developed and validated a patient-specific prognostic model for monitoring recovery after stroke and assessed its clinical utility. Methods Four hundred and ninety-five patients from the population-based South London Stroke Register were included in a substudy between 2002 and 2004. Activities of daily living were assessed using Barthel Index) at one, two, three, four, six, eight, 12, 26, and 52 weeks after stroke. Penalized linear mixed models were developed to predict patients' functional recovery trajectories. An external validation cohort included 1049 newly registered stroke patients between 2005 and 2011. Prediction errors on discrimination and calibration were assessed. The potential clinical utility was evaluated using prognostic accuracy measurements and decision curve analysis. Results Predictive recovery curves showed good accuracy, with root mean squared deviation of 3 Barthel Index points and a R 2 of 83% up to one year after stroke in the external cohort. The negative predictive values of the risk of poor recovery (Barthel Index <8) at three and 12 months were also excellent, 96% (95% CI [93.6-97.4]) and 93% [90.8-95.3], respectively, with a potential clinical utility measured by likelihood ratios (LR+:17 [10.8-26.8] at three months and LR+:11 [6.5-17.2] at 12 months). Decision curve analysis showed an increased clinical benefit, particularly at threshold probabilities of above 5% for predictive risk of poor outcomes. Conclusions A recovery curves tool seems to accurately predict progression of functional recovery in poststroke patients.
Borovtsova, T. M.; Krylov, S.V.; Udovichenko, V.I.
The possibility of applying the Makmiror-Complex preparation for treating post-radiation and post-chemiotherapeutical infections volvo-vaginitis in cancer patients is considered. The multicenter clinical studies of the preparation were conducted by treatment of cervicovaginitis and volvo-vaginitis of mixed etiology, caused by the simplest fungus and various types of bacterial flora. The efficiency of the preparation is as follow: 88% of complete recovery; 9% of improvements and only in 3% of cases with no change
Zaky, Hend Elham Mohamed; EL-Lateef Mohammad, Zienab Abd; EL-Labban, Abdou Saad Taha; Ahmed, Gahen
Background: Stroke is a leading cause of disability. Rehabilitation aims to hasten and maximize recovery from stroke by treating the disabilities caused by the stroke. Therefore, the aim of this study determine the post stroke patients' knowledge and practices in relation to disease and activities of daily living before the implementation of…
Alghadir, Ahmad; Iqbal, Zaheen Ahmed; Anwer, Shahnawaz
[Purpose] The aim of the present study was to compare the effect of pre-operative and post-operative physical therapy versus post-operative physical therapy alone on pain and recovery of function after total knee arthroplasty. [Subjects and Methods] Fifty patients (18 males and 32 females) ranging in age from 48 to 80?years (mean 63.28, SD 9.44) participated in a 6-week two-arm randomized rater-blinded trial. One group received pre- and post-operative physical therapy whereas the other group ...
I Nyoman Sudiarta
Full Text Available This study aimed to determine the effect of perceptions of distributive, procedural and interactional justice on post-service recovery satisfaction and post-service recovery satisfaction effect on the intention to revisit and WOM recommendations of foreign tourists to Bali. The respondents of this study were foreign tourists who visited Bali and ever experienced complaint. The number of eligible samples was 100 respondents. The questionnaire was given to tourists visiting tourist attractions of Tanah Lot, Kintamani and Besakih. Data were analyzed using multivariate statistical analysis, namely structural equation modeling (SEM. The results of this study indicated that the perception of distributive justice, procedural and interactional had a positive and significant effect on the post-service recovery satisfaction of foreign tourists who visited Bali. The study also found a positive and significant effect of post-service recovery satisfaction on the intention to revisit and the intention of recommending positive WOM of foreign tourists who visited Bali.
of participants' self-reporting of anxiety, pain and mood before and after surgery. Data were also collected on length of hospital stay, participants' satisfaction with the hospitalisation, and on participants' intake of analgesic medication. Participants self-reported through questionnaires on the importance...... and after treatment. Conclusion The sample was relatively small reducing the statistical power. However, the results tend to support findings from previous studies that have involved interventions with post-operative patients. Future research should investigate whether GRM would prove beneficial for wider...
Platt, Stephen; So, Emily
This paper compares recovery in the wake of three recent earthquakes: the Great East Japan Earthquake in March 2011; the Van earthquake in Turkey in October 2011; and the Maule earthquake in Chile in February 2010. The authors visited all three locations approximately 12-18 months after the incidents and interviewed earthquake specialists, disaster managers, urban planners, and local authorities. A key challenge to post-disaster recovery planning is balancing speed and deliberation. While affected communities must rebuild as quickly as possible, they must also seek to maximise the opportunities for improvement that disasters provide. The three case studies bring this dilemma into stark relief, as recovery was respectively slow, fast, and just right in the aftermath of the events: the Government of Japan adopted a deliberate approach to recovery and reconstruction; speed was of the essence in Turkey; and an effective balance between speed and deliberation was achieved in Chile. © 2017 The Author(s). Disasters © Overseas Development Institute, 2017.
Donoso Brown, Elena V; Fichter, Renae
Upper extremity hemiparesis is an impairment post-stroke that impacts quality of life. Home programs are an intervention strategy used by many occupational therapists to support continued motor recovery post-stroke, yet little is known about how these programs are designed and implemented. The purpose of this study was to describe how occupational therapy practitioners approach this task and specifically what strategies they use to support adherence and what types of technology are most commonly used. An on-line survey methodology was used. Participants were recruited through multiple sources including state associations and occupational therapy educational program directors. A total of 73 occupational therapy practitioners submitted complete surveys. It was found that majority of occupational therapy practitioners in the sample (n = 53) reported creating home programs focused on upper extremity motor recovery more than 80% of the time. Range of motion and strengthening were reported as being in the top three most commonly used interventions by more than half the sample, however incorporating clients' goals and interests were reported most often as strategies to create meaning in the home program. Respondents also reported limited incorporation of technology and strategies to support adherence. Personal motivation was reported by occupational therapy practitioners to be a key moderator of adherence to a home program. Occupational therapy practitioners often provide home programs for individuals post-stroke focusing on upper extremity function. Future research that aims to understand stakeholders' perspectives on home programs and determine effective strategies for ensuring adherence is needed.
M. A Peña
Full Text Available This study analyzed the state of recovery of the burnt vegetation in the National Park of Torres del Paine between December, 2011 and March, 2012. The calculation and comparison of the NVDI (normalized difference vegetation index of the burnt area throughout a time series of 24 Landsat images acquired before, during and after the fire (2009- 2015, showed the temporal variation in the biomass levels of the burnt vegetation. The subsequent classification and comparison of the spectral indices: NDVI, NBR (normalized burnt ratio and NDWI (normalized difference water index on a full-data available and phenologically matched pre- and post-fire image pair (acquired in October 2009 and 2014, enabled to analyze and mapping the state of recovery of the burnt vegetation. The results show that the area of the lowest classes of all the spectral indices of the pre-fire date became the most dominant on the post-fire date. The pre- and post- fire NDVI class crossing by a confusion matrix showed that the highest and most prevailing pre-fire NDVI classes, mostly corresponding to hydromorphic forests and Andean scrubs, turned into the lowest class in 2014. The remaining area, comprising Patagonian steppe, reestablished its biomass levels in 2014, mostly exhibiting the same pre-fire NDVI classes. These results may provide guidelines to monitor and manage the regeneration of the vegetation impacted by this fire.
Alfredo J Garcia
Full Text Available The preBötzinger complex (preBötC is a critical neuronal network for the generation of breathing. Lesioning the preBötC abolishes respiration, while when isolated in vitro, the preBötC continues to generate respiratory rhythmic activity. Although several factors influence rhythmogenesis from this network, little is known about how gender may affect preBötC function. This study examines the influence of gender on respiratory activity and in vitro rhythmogenesis from the preBötC. Recordings of respiratory activity from neonatal mice (P10-13 show that sustained post-hypoxic depression occurs with greater frequency in males compared to females. Moreover, extracellular population recordings from the preBötC in neonatal brainstem slices (P10-13 reveal that the time to the first inspiratory burst following reoxygenation (TTFB is significantly delayed in male rhythmogenesis when compared to the female rhythms. Altering activity of ATP sensitive potassium channels (KATP with either the agonist, diazoxide, or the antagonist, tolbutamide, eliminates differences in TTFB. By contrast, glucose supplementation improves post-hypoxic recovery of female but not male rhythmogenesis. We conclude that post-hypoxic recovery of respiration is gender dependent, which is, in part, centrally manifested at the level of the preBötC. Moreover, these findings provide potential insight into the basis of increased male vulnerability in a variety of conditions such as Sudden Infant Death Syndrome (SIDS.
Stawski, Clare; Hume, Taylor; Körtner, Gerhard; Currie, Shannon E; Nowack, Julia; Geiser, Fritz
To cope with the post-fire challenges of decreased availability of food and shelter, brown antechinus ( Antechinus stuartii ), a small marsupial mammal, increase the use of energy-conserving torpor and reduce activity. However, it is not known how long it takes for animals to resume pre-fire torpor and activity patterns during the recovery of burnt habitat. Therefore, we tested the hypothesis that antechinus will adjust torpor use and activity after a fire depending on vegetation recovery. We simultaneously quantified torpor and activity patterns for female antechinus from three adjacent areas: (i) the area of a management burn 1 year post-fire, (ii) an area that was burned 2 years prior, and (iii) a control area. In comparison to shortly after the management burn, antechinus in all three groups displayed less frequent and less pronounced torpor while being more active. We provide the first evidence that only 1 year post-fire antechinus resume pre-fire torpor and activity patterns, probably in response to the return of herbaceous ground cover and foraging opportunities. © 2017 The Author(s).
Jovel, Roberto J.; Mudahar, Mohinder
This is a guideline for World Bank task team leaders (TTLs) entrusted with the design and execution of assessments to determine disaster impacts as well as post-disaster needs for recovery, reconstruction, and disaster risk reduction or management. Assessments estimate, first, the short-term government interventions required to initiate recovery and second, the financial requirements to ac...
Leila M juybari
Full Text Available Background and objective: Delirium is an acute and transient disorder in the function of the brain. Although the main core of this syndrome is consciousness disorder and deficiencies in attention and concentration, the general deficiency is seen in all psychological areas of thinking, temperament, cognition, language, speaking, sleeping, and mental-motional and other cognitive areas. Delirium is often seen in recovery room and is a predictor of post-operative delirium in the general ward. This study was conducted to determine the incidence of delirium in patients after surgery in the recovery room.Materials and Methods: This descriptive cross-sectional study was conducted on 75 patients after general and orthopedic surgery and in the recovery room of the educational-therapeutic center of Gorgan in 1389 using the DESC-Nu nursing delirium screening scale. Data was analyzed using chi-square descriptive and analytical statistics and T-test.Results: Among the 75 studied patients in the recovery room after orthopedic surgery and general surgery, 53.3% were women with a mean age of 48.7. The mean surgery duration was 129.21 minutes. 26.6% had been under spinal anesthesia and 73.3% had been under general anesthesia. Delirium was observed in 30.6% of all the patients. Delirium was observed in 21.3% of patients having orthopedic surgery and 9.3% of the patients having general surgery. Delirium had a significant statistical relation with the variables of age, gender, and type of surgery (p<0.05.Conclusion: This study showed that 30.6% of patients had delirium. Male and older patients having orthopedic surgery were more vulnerable. Therefore, usual assessment of delirium in recovery room to identify patients with delirium can be a guide of nurses’ appropriate care of patients after surgery.
Hope, Allen; Albers, Noah; Bart, Ryan
Wildland fires in Mediterranean-Type Ecosystems (MTEs) are episodic events that dramatically alter land-cover conditions. Monitoring post-fire vegetation recovery is important for land management applications such as the scheduling of prescribed burns, post-fire resource management and soil erosion control. Full recovery of MTE shrublands may take many years and have a prolonged effect on water, energy and carbon fluxes in these ecosystems. Comparative studies of fynbos ecosystems in the Cape Floristic Region of South Africa (Western Cape Region) and chaparral ecosystems of California have demonstrated that there is a considerable degree of convergence in some aspects of post-fire vegetation regeneration and marked differences in other aspects. Since these MTEs have contrasting rainfall and soil nutrient conditions, an obvious question arises as to the similarity or dissimilarity in remotely sensed post-fire recovery pathways of vegetation stands in these two regions and the extent to which fire severity and drought impact the rate of vegetation recovery. Post-fire recovery pathways of chaparral and fynbos vegetation stands were characterized using the normalized difference vegetation index (NDVI) based on TM/ETM+ and MODIS (250 m) data. Procedures based on stands of unburned vegetation (control) were implemented to normalize the NDVI for variations associated with inter-annual differences in rainfall. Only vegetation stands that had not burned for 20 years were examined in this study to eliminate potential effects of variable fire histories on the recovery pathways. Post-fire recovery patterns of vegetation in both regions and across different vegetation types were found to be very similar. Post-fire stand age was the primary control over vegetation recovery and the NDVI returned to pre-fire values within seven to 10 years of the fires. Droughts were shown to cause slight interruptions in recovery rates while fire severity had no discernable effect. Intra
O'Hanlon, Katherine P; Budosan, Boris
A professional understanding of disasters, paired with the need for health service development, can provide opportunities for the recovery and improvement of the health sector. Investment in training capacity ranks among the top priorities of a recovering health sector. The recovery and development of primary healthcare delivery systems has been implemented by various international and local health players in the aftermath of conflicts around the world. However, human resource development in the post-conflict environment has not been evaluated and/or published appropriately in the medical literature. In this retrospective, descriptive study, the authors describe the strategy and evaluate the effectiveness of a field-based training program for primary healthcare doctors implemented by the US-based international non-governmental organization, the International Medical Corps, after the conflict in Kosovo in 1999. A six-month, comprehensive education and training program on primary healthcare issues was delivered to 134 Kosovar primary healthcare physicians in 10 Kosovo municipalities in 1999 and 2000. Qualitative and quantitative data were collected. The qualitative methods included open-ended, semi-structured, key informant interviews, structured focus groups, and unstructured participant observations. The quantitative method was multiple-choice knowledge tests. The education and training program proved to be culturally appropriate and well-accepted by local communities. The program met its overall objective to refresh the knowledge of primary care doctors on various primary healthcare issues and set the stage for further strengthening and development of primary health services and their required human resources in Kosovo. The comprehensive education and training of primary healthcare doctors in Kosovo was a feasible, much appreciated, and effective intervention implemented in a difficult post-conflict environment. This training was one of the early steps in the
Itenov, Theis S; Berthelsen, Rasmus Ehrenfried; Jensen, Jens-Ulrik
these patients. DESIGN: Observational study with development and validation of a risk prediction model. SETTING: Nine academic ICUs in Denmark. PARTICIPANTS: Development cohort of critically ill patients with AKI at ICU admission from the Procalcitonin and Survival Study cohort (n = 568), validation cohort.......1%. CONCLUSION: We constructed and validated a simple model that can predict the chance of recovery from AKI in critically ill patients....
Full Text Available To prevent surgical site infection (SSI, the airborne microbial concentration in operating theaters must be reduced. The air quality in operating theaters and nearby areas is also important to healthcare workers. Therefore, this study assessed air quality in the post-operative recovery room, locations surrounding the operating theater area, and operating theaters in a medical center. Temperature, relative humidity (RH, and carbon dioxide (CO2, suspended particulate matter (PM, and bacterial concentrations were monitored weekly over one year. Measurement results reveal clear differences in air quality in different operating theater areas. The post-operative recovery room had significantly higher CO2 and bacterial concentrations than other locations. Bacillus spp., Micrococcus spp., and Staphylococcus spp. bacteria often existed in the operating theater area. Furthermore, Acinetobacter spp. was the main pathogen in the post-operative recovery room (18% and traumatic surgery room (8%. The mixed effect models reveal a strong correlation between number of people in a space and high CO2 concentration after adjusting for sampling locations. In conclusion, air quality in the post-operative recovery room and operating theaters warrants attention, and merits long-term surveillance to protect both surgical patients and healthcare workers.
Tang, Chin-Sheng; Wan, Gwo-Hwa
To prevent surgical site infection (SSI), the airborne microbial concentration in operating theaters must be reduced. The air quality in operating theaters and nearby areas is also important to healthcare workers. Therefore, this study assessed air quality in the post-operative recovery room, locations surrounding the operating theater area, and operating theaters in a medical center. Temperature, relative humidity (RH), and carbon dioxide (CO2), suspended particulate matter (PM), and bacterial concentrations were monitored weekly over one year. Measurement results reveal clear differences in air quality in different operating theater areas. The post-operative recovery room had significantly higher CO2 and bacterial concentrations than other locations. Bacillus spp., Micrococcus spp., and Staphylococcus spp. bacteria often existed in the operating theater area. Furthermore, Acinetobacter spp. was the main pathogen in the post-operative recovery room (18%) and traumatic surgery room (8%). The mixed effect models reveal a strong correlation between number of people in a space and high CO2 concentration after adjusting for sampling locations. In conclusion, air quality in the post-operative recovery room and operating theaters warrants attention, and merits long-term surveillance to protect both surgical patients and healthcare workers.
Full Text Available Background. At present neurocognitive impairment is considered a core feature of schizophrenia. This statement is grounded on cognitive impairment stability, the persistence of cognitive impairment independently of the disease stage and other symptoms of schizophrenia. The relevance of the search for cognitive remediation methods is determined by the influence of cognitive functioning on the functional outcome in patients with schizophrenia. In order to solve this problem, scientists are actively investigating such direction in the treatment of patients with this psychopathology as «neurocognitive therapy» or neurocognitive training. Objective.To evaluate the effectiveness of neurocognitive training in patients with paranoid schizophrenia. Methods and materials. The patients who matched inclusion criteria were assessed on Positive and Negative Syndrome Scale (PANSS, Personal and Social Performance scale (PSP, neuropsychological tests (Trail Making Test part A and B, Wisconsin Card Sorting Test, Luria test at the baseline, 1st and 6th month. All patients who were included in the study were randomly assigned into two groups. The intervention group (n=40 underwent a standard supportive treatment and neurocognitive training. The control group (n=31 received supportive medication treatment alone. Results. After 1st month, a statistically significant difference between the intervention and control groups was found both for the overall PANSS score improvement and improvement in several items, which represented the cognitive decline. Total PSP score increased significantly in the intervention group from 41-50 to 51-60 (р=0.0001. In Wisconsin Card Sorting Test the proportion of incorrect answers decreased by 31.4% (р=0.0001, perseverative errors by 20.1% (р=0.042, the number of completed categories increased by 33.5% (р=0.002. Conclusion. The proposed neurocognitive training program showed positive results, which was reflected in a statistically
Kevin Fox Gotham
Full Text Available In this paper, we draw on multi-level census data, in-depth interviews, ethnographic and Geographical Information Systems (GIS methods to examine the effects of median household income, ethnoracial diversity, and flood damage on rates of post-Katrina repopulation in New Orleans. Our main finding is that New Orleans neighborhoods have been experiencing modest increases in ethnoracial diversity as well as a retrenchment of socio-spatial inequalities, as measured by low diversity scores, low median household income levels, and high poverty rates. In addition to documenting the objective indicators of “recovery”, we draw attention to the socially constructed nature of resilience. Based on interviews and ethnographic field observations, we investigate how resident constructions of resilience shape their views of the post-Katrina recovery process, provide a compelling and reassuring story of community revitalization, and convey a sense of collective power and control despite continued vulnerability to hazards and disasters.
Dhillon, D P; Haslam, P L; Townsend, P J; Primett, Z; Collins, J V; Turner-Warwick, M
One hundred and seventy patients with interstitial lung diseases undergoing bronchoalveolar lavage (BAL), were contrasted with 51 patients undergoing fibreoptic bronchoscopy alone to define the factors which predispose to post-lavage side-effects. Transient post-bronchoscopy fall in the peak expired flow (PEF) greater than or equal to 20% occurred in both groups (24% and 23% respectively), and thus was probably related to the bronchoscopy procedure. Post-lavage pyrexia (greater than or equal to 1 degree C) occurred only in the patients undergoing BAL (26%), p less than 0.001. Only 4% with pyrexia required antibiotics, and only 2% with falls in PEF needed bronchodilator therapy. The only significant clinical association was more frequent pyrexia in patients on treatment with prednisolone, particularly in women (p less than 0.01). Pyrexia was also associated with higher lavage fluid introduction volumes (greater than 240 ml). Side effects did not relate to the percentages of lavage fluid recovered, although smokers had lower recoveries and, recoveries tended to be higher in sarcoidosis than cryptogenic fibrosing alveolitis. Serial lavages in 25 patients caused no significant increase in side effects.
Iglesias, Jose; Frank, Elliot; Mehandru, Sushil; Davis, John M; Levine, Jerrold S
Renal dysfunction occurs commonly in patients awaiting orthotopic liver transplantation (OLT) for end-stage liver disease. The use of simultaneous liver-kidney transplantation has increased in the MELD scoring era. As patients may recover renal function after OLT, identifying factors predictive of renal recovery is a critical issue, especially given the scarcity of available organs. Employing the UNOS database, we sought to identify donor- and patient-related predictors of renal recovery among 1720 patients with pre-OLT renal dysfunction and transplanted from 1989 to 2005. Recovery of renal function post-OLT was defined as a composite endpoint of serum creatinine (SCr) ≤1.5 mg/dL at discharge and survival ≥29 days. Pre-OLT renal dysfunction was defined as any of the following: SCr ≥2 mg/dL at any time while awaiting OLT or need for renal replacement therapy (RRT) at the time of registration and/or OLT. Independent predictors of recovery of renal function post-OLT were absence of hepatic allograft dysfunction, transplantation during MELD era, recipient female sex, decreased donor age, decreased recipient ALT at time of OLT, decreased recipient body mass index at registration, use of anti-thymocyte globulin as induction therapy, and longer wait time from registration. Contrary to popular belief, a requirement for RRT, even for prolonged periods in excess of 8 weeks, was not an independent predictor of failure to recover renal function post-OLT. These data indicate that the duration of renal dysfunction, even among those requiring RRT, is a poor way to discriminate reversible from irreversible renal dysfunction.
Full Text Available Disturbance is a primary mechanism structuring ecological communities. However, human activity has the potential to alter the frequency and intensity of natural disturbance regimes, with subsequent effects on ecosystem processes. In Southern California, human development has led to increased fire frequency close to urban areas that can form a positive feedback with invasive plant spread. Understanding how abiotic and biotic factors structure post-fire plant communities is a critical component of post-fire management and restoration. In this study we considered a variety of mechanisms affecting post-fire vegetation recovery in Riversidean sage scrub. Comparing recently burned plots to unburned plots, we found that burning significantly reduced species richness and percent cover of exotic vegetation the first two years following a 100-hectare wildfire. Seed rain was higher in burned plots, with more native forb seeds, while unburned plots had more exotic grass seeds. Moreover, there were significant correlations between seed rain composition and plant cover composition the year prior and the year after. Collectively, this case study suggests that fire can alter community composition, but there was not compelling evidence of a vegetation-type conversion. Instead, the changes in the community composition were temporary and convergence in community composition was apparent within two years post-fire.
Conlisk, Erin; Swab, Rebecca; Martínez-Berdeja, Alejandra; Daugherty, Matthew P
Disturbance is a primary mechanism structuring ecological communities. However, human activity has the potential to alter the frequency and intensity of natural disturbance regimes, with subsequent effects on ecosystem processes. In Southern California, human development has led to increased fire frequency close to urban areas that can form a positive feedback with invasive plant spread. Understanding how abiotic and biotic factors structure post-fire plant communities is a critical component of post-fire management and restoration. In this study we considered a variety of mechanisms affecting post-fire vegetation recovery in Riversidean sage scrub. Comparing recently burned plots to unburned plots, we found that burning significantly reduced species richness and percent cover of exotic vegetation the first two years following a 100-hectare wildfire. Seed rain was higher in burned plots, with more native forb seeds, while unburned plots had more exotic grass seeds. Moreover, there were significant correlations between seed rain composition and plant cover composition the year prior and the year after. Collectively, this case study suggests that fire can alter community composition, but there was not compelling evidence of a vegetation-type conversion. Instead, the changes in the community composition were temporary and convergence in community composition was apparent within two years post-fire.
Fossaa, S.D.; Aabyholm, T.; Normann, N.; Jetne, V.
Sperm analysis and serum hormone measurements (LH, FSH, testosterone) were performed in 29 patients after orchiectomy for seminoma before and after irradiation. Before radiotherapy 14 of 20 orchiectomised patients were azoospermic or had impaired spermatogenesis. A minimum sperm count was found 1 year after radiotherapy with gradual improvement up to 2 years. The recovery of sperm cell production was impaired most in patients with pre-treatment sperm counts < 3 million/ ml. Serum testosterone remained at low normal levels throughout the observation period. The mean serum FSH was increased 1 year after radiotherapy but returned to normal in 50% of patients within 3 years after treatment. This post-treatment increase in FSH was significantly correlated with increased pre-treatment FSH but not with the gonadal dose, which was 1 to 3% of the target dose. Severe disturbances in spermatogenesis, observed 2 to 3 years after radiotherapy for early seminoma, are likely to be the expression of a highly impaired pre-treatment sperm cell production and only to a lesser degree dependent on the irradiation of the remaining testicle. (author)
Michael J. Saunders
Full Text Available The effects of protein supplementation on the ratings of energy/fatigue, muscle soreness [ascending (A and descending (D stairs], and serum creatine kinase levels following a marathon run were examined. Variables were compared between recreational male and female runners ingesting carbohydrate + protein (CP during the run (CPDuring, n = 8 versus those that were consuming carbohydrate (CHODuring, n = 8. In a second study, outcomes were compared between subjects who consumed CP or CHO immediately following exercise [CPPost (n = 4 versus CHOPost (n = 4]. Magnitude-based inferences revealed no meaningful differences between treatments 24 h post-marathon. At 72 h, recovery [Δ(72 hr-Pre] was likely improved with CPDuring versus CHODuring, respectively, for Physical Energy (+14 ± 64 vs −74 ± 70 mm, Mental Fatigue (−52 ± 59 vs +1 ± 11 mm, and Soreness-D (+15 ± 9 vs +21 ± 70 mm. In addition, recovery at 72 h was likely-very likely improved with CPPost versus CHOPost for Physical Fatigue, Mental Energy, and Soreness-A. Thus, protein supplementation did not meaningfully alter recovery during the initial 24 h following a marathon. However, ratings of energy/fatigue and muscle soreness were improved over 72 h when CP was consumed during exercise, or immediately following the marathon.
Switzer, Adam D.; Gouramanis, Chris; Bristow, Charles; Yeo, Jeffrey; Kruawun, Jankaew; Rubin, Charles; Sin Lee, Ying; Tien Dat, Pham
A morpho-geophysical investigation of two beaches in Thailand over the last decade shows that they have completely recovered from the 2004 Indian Ocean tsunami (IOT) without any human intervention. Although the beach systems show contrasting styles of recovery in both cases natural processes have reconstructed the beaches to comparable pre-tsunami morphologies in under a decade, demonstrating the existence of punctuated equilibrium in coastal systems and the resilience of natural systems to catastrophic events. Through a combination of remote sensing, field surveys and shallow geophysics we reconstruct the post-event recovery of beaches at Phra Thong Island, a remote, near pristine site that was severely impacted by the IOT. We identify periods of aggradation, progradation and washover sedimentation that match with local events including a storm in November 2007. The rapid recovery of these systems implies that majority of sediment scoured by the tsunami was not transported far offshore but remained in the littoral zone within reach of fair-weather waves that returned it (the sediment) to the beach naturally.
Full Text Available Stroke is a major health problem world-wide and its burden has been rising in last few decades. Until now tissue plasminogen activator is only approved treatment for stroke. Angiogenesis plays a vital role for striatal neurogenesis after stroke. Administration of various growth factors in an early post ischemic phase, stimulate both angiogenesis and neurogenesis and lead to improved functional recovery after stroke. However vascular endothelial growth factors (VEGF is the most potent angiogenic factor for neurovascularization and neurogenesis in ischemic injury can be modulated in different ways and thus can be used as therapy in stroke. In response to the ischemic injury VEGF is released by endothelial cells through natural mechanism and leads to angiogenesis and vascularization. This release can also be up regulated by exogenous administration of Mesenchymal stem cells, by various physical therapy regimes and electroacupuncture, which further potentiate the efficacy of VEGF as therapy in post stroke recovery. Recent published literature was searched using PubMed and Google for the article reporting on methods of up regulation of VEGF and therapeutic potential of growth factors in stroke.
Background: Assessment of treatment efficacy through outcomes evaluation is an established practice in stroke rehabilitation. The evaluation of motor recovery is a cornerstone of the assessment of patients with stroke; and an integral component of stroke rehabilitation. Objective: The purpose of this study was to evaluate ...
Pais-Costa, Antonia Juliana [IMAR—Institute of Marine Research, MARE—Marine and Environmental Sciences Centre, Faculty of Sciences and Technology, University of Coimbra, 3004-517 Coimbra (Portugal); Acevedo, Pelayo [SaBio IREC, Instituto de Investigación en Recursos Cinegéticos (UCLM-CSIC-JCCM), Ciudad Real 13005 (Spain); Marques, João Carlos [IMAR—Institute of Marine Research, MARE—Marine and Environmental Sciences Centre, Faculty of Sciences and Technology, University of Coimbra, 3004-517 Coimbra (Portugal); Martinez-Haro, Mónica, E-mail: email@example.com [IMAR—Institute of Marine Research, MARE—Marine and Environmental Sciences Centre, Faculty of Sciences and Technology, University of Coimbra, 3004-517 Coimbra (Portugal)
Post-exposure bioassays are used in environmental assessment as a cost-effective tool, but the effects of organism's recovery after exposure to pollutant has not yet been addressed in detail. The recoveries of post-exposure feeding rates after being exposed to two sublethal concentrations of cadmium during two different exposure periods (48 h and 96 h) were evaluated under laboratory conditions using the estuarine isopod Cyathura carinata. Results showed that feeding depression was a stable endpoint up to 24 h after cadmium exposure, which is useful for ecotoxicological bioassays. - Highlights: • We studied recovery of post-exposure feeding rates 48–96 h after cadmium exposure. • The assay is based on the isopod Cyathura carinata. • Post-exposure feeding inhibition is a stable sublethal endpoint.
Andreoli, Maria Claudia Cruz; Souza, Nádia Karina Guimarães de; Ammirati, Adriano Luiz; Matsui, Thais Nemoto; Carneiro, Fabiana Dias; Ramos, Ana Claudia Mallet de Souza; Iizuca, Ilson Jorge; Coelho, Maria Paula Vilela; Afonso, Rogério Carballo; Ferraz-Neto, Ben-Hur; Almeida, Marcio Dias de; Durão, Marcelino; Batista, Marcelo Costa; Monte, Julio Cesar; Pereira, Virgílio Gonçalves; Santos, Oscar Pavão Dos; Santos, Bento Cardoso Dos
Renal dysfunction frequently occurs during the periods preceding and following orthotopic liver transplantation (OLT), and in many cases, renal replacement therapy (RRT) is required. Information regarding the duration of RRT and the rate of kidney function recovery after OLT is crucial for transplant program management. We evaluated a sample of 155 stable patients undergoing post-intensive care hemodialysis (HD) from a patient population of 908 adults who underwent OLT. We investigated the average time to renal function recovery (duration of RRT required) and determined the risk factors for remaining on dialysis > 90 days after OLT. Log-rank tests were used for univariate analysis, and Cox proportional hazards models were used to identify factors associated with the risk of remaining on HD. The results of our analysis showed that of the 155 patients, 28% had pre-OLT diabetes mellitus, 21% had pre-OLT hypertension, and 40% had viral hepatitis. Among the patients, the median MELD (Model for End-Stage Liver Disease) score was 27 (interquartile range [IQR] 22-35). When they were listed for liver transplantation, 32% of the patients had serum creatinine (Scr) levels > 1.5 mg/dL or were on HD, and 50% had serum creatinine (Scr) levels > 1.5 mg/dL or were on HD at the time of OLT. Of the transplanted patients, 25% underwent pre-OLT intermittent HD, and 14% and 41% underwent continuous renal replacement therapy (CRRT) pre-OLT and post-OLT, respectively. At 90 days post-OLT, 118 (76%) patients had been taken off dialysis, and 16 (10%) patients had died while undergoing HD. The median recovery time of these post-OLT patients was 33 (IQR 27-39) days. In the multivariate analysis, fulminant hepatic failure as the cause of liver disease (prenal function after OLT, and those who were diagnosed with fulminant hepatic failure, had no pre-OLT hypertension, received a lower transfused volume of intraoperative FFP and did not undergo pre-OLT intermittent HD had a higher probability
Jensen, K; Kehlet, H; Lund, Claus Michael
BACKGROUND: Laparoscopic cholecystectomy is now often an ambulatory procedure, but dependent on short-term post-operative complaints of pain and post-operative nausea and vomiting (PONV). The efficacy of post-anaesthesia care units (PACUs) is therefore important to facilitate return to normal fun...... are predictors of a complicated recovery profile and deserve further attention. Transient oxygen desaturations postpone discharge from the PACU, but the clinical significance of this fact is questionable. Udgivelsesdato: 2007-Apr...
Peterson-Burch, Frances; Reuter-Rice, Karin; Barr, Taura L.
Stroke is a life changing experience. Current treatments focus on treating the condition, rather than the whole person. The goal of this report is to communicate the benefits of a holistic approach to the treatment and recovery of stroke. Our intent is to begin a conversation to transform our approach to stroke care to focus on the whole person, body, mind and spirit. Wellness approaches are fiscally responsible ways of providing holistic care for patients and their family members to help them achieve optimal individualized recovery. Very few multidimensional programs for wellness exist for stroke and brain injury patients. Given the changes in healthcare and the call to action set forth in the Institute of Medicine's 2010 report, it would behoove us to consider holistic approaches to stroke care and research programs. Nurses are uniquely positioned to implement multidisciplinary, innovative holistic approaches to address solutions for issues in stroke care. Wellness is a critically important area of stroke care and an opportunity for research. As both patient advocates and nurses with personal experiences, we hope this commentary stimulates conversation around developing and testing multi-dimensional holistic programs of wellness for stroke prevention, treatment, and recovery. PMID:27902520
Pappalardo, A; Ciancio, M R; Patti, F
Basic trunk movement control is often impaired after stroke and its recovery is a "miliary stone" in rehabilitation. In this prospective, observational, parallel-group study, we investigated whether there are differences in terms of post-stroke recovery of basic trunk control between patients with left or with right hemiparesis. We recruited 94 patients with loss of postural trunk control due to stroke. Patients were divided into Group A (48 patients with left hemiparesis) and Group B (46 patients with right hemiparesis). We administered the Trunk Control Test (TCT) and the 13 motor items included on the Functional Independence Measure. Evaluation was performed at admission (To) and discharge (T1). TCT increased respectively from 46.7 ± 23.3 to 62.6 ± 19.5 (mean ± standard deviation-SD, p hemiparesis could affect the degree of recovery of basic trunk control after stroke. Patients with right hemiparesis benefit more than those with left hemiparesis. Improvement of basic trunk control was not responsible for an advantage on functional independence.
Citisli, Veli; Kocaoglu, Murat; Necan, Ceyda; İbrahimoglu, Muhammet; Celiker, Özkan; Baykara, Eyüp; Ozdemir, Mevci; Acar, Feridun; Coskun, Mehmet Erdal
The aim of the present report was to present the patient with an anterior cranial base fracture who developed post-traumatic cerebrospinal fluid rhinorrhea, which recovered after onset of meningitis complication. A 26-year-old male patient who had a traffic accident one week ago was sent to our clinic because of his rhinorrhea persisting for 4 days. On cranial computed tomography, fracture of the left frontal skull base and sinus walls, a fracture line on temporal bone, parenchymal bleeding i...
Clarke, David J; Forster, Anne
Stroke is a leading cause of serious, long-term disability, the effects of which may be prolonged with physical, emotional, social, and financial consequences not only for those affected but also for their family and friends. Evidence for the effectiveness of stroke unit care and the benefits of thrombolysis have transformed treatment for people after stroke. Previously viewed nihilistically, stroke is now seen as a medical emergency with clear evidence-based care pathways from hospital admission to discharge. However, stroke remains a complex clinical condition that requires health professionals to work together to bring to bear their collective knowledge and specialist skills for the benefit of stroke survivors. Multidisciplinary team working is regarded as fundamental to delivering effective care across the stroke pathway. This paper discusses the contribution of team working in improving recovery at key points in the post-stroke pathway.
Baty, Florent; Ritz, Christian; Jensen, Signe Marie
6-min walk tests (6MWT) are routinely performed in patients with chronic obstructive pulmonary disease (COPD). Oxygen uptake ([Formula: see text]) kinetics during 6MWT can be modeled and derived parameters provide indicators of patients' exercise capacity. Post-exercise [Formula: see text] recovery...... also provides important parameters of patients' fitness which has not been extensively investigated in COPD. Several nonlinear regression models with different underlying biological assumptions may be suitable for describing recovery kinetics. Multimodel inference (model averaging) can then be used...... to capture the uncertainty in considering several models. Our aim was to apply multimodel inference in order to better understand the physiological underpinnings of [Formula: see text] recovery after 6MWT in patients with COPD. 61 patients with COPD (stages 2 to 4) were included in this study. Oxygen...
Yu Ri Kim
Full Text Available To investigate the question of whether electroacupuncture (EA promotes functional recovery via enhancement of proliferation and differentiation of neuronal stem cells (NSCs in ischemic stroke, EA stimulation with 2 Hz was applied at bilateral acupoints to Baihui (GV20 and Dazhui (GV14 in middle cerebral artery occlusion (MCAO mice. EA stimulation improved neuromotor function and cognitive ability after ischemic stroke. EA stimulation resulted in an increase in the number of proliferated cells, especially in the subventricular zone (SVZ of the ipsilateral hemisphere. Although a very limited number of NSCs survived and differentiated into neurons or astrocytes, EA treatment resulted in a significant increase in the number of proliferative cells and differentiated cells in the hippocampus and SVZ of the ipsilateral hemisphere compared to MCAO mice. EA stimulation resulted in significantly increased mRNA expression of brain-derived neurotrophic factor (BDNF and vascular endothelial growth factor (VEGF. Protein levels of these factors were confirmed in the ipsilateral hippocampus and SVZ by immunohistochemical and Western blotting analyses. Expression of phosphorylated phosphatidylinositol-3-kinase, BDNF, and VEGF-mediated down-stream were enhanced by EA stimulation in newly formed neuroblasts. These results indicate that EA treatment after ischemic stroke may promote post-stroke functional recovery by enhancement of proliferation and differentiation of NSCs via the BDNF and VEGF signaling pathway.
K. F. Fatullayeva
Full Text Available Objective: to evaluate the effect of the metabolic antihypoxant cytoflavin on the course of early postanesthetic recovery in patients operated on for various cancers. Subjects and methods: Fifty-seven patients aged 30 to 65 years, operated on for gynecological cancer, were examined. The patients were divided into 2 groups: 1 28 patients who took cytoflavin and 2 29 who did not. At the end of an operation, the agent was intravenously injected in a dose of 10 ml in a mixture with an equal volume of 0.9% sodium chloride solution. Thiopental sodium was used for initial anesthesia; arduan was employed to maintain muscle relaxation. Neuroleptic analgesia with fentanyl and droperidol or ataralgesia (fentanyl + relanium was applied in both groups. The levels of hemoglobin, glucose, sodium, potassium, calcium, malonic dialdehyde (MDA (Andreyev’s test, antioxidative activity (AOA (Semenov’s test were measured to evaluate the functional state of patients. The rating system for determining the recovery of consciousness, respiration, and motor activity, proposed by Aldret and Kroulik , and Bidway’s psychological testing, blood oxygen saturation and cardiac performance monitoring (TRITON, Russia and some others were used to evaluate the efficacy of the drug in the early postanesthetic period. The results were statistically processed using Microsoft Excel and a package of Biostatistics 6.0. Results. The use of cytoflavin at the end of surgery has been established to have a beneficial effect on the early recovery period. This is manifested as shorter recovery of consciousness and respiration mainly in the ataralgesia group; fair oxygen saturation, lower MDA concentrations and higher AOA are revealed. Conclusion. Cytoflavin significantly reduces the recovery of consciousness and adequate respiration and the incidence of the fever, muscle tremor syndrome and fails to favor the occurrence of hypoglycemia. Inclusion of cytoflavin into a complex of
Sun, Fan-Ko; Lu, Chu-Yun; Tseng, Yun Shan; Chiang, Chun-Ying
The aim of this study was to explore the factors predicting suicide recovery and to provide guidance for healthcare professionals when caring for individuals who have attempted suicide. The high rate of suicide is a global health problem. Suicide prevention has become an important issue in contemporary mental health. Most suicide research has focused on suicidal prevention and care. There is a lack of research on the factors predicting suicidal recovery. A cross-sectional design was adopted. A correlational study with a purposive sample of 160 individuals from a suicide prevention centre in southern Taiwan was conducted. The questionnaires included the Brief Symptom Rating Scale-5, Suicidal Recovery Assessment Scale and Beck Hopelessness Scale. Descriptive statistics and linear regressions were used for the analysis. The mean age of the participants was 40.2 years. Many participants were striving to make changes to create a more stable and fulfilling life, had an improved recovery from suicide and had a good ability to adapt or solve problems. The linear regression showed that the Beck Hopelessness Scale scores (ß = -.551, p suicidal behaviour (ß = -.145, p = .008) were significant predictors of individuals' recovery from suicide. They accounted for 57.1% of the variance. Suicidal individuals who have a lower level of hopelessness, a better ability to cope with their mental condition and fewer past suicidal behaviours may better recover from suicide attempts. The nurses could use the results of this study to predict recovery from suicide in patients with attempted suicide. © 2017 John Wiley & Sons Ltd.
Barasch, Marc Ian
Mind-body therapies are often portrayed in the literature as self-palliative, adjunctive, and complementary, but rarely as contributive to cure. Many physicians continue to view them as acceptable indulgences so long as they are harmless and the patient remains fully compliant with a standard treatment regimen. The possibility that such modalities might help drive the healing process itself is infrequently acknowledged. This article addresses the topic of such therapies, examining remarkable recoveries in cancer, and suggesting the need for a "Remarkable Recovery Registry" to expand the literature on these cases. The author discusses the importance of complementary alternative medicine, and emotional and pyschologic support in the treatment regimen, and the need for health care providers and patients to work together to provide the best emotional environment for the healing process.
Keller, H; Payette, H; Laporte, M; Bernier, P; Allard, J; Duerksen, D; Gramlich, L; Jeejeebhoy, K
Transitions out of hospital can influence recovery. Ideally, malnourished patients should be followed by someone with nutrition expertise, specifically a dietitian, post discharge from hospital. Predictors of dietetic care post discharge are currently unknown. The present study aimed to determine the patient factors independently associated with 30-days post hospital discharge dietetic care for free-living patients who transitioned to the community. Nine hundred and twenty-two medical or surgical adult patients were recruited in 16 acute care hospitals in eight Canadian provinces on admission. Eligible patients could speak English or French, provide their written consent, were anticipated to have a hospital stay of ≥2 days and were not considered palliative. Telephone interviews were completed with 747 (81%) participants using a standardised questionnaire to determine whether dietetic care occurred post discharge; 544 patients discharged to the community were included in the multivariate analyses, excluding those who were admitted to nursing homes or rehabilitation facilities. Covariates during and post hospitalisation were collected prospectively and used in logistic regression analyses to determine independent patient-level predictors. Dietetic care post discharge was reported by 61/544 (11%) of participants and was associated with severe malnutrition [Subjective Global Assessment category C: odd's ratio (OR) 2.43 (1.23-4.83)], weight loss post discharge [(OR 2.86 (1.45-5.62)], comorbidity [(OR 1.09 (1.02-1.17)] and a dietitian consultation on admission [(OR 3.41 (1.95-5.97)]. Dietetic care post discharge occurs in few patients, despite the known high prevalence of malnutrition on admission and discharge. Dietetic care in hospital was the most influential predictor of post-hospital care. © 2017 The British Dietetic Association Ltd.
Yeo, Sang Seok; Jang, Sung Ho
Knowledge about recovery of an injured fornix following brain injury is limited. We describe here a patient who showed recovery of an injured fornix following stroke. A 57-year-old female patient underwent coiling for a ruptured anterior communicating cerebral artery aneurysm, and conservative management for subarachnoid and intraventricular haemorrhage. The patient showed severe cognitive impairment 6 weeks after onset. However, her cognition showed continuous improvement with time; based on the Mini-Mental State Examination and the Memory Assessment Scale, her cognition was within the normal range 7 months after onset. Findings from diffusion tensor tractography at 6 weeks and 7 months showed discontinuations in both columns of the fornix. The proximal portion of both crus also showed discontinuation on diffusion tensor tractography at 6 weeks and 7 months; however, on 7-month diffusion tensor tractography, the end of the fornical body was shown to be connected to the splenium of the corpus callosum and then branched to the right medial temporal lobe and right thalamus. The unusual neural connection between the injured fornix and the thalamus appears to be a recovery phenomenon, which allows the injured fornix and the medial temporal lobe to obtain cholinergic innervation from cholinergic nuclei in the brainstem rather than from cholinergic nuclei in the basal forebrain.
Michael, Scott; Jay, Ollie; Graham, Kenneth S; Davis, Glen M
This study investigated indirect measures of post-exercise parasympathetic reactivation (using heart-rate-variability, HRV) and sympathetic withdrawal (using systolic-time-intervals, STI) following upper- and lower-body exercise. Randomized, counter-balanced, crossover. 13 males (age 26.4±4.7years) performed maximal arm-cranking (MAX-ARM) and leg-cycling (MAX-LEG). Subsequently, participants undertook separate 8-min bouts of submaximal HR-matched exercise of each mode (ARM and LEG). HRV (including natural-logarithm of root-mean-square-of-successive-differences, Ln-RMSSD) and STI (including pre-ejection-period, PEP) were assessed throughout 10-min seated recovery. Peak-HR was higher (p=0.001) during MAX-LEG (182±7beatsmin -1 ) compared with MAX-ARM (171±12beatsmin -1 ), while HR (preflecting sympathetic withdrawal). Exercise modality appears to influence post-exercise parasympathetic reactivation and sympathetic withdrawal in an intensity-dependent manner. These results highlight the need for test standardization and may be relevant to multi-discipline athletes and in clinical applications with varying modes of exercise testing. Copyright © 2018 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.
Brice, Roanne G.; Brice, Alejandro
This second article of a two-part case study focuses on the experiences of a patient and his spouse (caregiver) when a neurological trauma occurs. It is the personal account when A.B. survived a vertebral artery aneurysm and hemorrhage resulting in a subarachnoid hemorrhage. It is also an in-depth post-trauma account from two speech-language…
Poudel, Dilli Ram; Ghimire, Sushil; Dhital, Rashmi; Forman, Daniel A; Warkentin, Theodore E
Recently published reports have established a heparin-induced thrombocytopenia (HIT)-mimicking thromboembolic disorder without proximate heparin exposure, called spontaneous HIT syndrome. Although the pathophysiology remains unclear, anti-platelet factor 4 (PF4)/heparin antibodies possibly triggered by exposure to knee cartilage glycosaminoglycans or other non-heparin polyanions found on bacterial surfaces and nucleic acids have been postulated. We present a 53-year-old female receiving antithrombotic prophylaxis with aspirin following right total knee replacement surgery (without perioperative or any previous lifetime heparin exposure) who acutely presented with high-risk pulmonary embolism (PE) and right great saphenous vein thrombophlebitis on postoperative day (POD) 14; her platelet count at presentation was 13 × 10 9 /L. Prior to diagnostic consideration of spontaneous HIT syndrome, the patient briefly received unfractionated heparin (UFH) and one dose of enoxaparin. The patient's serum tested strongly positive for anti-PF4/heparin antibodies by two different PF4-dependent enzyme-linked immunosorbent assays (ELISAs) and by serotonin release assay (SRA). Failure of fondaparinux anticoagulation (persisting HIT-associated disseminated intravascular coagulation) prompted switching to argatroban. Severe thrombocytopenia persisted (platelet count nadir, 12 × 10 9 /L, on POD21), and 9 days after starting argatroban symptomatic right leg deep-vein thrombosis (DVT) occurred, prompting switch to rivaroxaban. Thereafter, her course was uneventful, although platelet count recovery was prolonged, reaching 99 × 10 9 /L by POD45 and 199 × 10 9 /L by POD79. The patient's serum elicited strong serotonin release in the absence of heparin (seen even with 1/32 serum dilution) that was enhanced by pharmacological concentrations of UFH (0.1 and 0.3 IU/mL) and fondaparinux (0.1-1.2 μg/mL, i.e., in vitro fondaparinux "cross-reactivity"). Ultimately, platelet count recovery was
Catherine A Waight
Full Text Available Recent research in posttraumatic growth has been applied to people with life-threatening illnesses to optimise recovery. There is a lack of research exploring posttraumatic growth in coronary artery bypass graft patients. This article describes the recovery experience of 14 coronary artery bypass graft patients (13 males and 1 female at their first outpatient review post-surgery. Grounded theory analysis was used to develop a model of distinct and shared pathways to growth depending on whether patients were symptomatic or asymptomatic pre-coronary artery bypass graft. Outcomes of posttraumatic growth in this sample included action-based healthy lifestyle growth and two forms of cognitive growth: appreciation of life and new possibilities. The model of posttraumatic growth developed in this study may be helpful in guiding future research into promoting posttraumatic growth and behaviour change in coronary artery bypass graft patients.
Paul A. Fournier
Full Text Available Glycogen plays a major role in supporting the energy demands of skeletal muscles during high intensity exercise. Despite its importance, the amount of glycogen stored in skeletal muscles is so small that a large fraction of it can be depleted in response to a single bout of high intensity exercise. For this reason, it is generally recommended to ingest food after exercise to replenish rapidly muscle glycogen stores, otherwise one's ability to engage in high intensity activity might be compromised. But what if food is not available? It is now well established that, even in the absence of food intake, skeletal muscles have the capacity to replenish some of their glycogen at the expense of endogenous carbon sources such as lactate. This is facilitated, in part, by the transient dephosphorylation-mediated activation of glycogen synthase and inhibition of glycogen phosphorylase. There is also evidence that muscle glycogen synthesis occurs even under conditions conducive to an increased oxidation of lactate post-exercise, such as during active recovery from high intensity exercise. Indeed, although during active recovery glycogen resynthesis is impaired in skeletal muscle as a whole because of increased lactate oxidation, muscle glycogen stores are replenished in Type IIa and IIb fibers while being broken down in Type I fibers of active muscles. This unique ability of Type II fibers to replenish their glycogen stores during exercise should not come as a surprise given the advantages in maintaining adequate muscle glycogen stores in those fibers that play a major role in fight or flight responses
Abney, Morgan B.; Greenwood, Zachary; Miller, Lee A.; Alvarez, Giraldo; Iannantuono, Michelle; Jones, Kenny
State-of-the-art life support carbon dioxide (CO2) reduction technology, based on the Sabatier reaction, is theoretically capable of 50% recovery of oxygen from metabolic CO2. This recovery is constrained by the limited availability of reactant hydrogen. Post-processing of the methane byproduct from the Sabatier reactor results in hydrogen recycle and a subsequent increase in oxygen recovery. For this purpose, a Methane Post-Processor Assembly containing three sub-systems has been developed and tested. The assembly includes a Methane Purification Assembly (MePA) to remove residual CO2 and water vapor from the Sabatier product stream, a Plasma Pyrolysis Assembly (PPA) to partially pyrolyze methane into hydrogen and acetylene, and an Acetylene Separation Assembly (ASepA) to purify the hydrogen product for recycle. The results of partially integrated testing of the sub-systems are reported
Reja, Md Y.; Brody, Samuel D.; Highfield, Wesley E.; Newman, Galen D.
Recovery after hurricane events encourages new development activities and allows reconstruction through the conversion of naturally occurring wetlands to other land uses. This research investigates the degree to which hurricane recovery activities in coastal communities are undermining the ability of these places to attenuate the impacts of future storm events. Specifically, it explores how and to what extent wetlands are being affected by the CWA Section 404 permitting program in the context of post-Hurricane Ike 2008 recovery. Wetland alteration patterns are examined by selecting a control group (Aransas and Brazoria counties with no hurricane impact) vs. study group (Chambers and Galveston counties with hurricane impact) research design with a pretest-posttest measurement analyzing the variables such as permit types, pre-post Ike permits, land cover classes, and within-outside the 100-year floodplain. Results show that permitting activities in study group have increased within the 100-year floodplain and palustrine wetlands continue to be lost compare to the control group. Simultaneously, post-Ike individual and nationwide permits increased in the Hurricane Ike impacted area. A binomial logistic regression model indicated that permits within the study group, undeveloped land cover class, and individual and nationwide permit type have a substantial effect on post-Ike permits, suggesting that post-Ike permits have significant impact on wetland losses. These findings indicate that recovery after the hurricane is compromising ecological resiliency in coastal communities. The study outcome may be applied to policy decisions in managing wetlands during a long-term recovery process to maintain natural function for future flood mitigation.
Objectives: To determine the number of patients whose non-depolarising muscle relaxation is adequately reversed. To define factors that contribute to reversal. Design: A cross sectional study. Setting: Universitas Hospital recovery room over a 2 month period. Subjects: Patients that received non-depolarising muscle ...
Baxter, M; Gorick, S; Swords, F M
Summary Addison's disease is a condition characterised by immune-mediated destruction of the adrenal glands leading to a requirement of lifelong replacement therapy with mineralocorticoid and glucocorticoid. We present a case of a 53-year-old man who presented at the age of 37 years with nausea, fatigue and dizziness. He was found to have postural hypotension and buccal pigmentation. His presenting cortisol level was 43 nmol/l with no response to Synacthen testing. He made an excellent response to conventional replacement therapy with hydrocortisone and fludrocortisone and then remained well for 16 years. On registering with a new endocrinologist, his hydrocortisone dose was revised downwards and pre- and post-dose serum cortisol levels were assessed. His pre-dose cortisol was surprisingly elevated, and so his dose was further reduced. Subsequent Synacthen testing was normal and has remained so for further 12 months. He is now asymptomatic without glucocorticoid therapy, although he continues on fludrocortisone 50 μg daily. His adrenal antibodies are positive, although his ACTH and renin levels remain elevated after treatment. Addison's disease is generally deemed to lead to irreversible cell-mediated immune destruction of the adrenal glands. For this reason, patients receive detailed counselling and education on the need for lifelong replacement therapy. To our knowledge, this is the third reported case of spontaneous recovery of the adrenal axis in Addison's disease. Recovery may therefore be more common than previously appreciated, which may have major implications for the treatment and monitoring of this condition, and for the education given to patients at diagnosis. Learning points Partial recovery from Addison's disease is possible although uncommon.Patients with long-term endocrine conditions on replacement therapy still benefit from regular clinical and biochemical assessment, to revisit optimal management.As further reports of adrenal axis recovery
Baxter, M; Gorick, S; Swords, F M
Addison's disease is a condition characterised by immune-mediated destruction of the adrenal glands leading to a requirement of lifelong replacement therapy with mineralocorticoid and glucocorticoid. We present a case of a 53-year-old man who presented at the age of 37 years with nausea, fatigue and dizziness. He was found to have postural hypotension and buccal pigmentation. His presenting cortisol level was 43 nmol/l with no response to Synacthen testing. He made an excellent response to conventional replacement therapy with hydrocortisone and fludrocortisone and then remained well for 16 years. On registering with a new endocrinologist, his hydrocortisone dose was revised downwards and pre- and post-dose serum cortisol levels were assessed. His pre-dose cortisol was surprisingly elevated, and so his dose was further reduced. Subsequent Synacthen testing was normal and has remained so for further 12 months. He is now asymptomatic without glucocorticoid therapy, although he continues on fludrocortisone 50 μg daily. His adrenal antibodies are positive, although his ACTH and renin levels remain elevated after treatment. Addison's disease is generally deemed to lead to irreversible cell-mediated immune destruction of the adrenal glands. For this reason, patients receive detailed counselling and education on the need for lifelong replacement therapy. To our knowledge, this is the third reported case of spontaneous recovery of the adrenal axis in Addison's disease. Recovery may therefore be more common than previously appreciated, which may have major implications for the treatment and monitoring of this condition, and for the education given to patients at diagnosis. Partial recovery from Addison's disease is possible although uncommon.Patients with long-term endocrine conditions on replacement therapy still benefit from regular clinical and biochemical assessment, to revisit optimal management.As further reports of adrenal axis recovery emerge, this may
Colagiuri, Ben; Zachariae, Robert
to determine the strength of the relationship between expectancy and post-chemotherapy nausea. METHODS: The findings from 17 relevant studies (n = 2,400) identified through systematic searches of Medline, PsycInfo, and Cinhal were analyzed using a combination of meta-analytic techniques. RESULTS: Overall...
Full Text Available The mechanisms of mechanical energy recovery during gait have been thoroughly investigated in healthy subjects, but never described in patients with Parkinson disease (PD. The aim of this study was to investigate whether such mechanisms are preserved in PD patients despite an altered pattern of locomotion. We consecutively enrolled 23 PD patients (mean age 64±9 years with bilateral symptoms (H&Y ≥II if able to walk unassisted in medication-off condition (overnight suspension of all dopaminergic drugs. Ten healthy subjects (mean age 62±3 years walked both at their 'preferred' and 'slow' speeds, to match the whole range of PD velocities. Kinematic data were recorded by means of an optoelectronic motion analyzer. For each stride we computed spatio-temporal parameters, time-course and range of motion (ROM of hip, knee and ankle joint angles. We also measured kinetic (Wk, potential (Wp, total (WtotCM energy variations and the energy recovery index (ER. Along with PD progression, we found a significant correlation of WtotCM and Wp with knee ROM and in particular with knee extension in terminal stance phase. Wk and ER were instead mainly related to gait velocity. In PD subjects, the reduction of knee ROM significantly diminished both Wp and WtotCM. Rehabilitation treatments should possibly integrate passive and active mobilization of knee to prevent a reduction of gait-related energetic components.
Crewther, Blair T; Cook, Christian J
We tested the effects of different post-match recovery interventions on the subsequent hormonal responses to a physical stress-test and game performance in professional rugby union players. On four occasions, participants (n=12) completed a video session (1 h each) with accompanying coach feedback the day after a rugby union match. The interventions showed either video footage of player mistakes with negative coach feedback (NCF1) or player successes with positive feedback (PCF1). Both approaches were repeated (NCF2 and PCF2). In the following week, participants were assessed for their free testosterone (T) and cortisol (C) responses to a physical stress-test, pre-game T and game-ranked performance. The PFC1 and PCF2 approaches were both associated with significantly (pgame T concentrations and superior game-ranked performances than the NCF approaches (pgame presentation of specific video footage combined with different coach feedbacks appeared to influence the free hormonal state of rugby players and game performance several days later. Therefore, within the sporting context, future behaviour and performance might be modified through the use of simple psychological strategies. These data are applicable to generalised human stress responses and their modifiability by prior exposure to a stressor. Copyright © 2012 Elsevier Inc. All rights reserved.
Kovacs, Christopher S
During pregnancy and lactation, female physiology adapts to meet the added nutritional demands of fetuses and neonates. An average full-term fetus contains ∼30 g calcium, 20 g phosphorus, and 0.8 g magnesium. About 80% of mineral is accreted during the third trimester; calcium transfers at 300-350 mg/day during the final 6 wk. The neonate requires 200 mg calcium daily from milk during the first 6 mo, and 120 mg calcium from milk during the second 6 mo (additional calcium comes from solid foods). Calcium transfers can be more than double and triple these values, respectively, in women who nurse twins and triplets. About 25% of dietary calcium is normally absorbed in healthy adults. Average maternal calcium intakes in American and Canadian women are insufficient to meet the fetal and neonatal calcium requirements if normal efficiency of intestinal calcium absorption is relied upon. However, several adaptations are invoked to meet the fetal and neonatal demands for mineral without requiring increased intakes by the mother. During pregnancy the efficiency of intestinal calcium absorption doubles, whereas during lactation the maternal skeleton is resorbed to provide calcium for milk. This review addresses our current knowledge regarding maternal adaptations in mineral and skeletal homeostasis that occur during pregnancy, lactation, and post-weaning recovery. Also considered are the impacts that these adaptations have on biochemical and hormonal parameters of mineral homeostasis, the consequences for long-term skeletal health, and the presentation and management of disorders of mineral and bone metabolism.
Full Text Available Cathepsin B is one of the major lysosomal cysteine proteases involved in neuronal protein catabolism. This cathepsin is released after traumatic injury and increases neuronal death; however, release of cystatin C, a cathepsin inhibitor, appears to be a self-protective brain response. Here we describe the effect of cystatin C intracerebroventricular administration in rats prior to inducing a traumatic brain injury. We observed that cystatin C injection caused a dual response in post-traumatic brain injury recovery: higher doses (350 fmoles increased bleeding and mortality, whereas lower doses (3.5 to 35 fmoles decreased bleeding, neuronal damage and mortality. We also analyzed the expression of cathepsin B and cystatin C in the brains of control rats and of rats after a traumatic brain injury. Cathepsin B was detected in the brain stem, cerebellum, hippocampus and cerebral cortex of control rats. Cystatin C was localized to the choroid plexus, brain stem and cerebellum of control rats. Twenty-four hours after traumatic brain injury, we observed changes in both the expression and localization of both proteins in the cerebral cortex, hippocampus and brain stem. An early increase and intralysosomal expression of cystatin C after brain injury was associated with reduced neuronal damage.
Harasym, Jessica; Langevin, Marilyn; Kully, Deborah
This multiple-baseline across subjects study investigated the effectiveness of video self-modeling (VSM) in reducing stuttering and bringing about improvements in associated self-report measures. Participants' viewing practices and perceptions of the utility of VSM also were explored. Three adult males who had previously completed speech restructuring treatment viewed VSM recordings twice per week for 6 weeks. Weekly speech data, treatment viewing logs, and pre- and post-treatment self-report measures were obtained. An exit interview also was conducted. Two participants showed a decreasing trend in stuttering frequency. All participants appeared to engage in fewer avoidance behaviors and had less expectations to stutter. All participants perceived that, in different ways, the VSM treatment had benefited them and all participants had unique viewing practices. Given the increasing availability and ease in using portable audio-visual technology, VSM appears to offer an economical and clinically useful tool for clients who are motivated to use the technology to recover fluency. Readers will be able to describe: (a) the tenets of video-self modeling; (b) the main components of video-self modeling as a fluency recovery treatment as used in this study; and (c) speech and self-report outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.
Full Text Available The disposal of waste plastics has become a major worldwide environmental problem. The USA, Europe and Japan generate annually about 50 million tons of post-consumer plastic waste, previously landfilled, generally considered as a non-sustainable and environmentally questionable option. Landfill sites and their capacity are, moreover, decreasing rapidly, and legislation is stringent. Several European Directives and US legislation concern plastic wastes and the required management. They are briefly discussed in this paper. New processes have emerged, i.e., advanced mechanical recycling of plastic waste as virgin or second grade plastic feedstock, and thermal treatments to recycle the waste as virgin monomer, as synthetic fuel gas, or as heat source (incineration with energy recovery. These processes avoid land filling, where the non-biodegradable plastics remain a lasting environmental burden. The paper reviews these alternative options through mostly thermal processing (pyrolysis, gasification and waste-to-energy. Additional research is, however, still needed to confirm the potential on pilot and commercial scale. [Acknowledgments. The research was partly funded by the Fundamental Research Funds for the Central Universities RC1101 (PR China and partly funded by Project KP/09/005 (SCORES4CHEM Knowledge Platform of the Industrial Research Council of the KU Leuven (Belgium.
Full Text Available David J Clarke, Anne Forster Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK Abstract: Stroke is a leading cause of serious, long-term disability, the effects of which may be prolonged with physical, emotional, social, and financial consequences not only for those affected but also for their family and friends. Evidence for the effectiveness of stroke unit care and the benefits of thrombolysis have transformed treatment for people after stroke. Previously viewed nihilistically, stroke is now seen as a medical emergency with clear evidence-based care pathways from hospital admission to discharge. However, stroke remains a complex clinical condition that requires health professionals to work together to bring to bear their collective knowledge and specialist skills for the benefit of stroke survivors. Multidisciplinary team working is regarded as fundamental to delivering effective care across the stroke pathway. This paper discusses the contribution of team working in improving recovery at key points in the post-stroke pathway. Keywords: stroke care, rehabilitation, multidisciplinary, interdisciplinary, team working
Rani, Wan Nurul Mardiah Wan Mohd; Nifa, Faizatul Akmar Abdul; Ismail, Mohd Noorizhar; Khalid, Khairin Norhashidah
As the frequency of disaster occurrence increases, the world cities today are getting more difficult in terms of the management of the event. One of the most discussed issues today is the management of the post-disaster recovery that involves several stages such as the planning, management of multiple stakeholders, restoration, reconstruction and delivery. It is important to note that input from related stakeholders is necessary to make the right decision during this most critical period. In the process of building back after a disaster, it is important to ensure the newly constructed infrastructures are built to be more resilient and able to withstand a certain level of disaster recurrence. Elements of disaster risk reduction should be incorporated in the planning, redesign, construction and the operation of the built environment. In Malaysia, the disaster management has been the responsibility of the Disaster Management and Relief Committee that consists of agencies at the central, state and local levels. This is to ensure that all aspects are being considered and to be more effective in managing the situation.
Huang, Zhen; Tong, Hongfei; Li, Yuan; Zhou, Haixia; Qian, Jiangchao; Wang, Juxiang; Ruan, Jichen
The predictive value of interleukin-35 (IL-35) on efficacy of immunosuppressive therapy (IST) in aplastic anemia (AA) has not been well investigated. The aim of the study was to evaluate the association between serum IL-35 level and response to IST in pediatric AA. A total of 154 children with AA and 154 controls were included between January 2012 and December 2013. Blood and bone marrow fluid specimens were collected. Serum level of IL-35 was determined by enzyme-linked immunosorbent assay. Patients were treated with IST, and response to therapy was evaluated during 180-day follow-up period after starting therapy. Serum levels of IL-35 at admission decreased significantly in patients compared with that in controls (10.9 ± 5.5 pg ml -1 and 45.3 ± 8.8 pg ml -1 , p < 0.001). After starting IST, serum levels of IL-35 in patients recovered 30.7 ± 9.7 pg ml -1 in the first 28 days (p < 0.001). During the follow-up period, increased range of serum IL-35 level ≥30.7 pg ml -1 in the first 28 days was associated with effective response to therapy (odds ratio 7.97, 95% confidence interval 3.82-16.79). In addition, Fas/FasL protein expression in bone marrow mononuclear cells dropped significantly in the same group of patients in the first 28 days (p < 0.05). The study revealed that post-therapeutic recovery of circulating IL-35 concentration might be an independent predictor for effective response to IST in pediatric AA. Moreover, apoptosis might be involved in such a forecasting process.
Trickett, R W; Mudge, Elizabeth; Price, Patricia; Pallister, Ian
The aim of this study was to describe how patients perceive their recovery following open tibial fractures using a qualitative approach. Following the appropriate ethical approval, adult patients with a diagnosis of open tibial fracture were recruited after completion of their surgical treatment and discharge from Morriston Hospital, a centre with orthoplastic surgical care. A purposive sampling method was employed to ensure that a range of injuries as well as clinical outcomes were included. All patients took part in an in-depth semi-structured interview, exploring aspects of their injury, treatment, rehabilitation and psychosocial and financial situations. Interviews were completed with two interviewers present and were recorded for verbatim transcription. Interview transcripts were analysed to identify items important to patients during their recovery. Nine patients with a mean injury to interview interval of 2.3 years were interviewed. A total of 538 items were identified and subsequently mapped onto 18 categories: pain; mobility; flexibility; temperature (effects on symptoms); fear; appearance; sleep; diet/weight; employment; social; finance; impact on others; self-care; recovery (patient perceptions of recovery); frustration; goal setting (by patients and health-care providers); and adaptation (both physical and mental). There is a wide range of factors that our cohort found important during their recovery from open tibial fracture. Despite being considered as 'healed' by the medical staff, patients did not report a corresponding full recovery and return to pre-injury normality. The categories identified will enable the development of a patient-reported recovery scale to be used in lower-limb trauma. Copyright © 2012 Elsevier Ltd. All rights reserved.
Miao, Ling-Feng; Yang, Fan; Han, Chun-Yu; Pu, Yu-Jin; Ding, Yang; Zhang, Li-Jia
Winter flooding events are common in some rivers and streams due to dam constructions, and flooding and waterlogging inhibit the growth of trees in riparian zones. This study investigated sex-specific morphological, physiological and ultrastructural responses to various durations of winter flooding and spring waterlogging stresses, and post-flooding recovery characteristics in Populus deltoides. There were no significant differences in the morphological, ultrastructural and the majority of physiological traits in trees subjected to medium and severe winter flooding stresses, suggesting that males and females of P. deltoides were winter flooding tolerant, and insensitive to winter flooding duration. Males were more tolerant to winter flooding stress in terms of photosynthesis and chlorophyll fluorescence than females. Females displayed greater oxidative damage due to flooding stress than males. Males developed more efficient antioxidant enzymatic systems to control reactive oxygen species. Both sexes had similarly strong post-flooding recovery capabilities in terms of plant growth, and physiological and ultrastructural parameters. However, Males had better recovery capabilities in terms of pigment content. These results increase the understanding of poplars's adaptation to winter flooding stress. They also elucidate sex-specific differences in response to flooding stress during the dormant season, and during post-flooding recovery periods.
Hallett, J. K. E.; Miller, D.; Roberts, D. A.
Forest fires play a key role in shaping eco-systems. The risk to vegetation depends on the fire regime, fuel conditions (age and amount), fire temperature, and physiological characteristics such as bark thickness and stem diameter. The 2007 Zaca Fire (24 kilometers NE of Buellton, Santa Barbara County, California) burned 826.4 km2 over the course of 2 months. In this study, we used a time series of Landsat 5 Thematic Mapper and Landsat 8 Operational Land Imager imagery, to evaluate plant burn severity and post fire recovery as defined into classes of above average recovery, normal recovery, and below average recovery. We spectrally unmixed the images into green vegetation (GV), non-photosynthetic vegetation (NPV), soil surface (SOIL), and ash with a spectral library developed using Constrained Reference Endmember Selection (CRES). We delineated the fire perimeter using the differenced Normalized Burn Ratio (dNBR) and evaluated changes in this index and the Normalized Difference Vegetation Index through time. The results showed an immediate decline in GV and NPV fractions, with a rise in soil and ash fractions directly following the fire, with a slow recovery in GV fraction and a loss of bare soil cover. The was a sharp increase in the ash fraction following the fire and gradual decrease in the year after. Most areas have recovered as of 2017, with prominent recovery in the center of the burn scar and reduced recovery in areas to the south. These results indicate how post-fire vegetation varies based on initial burn severity and pre-fire GV and NPV fractions.
Full Text Available INTRODUCTION: Post - operative restlessness is observed commonly among children following Ear Nose Throat surgeries. This post anesthetic problem is also termed as Emergence Agitation (EA which interferes with patient’s recovery, presenting a challenging task to the ane sthetist in terms of assessment and convincing the parents. Many factors play a role singly or in combination in producing EA. EA consist of restlessness, excessive crying and spells of breath holding, head banging and incoherent speech. In this prospectiv e clinical study the incidence of post - operative recovery restlessness EA in children aged between 3 to 12 years, enumeration of the causes, and prediction of EA in Indian population. MATERIALS AND METHODS: 246 Children undergoing elective surgeries of Ear Nose and throat are selected and their demographic data, socio - economic back ground and emotional attachment with parents were elicited. Parents of the children were interviewed prior to surgery using a questionnaire enquiring of their children’s personal ity, and emotional attachment and meekness. Their preoperative clinical data are documented. Their post - operative general condition, behavior, time taken for awakening, period of total recovery and treatment factors are recorded and analyzed. RESULTS: The incidence of EA was found in 23.6% of the children. EA lasted between 21 minutes to 52 minutes with a mean period of 28.4±9.5 minutes. 67% of the children required medication with sedatives, analgesics and anti - emetics. Post - operative stay in the Surgical ICU ranged between Hrs . 3.12±0.36mts to Hrs . 8.39±2.10mts in the children showing restlessness, compared to those not showing agitation. CONCLUSIONS: The factors associated with EA were, age, emotional attachment, meekness, adaptability, previous surgery, analgesics, sedatives, dose of pentothal sodium for induction, time taken for awakening and duration of surgery. Shorter was the time of awakening
Full Text Available The frequency and severity of forest fires, coupled with changes in spatial and temporal precipitation and temperature patterns, are likely to severely affect the characteristics of forest and permafrost patterns in boreal eco-regions. Forest fires, however, are also an ecological factor in how forest ecosystems form and function, as they affect the rate and characteristics of tree recruitment. A better understanding of fire regimes and forest recovery patterns in different environmental and climatic conditions will improve the management of sustainable forests by facilitating the process of forest resilience. Remote sensing has been identified as an effective tool for preventing and monitoring forest fires, as well as being a potential tool for understanding how forest ecosystems respond to them. However, a number of challenges remain before remote sensing practitioners will be able to better understand the effects of forest fires and how vegetation responds afterward. This article attempts to provide a comprehensive review of current research with respect to remotely sensed data and methods used to model post-fire effects and forest recovery patterns in boreal forest regions. The review reveals that remote sensing-based monitoring of post-fire effects and forest recovery patterns in boreal forest regions is not only limited by the gaps in both field data and remotely sensed data, but also the complexity of far-northern fire regimes, climatic conditions and environmental conditions. We expect that the integration of different remotely sensed data coupled with field campaigns can provide an important data source to support the monitoring of post-fire effects and forest recovery patterns. Additionally, the variation and stratification of pre- and post-fire vegetation and environmental conditions should be considered to achieve a reasonable, operational model for monitoring post-fire effects and forest patterns in boreal regions.
Bindawas, Saad M.; Mawajdeh, Hussam M.; Vennu, Vishal S.; Alhaidary, Hisham M.
Objective: To examine the functional recovery differences after stroke rehabilitation in patients with uni- or bilateral hemiparesis. Methods: In this retrospective study, we included data from the medical record of all 383 patients with uni- or bilateral hemiparesis after stroke who were admitted to King Fahad Medical City-Rehabilitation Hospital between 2008 and 2014 in Riyadh, Kingdom of Saudi Arabia. According to the site of hemiparesis, we classified patients into 3 groups: right hemiparesis (n=208), left hemiparesis (n=157), and bilateral hemipareses (n=18). The patients (n=49) who did not have either site of hemiparesis were excluded. The Functional Independence Measures (FIM) instrument was used to assess the score at admission and discharge. A post hoc test was conducted to examine the functional recovery differences between groups. Multiple regression analyses were used to confirm the findings. Results: Amongst the three groups, there were significant (phemiparesis group. Multiple regression analyses also confirmed that the site of hemiparesis significantly (phemiparesis after stroke. PMID:28678212
Maeda, Shunta; Sato, Tomoya; Shimada, Hironori; Tsumura, Hideki
There is growing evidence that individuals with social anxiety show impaired cortisol recovery after experiencing social evaluative stressors. Yet, little is known regarding the cognitive processes underlying such impaired cortisol recovery. The present study examined the effect of post-event processing (PEP), referred to as repetitive thinking about social situations, on cortisol recovery following a social stressor. Forty-two non-clinical university students (23 women, 19 men, mean age = 22.0 ± 2.0 years) completed the Trier Social Stress Test (TSST), followed by a thought sampling procedure which assessed the frequency of PEP reflecting the TSST. A growth curve model showed PEP and social anxiety interactively predicted cortisol recovery. In particular, PEP predicted impaired cortisol recovery in those with low levels of social anxiety but not in those with high levels of social anxiety, which contradicted the initial hypothesis. These findings suggest that PEP is differentially associated with cortisol recovery depending on levels of social anxiety. The possible mechanisms underlying these findings were discussed in terms of protective inhibition framework.
Kooistra, C.; Hall, T. E.; Paveglio, T.; Pickering, M.
Disturbances such as wildfire are important features of forested landscapes. The trajectory of changes following wildfires (often referred to as landscape recovery) continues to be an important research topic among ecologists and wildfire scientists. However, the landscape recovery process also has important social dimensions that may or may not correspond to ecological or biophysical perspectives. Perceptions of landscape recovery may affect people's attitudes and behaviors related to forest and wildfire management. We explored the variables that influence people's perceptions of landscape recovery across 25 fires that occurred in 2011 or 2012 in the United States of Washington, Oregon, Idaho, and Montana and that represented a range of fire behavior characteristics and landscape impacts. Residents near each of the 25 fires were randomly selected to receive questionnaires about their experiences with the nearby fire, including perceived impacts and how the landscape had recovered since the fire. People generally perceived landscapes as recovering, even though only one to two years had passed. Regression analysis suggested that perceptions of landscape recovery were positively related to stronger beliefs about the ecological role of fire and negatively related to loss of landscape attachment, concern about erosion, increasing distance from the fire perimeter, and longer lasting fires. Hierarchical linear modeling (HLM) analysis indicated that the above relationships were largely consistent across fires. These findings highlight that perceptions of post-fire landscape recovery are influenced by more than vegetation changes and include emotional and cognitive factors. We discuss the management implications of these findings.
May 3, 2004 ... Electrical stimulation of peripheral nerves and the evaluation of the muscle ... Various modes of stimulation are used such as titanic stimulation, post ti- .... The patients' ages ranged from 5 to 79 years (median 38.5 years);.
Brain plasticity after stroke remains poorly understood. Patients may improve spontaneously within the first 3 months and then more slowly in the coming year. The first day, decreased edema and reperfusion of the ischemic penumbra may possibly account for these phenomena, but the improvement during the next weeks suggests plasticity phenomena and cortical reorganization of the brain ischemic areas and of more remote areas. Indeed, the injured ischemic motor cortex has a reduced cortical excitability at the acute phase and a suspension of the topographic representation of affected muscles, whereas the contralateral motor cortex has an increased excitability and an enlarged somatomotor representation; furthermore, contralateral cortex exerts a transcallosal interhemispheric inhibition on the ischemic cortex. This results from the imbalance of the physiological reciprocal interhemispheric inhibition of each hemisphere on the other, contributing to worsening of neurological deficit. Cortical excitability is measurable through transcranial magnetic stimulation (TMS) and prognosis has been established according to the presence of motor evoked potentials (MEP) at the acute phase of stroke, which is predictive of better recovery. Conversely, the lack of response to early stimulation is associated with a poor functional outcome. Non-invasive stimulation techniques such as repetitive TMS (rTMS) or transcranial direct current stimulation (tDCS) have the potential to modulate brain cortical excitability with long lasting effects. In the setting of cerebrovascular disease, around 1000 stroke subjects have been included in placebo-controlled trials so far, most often with an objective of promoting motor recovery of the upper limb. High frequency repetitive stimulation (>3 Hz) rTMS, aiming to increase excitability of the ischemic cortex, or low frequency repetitive stimulation (≤1 Hz), aiming to reduce excitability of the contralateral homonymous cortex, or combined therapies
Bedini, Gloria; Bersano, Anna; Sebastiano, Davide Rossi; Sattin, Davide; Ciaraffa, Francesca; Tosetti, Valentina; Brenna, Greta; Franceschetti, Silvana; Ciusani, Emilio; Leonardi, Matilde; Vela-Gomez, Jesus; Boncoraglio, Giorgio B; Parati, Eugenio A
Background Sleep evaluation is increasingly being used as prognostic tool in patients with disorders of consciousness, but, surprisingly, the role of Period3 (Per3) gene polymorphism has never been evaluated. Objective The aim of this study was to investigate the contribution of Per3 genotype on sleep quantity and consciousness recovery level in patients with disorders of consciousness (DOC). Methods In this observational study, we evaluated 71 patients with DOC classified as vegetative state/unresponsive wakefulness syndrome or minimally conscious state. Demographic and clinical data were collected and a standardised diagnostic workup, including a polysomnographic record, was applied. After informed consent provided by proxy, genomic DNA was obtained and Per3 polymorphism was analysed by polymerase chain reaction to identify 5/5, 4/5, or 4/4 genotype. Results Per3(5/5) genotype was found in 12.7% of our DOC patients. The median total Coma Recovery Scale-revised score in Per3(5/5) carriers was significantly higher than 4/4 genotype (10, range 5-16 vs 7, range 4-11; post hoc P = .036). Moreover, total sleep time seemed to be higher in 5/5 genotype (5/5, 221 minutes, range 88-515 minutes; 4/4, 151.5 minutes, range 36-477 minutes; and 4/5, 188 minutes, range 44-422 minutes). Conclusion For the first time we have shown a possible association between Per3 polymorphism and consciousness recovery level in DOC patients. Even though the exact molecular mechanism has not been defined, we speculate that its effect is mediated by higher total sleep time and slow wave sleep, which would improve the preservation of main cerebral connections. © The Author(s) 2015.
García-Saldivia, Marianna; Ilarraza-Lomelí, Hermes; Myers, Jonathan; Lara, Jorge; Bueno, Leopoldo
Physical training programs (PTP) have shown several beneficial effects for patients with cardiovascular disease (CVD), particularly by increasing survival and quality of life. Physiological response during the effort and recovery phases of an exercise testing, is one of the strongest prognostic markers among patients with CVD. A reasonable mechanism that explains those training effects on survival is through the adaptations seen on heart rate recovery (HRR) and oxygen uptake kinetics at the post-exertional phase (RVO 2 ). Compare the HRR and RVO 2 values before and after a PTP in patients with CVD. We studied a cohort of patients included in a cardiac rehabilitation program, whom performed a cardiopulmonary exercise testing (CPX). Then, risk stratification and an individualized exercise training program were performed. The exercise training program included 20 sessions of aerobic exercise, 30min a day, five times a week, at moderate intensity. Finally, a second CPX was performed. A total of 215 patients were included. Peak oxygen uptake values rose 2.2±5.2ml/kg/min (p<0.001), HRR increased 1.6±10bpm (p<0.05) and RVO 2 improved -21±98s (p<0.001). A post-hoc analysis show that the percentage of maximum heart rate remained statistically associated with HRR increment. Furthermore, diabetes and sedentarism were strongly related to RVO 2 improvement. No correlation between HRR and RVO 2 was found (R 2 =0.002). Physical exercise was associated with a beneficial effect on HRR and RVO 2 . Nevertheless, both variables were statistically unrelated. Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. All rights reserved.
Citisli, Veli; Kocaoglu, Murat; Necan, Ceyda; İbrahimoglu, Muhammet; Celiker, Özkan; Baykara, Eyüp; Ozdemir, Mevci; Acar, Feridun; Coskun, Mehmet Erdal
The aim of the present report was to present the patient with an anterior cranial base fracture who developed post-traumatic cerebrospinal fluid rhinorrhea, which recovered after onset of meningitis complication. A 26-year-old male patient who had a traffic accident one week ago was sent to our clinic because of his rhinorrhea persisting for 4 days. On cranial computed tomography, fracture of the left frontal skull base and sinus walls, a fracture line on temporal bone, parenchymal bleeding in the vicinity of the frontal sinus, subarachnoidal bleeding and left temporal extradural hematoma were detected. Then he underwent sinus wall repair and extradural hematoma was drained through bifrontal craniotomy. However, rhinorrhea persisted which resulted a deterioration in consciousness and he entered into a deep somnolent state. When his symptoms of meningitis became apparent, rhinorrhea of the patient disappeared. The patient transferred in intensive care unit and re-connected to a lumbar drainage system. On cerebral magnetic resonance imaging, regression of contrast-enhanced lesions localized in the left anterotemporal and frontal and in the regions lateral to the right trigon and medial to the right thalamus and in the right posteroparietal regions was observed. Despite repair of the anterior cranial fracture and lumbar drainage, rhinorrhea may persist. Herein, development of meningitis caused disappearing of rhinorrhea symptoms without any need for surgical intervention.
Tang, Nou-Ying; Liu, Chung-Hsiang; Liu, Hsu-Jan; Li, Tsai-Chung; Liu, Jui-Chen; Chen, Ping-Kun; Hsieh, Ching-Liang
A stroke often results in post-stroke dementia, a rapid decline in memory and intelligence causing dysfunctions in daily life. The Chinese medicine doctor uses 4 examinations of inspection, listening, smelling, and feeling to determine the Chinese medicine pattern (CMP). Therefore, the purpose of the present study was to investigate the CMP in patients with post-stroke dementia. A total of 101 stroke patients were examined, consistent with the DSM IV diagnostic criteria of the American Psychi...
Wine, Michael L.; Cadol, Daniel; Makhnin, Oleg
Continued growth of the human population on Earth will increase pressure on already stressed terrestrial water resources required for drinking water, agriculture, and industry. This stress demands improved understanding of critical controls on water resource availability, particularly in water-limited regions. Mechanistic predictions of future water resource availability are needed because non-stationary conditions exist in the form of changing climatic conditions, land management paradigms, and ecological disturbance regimes. While historically ecological disturbances have been small and could be neglected relative to climatic effects, evidence is accumulating that ecological disturbances, particularly wildfire, can increase regional water availability. However, wildfire hydrologic impacts are typically estimated locally and at small spatial scales, via disparate measurement methods and analysis techniques, and outside the context of climate change projections. Consequently, the relative importance of climate change driven versus wildfire driven impacts on streamflow remains unknown across the western USA. Here we show that considering wildfire in modeling streamflow significantly improves model predictions. Mixed effects modeling attributed 2%-14% of long-term annual streamflow to wildfire effects. The importance of this wildfire-linked streamflow relative to predicted climate change-induced streamflow reductions ranged from 20%-370% of the streamflow decrease predicted to occur by 2050. The rate of post-wildfire vegetation recovery and the proportion of watershed area burned controlled the wildfire effect. Our results demonstrate that in large areas of the western USA affected by wildfire, regional predictions of future water availability are subject to greater structural uncertainty than previously thought. These results suggest that future streamflows may be underestimated in areas affected by increased prevalence of hydrologically relevant ecological
Terrados, Nicolas; Mielgo-Ayuso, Juan; Delextrat, Anne; Ostojic, Sergej M; Calleja-González, Julio
To a proper recovery, is absolutely necessary to know that athletes with enhanced recovery after maximal exercise are likely to perform better in sports. Recovery strategies are commonly used in team sports despite limited scientific evidence to support their effectiveness in facilitating optimal recovery and the players spend a much greater proportion of their time recovering than they do in training. According to authors, some studies investigated the effect of recovery strategies on physical performance in team sports, lack of experimental studies about the real origin of the fatigue, certify the need for further study this phenomenon. Thus, developing effective methods for helping athletes to recover is deemed essential. Therefore, the aim of this review is provide information for his practical application, based on scientific evidence about recovery in team sports.
Graven, Christine; Brock, Kim; Hill, Keith; Ames, David; Cotton, Susan; Joubert, Lynette
There is much discourse in healthcare about the importance of client-centred rehabilitation, however in the realm of community-based therapy post-stroke there has been little investigation into the efficacy of goal-directed practice that reflects patients' valued activities. In addition, the effect of active involvement of carers in such a rehabilitation process and their subsequent contribution to functional and emotional recovery post-stroke is unclear. In community based rehabilitation, interventions based on patients' perceived needs may be more likely to alter such outcomes. In this paper, we describe the methodology of a randomised controlled trial of an integrated approach to facilitating patient goal achievement in the first year post-stroke. The effectiveness of this intervention in reducing the severity of post-stroke depression, improving participation status and health-related quality of life is examined. The impact on carers is also examined. Patients (and their primary carers, if available) are randomly allocated to an intervention or control arm of the study. The intervention is multimodal and aims to screen for adverse stroke sequelae and address ways to enhance participation in patient-valued activities. Intervention methods include: telephone contacts, written information provision, home visitation, and contact with treating health professionals, with further relevant health service referrals as required. The control involves treatment as usual, as determined by inpatient and community rehabilitation treating teams. Formal blinded assessments are conducted at discharge from inpatient rehabilitation, and at six and twelve months post-stroke. The primary outcome is depression. Secondary outcome measures include participation and activity status, health-related quality of life, and self-efficacy. The results of this trial will assist with the development of a model for community-based rehabilitation management for stroke patients and their carers
Full Text Available Abstract Background There is much discourse in healthcare about the importance of client-centred rehabilitation, however in the realm of community-based therapy post-stroke there has been little investigation into the efficacy of goal-directed practice that reflects patients' valued activities. In addition, the effect of active involvement of carers in such a rehabilitation process and their subsequent contribution to functional and emotional recovery post-stroke is unclear. In community based rehabilitation, interventions based on patients' perceived needs may be more likely to alter such outcomes. In this paper, we describe the methodology of a randomised controlled trial of an integrated approach to facilitating patient goal achievement in the first year post-stroke. The effectiveness of this intervention in reducing the severity of post-stroke depression, improving participation status and health-related quality of life is examined. The impact on carers is also examined. Methods/Design Patients (and their primary carers, if available are randomly allocated to an intervention or control arm of the study. The intervention is multimodal and aims to screen for adverse stroke sequelae and address ways to enhance participation in patient-valued activities. Intervention methods include: telephone contacts, written information provision, home visitation, and contact with treating health professionals, with further relevant health service referrals as required. The control involves treatment as usual, as determined by inpatient and community rehabilitation treating teams. Formal blinded assessments are conducted at discharge from inpatient rehabilitation, and at six and twelve months post-stroke. The primary outcome is depression. Secondary outcome measures include participation and activity status, health-related quality of life, and self-efficacy. Discussion The results of this trial will assist with the development of a model for community
El-Solh, Ali A; Riaz, Usman; Roberts, Jasmine
A growing body of evidence supports a bidirectional relationship between post-traumatic stress disorder (PTSD) and sleep disturbances. Fragmented sleep induced by sleep-related breathing disorders, insomnia, and nightmares impacts recovery and treatment outcomes and worsens PTSD symptoms. Despite recent attention, management of these disorders has been unrewarding in the setting of PTSD. This review summarizes the evidence for empirically supported treatments of these sleep ailments as it relates to PTSD including psychotherapeutic and pharmacologic interventions. Recent advances in positive airway pressure technology have made treatment of OSA more acceptable however adherence to CPAP represents a significant challenge. The presence of concomitant insomnia, which engenders psychiatric and medical conditions including depression, suicide, alcohol and substance abuse, can be managed with cognitive behavioral therapy (CBT). Hypnotic agents are considered an alternative therapy but concerns about adverse events and lack of high level evidence supporting their efficacy in PTSD have limited their use to resistant cases or as adjunct to behavioral therapy when the response is less than desirable. Intrusion of nightmares can complicate PTSD treatment and exert serious strain on social, occupational and marital relations. Image rehearsal therapy has shown significant reduction in nightmares intensity and frequency. The success of noradrenergic blocking agents has not been consistent among studies with half reporting treatment failure. An integrated stepped care approach that includes components of both behavioral and pharmacologic interventions customized to patients sleep maladaptive behaviors may offer a solution to delivering accessible, effective, and efficient services for individuals with PTSD. Copyright © 2018. Published by Elsevier Inc.
Cooper, Denise C; Thayer, Julian F; Waldstein, Shari R
Prayer is often used to cope with racism-related stress. Little is known about its impact on cardiovascular function. This study examined how prayer coping relates to cardiovascular reactivity (CVR), post-stress recovery, and affective reactivity in response to racism-related stress. African American women (n =81; mean age=20 years) reported their use of prayer coping on the Perceived Racism Scale and completed anger recall and racism recall tasks while undergoing monitoring of systolic and diastolic blood pressure (DBP), heart rate, heart rate variability (HRV), and hemodynamic measures. Prayer coping was examined for associations with CVR, recovery, and affective change scores using general linear models with repeated measures. Higher prayer coping was associated with decreased state stress and DBP reactivity during racism recall (p'sracism recall recovery(p'sracism by utilizing prayer may have cardiovascular benefits for African American women.
Chen, Jinshui; Wang, Juying; Wang, Benhai; Xu, Hao; Lin, Songqing; Zhang, Huihao
T1- and T2-weighted magnetic resonance images (MRI) can reveal lumbar redundant nerve roots (RNRs), a result of chronic compression and nerve elongation associated with pathogenesis of cauda equina claudication (CEC) in degenerative lumbar canal stenosis (DLCS). The study investigated effects of lumbar lordosis angle and range of motion on functional recovery in lumbar stenosis patents with and without RNRs. A retrospective study was conducted of 93 lumbar spinal stenosis patients who underwent decompressive surgery. Eligible records were assessed by 3 independent blinded radiologists for presence or absence of RNRs on sagittal T2-weighted MR (RNR and non-RNR groups), pre- and post-operative JOA score, lumbar lordosis angle, and range of motion. Of 93 total patients, the RNR group (n=37, 21/37 female) and non-RNR group (n=56; 31/56 female) had similar preoperative conditions (JOA score) and were not significantly different in age (mean 64.19 ± 8.25 vs. 62.8 ± 9.41 years), symptom duration (30.92 ± 22.43 vs. 28.64 ± 17.40 months), or follow-up periods (17.35 ± 4.02 vs. 17.75 ± 4.29 mo) (all p>0.4). The non-RNR group exhibited significantly better final JOA score (p=0.015) and recovery rate (p=0.002). RNR group patients exhibited larger lumbar lordosis angles in the neutral position (p=0.009) and extension (p=0.021) and larger range of motion (p=0.008). Poorer surgical outcomes in patients with RNRs indicated that elevated lumbar lordosis angle and range of motion increased risks of RNR formation, which in turn may cause poorer post-surgical recovery, this information is possibly useful in prognostic assessment of lumbar stenosis complicated by RNRs. Copyright © 2015 Elsevier B.V. All rights reserved.
Ling-Feng Miao; Fan Yang; Chun-Yu Han; Yu-Jin Pu; Yang Ding; Li-Jia Zhang
Winter flooding events are common in some rivers and streams due to dam constructions, and flooding and waterlogging inhibit the growth of trees in riparian zones. This study investigated sex-specific morphological, physiological and ultrastructural responses to various durations of winter flooding and spring waterlogging stresses, and post-flooding recovery characteristics in Populus deltoides. There were no significant differences in the morphological, ultrastructural and the majority of ph...
Andrade, G H B; Simão, V A; Souza, B R; Chuffa, L G A; Camargo, I C C
Anabolic androgenic steroids (AAS) are recommended for therapeutic clinic, but their use has increased in recent decades for aesthetic reasons. No study has evaluated the impact of AAS in the fallopian tube, after treatment and recovery periods. Herein, the aim of study was to investigate the effects of Nandrolone Decanoate (ND), administered in different doses (1.87; 3.75; 7.5 and 15 mg/kg) on the ampulla of the fallopian tube in rats, following post-treatment (PT; 15 consecutive days) and post-recovery (PR; 30 consecutive days) periods. The control group received mineral oil. Estrous cycle was monitored daily during both periods and in sequence the rats (n = 8/group/period) were killed. All ND-treated animals showed estral acyclicity during the PT and PR periods, but the histomorphometric changes in the fallopian tube varied according to the ND dose level. The expression of AR, ERα and ERβ varied in the nucleus and cytoplasm of epithelial cells. No AR expression was observed in the stroma. The muscle cells exhibited variation in immunostaining. In conclusion, ND promoted histomorphometric and immunohistochemical changes in the ampullary portion of the fallopian tube after treatment and recovery periods in a dose-independent manner. Copyright © 2018 Elsevier Ltd. All rights reserved.
Li, S J; Hu, H Q; Wang, X L; Cao, B Z
Objective: To investigate the correlation between post-stroke pneumonia and outcome in patients with acute brain infarction. Methods: Consecutive acute cerebral infarction patients who were hospitalized in Department of Neurology, Jinan Military General Hospital were prospectively recruited from August 2010 to August 2014. The baseline data including age, sex, the National Institute of Health Stroke Scale (NIHSS) scores, type of Oxfordshire Community Stroke Project (OCSP: total anterior circulation infarct, partial anterior circulation infarct, posterior circulation infarct and lacunar infarct), fasting blood glucose etc. after admission were recorded. Post-stroke pneumonia was diagnosed by treating physician according to criteria for hospital-acquired pneumonia of the Centers for Disease Control and Prevention. Recovery was assessed by modified Rankin Scale (mRS) 180 days after stroke by telephone interview (mRS≤2 reflected good prognosis, and mRS>2 reflected unfavorable prognosis). Multinominal Logistic regression analysis, Kaplan-Meier curve and log rank test were used. Results: A total of 1 249 patients were enrolled, among them 173 patients were lost during follow-up. A total of 159 patients had post-stroke pneumonia, while 1 090 patients were without post-stroke. Compared with patients without post-stoke pneumonia, patients with post-stroke pneumonia were older (67±13 vs 63±12 years, P =0.000), more severe (NIHSS, 15(14) vs 4(4), P =0.000). Compared with patients without post-stoke pneumonia, more patients with post-stroke pneumonia suffered from heart failure (12.58% vs 3.40%, P =0.000), atrial fibrillation (26.42% vs 8.81%, P =0.000), myocardial infarction (10.06% vs 5.05%, P =0.016), recurrent brain infarction (30.19% vs 22.66%, P =0.045), total anterior circulation infarct type of OCSP (46.54% vs 19.63%, P =0.000), posterior circulation infarct of OCSP (39.62% vs 25.51%, P =0.001); more patients suffered from disorder of consciousness (60.38% vs 9
Lee, Sam; Kimmerly, Derek S
The purpose of this study was to examine the influence of fast tempo music (FM) on self-paced running performance (heart rate, running speed, ratings of perceived exertion), and slow tempo music (SM) on post-exercise heart rate and blood lactate recovery rates. Twelve participants (5 women) completed three randomly assigned conditions: static noise (control), FM and SM. Each condition consisted of self-paced treadmill running, and supine postexercise recovery periods (20 min each). Average running speed, heart rate (HR) and ratings of perceived exertion (RPE) were measured during the treadmill running period, while HR and blood lactate were measured during the recovery period. Listening to FM during exercise resulted in a faster self-selected running speed (10.8±1.7 vs. 9.9±1.4 km•hour-1, Peffect P<0.001) and blood lactate at the end of recovery (2.8±0.4 vs. 4.7±0.8 mmol•L-1, P<0.05). Listening to FM during exercise can increase self-paced intensity without altering perceived exertion levels while listening to SM after exercise can accelerate the recovery rate back to resting levels.
Jensen, Carsten; Aagaard, Per; Overgaard, Søren
the posterior-lateral approach. Prior to surgery no training program was initiated but the patients were encouraged to live as usual. Post surgery all patients were allowed fully weight-bearing and they were instructed to follow a conventional home-based rehabilitation, but were otherwise not engaged in any......-test for between group comparisons while ANOVA was used for repeated measures for comparisons over time (α=0.05) RESULTS The results were calculated as deficits in percentages of the unaffected side (A-NA/NA)*100)) in order to evaluate degree of asymmetry. Our overall side-to-side deficits for peak torque ranged...... from 32.6 to 0.4% and hip flexion deficit being significantly more impacted then the other muscle groups (32.6%). At baseline all muscle groups showed a significant torque deficit. At 8 weeks post surgery that asymmetry had increased for 4 out of 6 muscle groups. At 26 weeks the hip adduction and hip...
Full Text Available Post-acute care (PAC facilities improve patient recovery, as measured by activities of daily living, rehabilitation, hospital readmission, and survival rates. Seamless transitions between discharge and PAC settings continue to be challenges that hamper patient outcomes, specifically problems with effective communication and coordination between hospitals and PAC facilities at patient discharge, patient adherence and access to cardiac rehabilitation (CR services, caregiver burden, and the financial impact of care. The objective of this review is to examine existing models of cardiac transitional care, identify major challenges and social factors that affect PAC, and analyze the impact of current transitional care efforts and strategies implemented to improve health outcomes in this patient population. We intend to discuss successful methods to address the following aspects: hospital-PAC linkages, improved discharge planning, caregiver burden, and CR access and utilization through patient-centered programs. Regular home visits by healthcare providers result in decreased hospital readmission rates for patients utilizing home healthcare while improved hospital-PAC linkages reduced hospital readmissions by 25%. We conclude that widespread adoption of improvements in transitional care will play a key role in patient recovery and decrease hospital readmission, morbidity, and mortality.
Sakurai, Kenichi; Enomoto, Katsuhisa; Amano, Sadao
A luteinizing hormone-releasing hormone (LH-RH) agonist and tamoxifen (TAM) are used in hormonal therapy following pre- and post-operative chemotherapy in pre-menopausal advanced breast cancer patients who are positive for hormone receptors. However, it remains to be clarified how often patients recover menstruation after long-term LH-RH agonist plus TAM therapy. In this study, the incidence of menstruation recovery after therapy was examined. The subjects included 125 pre-menopausal patients with breast cancer who were positive for hormone receptors and had undergone surgery at our institution. They were treated with four cycles of the CEF regimen and four cycles of docetaxel (Doc) before surgery as adjuvant chemotherapy. Thereafter, they were treated with an LH-RH agonist plus TAM for 24 months and followed to determine menstruation recovery. Menstruation resumed in 24 cases (19.2%) after the last LH-RH agonist treatment session. It took 7.3 ± 2.8 months for the patients to recover menstruation. The rate of menstruation recovery was 42.1% in patients aged 40 or younger and 9.2% in those aged 41 or older; the difference was significant. The period until menstruation recovery tended to be longer in older patients at the end of treatment. The menstruation recovery rate after therapy was higher in younger women. However, since ovarian function may be lost even in younger patients, the potential consequences of this therapy should be fully explained beforehand to patients who may wish to become pregnant.
Shappert, L.B.; Pope, R.B.; Best, R.E.; Jones, R.H.
Spent fuel casks and other large radioactive material packages have been examined to determine whether the designs are adequate to allow the casks to be recovered using conventional recovery methods following a transportation accident. Casks and similar packages are typically designed with, and handled by, trunnions that support the package during transport. These trunnions are considered the best cask feature with which to grapple the cask once it is no longer in its usual shipping mode. Following a transport accident, the trunnions may be buried or entangled so that they are not readily accessible to initiate the recovery process. To evaluate the effectiveness of applying traditional recovery methods to spent fuel casks, a workshop was held in which a series of accidents involving casks were postulated; the modes of transportation considered included truck, rail, and barge. These participants knowledgeable in transport, handling, and, in some cases, recovery of large, heavy containers attended. Participants concluded that the physical recovery of a cask involved in an accident, irrespective of where the accident occurs, would be a straightforward rigging operation and that the addition of specific recovery features (e.g., additional trunnions) to the cask appears unnecessary
Thomas, Donald J; Coxe, Kathryn; Li, Hongmei; Pommering, Thomas L; Young, Julie A; Smith, Gary A; Yang, Jingzhen
We quantified the length of recovery time by week in a cohort of pediatric sports-related concussion patients treated at concussion clinics, and examined patient and injury characteristics associated with prolonged recovery. A retrospective, cohort design. Seven concussion clinics at a Midwest children's hospital. Patients aged 10 to 17 years with a diagnosed sports-related concussion presenting to the clinic within 30 days of injury. Length of recovery by week. Unadjusted and adjusted multinomial logistic regression analyses were used to model the effect of patient and injury characteristics on length of recovery by week. Median length of recovery was 17 days. Only 16.3% (299/1840) of patients recovered within one week, whereas 26.4% took longer than four weeks to recover. By 2 months postinjury, 6.7% of patients were still experiencing symptoms. Higher symptom scores at injury and initial visit were significantly associated with prolonged symptoms by week. Patients who presented to the clinic more than 2 weeks postinjury or who had 2 or more previous concussions showed increased risk for prolonged recovery. Females were at greater risk for prolonged recovery than males (odds ratio = 2.08, 95% confidence interval = 1.49-2.89). Age was not significantly associated with recovery length. High symptom scores at injury and initial visit, time to initial clinical presentation, presence of 2 or more previous concussions, and female sex are associated with prolonged concussion recovery. Further research should aim to establish objective measures of recovery, accounting for treatment received during the recovery. The median length of recovery is 17 days among pediatric sports-related concussion patients treated at concussion clinics. Only 16.3% of patients recovered within one week, whereas 26.4% took longer than 4 weeks to recover.
Olsen, N.; Counts, A.; Quistorff, C.; Ohr, C. A.; Toner, C.
Increasing wildfire frequency and severity has emphasized the importance of post-wildfire recovery efforts in southern Idaho's sagebrush ecosystems. These changing fire regimes favor invasive grass species while hindering native sagebrush habitat regeneration, causing a positive feedback cycle of invasive growth - wildfires - invasive growth. Due to this undesirable process and anthropogenic influences, the sagebrush ecosystem is one of the most endangered in the US. In this project the NASA DEVELOP group of Pocatello, Idaho partnered with the Bureau of Land Management, Idaho Department of Fish and Game, and the US Department of Agriculture to characterize ecosystem recovery following the Crystal (2006), Henry Creek (2016), Jefferson (2010), and Soda (2015) wildfires. Determining vegetation cover heterogeneity and density can be time consuming and the factors affecting ecosystem recovery can be complex. In addition, restoration success is difficult to determine as vegetation composition is not often known prior to wildfire events and monitoring vegetation composition after restoration efforts can be resource intensive. These wildfires temporal monitoring consisted of 2001 to 2017 using NASA Earth observations such as Landsat 5 Thermal Mapper (TM), Landsat 8 Operational Land Imager (OLI), Terra Moderate Resolution Imaging Spectroradiometer (MODIS), and Shuttle Radar Topography Mission (SRTM) to determine the most significant factors of wildfire recovery and the influence targeted grazing could have for recovery. In addition, this project will include monitoring of invasive species propagation and whether spatial patterns or extents of the wildfire contribute to propagation. Understanding the key variables that made reseeding and natural recovery work in some areas, assessing why they failed in others, and identifying factors that made non-native propagation ideal are important issues for land managers in this region.
Rao, B; David, G
Semen was collected in the laboratory from nine healthy donors. The concentrations and the percentages of live and motile spermatozoa in all semen samples were within the normal range. Each sample was diluted with citrate-egg yolk-glycerol medium with and without 5 mM dithiothreitol (DTT). Samples were frozen in liquid nitrogen vapor (-70 degrees C) for 7 min and subsequently stored in liquid nitrogen. The effect of DTT in cryopreservation of sperm was determined by comparing percentage of motile and live spermatozoa between controls and DTT-treated post-thaw samples. Percentage of motile spermatozoa was determined by two techniques, laser Doppler velocimetry (LDV) and light microscopy. The percentage of live spermatozoa was measured by microscopic evaluation after staining with eosin-nigrosin. It was shown that the addition of DTT to the freezing medium significantly improved the recovery of motile and live spermatozoa in the post-thaw samples. The mean motility recovery, as measured by LDV, was 44.9% in the controls as compared to 73.9% in the DTT-treated samples. Similarly the mean recovery of live spermatozoa in the controls and DTT-treated samples was 66.5 and 86.6%, respectively. Based on these results, a new hypothesis implicating lipid peroxidation in cryoinjury is proposed. It is also suggested that the use of DTT in the freezing medium may offer an advantage over the commonly used techniques of human sperm cryopreservation.
Mori, Tomohiro; Agata, Nobuhide; Itoh, Yuta; Inoue-Miyazu, Masumi; Mizumura, Kazue; Sokabe, Masahiro; Taguchi, Toru; Kawakami, Keisuke
We investigated the cellular mechanisms and therapeutic effect of post-injury stretch on the recovery process from muscle injury induced by lengthening contractions (LC). One day after LC, a single 15-min bout of muscle stretch was applied at an intensity of 3 mNm. The maximal isometric torque was measured before and at 2-21 days after LC. The myofiber size was analyzed at 21 days after LC. Developmental myosin heavy chain-immunoreactive (dMHC-ir) cells, a marker of regenerating myofibers, were observed in the early recovery stage (2-5 days after LC). We observed that LC-induced injury markedly decreased isometric torque and myofiber size, which recovered faster in rats that underwent stretch than in rats that did not. Regenerating myofiber with dMHC-ir cells was observed earlier in rats that underwent stretch. These results indicate that post-injury stretch may facilitate the regeneration and early formation of new myofibers, thereby promoting structural and functional recovery from LC-induced muscle injury.
Moerman, Jan; Vermeulen, Edith; Van Mullem, Mia
Objectives: The objective of this retrospective study was to evaluate the added value of communicating post-transfusion hemoglobin values to clinicians as a strategy to improve RBC utilization in a 500-bed hospital. Methods: The total number of RBC transfusions, the mean number of RBC units...... transfused per patient, the mean pre- and post-transfusion hemoglobin values, the ratio of patients transfused and the ratio of patients with a post-transfusion hemoglobin > 10.5 g/dL were calculated per service and per department for six months. The data were reported to each service and compared...... with the data of the department as peer group. The impact of this communication strategy was evaluated in the following six months. Results: In the six months pre-intervention, the mean post-transfusion hemoglobin value was 9.2 g/dL. Post-transfusion hemoglobin was > 10.5 g/dL in 13.4% of patients (112...
Full Text Available The worst forest fire in South Korea occurred in April 2000 on the eastern coast. Forest recovery works were conducted until 2005, and the forest has been monitored since the fire. Remote sensing techniques have been used to detect the burned areas and to evaluate the recovery-time point of the post-fire processes during the past 18 years. We used three indices, Normalized Burn Ratio (NBR, Normalized Difference Vegetation Index (NDVI, and Gross Primary Production (GPP, to temporally monitor a burned area in terms of its moisture condition, vegetation biomass, and photosynthetic activity, respectively. The change of those three indices by forest recovery processes was relatively analyzed using an unburned reference area. The selected unburned area had similar characteristics to the burned area prior to the forest fire. The temporal patterns of NBR and NDVI, not only showed the forest recovery process as a result of forest management, but also statistically distinguished the recovery periods at the regions of low, moderate, and high fire severity. The NBR2.1 for all areas, calculated using 2.1 μm wavelengths, reached the unburned state in 2008. The NDVI for areas with low and moderate fire severity levels became significantly equal to the unburned state in 2009 (p > 0.05, but areas with high severity levels did not reach the unburned state until 2017. This indicated that the surface and vegetation moisture conditions recovered to the unburned state about 8 years after the fire event, while vegetation biomass and health required a longer time to recover, particularly for high severity regions. In the case of GPP, it rapidly recovered after about 3 years. Then, the steady increase in GPP surpassed the GPP of the reference area in 2015 because of the rapid growth and high photosynthetic activity of young forests. Therefore, the concluding scientific message is that, because the recovery-time point for each component of the forest ecosystem is
Alazraki, N.; Krawczynska, E.
The role of myocardial perfusion imaging in the evaluation of post revascularization patients has not been well defined. Published data with special emphasis on the results from the Emory Angioplasty versus Surgery Trial (EAST) indicate that the frequency of adverse cardiac events (death, MI, repeat revascularization) following PTCA or CABG is equal in symptomatic and asymptomatic patients with ischemic thallium defects. Current American Heart Association Guidelines recommend radionuclide studies only in symptomatic patients. Recently reported data support the need for non invasive testing in asymptomatic as well as symptomatic patients at 1 year postrevascularization. Prognostic variables including transient and permanent left ventricular dilatation and thallium lung uptake in addition to stress perfusion defect reversibility on myocardial thallium SPECT scans are important prognostic indicators in post revascularization patients
Full Text Available Post-exercise recovery has largely focused on peripheral mechanisms of fatigue, but there is growing acceptance that fatigue is also contributed to through central mechanisms which demands that attention should be paid to optimising recovery of the brain. In this narrative review we assemble evidence for the role that many currently utilised recovery strategies may have on the brain, as well as potential mechanisms for their action. The review provides discussion of how common nutritional strategies as well as physical modalities and methods to reduce mental fatigue are likely to interact with the brain, and offer an opportunity for subsequent improved performance. We aim to highlight the fact that many recovery strategies have been designed with the periphery in mind, and that refinement of current methods are likely to provide improvements in minimising central fatigue. Whilst we offer a number of recommendations, it is evident that there are many opportunities for improving the research, and practical guidelines in this area.
Meilianda, E.; Munadi, K.; Azmeri; Safrida; Direzkia, Y.; Syamsidik; Oktari, R. S.
Post-tsunami recovery process at Banda Aceh city of Indonesia were assessed in this study. Several actions and programs implemented during the recovery process were exercised and examined through several FGDs, to identify any windows of opportunities to change were captured in the aspects of infrastructure and housing, economic revitalization of the affected community, mental health and psychosocial condition and development, establishment and implementation of disaster risk reduction programs and community preparedness. Subsequently, whether or not those changes fit into the principle criteria of sustainability were examined. The results give insights on the dynamics of recovery process after more than a decade since the tsunami was affected the area. Some success and not-so-success stories of actions and program implementations during the recovery process were captured. On the aspect of livelihoods and public finance, the local government seems to have seen a window of opportunity and subsequently seize the opportunity to revitalize the administrative system of financing the micro-finance for communities. In contrast, on the aspect of socio-ecological systems integrity toward preserving the natural environment, the case of housing development at the coastal areas against the blueprint city masterplan exemplifies the failure in seizing the window of opportunity to “build back better”.
Full Text Available Business sectors are essential for community prosperity, and thus it is important to investigate the recovery of businesses after disasters. However, current studies on business recovery after natural disasters are limited, particularly a lack of empirical observations in developing countries. Our observations of the patterns and transformations of small businesses in the recovery process after the 2008 Wenchuan earthquake in China can bridge this gap and provide a valuable contribution to academia. We conducted research through a four-year longitudinal study to track small business recovery in Beichuan County since 2014. Field observations, repeat photography, and semi-structured interviews were used to collect data. The operating status, business type, and spatiotemporal changes of small businesses in the new business district, Banaqia, were demonstrated. Overall, less than 50% of the planned shops were occupied and in operation, and this figure keeps declining from 2014 to 2017. Catering, garments, and souvenirs are the primary business types, but they show individual patterns in terms of sustainable development and spatial configuration. The results help to inform the development of recovery policies following disasters in developing countries.
Connolly, Bronwen; O'Neill, Brenda; Salisbury, Lisa; McDowell, Kathryn; Blackwood, Bronagh
synthesis and interpretation of existing evidence regarding physical rehabilitation interventions and physical recovery in post-critical illness patients across the continuum of recovery. PROSPERO CRD42015001068.
Vieira Carlos, Ricardo; Luis Abramides Torres, Marcelo; de Boer, Hans Donald
After reversal of a rocuronium-induced neuromuscular blockade with sugammadex, the recovery of train-of-four ratio to 0.9 is faster than recovery of first twitch of the train-of-four to 90% in adults. These findings after reversal of neuromuscular blockade with sugammadex have not yet been investigated in pediatric patients. The aim of this retrospective analysis was to investigate the relationship of the recovery of first twitch of the train-of-four height and train-of-four ratio after reversal of rocuronium-induced neuromuscular blockade with sugammadex in pediatric patients. Patients ASA I-III, aged 2-11 years, and who underwent abdominal and/or perineal surgery were included in the analysis. After extracting the necessary data from the hospital database, the patients were divided into 2 groups based on the dose of sugammadex received: group A: 2 mg.kg -1 for reversal of moderate neuromuscular blockade and group B: 4 mg.kg -1 for reversal of deep neuromuscular blockade. The relationship of the recovery of first twitch of the train-of-four height and train-of-four ratio in these 2 groups were analyzed. Data from 43 pediatric patients aged 2-11 years could be analyzed. The first twitch of the train-of-four height at the recovery of train-of-four ratio to 0.9 in group B was statistically significantly lower compared with group A. This height 3 and 5 minutes after the train-of-four ratio reached 0.9 showed no statistically significant differences between groups. The results were in line with the results found in adults and showed that the train-of-four ratio recovered to 0.9 was faster than first twitch of the train-of-four height recovered to the same level. © 2018 John Wiley & Sons Ltd.
Jørgensen, H S; Reith, J; Nakayama, H
Even patients with the most severe strokes sometimes experience a remarkably good recovery. We evaluated possible predictors of a good outcome to search for new therapeutic strategies.......Even patients with the most severe strokes sometimes experience a remarkably good recovery. We evaluated possible predictors of a good outcome to search for new therapeutic strategies....
Full Text Available The disaster management cycle is made up of three phases: 1 the prevention during the pre-disaster time 2 the crisis management during the disaster then 3 the post-disaster recovery. Both the “pre-disaster” time and the “crisis” are the most studied phases and tap into the main resources and risk management tools. The post-disaster period is complex, poorly understood, least anticipated, and is characterized by the implication of a wide range of people who have a vested interest. In most cases, the collective will is to recover the initial state, without learning from the disaster. Nevertheless, the post-disaster period could be seen as an opportunity to better reorganize the territory to reduce its vulnerability in anticipation of future flood events. To explore this hypothesis, this work consists in analyzing the post-flood phase from a bibliographical work and the detailed study of 3 disaster areas. These results will lead us to better understand the concept of “recovery” in the post-disaster phase.
Full Text Available Kento Nakagawa, Takashi Obu, Kazuyuki KanosueFaculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan Purpose: To investigate the potential benefit of post-race wearing of unstable shoes (Masai Barefoot Technology [MBT] on recovery from marathon race–induced fatigue.Patients and methods: Forty-five runners who participated in a full marathon race were divided into three groups: 1 MBT shoes, 2 trail running shoes, and 3 control (CON. Participants ran a full marathon with their own running shoes, and then put on the assigned shoes immediately after the race. They continued to wear the assigned shoes for the ensuing 3 days. The CON group wore their usual shoes. Estimates of post-race fatigue were made by the participants on questionnaires that utilized a visual analog scale. Estimates were made just after the race, as well as for the next 3 days.Results: The subjective fatigue of the MBT group was lower than that of the CON (P<0.05 or trail running shoe groups (P<0.05 on day 3.Conclusion: MBT shoe intervention can promote recovery from the fatigue induced by running a full marathon.Keywords: footwear, VAS, full marathon
Raine, N M; Cable, N T; George, K P; Campbell, I G
Postexercise hypotension may be the result of an impaired vasoconstrictor response. This hypothesis was investigated by examining the central and peripheral hemodynamic responses during supine and seated recovery after maximal upright exercise. After supine or seated baseline measurements, seven normotensive male volunteers completed a graded upright cycling protocol to volitional exhaustion. This was immediately followed by either supine or seated recovery. Measurements of pulsatile arterial blood pressure and central and peripheral hemodynamic variables recorded 30 min before exercise were compared with those taken throughout 60 min of recovery. Compared with baseline, mean arterial pressure (MAP) was reduced after exercise (P different between the supine (-9 +/- 4 mm Hg) and seated positions (-6 +/- 2 mm Hg). This change in MAP was associated with a reduction in diastolic blood pressure (DBP) (P pressure (APP) (P positions, respectively. The reduction in APP during seated recovery was accompanied by a decline in stroke volume (SV) (P position, that limited the contribution of cardiac output (CO) to the maintenance of MAP. This effect of seated recovery was compensated by greater systemic (SVR) and regional vascular resistances in the forearm (FVR) and the forearm skin (SkVRA). There was also evidence of an augmented return of FVR and SkVRA to resting levels in the seated position after exercise. The lower peripheral resistance in the supine compared with seated recovery position suggests there is potential for greater vasoconstriction, although this is not evoked to increase blood pressure. This further suggests that the arterial baroreceptor reflex is reset to a lower operating pressure after exercise.
Oh, Hyunsoo; Seo, Whasook
The purpose of this study was to examine whether positive changes in consciousness level after applying a sensory stimulation programme exceed natural recovery. A single experimental group interrupted time series design was used. Subjects were brain-injured patients who were hospitalized at a university hospital in South Korea. The sensory stimulation programme was composed of auditory, visual, olfactory, gustatory, tactile and physical stimulation. Levels of consciousness were evaluated using the Glasgow Coma Scale. The intervention was carried out twice, first for 4 weeks, then a recession period was allowed for 4 weeks, and immediately after this the second intervention was implemented for 4 weeks. Results showed significant alterations in consciousness levels 2 weeks after starting intervention 1. This effect increased gradually and was maintained for 3-4 weeks. However, consciousness levels began to decrease 2 weeks after terminating intervention 1 and this decrement continued until starting intervention 2. The pattern of improvement of intervention 1 could be represented as a gradual onset and temporary duration model. At the beginning of intervention 2, consciousness levels were maintained at a low level. However, they began to increase again after 2 weeks and this increment continued even after terminating intervention 2. Therefore, the effect of intervention 2 could be represented as a gradual onset and permanent duration model. These results suggest that an intervention programme should be applied for more than 1 month to achieve a permanent effect on consciousness levels and that at least 2 weeks are required for any significant effect.
Nair, Abhilash T; Ahammed, M Mansoor
In the present study, feasibility of recovering the coagulant from water treatment plant sludge with sulphuric acid and reusing it in post-treatment of upflow anaerobic sludge blanket (UASB) reactor effluent treating municipal wastewater were studied. The optimum conditions for coagulant recovery from water treatment plant sludge were investigated using response surface methodology (RSM). Sludge obtained from plants that use polyaluminium chloride (PACl) and alum coagulant was utilised for the study. Effect of three variables, pH, solid content and mixing time was studied using a Box-Behnken statistical experimental design. RSM model was developed based on the experimental aluminium recovery, and the response plots were developed. Results of the study showed significant effects of all the three variables and their interactions in the recovery process. The optimum aluminium recovery of 73.26 and 62.73 % from PACl sludge and alum sludge, respectively, was obtained at pH of 2.0, solid content of 0.5 % and mixing time of 30 min. The recovered coagulant solution had elevated concentrations of certain metals and chemical oxygen demand (COD) which raised concern about its reuse potential in water treatment. Hence, the coagulant recovered from PACl sludge was reused as coagulant for post-treatment of UASB reactor effluent treating municipal wastewater. The recovered coagulant gave 71 % COD, 80 % turbidity, 89 % phosphate, 77 % suspended solids and 99.5 % total coliform removal at 25 mg Al/L. Fresh PACl also gave similar performance but at higher dose of 40 mg Al/L. The results suggest that coagulant can be recovered from water treatment plant sludge and can be used to treat UASB reactor effluent treating municipal wastewater which can reduce the consumption of fresh coagulant in wastewater treatment.
Vlassova, Lidia; Pérez-Cabello, Fernando
The study contributes remote sensing data to the discussion about effects of post-fire wood management strategies on forest regeneration. Land surface temperature (LST) and Normalized Differenced Vegetation Index (NDVI), estimated from Landsat-8 images are used as indicators of Pinus halepensis ecosystem recovery after 2008 fire in areas of three post-fire treatments: (1) salvage logging with wood extraction from the site on skidders in suspended position (SL); (2) snag shredding in situ leaving wood debris in place (SS) performed two years after the event; and (3) non-intervention control areas (CL) where all snags were left standing. Six years after the fire NDVI values ∼0.5 estimated from satellite images and field radiometry indicate considerable vegetation recovery due to efficient regeneration traits developed by the dominant plant species. However, two years after management activities in part of the burnt area, the effect of SL and SS on ecosystem recovery is observed in terms of both LST and NDVI. Statistically significant differences are detected between the intervened areas (SL and SS) and control areas of non-intervention (CL); no difference is registered between zones of different intervention types (SL and SS). CL areas are on average 1 °C cooler and 10% greener than those corresponding to either SL or SS, because of the beneficial effects of burnt wood residuals, which favor forest recovery through (i) enhanced nutrient cycling in soils, (ii) avoidance of soil surface disturbance and mechanical damage of seedlings typical to the managed areas, and (iii) ameliorated microclimate. The results of the study show that in fire-resilient ecosystems, such as P. halepensis forests, NDVI is higher and LST is lower in areas with no management intervention, being an indication of more favorable conditions for vegetation regeneration.
Change in cognitive performance is associated with functional recovery during post-acute stroke rehabilitation: a multi-centric study from intermediate care geriatric rehabilitation units of Catalonia.
Pérez, Laura Mónica; Inzitari, Marco; Roqué, Marta; Duarte, Esther; Vallés, Elisabeth; Rodó, Montserrat; Gallofré, Miquel
Recovery after a stroke is determined by a broad range of neurological, functional and psychosocial factors. Evidence regarding these factors is not well established, in particular influence of cognition changes during rehabilitation. We aimed to investigate whether selective characteristics, including cognitive performance and its change over time, modulate functional recovery with home discharge in stroke survivors admitted to post-acute rehabilitation units. We undertook a multicenter cohort study, including all patients discharged from acute wards to any geriatric rehabilitation unit in Catalonia-Spain during 2008. Patients were assessed for demographics, clinical and functional variables using Conjunt Mínim Bàsic de Dades dels Recursos Sociosanitaris (CMBD-RSS), which adapts the Minimum Data Set tool used in America's nursing homes. Baseline-to-discharge change in cognition was calculated on repeated assessments using the Cognitive Performance Scale (CPS, range 0-6, best-worst cognition). The multivariable effect of these factors was analyzed in relation to the outcome. 879 post-stroke patients were included (mean age 77.48 ± 10.18 years, 52.6% women). A worse initial CPS [OR (95% CI) = 0.851 (0.774-0.935)] and prevalent fecal incontinence [OR (95% CI) = 0.560 (0.454-0.691)] reduced the likelihood of returning home with functional improvement; whereas improvement of CPS, baseline to discharge, [OR (95% CI) = 1.348 (1.144-1.588)], more rehabilitation days within the first 2 weeks [OR (95% CI) = 1.011 (1.006-1.015)] and a longer hospital stay [OR (95% CI) = 1.011 (1.006-1.015)] were associated with the outcome. In our sample, different clinical characteristics, including cognitive function and its improvement over time, are associated with functional improvement in stroke patients undergoing rehabilitation. Our results might provide information to further studies aimed at exploring the influence of cognition changes during rehabilitation.
Vassilakis, Emmanuel; Mallinis, George; Christopoulou, Anastasia; Farangitakis, Georgios-Pavlos; Papanikolaou, Ioannis; Arianoutsou, Margarita
Mt Taygetos (2407m), located at southern Peloponnese (Greece) suffered a large fire during the summer of 2007. The fire burned approximately 45% of the area covered by the endemic Greek fir (Abies cephalonica) and Black Pine (Pinus nigra) forest ecosystems. The aim of the current study is to examine the potential differences on post-fire vegetation recovery imposed by the lithology as well as the geomorphology of the given area over sites of the same climatic and landscape conditions (elevation, aspect, slope etc.). The main lithologies consist of carbonate, permeable, not easily erodible formations (limestones and marbles) and clastic, impermeable (schists, slate and flysch) erodible ones. A time-series of high spatial resolution satellite images were interpreted, analyzed and compared in order to detect changes in vegetation coverage which could prioritize areas of interest for fieldwork campaigns. The remote sensing datasets were acquired before (Ikonos-2), a few months after (Quickbird-2) and some years after (Worldview-3) the 2007 fire. High resolution Digital Elevation Model was used for the ortho-rectification and co-registration of the remote sensing data, but also for the extraction of the mountainous landscape characteristics. The multi-temporal image dataset was analyzed through GEographic-Object Based Image Analysis (GEOBIA). Objects corresponding to different vegetation types through time were identified through spectral and textural features. The classification results were combined with basic layers such as lithological outcrops, pre-fire vegetation, landscape morphology etc., supplementing a spatial geodatabase used for classifying burnt areas with varying post-fire plant community recovery. We validated the results of the classification during fieldwork and found that at a local scale, where the landscape features are quite similar, the bedrock type proves to be an important factor for vegetation recovery, as it clearly defines the soil generation
Ruedig, E.; Bhattacharyya, A.; Borch, T.; Johnson, T. [Colorado State University (United States); Till, J. [Risk Assessment Corporation (United States)
In the United States, the restoration of in situ recovery (ISR) uranium mines is aimed at returning sites to pre-mining conditions. While this may seem an appropriate goal, little or no scientific information is available to justify utilizing baseline conditions for regulatory compliance. The chemical and radiological contaminants monitored for restoration compliance have not been evaluated to ensure they are proper indicators of the mitigation of risk. Pre-mining aquifers do not meet minimum United States drinking water standards, and must have an aquifer exemption in place prior to mining. Under these conditions, returning groundwater to near the original concentrations of contaminants may be unnecessary. Post-mining groundwater is also unlikely to meet standards for drinking water, but may be depleted in at least some toxic species as a result of the mining process. Here, we examine the risk to representative person from the personal use of groundwater sourced from an Uranium ISR mine. Water samples were collected from Cameco Resource's Smith Ranch-Highlands ISR Uranium mine near Casper, Wyoming, USA. Samples were acquired pre-mining, post-mining, and post-restoration. Concentrations of heavy metals and radionuclides were assessed by appropriate analytical techniques (e.g., mass spectroscopy or alpha spectroscopy) and these concentrations were used to estimate human health risk for three exposure scenarios: a scenario with high exposure, a scenario with medium exposure, and a scenario with low exposure. A simple biosphere transport model was constructed for each scenario to estimate the risk to humans from the use of contaminated waters for subsistence-related activities. Chemical and radiological risks were harmonized according to the United States Environmental Protection Agency's guidance for superfund sites. Each exposure scenario and its subsequent risk were evaluated individually for pre-mining, post-mining, and post-restoration aquifer waters
Background: The global frequency for open long bone fracture is at least 11.5 cases per 100,000 persons per year. Precise published research information regarding the characteristics and the management of patients with post- traumatic exposed bones for Africa, Kenya and Moi Teaching and Referral Hospital- Eldoret is ...
Outcome measures: Post-operative morbidity measures – infection, seroma, pulmonary embolism, urinary tract infection, neurological injury and dural tears. Methods: One hundred consecutive patients undergoing posterior lumbar spine surgery were enrolled in the study. Three fellowship trained attending orthopaedic ...
Full Text Available The aim of this review and meta-analysis was to critically determine the possible effects of different cooling applications, compared to non-cooling, passive post-exercise strategies, on recovery characteristics after various, exhaustive exercise protocols up to 96 hours (hrs. A total of n = 36 articles were processed in this study. To establish the research question, the PICO-model, according to the PRISMA guidelines was used. The Cochrane's risk of bias tool, which was used for the quality assessment, demonstrated a high risk of performance bias and detection bias. Meta-analyses of subjective characteristics, such as delayed-onset muscle soreness (DOMS and ratings of perceived exertion (RPE and objective characteristics like blood plasma markers and blood plasma cytokines, were performed. Pooled data from 27 articles revealed, that cooling and especially cold water immersions affected the symptoms of DOMS significantly, compared to the control conditions after 24 hrs recovery, with a standardized mean difference (Hedges' g of -0.75 with a 95% confidence interval (CI of -1.20 to -0.30. This effect remained significant after 48 hrs (Hedges' g: -0.73, 95% CI: -1.20 to -0.26 and 96 hrs (Hedges' g: -0.71, 95% CI: -1.10 to -0.33. A significant difference in lowering the symptoms of RPE could only be observed after 24 hrs of recovery, favouring cooling compared to the control conditions (Hedges' g: -0.95, 95% CI: -1.89 to -0.00. There was no evidence, that cooling affects any objective recovery variable in a significant way during a 96 hrs recovery period.
Potter, J; Fuller, B
Recovery is essential to effective performance in climbing competitions which often involve repeated bouts, and sport climbing where climbers may work a route over a number of days prior to a complete ascent. This study employed a cross-over design to compare water with chocolate milk as recovery aids following an exhaustive bout of high intensity endurance climbing. Ten male climbers (age: 22±1 years; height: 178.5±7.9 cm; mass: 74.7±11.3 kg) climbed a Tredwall (Brewer Ledge M6) until volitional exhaustion. The participants consumed either water or chocolate milk 20 minutes after the climb and then again with their evening meal. The exercise protocol was repeated 24 hours after the original climb. The second condition was completed 7 days later. Workload indicators of heart rate, rate of perceived exertion (RPE), blood lactate and muscle soreness scores were recorded alongside climbing performance measures of duration and distance of the climb. A improved performance was found after the consumption of chocolate milk, with both a greater distance climbed (F(1,9)=11.704, P=0.008) and duration (F(1,9) =10.922, P=0.009), there were no differences in end of climb heart rate or RPE. Muscle soreness scores were lower three days after exercise following chocolate milk (t(8)=3.773, P=0.005). Chocolate milk as a recovery drink resulted in further sustained climbing, a decrease in muscle soreness, compared to water. It may be pertinent for climbers to consider its use as a recovery aid during repeated climbing bouts. Chocolate milk is a relatively unexplored recovery aid and warrants further attention.
Van Colen, Carl; Rossi, Francesca; Montserrat, Francesc; Andersson, Maria G. I.; Gribsholt, Britta; Herman, Peter M. J.; Degraer, Steven; Vincx, Magda; Ysebaert, Tom; Middelburg, Jack J.
Hypoxia represents one of the major causes of biodiversity and ecosystem functioning loss for coastal waters. Since eutrophication-induced hypoxic events are becoming increasingly frequent and intense, understanding the response of ecosystems to hypoxia is of primary importance to understand and predict the stability of ecosystem functioning. Such ecological stability may greatly depend on the recovery patterns of communities and the return time of the system properties associated to these patterns. Here, we have examined how the reassembly of a benthic community contributed to the recovery of ecosystem functioning following experimentally-induced hypoxia in a tidal flat. We demonstrate that organism-sediment interactions that depend on organism size and relate to mobility traits and sediment reworking capacities are generally more important than recovering species richness to set the return time of the measured sediment processes and properties. Specifically, increasing macrofauna bioturbation potential during community reassembly significantly contributed to the recovery of sediment processes and properties such as denitrification, bedload sediment transport, primary production and deep pore water ammonium concentration. Such bioturbation potential was due to the replacement of the small-sized organisms that recolonised at early stages by large-sized bioturbating organisms, which had a disproportionately stronger influence on sediment. This study suggests that the complete recovery of organism-sediment interactions is a necessary condition for ecosystem functioning recovery, and that such process requires long periods after disturbance due to the slow growth of juveniles into adult stages involved in these interactions. Consequently, repeated episodes of disturbance at intervals smaller than the time needed for the system to fully recover organism-sediment interactions may greatly impair the resilience of ecosystem functioning. PMID:23185440
Umholtz, Matthew; Cilnyk, John; Wang, Christopher K; Porhomayon, Jahan; Pourafkari, Leili; Nader, Nader D
Recovery from anesthesia may be complicated with development of severe panic symptoms and anxiety. Preexisting anxiety disorder has been reported as a risk factor for development of these symptoms. We aimed to examine the frequency of emergence delirium (EDL) among veterans diagnosed with posttraumatic stress disorders (PTSDs). Retrospective cohort. Postoperative recovery area. Perioperative information of 1763 consecutive patients who underwent a surgical procedure requiring general anesthesia were collected. The patients were grouped on the basis of previous diagnosis of PTSD. A total of 317 patients were identified with a positive history of PTSD and were compared to 1446 patients without such a history for the occurrence of EDL in the postanesthesia care unit (PACU) as the primary endpoint. Duration of stay in PACU in minutes and the frequency of hospital admission were the secondary endpoints. Multivariate binary logistic regression analysis was performed to identify the predictors of EDL among the veteran population. Emergence delirium was reported in 37 cases (2.1%) after general anesthesia. Fifteen (4.7%) of 317 patients with PTSD and 22 (1.5%) of 1446 patients without history of PTSD demonstrated symptoms related to EDL in the PACU (P=.002). After propensity matching, there were 8 patients with EDL in the PTSD group whereas there were only 2 patients with EDL among controls. Posttraumatic stress disorder was also an independent predictor of EDL in multivariate analysis with an odds ratio of 6.66 and a 95% confidence interval of 2.04 to 21.72 (P=.002). Posttraumatic stress disorder independently predicted the frequency of EDL even after correcting for preexisting depression and anxiety disorders. A relatively longer duration of PACU stay in PTSD patients may reflect raised awareness of the health care workers about this debilitating mental disorder. Published by Elsevier Inc.
Bruun-Olsen, Vigdis; Bergland, Astrid; Heiberg, Kristi Elisabeth
Recovery outlooks of physical functioning and quality of life after hip fracture have not changed significantly over the past 25 years. Previous research has mainly dealt with causalities and acute treatment, while the recovery process from the patients' perspective has been less comprehensively described. Expanded knowledge of what the patients consider important in their recovery process may have important consequences for how these patients are treated in the future and thereby on future patient outcomes. The aim presently is therefore to explore how elderly patients with hip fracture enrolled in an ongoing RCT have experienced their recovery process. The study was qualitative in design. Eight frail elderly in recovery after hip fracture (aged 69-91) were interviewed in their home four months after their fracture. The interviews covered issues related to their experiences of facilitators and barriers throughout the different stages in the recovery process. The patients were already enrolled in an ongoing randomized controlled trial, examining the effects of habitual functional training during their short term stays at nursing homes. The patients were chosen strategically according to age, gender, and participation in rehabilitation. The interviews were recorded, transcribed and subjected to a method of systematic text condensation inspired by Giorgi's phenomenological method. The results revealed that the patients' experiences of the recovery process fell into three main themes: "Feeling vulnerable", "A span between self-reliance and dependency" and "Disruption from a normal life". The feeling of gloominess and vulnerability persisted throughout. Being in recovery was also experienced as a tension between self-reliance and dependency; a disrupted life where loss of mobility and the impact of age was profoundly present. Being in recovery after hip fracture was experienced as a life breaking event. Based on these findings, increased focus on individualized
The PULSAR primary care protocol: a stepped-wedge cluster randomized controlled trial to test a training intervention for general practitioners in recovery-oriented practice to optimize personal recovery in adult patients.
Enticott, Joanne C; Shawyer, Frances; Brophy, Lisa; Russell, Grant; Fossey, Ellie; Inder, Brett; Mazza, Danielle; Vasi, Shiva; Weller, Penelope June; Wilson-Evered, Elisabeth; Edan, Vrinda; Meadows, Graham
General practitioners (GPs) in Australia play a central role in the delivery of mental health care. This article describes the PULSAR (Principles Unite Local Services Assisting Recovery) Primary Care protocol, a novel mixed methods evaluation of a training intervention for GPs in recovery-oriented practice. The aim of the intervention is to optimize personal recovery in patients consulting study GPs for mental health issues. The intervention mixed methods design involves a stepped-wedge cluster randomized controlled trial testing the outcomes of training in recovery-oriented practice, together with an embedded qualitative study to identify the contextual enablers and challenges to implementing recovery-oriented practice. The project is conducted in Victoria, Australia between 2013 and 2017. Eighteen general practices and community health centers are randomly allocated to one of two steps (nine months apart) to start an intervention comprising GP training in the delivery of recovery-oriented practice. Data collection consists of cross-sectional surveys collected from patients of participating GPs at baseline, and again at the end of Steps 1 and 2. The primary outcome is improvement in personal recovery using responses to the Questionnaire about the Process of Recovery. Secondary outcomes are improvements in patient-rated measures of personal recovery and wellbeing, and of the recovery-oriented practice they have received, using the INSPIRE questionnaire, the Warwick-Edinburgh Mental Well-being Scale, and the Kessler Psychological Distress Scale. Participant data will be analyzed in the group that the cluster was assigned to at each study time point. Another per-protocol dataset will contain all data time-stamped according to the date of intervention received at each cluster site. Qualitative interviews with GPs and patients at three and nine months post-training will investigate experiences and challenges related to implementing recovery-oriented practice in primary
Liou, Yan-Ting; Chiang, Pin-Yi; Shun, Shiow-Ching
Cachexia is one of the most widely overlooked of the syndromes that are experienced by cancer patients. This syndrome is especially prevalent among patients with gastroenterology tract cancer. Although the National Comprehensive Cancer Network (NCCN) issued palliative-care practice guidelines for cachexia in 2015, guidelines have yet to be issued for the clinical setting. The authors reviewed the literature and applied their clinical experience to create an approach for identifying the degree of cachexia in a post-operative patient with periampullary cancer. This approach assesses the nutritional status, physical status, laboratory results, and gastrointestinal system functions of the patient using the Cachexia Assessment Scale (CAS) and NCCN Practice Guidelines for Cachexia. The patient improved under nursing care with an increase in nutritional intake and physical activity facilitating their process of post-surgical physical recovery. The authors hope that this experience using the combined CAS-NCCN Practice Guidelines will help clinical caregivers better understand how to apply the relevant guidelines in clinical settings. The developed approach may help nurses assess the comprehensive nutrition status of patients and related factors in order to provide interventions that will decrease the progression of cachexia effectively and promote quality of life.
Marshall, Tara C.
Copyright @ 2012 Mary Ann Liebert, Inc. This article has been made available through the Brunel Open Access Publishing Fund. Previous research has found that continuing offline contact with an ex-romantic partner following a breakup may disrupt emotional recovery. The present study examined whether continuing online contact with an ex-partner through remaining Facebook friends and/or engaging in surveillance of the ex-partner's Facebook page inhibited postbreakup adjustment and growth a...
This paper reports on the recovery of fish and decapod fauna in the East Branch (EB) of the Finniss River following the remediation of the Rum Jungle mine site in the mid 1980s. These results show a substantial recovery in fish and decapod occurrence within the EB below the Rum Jungle mine site subsequent to remediation. Whereas only two species of fish, and no decapods, were observed alive prior to remediation, up to seven species of fish and two decapod species have now been seen living in the stream. The penetration towards the mine has also increased with M. nigrans now occurring to within 1 km downstream of the site. The mobility of many taxa in the wet/dry tropics has evolved to allow for rapid recruitment, particularly into ephemeral streams such as the EB. Hence, the recovery probably reflects both the reduced toxicity of the stream, as well as the ecological robustness of the fish and decapod fauna to the dramatic seasonal variation. Hence, the ecological risk presented by the currently reduced contaminant levels is still higher than would be accepted for an undisturbed system. Further reductions in contaminant loads are required to improve this situation
Willem J. D. van Leeuwen
Full Text Available This study examines how satellite based time-series vegetation greenness data and phenological measurements can be used to monitor and quantify vegetation recovery after wildfire disturbances and examine how pre-fire fuel reduction restoration treatments impact fire severity and impact vegetation recovery trajectories. Pairs of wildfire affected sites and a nearby unburned reference site were chosen to measure the post-disturbance recovery in relation to climate variation. All site pairs were chosen in forested uplands in Arizona and were restricted to the area of the Rodeo-Chediski fire that occurred in 2002. Fuel reduction treatments were performed in 1999 and 2001. The inter-annual and seasonal vegetation dynamics before, during, and after wildfire events can be monitored using a time series of biweekly composited MODIS NDVI (Moderate Resolution Imaging Spectroradiometer - Normalized Difference Vegetation Index data. Time series analysis methods included difference metrics, smoothing filters, and fitting functions that were applied to extract seasonal and inter-annual change and phenological metrics from the NDVI time series data from 2000 to 2007. Pre- and post-fire Landsat data were used to compute the Normalized Burn Ratio (NBR and examine burn severity at the selected sites. The phenological metrics (pheno-metrics included the timing and greenness (i.e. NDVI for the start, peak and end of the growing season as well as proxy measures for the rate of green-up and senescence and the annual vegetation productivity. Pre-fire fuel reduction treatments resulted in lower fire severity, which reduced annual productivity much less than untreated areas within the Rodeo-Chediski fire perimeter. The seasonal metrics were shown to be useful for estimating the rate of post-fire disturbance recovery and the timing of phenological greenness phases. The use of satellite time series NDVI data and derived pheno-metrics show potential for tracking vegetation
Full Text Available The kinetics of T and B cell immune recovery after bone marrow transplantation (BMT is affected by many pre- and post-transplant factors. Because of the profoundly depleted baseline T and B cell immunity in recombination activating gene 2 (RAG-2-deficient severe combined immunodeficiency (SCID patients, some of these factors are eliminated, and the immune recovery after BMT can then be clearly assessed. This process was followed in ten SCID patients in parallel to their associated transplant-related complications. Early peripheral presence of T and B cells was observed in 8 and 4 patients, respectively. The latter correlated with pre-transplant conditioning therapy. Cells from these patients carried mainly signal joint DNA episomes, indicative of newly derived B and T cells. They were present before the normalization of the T cell receptor (TCR and the B cell receptor (BCR repertoire. Early presentation of the ordered TCR gene rearrangements after BMT occurred simultaneously, but this pattern was heterogeneous over time, suggesting different and individual thymic recovery processes. Our findings early after transplant could suggest the long-term patients' clinical outcome. Early peripheral presence of newly produced B and T lymphocytes from their production and maturation sites after BMT suggests donor stem cell origin rather than peripheral expansion, and is indicative of successful outcome. Peripheral detection of TCR excision circles and kappa-deleting recombination excision circles in RAG-2-deficient SCID post-BMT are early markers of T and B cell reconstitution, and can be used to monitor outcome and tailor specific therapy for patients undergoing BMT.
Full Text Available A stroke often results in post-stroke dementia, a rapid decline in memory and intelligence causing dysfunctions in daily life. The Chinese medicine doctor uses 4 examinations of inspection, listening, smelling, and feeling to determine the Chinese medicine pattern (CMP. Therefore, the purpose of the present study was to investigate the CMP in patients with post-stroke dementia. A total of 101 stroke patients were examined, consistent with the DSM IV diagnostic criteria of the American Psychiatric Association, as well as the National Institute of Neurological Disorders and Stroke-Association International pour Ia Recherche et I’Enseignement en Neurosciences vascular dementia diagnostic criteria of post-stroke dementia. Results: 100 patients (99.0% were KEDP (kidney essence deficiency pattern, shèn jīng kuī xū zhèng, 腎精虧虛證, 83 patients were AHLYP (ascendant hyperactivity of liver yang pattern, gān yáng shàng kàng zhèng, 肝陽上亢證, 83 patients were QBDP (qi-blood deficiency pattern, qì xuè kuī xū zhèng, 氣血虧虛證, 81 patients were SBOCP (static blood obstructing the collaterals pattern, yū xuè zǔ luò zhèng, 瘀血阻絡證, 72 patients were BSTRP (bowels stagnation turbidity retention pattern, fǔ zhì zhuó liú zhèng, 腑滯濁留證, 50 patients were FHIEP (fire heat interior excess pattern, huǒ rè nèi sheng zhèng, 火熱內盛證, and 39 participants (38.6% were PTOOP (phlegm turbidity obstructing the orifices pattern, tán zhuó zǔ qiào zhèng, 痰濁阻竅證; one to 31 patients have at least 2 CMPs simultaneously. In conclusion, the most CMP is KEDP CMP in the post-stroke dementia patients, and one patient may have one or at least 2 CMPs simultaneously.
Tang, Nou-Ying; Liu, Chung-Hsiang; Liu, Hsu-Jan; Li, Tsai-Chung; Liu, Jui-Chen; Chen, Ping-Kun; Hsieh, Ching-Liang
A stroke often results in post-stroke dementia, a rapid decline in memory and intelligence causing dysfunctions in daily life. The Chinese medicine doctor uses 4 examinations of inspection, listening, smelling, and feeling to determine the Chinese medicine pattern (CMP). Therefore, the purpose of the present study was to investigate the CMP in patients with post-stroke dementia. A total of 101 stroke patients were examined, consistent with the DSM IV diagnostic criteria of the American Psychiatric Association, as well as the National Institute of Neurological Disorders and Stroke-Association International pour Ia Recherche et I'Enseignement en Neurosciences vascular dementia diagnostic criteria of post-stroke dementia. 100 patients (99.0%) were KEDP (kidney essence deficiency pattern, shèn jīng kuī xū zhèng, ), 83 patients were AHLYP (ascendant hyperactivity of liver yang pattern, gān yáng shàng kàng zhèng, ), 83 patients were QBDP (qi-blood deficiency pattern, qì xuè kuī xū zhèng, ), 81 patients were SBOCP (static blood obstructing the collaterals pattern, yū xuè zǔ luò zhèng, ), 72 patients were BSTRP (bowels stagnation turbidity retention pattern, fǔ zhì zhuó liú zhèng, ), 50 patients were FHIEP (fire heat interior excess pattern, huǒ rè nèi sheng zhèng, ), and 39 participants (38.6%) were PTOOP (phlegm turbidity obstructing the orifices pattern, tán zhuó zǔ qiào zhèng, ); one to 31 patients have at least 2 CMPs simultaneously. In conclusion, the most CMP is KEDP CMP in the post-stroke dementia patients, and one patient may have one or at least 2 CMPs simultaneously.
Llewellyn, A; McCabe, CS; Hibberd, Y
Background: Complex Regional Pain Syndrome (CRPS) symptoms can significantly differ between patients, fluctuate over time, disappear or persist. This leads to problems in defining recovery and in evaluating the efficacy of therapeutic interventions. Objectives: To define recovery from the patient...
Ryan R. Kroll
Full Text Available Abstract Background Wearable devices generate signals detecting activity, sleep, and heart rate, all of which could enable detailed and near-continuous characterization of recovery following critical illness. Methods To determine the feasibility of using a wrist-worn personal fitness tracker among patients recovering from critical illness, we conducted a prospective observational study of a convenience sample of 50 stable ICU patients. We assessed device wearability, the extent of data capture, sensitivity and specificity for detecting heart rate excursions, and correlations with questionnaire-derived sleep quality measures. Results Wearable devices were worn over a 24-h period, with excellent capture of data. While specificity for the detection of tachycardia was high (98.8%, sensitivity was low to moderate (69.5%. There was a moderate correlation between wearable-derived sleep duration and questionnaire-derived sleep quality (r = 0.33, P = 0.03. Devices were well-tolerated and demonstrated no degradation in quality of data acquisition over time. Conclusions We found that wearable devices could be worn by patients recovering from critical illness and could generate useful data for the majority of patients with little adverse effect. Further development and study are needed to better define and enhance the role of wearables in the monitoring of post-ICU recovery. Trial registration Clinicaltrials.gov, NCT02527408
Rosenbaum, Talli; Vadas, Dor; Kalichman, Leonid
While the rehabilitation goals of post-stroke patients include improving quality of life and returning to functional activities, the extent to which sexual activity is addressed as part of the standard rehabilitation process is unknown. Moreover, the specific sexual concerns of stroke patients, including the effect of stroke on intimate relationships and sexuality of the partner, the ability to physically engage in sex, and the effect of psychological components such as role identity, depression, and anxiety on sexuality, all warrant examination by rehabilitation professionals. The aim of this study is to examine the existing literature on sexuality and stroke patients in order to better understand how the sexual lives of stroke patients and their partners are affected and to provide recommendations to rehabilitation professionals for addressing sexuality as part of treatment. Narrative review, PubMed, PEDro, ISI Web of Science, and Google Scholar databases (inception-December 2012) were searched for the key words "stroke," "sexual dysfunction," "sexuality," "quality of life," and their combination. All relevant articles in English and secondary references were reviewed. We report the results of the literature review. Sexual dysfunction and decreased sexual satisfaction are common in the post-stroke population and are related to physical, psychosocial, and relational factors. However, they are not adequately addressed in post-stroke rehabilitation. As sexual function is an important component to quality of life and activities of daily living, physicians and rehabilitation specialists, including physical, occupational, and speech therapists, should receive training in addressing sexuality in the treatment of post-stroke patients. Sexologists and sex therapists should be an integral part of the rehabilitation team. © 2013 International Society for Sexual Medicine.
Brown, Meghan A.; Green, Benjamin P.; James, Lewis J.; Stevenson, Emma J.; Rumbold, Penny L. S.
This study was designed to assess the effect of a dairy-based recovery beverage on post-exercise appetite and energy intake in active females. Thirteen active females completed three trials in a crossover design. Participants completed 60 min of cycling at 65% V̇O2peak, before a 120 min recovery period. On completion of cycling, participants consumed a commercially available dairy-based beverage (DBB), a commercially available carbohydrate beverage (CHO), or a water control (H2O). Non-esterified fatty acids, glucose, and appetite-related peptides alongside measures of subjective appetite were sampled at baseline and at 30 min intervals during recovery. At 120 min, energy intake was assessed in the laboratory by ad libitum assessment, and in the free-living environment by weighed food record for the remainder of the study day. Energy intake at the ad libitum lunch was lower after DBB compared to H2O (4.43 ± 0.20, 5.58 ± 0.41 MJ, respectively; p = 0.046; (95% CI: −2.28, −0.20 MJ)), but was not different to CHO (5.21 ± 0.46 MJ), with no difference between trials thereafter. Insulin and GLP-17-36 were higher following DBB compared to H2O (p = 0.015 and p = 0.001, respectively) but not to CHO (p = 1.00 and p = 0.146, respectively). In addition, glucagon was higher following DBB compared to CHO (p = 0.008) but not to H2O (p = 0.074). The results demonstrate that where DBB consumption may manifest in accelerated recovery, this may be possible without significantly affecting total energy intake and subsequent appetite-related responses relative to a CHO beverage. PMID:27338460
Monaco, Vito; Galardi, Giuseppe; Coscia, Martina; Martelli, Dario; Micera, Silvestro
Over the past decades, a large number of robotic platforms have been developed which provide rehabilitative treatments aimed at recovering walking abilities in post-stroke patients. Unfortunately, they do not significantly influence patients' performance after three months from the accident. One of the main reasons underlying this result seems to be related to the time of intervention. Specifically, although experimental evidences suggest that early (i.e., first days after the injury) and intense neuro-rehabilitative treatments can significantly favor the functional recovery of post-stroke patients, robots require patients to be verticalized. Consequently, this does not allow them to be treated immediately after the trauma. This paper introduces a new robotic platform, named NEUROBike, designed to provide neuro-rehabilitative treatments to bedridden patients. It was designed to provide an early and well-addressed rehabilitation therapy, in terms of kinesiology, efforts, and fatigue, accounting for exercises functionally related to daily motor tasks. For this purpose, kinematic models of leg-joint angular excursions during both walking and sit-to-stand were developed and implemented in control algorithms leading both passive and active exercises. Finally, a set of pilot tests was carried out to evaluate the performance of the robotic platform on healthy subjects.
Kalichman, Leonid; Alperovitch-Najenson, Deborah; Treger, Iuly
Purpose To evaluate the influence of patient's weight on rehabilitation outcomes in first-event stroke patients. Design Retrospective, observational comparative study. 102 first-time stroke male and female patients admitted to the 52-bed neurology rehabilitation department in a rehabilitation hospital were included in the study. Body mass index (BMI), Functional Independence Measure (FIM) on admission and at discharge, as well as the delta-FIM (FIM on admission - FIM at discharge) were evaluated. The Kruskal-Wallis test was used to compare the FIM and the NIHSS scores between BMI groups (normal, overweight, moderate and severe obesity). Results A statistically significant negative correlation (rho = -0.20, p = 0.049) was found between FIM change and BMI, that remained significant after adjustments for age, sex and hospitalisation days. No difference was found between groups in FIM or NIHSS change between BMI groups. Conclusions In sub-acute post-stroke patients undergoing rehabilitation in rehabilitation hospital, BMI was negatively associated with the improvement of functional parameters. Patients' BMI should be taken into consideration when predicting rehabilitation outcome for stroke patients. Further investigations are needed to identify the functional parameters affected by the patients' BMI. Implications for Rehabilitation In sub-acute post-stroke patients undergoing rehabilitation in rehabilitation hospital, BMI was negatively associated with the improvement of functional parameters. Patients' BMI should be taken into consideration when predicting rehabilitation outcome for stroke patients. New rehabilitation strategies should be designed to improve the functional outcomes of rehabilitation of obese patients.
Ferrari, Stefano; Luksch, Roberto; Hall, Kirsten Sundby; Fagioli, Franca; Prete, Arcangelo; Tamburini, Angela; Tienghi, Amelia; DiGirolamo, Stefania; Paioli, Anna; Abate, Massimo Eraldo; Podda, Marta; Cammelli, Silvia; Eriksson, Mikael; Brach del Prever, Adalberto
Post-relapse survival (PRS) was evaluated in patients with Ewing sarcoma (EWS) enrolled in chemotherapy protocols based on the use of high-dose chemotherapy with busulfan and melfalan (HDT) as a first-line consolidation treatment in high-risk patients. EWS patients enrolled in ISG/SSG III and IV trials who relapsed after complete remission were included in the analysis. At recurrence, chemotherapy based on high-dose ifosfamide was foreseen, and patients who responded but had not received HDT underwent consolidation therapy with HDT. Data from 107 EWS patients were included in the analysis. Median time to recurrence (RFI) was 18 months, and 45 (42%) patients had multiple sites of recurrence. Patients who had previously been treated with HDT had a significantly (P = 0.02) shorter RFI and were less likely to achieve a second complete remission (CR2). CR2 status was achieved by 42 (39%) patients. Fifty patients received high-dose IFO (20 went to consolidation HDT). The 5-year PRS was 19% (95% CI 11 to 27%). With CR2, the 5-year PRS was 48% (95% CI 31 to 64%). Without CR2, median time to death was six months (range 1-45 months). According to the multivariate analysis, patients younger than 15 years, recurrence to the lung only, and RFI longer than 24 months significantly influenced the probability of PRS. Age, pattern of recurrence, RFI, and response to second-line chemotherapy influence post-relapse survival in patients with recurrent Ewing sarcoma. No survival advantage was observed from chemotherapy consolidation with HDT. © 2015 Wiley Periodicals, Inc.
Full Text Available Clonal plants are prevalent in wetlands and play important roles in maintaining the functions of the ecosystem. In the present study, we determined the effect of clone sizes (R1, R2, and R3 comprising 1, 3, and 5clumping ramets on the tolerance of Carex brevicuspis growing under 30-cm-deep water to three different periods (one, two, and three months of submergence and its growth recovery one month after de-submergence. Our results showed that the relative growth rate (RGR of C. brevicuspis significantly declined with increasing submergence time, and was higher in R3 and R5 than in R1 plants under both submergence and post-submergence conditions. The concentration of water-soluble carbohydrates (WSCs was highest in R3, intermediate in R5, and the lowest in R1 plants during the first two months of submergence, indicating an optimal trade-off between energy investment and vegetative growth (i.e., buds and ramets production in C. brevicuspis. WSCs were significantly reduced with increasing submergence time, while the starch content was significantly reduced only during the third month of submergence, implying that WSCs were a direct energy source for C. brevicuspis during submergence. The number of buds was higher in R5 than in R3 and R1 plants after two and three months of submergence, which directly resulted in a significantly higher post-submergence ramet production in R5 plants. These results indicated that plants with relatively larger clone sizes display better tolerance to submergence stress and post-submergence growth recovery. Therefore, we speculate that the large clone size in C brevicuspis might be an effective adaptive mechanism to survive under submergence stress in floodplain wetlands.
Gärtner, Rune; Callesen, Torben; Kroman, Niels Thorndahl
Extant literature shows that women having undergone breast cancer surgery have substantial problems at the post-anaesthesia care unit (PACU). Based on nursing reports and elements of the discharge scoring system recommended by The Danish Society of Anaesthesiology and Intensive Care Medicine...
Enevoldsen, L H; Simonsen, L; Bülow, J
plasma triacylglycerol (TAG) uptake and clearance in the exercising legs immediately and for at least 4 h post-exercise, while food intake per se did not change leg plasma TAG uptake or clearance for up to 6 h. It is hypothesized that the effect of exercise on leg plasma TAG metabolism is a result...
This thesis seeks to analyse whether and in what way institutional reconstruction meets the needs, and fits the context, of the population they are meant to serve. Often we talk about post-conflict societies as ‘being in transition’ or ‘moving out of crisis’, and this thesis basically asks the
Behrens, Jane; Gräns, Albin; Andersen, Niels Gerner
GER was affected after surgically introducing dummies of a blood-flow biotelemetry system into the abdominal cavity of Atlantic cod. Two days post surgery the cod with implants were, together with a control group, force-fed a standardized meal and the stomach contents recovered 24h later...
Kinoshita, Alicia; Nourbakhshbeidokhti, Samira; Chin, Anne
Wildfire can have significant impacts on watershed hydrology and geomorphology by changing soil properties and removing vegetation, often increasing runoff and soil erosion and deposition, debris flows, and flooding. Watershed systems may take several years or longer to recover. During this time, post-fire channel changes have the potential to alter hydraulics that influence characteristics such as time of concentration and increase time to peak flow, flow capacity, and velocity. Using the case of the 2012 Waldo Canyon Fire in Colorado (USA), this research will leverage field-based surveys and terrestrial Light Detection and Ranging (LiDAR) data to parameterize KINEROS2 (KINematic runoff and EROSion), an event oriented, physically-based watershed runoff and erosion model. We will use the Automated Geospatial Watershed Assessment (AGWA) tool, which is a GIS-based hydrologic modeling tool that uses commonly available GIS data layers to parameterize, execute, and spatially visualize runoff and sediment yield for watersheds impacted by the Waldo Canyon Fire. Specifically, two models are developed, an unburned (Bear Creek) and burned (Williams) watershed. The models will simulate burn severity and treatment conditions. Field data will be used to validate the burned watersheds for pre- and post-fire changes in infiltration, runoff, peak flow, sediment yield, and sediment discharge. Spatial modeling will provide insight into post-fire patterns for varying treatment, burn severity, and climate scenarios. Results will also provide post-fire managers with improved hydro-geomorphic modeling and prediction tools for water resources management and mitigation efforts.
Buonocore, Mariachiara; Bosia, Marta; Baraldi, Maria A; Bechi, Margherita; Spangaro, Marco; Cocchi, Federica; Bianchi, Laura; Guglielmino, Carmelo; Mastromatteo, Antonella R; Cavallaro, Roberto
Recovery, or functional remission, represents the ultimate treatment goal in schizophrenia. Despite its importance, a standardized definition of remission is still lacking, thus reported rates significantly vary across studies. Moreover, the effects of rehabilitative interventions on recovery have not been thoroughly investigated. This study aimed to evaluate recovery in a sample of patients with chronic schizophrenia engaged in rehabilitation programs and to explore contributing factors, with a focus on sociocognitive rehabilitative interventions. Data from 104 patients with schizophrenia treated either with a standard rehabilitation program, including cognitive remediation (n = 46), or the latter plus a specific sociocognitive intervention (n = 58), and assessed for psychopathology, cognition, social cognition, and Quality of Life Scale, were retrospectively analyzed for this study. Recovery, evaluated with the Quality of Life Scale, was achieved by 56.76% of patients in our sample. While no effects were observed for clinical, cognitive, or sociocognitive variables, participation in the sociocognitive rehabilitative interventions was positively associated with recovery. Our results indicate that high rates of recovery can be achieved in patients treated with psychosocial interventions and suggest that rehabilitative programs targeting social cognition may further facilitate the process of recovery. If confirmed, these results may have relevant implications for daily clinical practice and service provision, allowing clinicians to develop and optimize specific rehabilitation programs in order to promote recovery. © 2017 The Authors. Psychiatry and Clinical Neurosciences © 2017 Japanese Society of Psychiatry and Neurology.
Caiuby, Andrea Vannini Santesso; Andreoli, Paola Bruno de Araújo; Andreoli, Sergio Baxter
Post-traumatic stress disorder has been detected in patients after treatment in intensive care unit. The main goal of this study is to review the psychological aspects and therapeutic interventions on those patients after their treatment on intensive care unit. Thirty eight articles have been included. The prevalence of post-traumatic stress disorder has varied from 17% up to 30% and the incidence from 14% to 24%. The risk factors were: previous anxiety historic, depression or panic, having delusional traumatic memories (derived from psychic formations as dreams and delirium), belief effects, depressive behavior, stressing experiences and mechanical ventilation. High doses of opiates, symptoms caused by sedation or analgesia reduction and the use of lorazepam were related with the increase of delirium and delusional memory. The disorder sintomatology can be reduced with hydrocortisone administration, with daily sedation interruption. No other effectiveness psychological intervention study was found.
Full Text Available Financial services sector has become so competitive after Malaysia government’s liberalization policy. In order to address this intense competition, banks have shifted their strategy from product-centered to a customer-centered strategy. This study is to test a model related to the relationship between the service recovery, customer satisfaction and the after purchase behavior by the customers. To test the proposed model, 370 self-administered questionnaires were distributed. The analyses based on Structural Equation Modeling (SEM reveal that there are direct relationships between perceived distributive justice, perceived procedural justice, perceived interactional justice and customer satisfaction in regard to service recovery. The results also show that customer satisfaction increases the level of trust among customers. There is also a high possibility that satisfied customers will spread positive word of mouth that can reinforce the good reputation of the service provider. Bootstrap is used to examine the mediation effects of satisfaction and the results show that customer satisfaction fully mediates the relationship between perceived interactional justice and word of mouth. The results also indicate that customer satisfaction partially mediate the following relationships; perceived distributive justice with word of mouth, perceived procedural justice with word of mouth and perceived interactional justice with perceive trust. However, the fact that this study is conducted by using cross sectional method, focuses on banking industry and covers a small area of the country should be taken into consideration for any generalization of results.
Jensen, K; Kehlet, H; Lund, Claus
functions. We investigated the feasibility and efficacy of a standardized, evidence-based anaesthesia/analgesic regime to identify residual problems in the early post-operative phase. METHODS: One hundred and thirty-four consecutive patients admitted for elective laparoscopic cholecystectomy at Hvidovre...
Angelidaki, Irini; Hejnfelt, Anette; Ellegaard, L.
industry to generate biogas, which is used for electricity and thermal energy. A total of 20 such plants are currently active in Denmark, most of which were included in the investigation. From the plants, samples were obtained from various steps of the process. Samples were analysed and the residual biogas......The main objective of this study was to investigate the degradation efficiency of centralized biogas plants and provide guidance for the design of more efficient digester and post-digestion systems. These centralized biogas plants in Denmark digest manure together with organic waste from the food...... potential determined by batch post-digestion at various temperature levels. Results were correlated with plant characteristics and production statistics in order to judge the efficiency of various digestion concepts. A simplified model based on a two-step biogas production process was developed...
Background: The use of antiretroviral therapy (ART) for the treatment of human immunodeficiency virus (HIV) is associated with significant and sustained decrease in the viral RNA levels that allows the immune system to recover. The extent of this immune recovery depends on the baseline CD4 count. Evidence on the ...
Ishida, Tsuguharu; Yoshinaga, Kazumasa; Horibe, Takashi; Kokubu, Kiyokazu; Kokura, Yoshihiro; Matsui, Konosuke; Inamoto, Kazuo.
We retrospectively assessed the brain computed tomographic (CT) findings in 22 post-cardiopulmonary resuscitation (CPR) patients excluding neonatal cases. On the basis of the CT findings, the patients were divided into two groups. Eight patients (36.4 %) had bilateral abnormal lowdensity areas in the basal ganglia (Group I). The remaining 14 patients (63.6 %) had no abnormalities in that area (Group II). In Group I, the incidence of primary cardiac arrest and duration of advanced life support (ALS) was significantly different (p < 0.05) from Group II. Sex, age, duration of basic life support (BLS), time elapsed from initiation of BLS to initial CT and from initiation of ALS to initial CT was not significantly different between the two groups. Outcome was very poor in both groups and no significant difference was noted between them. We conclude that primary cardiac arrest and long duration of ALS were predictors of abnormal bilateral low-density areas in the basal ganglia in post-CPR patients. However, their appearance was not related to outcome. (author)
Magne Bjølseth, Tor; Engedal, Knut; Šaltytė Benth, Jūratė; Bergsholm, Per; Strømnes Dybedal, Gro; Lødøen Gaarden, Torfinn; Tanum, Lars
No study has previously investigated whether the speed of recovery from disorientation in the post-ictal period may predict the short-term treatment outcome of electroconvulsive therapy (ECT). This longitudinal cohort study included 57 elderly patients with unipolar or bipolar major depression, aged 60-85 years, treated with formula-based ECT. Treatment outcome was assessed weekly during the ECT course using the 17-item Hamilton Rating Scale for Depression (HRSD17). The post-ictal reorientation time (PRT) was assessed at the first and third treatments. Longer PRTs at the first and third treatments predicted a more rapid decline and a lower end-point in continuous HRSD17 scores (p=0.002 and 0.019, respectively). None of the patients who recovered from disorientation in less than 5 min met the remission criterion, defined as an HRSD17 score of 7 or less. A greater increment in stimulus dosage from the first to the third ECT session rendered a smaller relative decline in PRT (p<0.001). The limited number of subjects may reduce the generalizability of the findings. The speed of recovery from disorientation at the first and third sessions seems to be a predictor of the treatment outcome of formula-based ECT, at least in elderly patients with major depression. It remains to be clarified how the PRT may be utilized to guide stimulus dosing. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.
Naito, Muneyuki; Hirata, Akihiko; Ishimaru, Manabu; Hirotsu, Yoshihiko
We have investigated ion-beam-induced and thermal annealing-induced microstructures in high fluence Fe implanted Si using transmission electron microscopy. Si(1 1 1) substrates were irradiated with 120 keV Fe ions at 120 K to fluences of 0.4 x 10 17 and 4.0 x 10 17 cm -2 . A continuous amorphous layer was formed on Si substrates in both as-implanted samples. After thermal annealing at 1073 K for 2 h, β-FeSi 2 fine particles buried in a polycrystalline Si layer were observed in the low fluence sample, while a continuous β-FeSi 2 layer was formed in the high fluence sample. We discuss the relationship between ion fluence and defects recovery process in Fe ion implanted Si
Gordon, Christopher E; Price, Owen F; Tasker, Elizabeth M
There is a public perception that large high-severity wildfires decrease biodiversity and increase fire hazard by homogenizing vegetation composition and increasing the cover of mid-story vegetation. But a growing literature suggests that vegetation responses are nuanced. LiDAR technology provides a promising remote sensing tool to test hypotheses about post-fire vegetation regrowth because vegetation cover can be quantified within different height strata at fine scales over large areas. We assess the usefulness of airborne LiDAR data for measuring post-fire mid-story vegetation regrowth over a range of spatial resolutions (10 × 10 m, 30 × 30 m, 50 × 50 m, 100 × 100 m cell size) and investigate the effect of fire severity on regrowth amount and spatial pattern following a mixed severity wildfire in Warrumbungle National Park, Australia. We predicted that recovery would be more vigorous in areas of high fire severity, because park managers observed dense post-fire regrowth in these areas. Moderate to strong positive associations were observed between LiDAR and field surveys of mid-story vegetation cover between 0.5-3.0 m. Thus our LiDAR survey was an apt representation of on-ground vegetation cover. LiDAR-derived mid-story vegetation cover was 22-40% lower in areas of low and moderate than high fire severity. Linear mixed-effects models showed that fire severity was among the strongest biophysical predictors of mid-story vegetation cover irrespective of spatial resolution. However much of the variance associated with these models was unexplained, presumably because soil seed banks varied at finer scales than our LiDAR maps. Dense patches of mid-story vegetation regrowth were small (median size 0.01 ha) and evenly distributed between areas of low, moderate and high fire severity, demonstrating that high-severity fires do not homogenize vegetation cover. Our results are relevant for ecosystem conservation and fire management because they: indicate
Cismaru, Gabriel; Gusetu, Gabriel; Muresan, Lucian; Rosu, Radu; Andronache, Marius; Matuz, Roxana; Puiu, Mihai; Mester, Petru; Miclaus, Maria; Pop, Dana; Mircea, Petru Adrian; Zdrenghea, Dumitru
Ventriculo-atrial (VA) conduction can have negative consequences for patients with implanted pacemakers and defibrillators. There is concern whether impaired VA conduction could recover during stressful situations. Although the influence of isoproterenol and atropine are well established, the effect of adrenaline has not been studied systematically. The objective of this study was to determine if adrenaline can facilitate recovery of VA conduction in patients implanted with pacemakers. A prospective study was conducted on 61 consecutive patients during a 4-month period (April-July 2014). The presence of VA conduction was assessed during the pacemaker implantation procedure. In case of an impaired VA conduction, adrenaline infusio was used as a stress surrogate to test conduction recovery. The indications for pacemaker implantation were: sinus node dysfunction in 18 patients, atrioventricular (AV) block in 40 patients, binodal dysfunction (sinus node+ AV node) in two patients and other (carotid sinus syndrome) in one patient. In the basal state, 15/61 (24.6%) presented spontaneous VA conduction and 46/61 (75.4%) had no VA conduction. After administration of adrenaline, there was VA conduction recovery in 5/46 (10.9%) patients. Adrenaline infusion produced recovery of VA conduction in 10.9% of patients with absent VA conduction in a basal state. Recovery of VA conduction during physiological or pathological stresses could be responsible for the pacemaker syndrome, PMT episodes, or certain implantable cardiac defibrillator detection issues. © 2015 Wiley Periodicals, Inc.
Peres, Paulo; Carvalho, Antônio C; Perez, Ana Beatriz A; Medeiros, Wladimir M
Marfan syndrome patients present important cardiac structural changes, ventricular dysfunction, and electrocardiographic changes. An abnormal heart rate response during or after exercise is an independent predictor of mortality and autonomic dysfunction. The aim of the present study was to compare heart rate recovery and chronotropic response obtained by cardiac reserve in patients with Marfan syndrome subjected to submaximal exercise. A total of 12 patients on β-blocker therapy and 13 off β-blocker therapy were compared with 12 healthy controls. They were subjected to submaximal exercise with lactate measurements. The heart rate recovery was obtained in the first minute of recovery and corrected for cardiac reserve and peak lactate concentration. Peak heart rate (141±16 versus 155±17 versus 174±8 bpm; p=0.001), heart rate reserve (58.7±9.4 versus 67.6±14.3 versus 82.6±4.8 bpm; p=0.001), heart rate recovery (22±6 versus 22±8 versus 34±9 bpm; p=0.001), and heart rate recovery/lactate (3±1 versus 3±1 versus 5±1 bpm/mmol/L; p=0.003) were different between Marfan groups and controls, respectively. All the patients with Marfan syndrome had heart rate recovery values below the mean observed in the control group. The absolute values of heart rate recovery were strongly correlated with the heart rate reserve (r=0.76; p=0.001). Marfan syndrome patients have reduced heart rate recovery and chronotropic deficit after submaximal exercise, and the chronotropic deficit is a strong determinant of heart rate recovery. These changes are suggestive of autonomic dysfunction.
Pihl, Kenneth; Roos, Ewa M; Nissen, Nis
Background and purpose - Patients' expectations of outcomes following arthroscopic meniscus surgery are largely unknown. We investigated patients' expectations concerning recovery and participation in leisure-time activities after arthroscopic meniscus surgery and the postoperative fulfillment...... of these. Patients and methods - The study sample consisted of 491 consecutively recruited patients (mean age 50 (SD 13) years, 55% men) who were assigned for arthroscopy on suspicion of meniscus injury and later verified by arthroscopy. Before surgery, patients completed questionnaires regarding...... meniscus surgery were too optimistic regarding their recovery time and postoperative participation in leisure activities. This highlights the need for shared decision making which should include giving the patient information on realistic expectations of recovery time and regarding participation in leisure...
Mahajan, V A
Delayed recovery of cognitive function is a well-recognized phenomenon in older patients. The potential for the volatile anaesthetic used to contribute to alterations in postoperative cognitive function in older patients following minor surgical procedures has not been determined. We compared emergence from isoflurane and sevoflurane anaesthesia in older surgical patients undergoing urological procedures of short duration.
Abstract Previous research has found that continuing offline contact with an ex-romantic partner following a breakup may disrupt emotional recovery. The present study examined whether continuing online contact with an ex-partner through remaining Facebook friends and/or engaging in surveillance of the ex-partner's Facebook page inhibited postbreakup adjustment and growth above and beyond offline contact. Analysis of the data provided by 464 participants revealed that Facebook surveillance was associated with greater current distress over the breakup, more negative feelings, sexual desire, and longing for the ex-partner, and lower personal growth. Participants who remained Facebook friends with the ex-partner, relative to those who did not remain Facebook friends, reported less negative feelings, sexual desire, and longing for the former partner, but lower personal growth. All of these results emerged after controlling for offline contact, personality traits, and characteristics of the former relationship and breakup that tend to predict postbreakup adjustment. Overall, these findings suggest that exposure to an ex-partner through Facebook may obstruct the process of healing and moving on from a past relationship. PMID:22946958
Taylor, G Jeffrey; Wieczorek, Mark A
New estimates of the thickness of the lunar highlands crust based on data from the Gravity Recovery and Interior Laboratory mission, allow us to reassess the abundances of refractory elements in the Moon. Previous estimates of the Moon fall into two distinct groups: earthlike and a 50% enrichment in the Moon compared with the Earth. Revised crustal thicknesses and compositional information from remote sensing and lunar samples indicate that the crust contributes 1.13-1.85 wt% Al2O3 to the bulk Moon abundance. Mare basalt Al2O3 concentrations (8-10 wt%) and Al2O3 partitioning behaviour between melt and pyroxene during partial melting indicate mantle Al2O3 concentration in the range 1.3-3.1 wt%, depending on the relative amounts of pyroxene and olivine. Using crustal and mantle mass fractions, we show that that the Moon and the Earth most likely have the same (within 20%) concentrations of refractory elements. This allows us to use correlations between pairs of refractory and volatile elements to confirm that lunar abundances of moderately volatile elements such as K, Rb and Cs are depleted by 75% in the Moon compared with the Earth and that highly volatile elements, such as Tl and Cd, are depleted by 99%. The earthlike refractory abundances and depleted volatile abundances are strong constraints on lunar formation processes. © 2014 The Author(s) Published by the Royal Society. All rights reserved.
Audren, A.; Hallen, A.; Linnarsson, M.K.; Possnert, G.
ZnO bulk samples were implanted with 200 keV-Co ions at room temperature with two fluences, 1 x 10 16 and 8 x 10 16 cm -2 , and then annealed in air for 30 min at different temperatures up to 900 o C. After the implantation and each annealing step, the samples were analyzed by Rutherford backscattering spectrometry (RBS) in random and channeling directions to follow the evolution of the disorder profile. The RBS spectra reveal that disorder is created during implantation in proportion to the Co fluence. The thermal treatments induce a disorder recovery, which is however, not complete after annealing at 900 o C, where about 15% of the damage remains. To study the Co profile evolution during annealing, the samples were, in addition to RBS, characterized by secondary ion mass spectrometry (SIMS). The results show that Co diffusion starts at 800 o C, but also that a very different behavior is seen for Co concentrations below and above the solubility limit.
Huang, Yao-Hui; Lin, Yao-Yu; Lee, Shih-Kai; Lee, Ming-Feng; Lin, Ching-Lan Esther
The ideology of recovery addresses the autonomy of patients with mental illness and their ability to reconstruct a normal life. Empirical knowledge of this process of recovery and related factors remains unclear. To assess the process of recovery and related factors in patients with mental illness. This cross-sectional, correlational study was conducted on a convenience sample in a psychiatric hospital. Two-hundred and fifty patients with mental illness were recruited and were assessed using 3 instruments: Questionnaire about the Process of Recovery (QPR), Perceived Psychiatric Stigma Scale (PPSS), and Personal and Social Performance Scale (PSP). Data were analyzed using descriptive statistics, χ 2 , analysis of variance, and multiple linear regression analysis. Most of the participants were male, middle-aged, unmarried, educated to the senior high school level, employed, receiving home-care treatment, and diagnosed with schizophrenia. Those who were unemployed, living in a community rehabilitative house, and living in the community, respectively, earned relatively higher recovery scores (p mental illness. Community psychiatric nurses should provide care to help employed patients adapt to stresses in the workplace, strengthen their stigma-coping strategies, and promote public awareness of mental health issues by increasing public knowledge and acceptance of mental illness in order to minimize patient-perceived stigma and facilitate their recovery.
Toft, Søren; Nielsen, Søren Achim
Restoration of fat stores is metabolic first priority for many insects that emerge from hibernation with depleted fat bodies. To some extent, the animals must be flexible and use whatever foods available irrespective of their nutrient composition. Previously, the carabid beetles Anchomenus dorsalis have been found to refill their fat stores to the same extent over 9 days irrespective of the nutrient composition of their food. However, a higher cost of fat deposition when the food was rich in sugar or protein rather than lipid was indicated by higher total energy consumption. Here, we test the hypothesis of increased metabolic costs of building fat stores from sugar- or protein-rich food than from lipid-rich food by microcalorimetry. We measured the heat emitted from beetles that had fed on sugar-, protein-, or lipid-rich food for 0 (common control), 2, 5, or 10 days. As predicted, heat emission was increased in beetles getting sugar- and protein-rich food compared with those getting lipid-rich food. However, we did not confirm the beetles' ability to rebuild fat stores from protein-rich food; instead, they increased in lean mass. Overall, sugar-rich food seems to be optimal for post-winter recovery, because it is better than lipid-rich food that allows concurrent rebuilding of fat stores and lean mass, which may benefit preparation for spring migration and reproduction. We propose that overwintered fruits may be highly preferred post-diapause food for these otherwise mostly carnivorous beetles.
Grazia Di Giovanni
Full Text Available In 2009, Abruzzo Region was hit by a severe earthquake, which damaged the city of L’Aquila and other 56 minor municipalities already affected by trends of demographic and economic decline at the time of the disaster. This contribution focuses on the mid-term reconstruction of this “Seismic Crater” interpreted as a peculiar case in the scenario of Italian “inner areas”. The “National Strategy for Inner Areas” (SNAI was launched by the Italian Government in 2014 with the purpose of enhancing local development in peripheral fragile municipalities, distant from major service hubs. A large majority of the Crater is included in the list of inner areas. Special post-earthquake legislation and SNAI share multiple goals, especially related to supporting local revitalization. L’Aquila’s territory represents an “anomaly” in the milieu of inner areas: the disaster worsened pre-existing conditions of marginalisation, but post-earthquake reconstruction and related funds offered uncommon resources to shape transformative patterns of development, cooperation and innovation.Using a descriptive approach and focusing on purposes and contents of the Reconstruction Plans, the study questions the ongoing reconstruction process as an occasion to foster long-term socio-economic recovery, urban renewal, and innovative inter-municipal governance besides the rebuilding of urban fabrics in the light of SNAI.
Omori, Yasuo; Miake, Kiyotaka; Nakamura, Hiromi; Kage-Nakadai, Eriko; Nishikawa, Yoshikazu
The aim of this study was to evaluate the effect of lactic acid (LA) with and without organic material at various post-treatment recovery times on the heat resistance of Listeria monocytogenes (Lm). LA decreased Lm numbers; however, the effect was remarkably attenuated by the presence of organic matter. Five strains of Lm were treated with LA and the listericidal effects were compared. The effect of LA varied depending on the strain, with ≥3.0% (w/w) LA required to kill the Lm strains in a short time. The heat resistance of Lm treated with LA was examined with respect to the time interval between the acid treatment and the subsequent manufacturing step. The heat resistance of Lm was shown to significantly increase during the post-treatment period. Heat tolerance (D value) increased up to 3.4-fold compared with the non-treated control bacteria. RNA sequencing and RT-PCR analyses suggested that several stress chaperones, proteins controlled by RecA and associated with high-temperature survival, were involved in the mechanism of enhanced heat resistance. These results are applicable to manufacturers when LA and heat treatment methods are utilized for the effective control of Lm in foods. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.
Full Text Available Wildfires cause disturbances in ecosystems and generate environmental, economic, and social costs. Studies focused on vegetation regeneration in burned areas acquire interest because of the need to understand the species dynamics and to apply an adequate restoration policy. In this work we intend to study the variables that condition short-term regeneration (5 years of three species of the genus Pinus in the Mediterranean region of the Iberian Peninsula. Regeneration modelling has been performed through multiple regressions, using Ordinary Least Squares (OLS and Geographic Weight Regression (GWR. The variables used were fire severity, measured through the Composite Burn Index (CBI, and a set of environmental variables (topography, post-fire climate, vegetation type, and state after fire. The regeneration dynamics were measured through the Normalized Difference Vegetation Index (NDVI obtained from Landsat images. The relationship between fire severity and regeneration dynamics showed consistent results. Short-term regeneration was slowed down when severity was higher. The models generated by GWR showed better results in comparison with OLS (adjusted R2 = 0.77 for Pinus nigra and Pinus pinaster; adjusted R2 = 0.80 for Pinus halepensis. Further studies should focus on obtaining more precise variables and considering new factors which help to better explain post-fire vegetation recovery.
Ischaemic stroke is responsible for 80-85% of strokes. There is great interest in finding effective methods of rehabilitation for post-stroke patients. The aim of this study was to assess the results of rehabilitation carried out in the normalization of upper limb muscle tonus in patients, estimated on the Ashworth Scale for Grading Spasticity. The examined group consisted of 60 patients after ischaemic stroke. 10 sessions of NDT-Bobath therapy were provided within 2 weeks (ten days of therapy). Patient examinations using the Ashworth Scale for Grading Spasticity were done twice: the first time on admission and the second after the last session of the therapy to assess rehabilitation effects. Among the patients involved in the study, the results measured on the Ashworth Scale (where possible) were as follows: recovery in 16 cases (26.67%), relapse in 1 case (1.67%), no measurable changes (or change within the same grade of the scale) in 8 cases (13.33%). Statistically significant changes were observed in the health status of the patients. These changes, in the area of muscle tone, were favorable and reflected in the outcomes of the assessment using the Ashworth Scale for Grading Spasticity.
Nolla-Salas, M; Monmany-Roca, J; Vázquez-Mata, G
The concept of continuity of care by intensivists as an element of quality control in the medical care of Intensive Care Unit (ICU) patients surviving multiple organ dysfunction syndrome has led to a rethinking of the ICU model in recent years. We discuss the rationale to design and implement a hospital-based, prospective, randomized, multicenter Intervention/Control study in order to estimate the impact of an interdisciplinary intervention during the post-ICU recovery phase on medium-term medical outcomes in ICU patients with multiple organ dysfunction.
Felix, Erika; You, Sukkyung; Vernberg, Eric; Canino, Glorisa
This study focused on characteristics of the family environment that may mediate the relationship between disaster exposure and the presence of symptoms that met DSM-IV diagnostic criteria for symptom count and duration for an internalizing disorder in children and youth. We also explored how parental history of mental health problems may moderate this meditational model. Approximately 18 months after Hurricane Georges hit Puerto Rico in 1998, participants were randomly selected based on a probability household sample using 1990 US Census block groups. Caregivers and children (N=1,886 dyads) were interviewed with the Diagnostic Interview Schedule for Children and other questionnaires in Spanish. Areas of the family environment assessed include parent-child relationship quality, parent-child involvement, parental monitoring, discipline, parents’ relationship quality and parental mental health. SEM models were estimated for parents and children, and by age group. For children (4–10 years old), parenting variables were related to internalizing psychopathology, but did not mediate the exposure-psychopathology relationship. Exposure had a direct relationship to internalizing psychopathology. For youth (11–17 years old), some parenting variables attenuated the relation between exposure and internalizing psychopathology. Family environment factors may play a mediational role in psychopathology post-disaster among youth, compared to an additive role for children. Hurricane exposure had a significant relation to family environment for families without parental history of mental health problems, but no influence for families with a parental history of mental health problems. PMID:22688681
Full Text Available We aimed to analyze the relationship between fire regime attributes and the post-fire greenness recovery of fire-prone pine ecosystems over the short (2-year and medium (5-year term after a large wildfire, using both a single and a combined fire regime attribute approach. We characterized the spatial (fire size, temporal (number of fires, fire recurrence, and return interval, and magnitude (burn severity of the last fire fire regime attributes throughout a 40-year period with a long-time series of Landsat imagery and ancillary data. The burn severity of the last fire was measured by the dNBR (difference of the Normalized Burn Ratio spectral index, and classified according to the ground reference values of the CBI (Composite Burn Index. Post-fire greenness recovery was obtained through the difference of the NDVI (Normalized Difference Vegetation Index between pre- and post-fire Landsat scenes. The relationship between fire regime attributes (single attributes: fire recurrence, fire return interval, and burn severity; combined attributes: fire recurrence-burn severity and fire return interval-burn severity and post-fire greenness recovery was evaluated using linear models. The results indicated that all the single and combined attributes significantly affected greenness recovery. The single attribute approach showed that high recurrence, short return interval and low severity situations had the highest vegetation greenness recovery. The combined attribute approach allowed us to identify a wider variety of post-fire greenness recovery situations than the single attribute one. Over the short term, high recurrence as well as short return interval scenarios showed the best post-fire greenness recovery independently of burn severity, while over the medium term, high recurrence combined with low severity was the most recovered scenario. This novel combined attribute approach (temporal plus magnitude could be of great value to forest managers in the
Burg, Matthew M; Barefoot, John; Berkman, Lisa; Catellier, Diane J; Czajkowski, Susan; Saab, Patrice; Huber, Marc; DeLillo, Vicki; Mitchell, Pamela; Skala, Judy; Taylor, C Barr
In post hoc analyses, to examine in low perceived social support (LPSS) patients enrolled in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial (n = 1503), the pattern of social support following myocardial infarction (MI), the impact of psychosocial intervention on perceived support, the relationship of perceived support at the time of MI to subsequent death and recurrent MI, and the relationship of change in perceived support 6 months after MI to subsequent mortality. Partner status (partner, no partner) and score (12 = moderate support) on the ENRICHD Social Support Instrument (ESSI) were used post hoc to define four levels of risk. The resulting 4 LPSS risk groups were compared on baseline characteristics, changes in social support, and medical outcomes to a group of concurrently enrolled acute myocardial infarction patients without depression or LPSS (MI comparison group, n = 408). Effects of treatment assignment on LPSS and death/recurrent MI were also examined. All 4 LPSS risk groups demonstrated improvement in perceived support, regardless of treatment assignment, with a significant treatment effect only seen in the LPSS risk group with no partner and moderate support at baseline. During an average 29-month follow-up, the combined end point of death/nonfatal MI was 10% in the MI comparison group and 23% in the ENRICHD LPSS patients; LPSS conferred a greater risk in unadjusted and adjusted models (HR = 1.74-2.39). Change in ESSI score and/or improvement in perceived social support were not found to predict subsequent mortality. Baseline LPSS predicted death/recurrent MI in the ENRICHD cohort, independent of treatment assignment. Intervention effects indicated a partner surrogacy role for the interventionist and the need for a moderate level of support at baseline for the intervention to be effective.
Yaroko, A A; Shahrjerdi, B; M D, Md Khairi
Sensorineural hearing loss following trauma is a common finding in daily clinical practice and usually associated with a poor prognosis. Our case illustrates a patient who was involved in motor vehicle accident sustaining bilateral severe to profound sensorineural hearing loss but subsequently recovered fully after two years. Unless there is clear trauma to the cochlea or auditory nerve, a substantial duration of follow up is needed in the treatment of such cases.
Brain plasticity after stroke remains poorly understood. Patients may improve spontaneously within the first 3 months and then more slowly in the coming year. The first day, decreased edema and reperfusion of the ischemic penumbra may possibly account for these phenomena, but the improvement during the next weeks suggests plasticity phenomena and cortical reorganization of the brain ischemic areas and of more remote areas. Indeed, the injured ischemic motor cortex has a reduced cortical excit...
Udunna C Anazodo
Full Text Available Coronary artery disease (CAD poses a risk to the cerebrovascular function of older adults and has been linked to impaired cognitive abilities. Using magnetic resonance perfusion imaging, we investigated changes in resting cerebral blood flow (CBF and cerebrovascular reactivity (CVR to hypercapnia in 34 coronary artery disease (CAD patients and 21 age-matched controls. Gray matter volume images were acquired and used as a confounding variable to separate changes in structure from function. Compared to healthy controls, CAD patients demonstrated reduced CBF in the superior frontal, anterior cingulate, insular, pre- and post-central gyri, middle temporal and superior temporal regions. Subsequent analysis of these regions demonstrated decreased CVR in the anterior cingulate, insula, postcentral and superior frontal regions. Except in the superior frontal and precentral regions, regional reductions in CBF and CVR were identified in brain areas where no detectable reductions in gray matter volume were observed, demonstrating that these vascular changes were independent of brain atrophy. Because aerobic fitness training can improve brain function, potential changes in regional CBF were investigated in the CAD patients after completion of a 6-month exercise-based cardiac rehabilitation program. Increased CBF was observed in the bilateral anterior cingulate, as well as recovery of CBF in the dorsal aspect of the right anterior cingulate, where the magnitude of increased CBF was roughly equal to the reduction in CBF at baseline compared to controls. These exercise-related improvements in CBF in the anterior cingulate is intriguing given the role of this area in cognitive processing and regulation of cardiovascular autonomic control.
Full Text Available Recent studies advocated the use of active cycling coupled with functional electrical stimulation to induce neuroplasticity and enhance functional improvements in stroke adult patients. The aim of this work was to evaluate whether the benefits induced by such a treatment are superior to standard physiotherapy. A single-blinded randomized controlled trial has been performed on post-acute elderly stroke patients. Patients underwent FES-augmented cycling training combined with voluntary pedaling or standard physiotherapy. The intervention consisted of fifteen 30-minutes sessions carried out within 3 weeks. Patients were evaluated before and after training, through functional scales, gait analysis and a voluntary pedaling test. Results were compared with an age-matched healthy group. Sixteen patients completed the training. After treatment, a general improvement of all clinical scales was obtained for both groups. Only the mechanical efficiency highlighted a group effect in favor of the experimental group. Although a group effect was not found for any other cycling or gait parameters, the experimental group showed a higher percentage of change with respect to the control group (e.g. the gait velocity was improved of 35.4% and 25.4% respectively, and its variation over time was higher than minimal clinical difference for the experimental group only. This trend suggests that differences in terms of motor recovery between the two groups may be achieved increasing the training dose. In conclusion, this study, although preliminary, showed that FES-augmented active cycling training seems to be effective in improving cycling and walking ability in post-acute elderly stroke patients. A higher sample size is required to confirm results.
Davidson, Larry; Schmutte, Timothy; Dinzeo, Thomas; Andres-Hyman, Raquel
Schizophrenia remains a complex, dynamic, multi-dimensional, and poorly understood condition. Although the concept of heterogeneity in outcome has conceptually overturned the post Kraepelinian legacy of progressive deterioration, a number of factors appear to contribute to perpetuating a pessimistic attitude toward outcome within the field. These include the limited access people with schizophrenia have to effective interventions and the phenomenon of the “clinician's illusion,” which refers ...
Woods, B. K.; Wei, L. H.; Connor, T. C.
With the growth of natural hazard data available in near real-time it is increasingly feasible to deliver damage estimates caused by natural disasters. These estimates can be used in disaster management setting or by commercial entities to optimize the deployment of resources and/or routing of goods and materials. This work outlines an end-to-end, modular process to generate estimates of damage caused by severe weather. The processing stream consists of five generic components: 1) Hazard modules that provide quantitate data layers for each peril. 2) Standardized methods to map the hazard data to an exposure layer based on atomic geospatial blocks. 3) Peril-specific damage functions that compute damage metrics at the atomic geospatial block level. 4) Standardized data aggregators, which map damage to user-specific geometries. 5) Data dissemination modules, which provide resulting damage estimates in a variety of output forms. This presentation provides a description of this generic tool set, and an illustrated example using HWRF-based hazard data for Hurricane Arthur (2014). In this example, the Python-based real-time processing ingests GRIB2 output from the HWRF numerical model, dynamically downscales it in conjunctions with a land cover database using a multiprocessing pool, and a just-in-time compiler (JIT). The resulting wind fields are contoured, and ingested into a PostGIS database using OGR. Finally, the damage estimates are calculated at the atomic block level and aggregated to user-defined regions using PostgreSQL queries to construct application specific tabular and graphics output.
Unruh, Daniel M.; Church, Stanley E; Nimick, David A.; Fey, David L.
The legacy of acid mine drainage and toxic trace metals left in streams by historical mining is being addressed by many important yet costly remediation efforts. Monitoring of environmental conditions frequently is not performed but is essential to evaluate remediation effectiveness, determine whether clean-up goals have been met, and assess which remediation strategies are most effective. Extensive pre- and post-remediation data for water and sediment quality for the Boulder River watershed in southwestern Montana provide an unusual opportunity to demonstrate the importance of monitoring. The most extensive restoration in the watershed occurred at the Comet mine on High Ore Creek and resulted in the most dramatic improvement in aquatic habitat. Removal of contaminated sediment and tailings, and stream-channel reconstruction reduced Cd and Zn concentrations in water such that fish are now present, and reduced metal concentrations in streambed sediment by a factor of c. 10, the largest improvement in the district. Waste removals at the Buckeye/Enterprise and Bullion mine sites produced limited or no improvement in water and sediment quality, and acidic drainage from mine adits continues to degrade stream aquatic habitat. Recontouring of hillslopes that had funnelled runoff into the workings of the Crystal mine substantially reduced metal concentrations in Uncle Sam Gulch, but did not eliminate all of the acidic adit drainage. Lead isotopic evidence suggests that the Crystal mine rather than the Comet mine is now the largest source of metals in streambed sediment of the Boulder River. The completed removal actions prevent additional contaminants from entering the stream, but it may take many years for erosional processes to diminish the effects of contaminated sediment already in streams. Although significant strides have been made, additional efforts to seal draining adits or treat the adit effluent at the Bullion and Crystal mines would need to be completed to
Balzien, B; Hofner, B; Harlander-Weikert, E; Frommelt, P; Bork, H; Forst, R; Fujak, A
The prevalence of the post-polio syndrome (PPS) is in estimated 50 % of persons with established poliomyelitis with a subsequently stable phase of at least 15 years. The basic mechanism is a loss of motoneuron cells in the spinal cord resulting in muscle weakness and fatigue. In addition pain, cold intolerance and a loss of stamina are frequently reported. There are few studies focusing on the orthopaedic symptoms in the PPS. This study should support the health-care professionals to the address the needs of PPS patients. A questionnaire was developed to collect data on patients who have been diagnosed by a neurologist as fulfilling the criteria of a PPS. It consists of two parts. In the first part, general patient data are collected. In the second part, details of health, pain, and activities of daily living are collected at two points in time: the time of the stable phase immediately after the acute phase of the disease and the phase after the PPS diagnosis. The questionnaires were sent to patients with a diagnosis of PPS. A total of 124 questionnaires were analysed (male: 45, female: 79). Parts of the data were used to calculate a score. It was hypothesised that the score would demonstrate a higher load of orthopaedic symptoms in the PPS phase. The results show that the phase after poliomyelitis (stable phase vs. PPS phase) was associated with significantly different sum score relating to the orthopaedic impairments. The score in the stable phase is on average 18.6 units lower than that in the post-PPS diagnosis phase (p cell pools, treatment is focused on the compensation of the functional limitations. Georg Thieme Verlag KG Stuttgart · New York.
Lloyd, G M
Enhanced recovery after surgery (ERAS) programs can accelerate recovery and shorten the hospital stay after colorectal resections. The RAPID (remove, ambulate, postoperative analgesia, introduce diet) protocol is a simplified ERAS program that consists of a simplified, user-friendly single-page pro forma schedule. This study aimed to evaluate the impact of the RAPID protocol on patients undergoing both laparoscopic and open colorectal resections in two specialized colorectal units.
Full Text Available As the human and economic costs of natural disaster events have dramatically increased over the past three decades, governments, researchers and humanitarian agencies have increasingly focused on reducing disaster impacts and increasing the resilience of individuals, households and communities. Recent disaster recovery efforts have focused on implementing a holistic social-ecological disaster risk reduction approach popularized through post-2004 tsunami recovery programs under the mantra of ‘building back better’. Although this approach has been increasingly adopted by various government and humanitarian organizations to describe their recovery and reconstruction activities, defining what is meant by ‘better’ and measuring ‘better’ as an outcome has been difficult to conceptualize and operationalize. In order to rectify this gap in the literature, the Post-Disaster Sustainable Livelihoods, Resilience and Vulnerability framework (PD-SLRV was developed for the purposes of analyzing, evaluating and monitoring disaster recovery using the concepts of vulnerability, resilience and sustainable livelihoods.Using the 2006 Yogyakarta, Indonesia earthquake as a case study, this paper will explore how the concepts of vulnerability, resilience and sustainable livelihoods inform the disaster recovery process, the nature of the relationship between these concepts as well as their usefulness in evaluating disaster recovery efforts. Through a detailed analysis of the various vulnerabilities and resiliencies that exist within recovering communities, the complex and dynamic nature of resilience and vulnerability is revealed, indicating a multifaceted relationship dependent on scale, context and place.
Vestergaard-Poulsen, P; Thomsen, C; Nørregaard, J
OBJECTIVE. To investigate whether patients with fibromyalgia (FM) have normal motor unit recruitment in relation to muscle metabolism during exhausting exercise and recovery, and whether the reduced voluntary muscle force normally seen is related to a smaller muscle size. METHODS. Female patients...
Miles, Anna; McLellan, Naomi; Machan, Rochelle; Vokes, David; Hunting, Alexandra; McFarlane, Mary; Holmes, Jennifer; Lynn, Kelly
Cardiothoracic surgery is known to result in dysphagia and laryngeal injury. While prevalence has been explored, extent, trajectory and longevity of symptoms are poorly understood. This retrospective, observational study explored dysphagia and laryngeal injury in patients following cardiothoracic surgery referred for instrumental swallowing assessment. Clinical notes and endoscopic recordings of 106 patients (age range 18-87yrs; mean 63yrs; SD 15yrs) (including 190 endoscopes) at one large tertiary centre were reviewed by two speech-language pathologists and a laryngologist. Standardized measures of laryngeal anatomy and physiology, New Zealand Secretion Scale, Penetration-Aspiration scale and Yale Residue Scale were rated. Prevalence of abnormality included 39% silent aspiration, 65% laryngeal edema and 61% vocal paralysis. The incidence of pneumonia was 36% with a post-operative stroke rate of 14%. Forty percent of patients were receiving a standard diet by discharge from acute care; while, 24% continued to require enteral feeding and 8% received laryngeal surgery within twelve months of discharge. Vocal fold motion impairment was significantly associated with ventilation time and tracheostomy tube duration (pdysphagia and laryngeal injury in patients following cardiothoracic surgery may allow early management and prevention of secondary complications. Copyright © 2018 Elsevier Inc. All rights reserved.
Shin, Teo Jeon; Noh, Gyu-Jeong; Koo, Yong-Seo
Purpose Mentally disabled patients show different recovery profiles compared to normal patients after general anesthesia. However, the relationship of dose-recovery profiles of mentally disabled patients has never been compared to that of normal patients. Materials and Methods Twenty patients (10 mentally disabled patients and 10 mentally intact patients) scheduled to dental surgery under general anesthesia was recruited. Sevoflurane was administered to maintain anesthesia during dental treatment. At the end of the surgery, sevoflurane was discontinued. End-tidal sevoflurane and recovery of consciousness (ROC) were recorded after sevoflurane discontinuation. The pharmacodynamic relation between the probability of ROC and end-tidal sevoflurane concentration was analyzed using NONMEM software (version VII). Results End-tidal sevoflurane concentration associated with 50% probability of ROC (C50) and γ value were lower in the mentally disabled patients (C50=0.37 vol %, γ=16.5 in mentally intact patients, C50=0.19 vol %, γ=4.58 in mentally disabled patients). Mentality was a significant covariate of C50 for ROC and γ value to pharmacodynamic model. Conclusion A sigmoid Emanx model explains the pharmacodynamic relationship between end-tidal sevoflurane concentration and ROC. Mentally disabled patients may recover slower from anesthesia at lower sevoflurane concentration at ROC an compared to normal patients. PMID:25323901
Gao, Yinqiu; Zhou, Xinyao; Dong, Xichen; Jia, Qing; Xie, Shen; Pang, Ran
Purpose. To determine the efficacy of electroacupuncture on recovering postanesthetic bladder function. Materials and Methods. Sixty-one patients undergoing spinal anaesthesia were recruited and allocated into electroacupuncture or control group randomly. Patients in electroacupuncture group received electroacupuncture therapy whereas ones in control group were not given any intervention. Primary endpoint was incidence of bladder overdistension and postoperative urinary retention. Secondary ...
Bonios, Michael J; Koliopoulou, Antigone; Wever-Pinzon, Omar; Taleb, Iosif; Stehlik, Josef; Xu, Weining; Wever-Pinzon, James; Catino, Anna; Kfoury, Abdallah G; Horne, Benjamin D; Nativi-Nicolau, Jose; Adamopoulos, Stamatis N; Fang, James C; Selzman, Craig H; Bax, Jeroen J; Drakos, Stavros G
Impaired qualitative and quantitative left ventricular (LV) rotational mechanics predict cardiac remodeling progression and prognosis after myocardial infarction. We investigated whether cardiac rotational mechanics can predict cardiac recovery in chronic advanced cardiomyopathy patients. Sixty-three patients with advanced and chronic dilated cardiomyopathy undergoing implantation of LV assist device (LVAD) were prospectively investigated using speckle tracking echocardiography. Acute heart failure patients were prospectively excluded. We evaluated LV rotational mechanics (apical and basal LV twist, LV torsion) and deformational mechanics (circumferential and longitudinal strain) before LVAD implantation. Cardiac recovery post-LVAD implantation was defined as (1) final resulting LV ejection fraction ≥40%, (2) relative LV ejection fraction increase ≥50%, (iii) relative LV end-systolic volume decrease ≥50% (all 3 required). Twelve patients fulfilled the criteria for cardiac recovery (Rec Group). The Rec Group had significantly less impaired pre-LVAD peak LV torsion compared with the Non-Rec Group. Notably, both groups had similarly reduced pre-LVAD LV ejection fraction. By receiver operating characteristic curve analysis, pre-LVAD peak LV torsion of 0.35 degrees/cm had a 92% sensitivity and a 73% specificity in predicting cardiac recovery. Peak LV torsion before LVAD implantation was found to be an independent predictor of cardiac recovery after LVAD implantation (odds ratio, 0.65 per 0.1 degrees/cm [0.49-0.87]; P =0.014). LV rotational mechanics seem to be useful in selecting patients prone to cardiac recovery after mechanical unloading induced by LVADs. Future studies should investigate the utility of these markers in predicting durable cardiac recovery after the explantation of the cardiac assist device. © 2018 American Heart Association, Inc.
Douwe P. Bergsma
Full Text Available Whether rehabilitation after stroke profits from an early start is difficult to establish as the contributions of spontaneous recovery and treatment are difficult to tease apart. Here, we use a novel training design to dissociate these components for visual rehabilitation of subacute stroke patients with visual field defects such as hemianopia. Visual discrimination training was started within 6 weeks after stroke in 17 patients. Spontaneous and training-induced recoveries were distinguished by training one-half of the defect for 8 weeks, while monitoring spontaneous recovery in the other (control half of the defect. Next, trained and control regions were swapped, and training continued for another 8 weeks. The same paradigm was also applied to seven chronic patients for whom spontaneous recovery can be excluded and changes in the control half of the defect point to a spillover effect of training. In both groups, field stability was assessed during a no-intervention period. Defect reduction was significantly greater in the trained part of the defect than in the simultaneously untrained part of the defect irrespective of training onset (p = 0.001. In subacute patients, training contributed about twice as much to their defect reduction as the spontaneous recovery. Goal Attainment Scores were significantly and positively correlated with the total defect reduction (p = 0.01, percentage increase reading speed was significantly and positively correlated with the defect reduction induced by training (epoch 1: p = 0.0044; epoch 2: p = 0.023. Visual training adds significantly to the spontaneous recovery of visual field defects, both during training in the early and the chronic stroke phase. However, field recovery as a result of training in this subacute phase was as large as in the chronic phase. This suggests that patients benefited primarily of early onset training by gaining access to a larger visual field sooner.
Bazzi, Wassim M; Chen, Ling Y; Cordon, Billy H; Mashni, Joseph; Sjoberg, Daniel D; Bernstein, Melanie; Russo, Paul
To explore the association of non-neoplastic parenchymal changes (nNPC) with patients' health and renal function recovery after partial nephrectomy (PN). This retrospective review identified 800 pT1a patients who underwent PN at Memorial Sloan Kettering Cancer Center from 2007 to 2012. Pathology reports were reviewed for nNPC graded as mild or severe: vascular sclerosis (VS), glomerulosclerosis (GS), and fibrosis/scarring. Correlations between nNPC and known preoperative predictors of renal function [age, sex, African-American race, estimated glomerular filtration rate (eGFR), American Society of Anesthesiologists (ASA) score, body mass index, coronary artery disease, and hypertension (HTN)] were assessed using Spearman's rank correlation (ρ). Multivariable linear regression, adjusted for the described known preoperative risk predictors, was performed to evaluate whether the parenchymal features were able to predict 6-month postoperative eGFR. In this study, 46 % of tumors had benign surrounding parenchyma. We noted statistically significant yet weak associations of VS with age (ρ = 0.19; p < 0.001), ASA (ρ = 0.09; p < 0.001), preoperative eGFR (ρ = -0.14; p < 0.001), and HTN (ρ = 0.14; p < 0.001). GS also significantly correlated with HTN, but the correlation was again small (ρ = 0.12; p < 0.001). After adjusting for known risk predictors, only GS was a significant predictor of 6-month postoperative eGFR. When compared with no GS, mild and severe GS were negatively associated with a decrease of 4.9 and 10.8 mL/min/1.73 m(2) in 6-month postoperative eGFR, respectively. Presence of VS and GS correlated with patients' baseline health, and presence of GS predicted postoperative renal function recovery.
Jabbary Moghaddam, Morteza; Ommi, Davood; Mirkheshti, Alireza; Dabbagh, Ali; Memary, Elham; Sadeghi, Afsaneh; Yaseri, Mehdi
Opium is a highly addictive agent and the most common narcotic often misused in Iran. The pharmacokinetic of anesthetic drugs in patients with opium addiction is one of the great challenges for anesthesiologists. Hemodynamic instability and postoperative side effects are of these challenges which should be managed correctly. In this study we aimed to assess the effects of clonidine upon post anesthesia shivering and recovery time in patients with and without opium addiction after general anesthesia to decrease the subsequent complications related to the shivering and elongation of recovery time. In a randomized clinical trial, 160 patients candidates for elective leg fracture operations under general anesthesia were studied in four groups of 40 patients: Group 1 (placebo 1) were patients without addiction who got placebo 90 minutes before the operation. Group 2 (placebo 2) were patients with opium addiction which received placebo as group 1. Group 3 (Clonidine 1) patients without addiction who got clonidine 90 minutes before the operation and group 4 (Clonidine 2) who were opium addicted ones which received clonidine as premedication. None of the patients with and without addiction in clonidine groups had shivering after the operation but in placebo groups shivering was observed and the difference between clonidine and placebo groups was statistically significant (P opium addicted than non-addicted patients (P = 0.04). Premedication with clonidine in patients with and without opium addiction can be effective to decrease the incidence of shivering and recovery time after operation.
Toft, Søren; Nielsen, Søren Achim
Restoration of fat stores is metabolic first priority for many insects that emerge from hibernation with depleted fat bodies. To some extent, the animals must be flexible and use whatever foods available irrespective of their nutrient composition. Previously, the carabid beetles Anchomenus dorsalis have been found to refill their fat stores to the same extent over 9 days irrespective of the nutrient composition of their food. However, a higher cost of fat deposition when the food was rich in sugar or protein rather than lipid was indicated by higher total energy consumption. Here, we test the hypothesis of increased metabolic costs of building fat stores from sugar- or protein-rich food than from lipid-rich food by microcalorimetry. We measured the heat emitted from beetles that had fed on sugar-, protein-, or lipid-rich food for 0 (common control), 2, 5, or 10 days. As predicted, heat emission was increased in beetles getting sugar- and protein-rich food compared with those getting lipid-rich food. However, we did not confirm the beetles' ability to rebuild fat stores from protein-rich food; instead, they increased in lean mass. Overall, sugar-rich food seems to be optimal for post-winter recovery, because it is better than lipid-rich food that allows concurrent rebuilding of fat stores and lean mass, which may benefit preparation for spring migration and reproduction. We propose that overwintered fruits may be highly preferred post-diapause food for these otherwise mostly carnivorous beetles.
Haller, Chiara S
This study examines the influence of the personality of relatives on the trajectories of recovery of patients with severe traumatic brain injury (TBI). The present subsample (N = 376) of a larger population-based, prospective, 12-month multicenter cohort study in Switzerland (2007-2011) consists of patients with severe TBI (age ≥ 16) and their relatives. The predictors are the NEO Five-Factor Inventory and time (trajectory of functioning of the patient over time). The outcomes are the patients' (a) neurological functioning; (b) reported emotional, interpersonal, cognitive, and total functioning post-injury; and (c) health-related quality of life (HRQoL). The covariates included Abbreviated Injury Scale score of the head region and age. Results for patients > 50 are (a) relatives' Extraversion influenced patients' total, interpersonal, and cognitive functioning; (b) relatives' Agreeableness influenced patients' interpersonal functioning; and (c) relatives' Conscientiousness influenced patients' physical HRQoL (ps personality traits of the relative covary with the functioning of the patient, and psychological adaptation to the loss of function may progress at a later stage after physical health improvements have been achieved. Thus, a biopsychosocial perspective on the rehabilitation process is needed. © 2016 Wiley Periodicals, Inc.
Full Text Available Background: Surgical procedures for tumors of the paranasal sinus, palatal epithelium, minor salivary glands or osteosarcoma of the upper jaw require a partial or total maxillectomy of the upper jaw. When the surgical procedure and/or radiation therapy result in a communication, the solution is necessarily prosthetical, through a palatal obturator that recreates a partition between the oral and nasal cavities. Methods: Authors selected 32 post-oncological patients with the upper maxilla completely edentulous prosthetically rehabilitated with a palatal obturator. Results: No serious complications or adverse reactions were reported during the fabrication of surgical or definitive obturators. All patients stated to benefit the palatal obturator in terms of quality of life. Conclusion: Prosthetic rehabilitation of edentulous maxillectomy with oral communication is a demanding challenge for the prosthodontist. The goals of prosthetic rehabilitation include separation of oral and nasal cavities to allow adequate deglutition and articulation of teeth, restore midfacial soft tissue contour and a satisfactory esthetic outcome. When, for any reason, the patient is not a suitable candidate for an implant-retained overdenture, a total removable prosthesis should ensure the most comfort in terms of swallowing, phonation and aesthetics.
Terhaar, O.A.; Abbas, S.; Thornton, F.J.; Duke, D.; O'Kelly, P.; Abdullah, K.; Varghese, J.C.; Lee, M.J.
AIM: To assess the role of ultrasound (US), magnetic resonance cholangiopancreatography (MRCP) and liver function tests (LFTs) in the evaluation of selected patients presenting with late post-cholecystectomy syndrome (PCS) who were referred for endoscopic retrograde cholangiopancreatography (ERCP) MATERIALS AND METHODS: In a retrospective study a final group of 42 patients with PCS referred for diagnostic ERCP underwent MRCP and abdominal US. ERCP and MRCP images were assessed for bile duct diameters and the presence of strictures and stones. A common bile duct (CBD) diameter of <10 mm was considered normal, whereas ≥10 mm was considered abnormal on US. Findings were correlated to LFTs with contingency table results performed for single techniques and combination of methods. RESULTS: In total 14 stones and one stricture were seen. US had a high negative predictive value (86.4%). MRCP had a sensitivity of 100% and specificity of 88.0%. ERCP is the most accurate test but failed in 11 patients, five of whom had a stone. The accuracy of US and LFTs increases to 93.8% if test results agree in either negative or positive outcome. CONCLUSION: US and LFTs are first-line tests in PCS. If the CBD on US is ≥10 mm, but no cause is identified, MRCP should be performed. If US and LFTs are normal then MRCP is not necessary. The availability of LFTs raises the diagnostic value of imaging
Katzman, Martin A; Habert, Jeffrey; McIntosh, Diane; MacQueen, Glenda M; Milev, Roumen V; McIntyre, Roger S; Blier, Pierre
Abstract Major depressive disorder is an often chronic and recurring illness. Left untreated, major depressive disorder may result in progressive alterations in brain morphometry and circuit function. Recent findings, however, suggest that pharmacotherapy may halt and possibly reverse those effects. These findings, together with evidence that a delay in treatment is associated with poorer clinical outcomes, underscore the urgency of rapidly treating depression to full recovery. Early optimized treatment, using measurement-based care and customizing treatment to the individual patient, may afford the best possible outcomes for each patient. The aim of this article is to present recommendations for using a patient-centered approach to rapidly provide optimal pharmacological treatment to patients with major depressive disorder. Offering major depressive disorder treatment determined by individual patient characteristics (e.g., predominant symptoms, medical history, comorbidities), patient preferences and expectations, and, critically, their own definition of wellness provides the best opportunity for full functional recovery. PMID:29024974
Hansen, P.V.; Trykker, H.; Svennkjaer, I.L.; Hvolby, J.
Gonadal function was evaluated before irradiation and by serial analyses after treatment in 27 patients with seminomas and 24 patients with nonseminomatous germ cell tumors of the testis. During subdiaphragmatic irradiation, a median testicular dose of 1.7 reached the remaining testis. Twenty nonseminoma patients were treated with adjuvant chemotherapy. After orchiectomy, 94% had spermatozoa in semen, 49% had a total sperm count exceeding the reference value, and in 67% serum follicle-stimulating hormone levels were normal. The corresponding estimated values 5 and 9 years after treatment were 61%, 13%, 14%, and 84%, 35%, 32%, respectively. A Cox regression analysis of recovery, with azoospermia used as an endpoint, showed that (1) recovery depended on the radiation dose, (2) adjuvant chemotherapy prolonged the recovery period, (3) recovery was decreased in patients with low pretreatment total sperm counts and in patients older than 25 years. A prognostic index was derived from the regression model and radiation dose-response curves were calculated. The authors conlude that a profound, dose-dependent impairment of spermatogenesis is caused by raiation scatter reaching the testis during subdiaphragmal irradiation. An effective gonadal shield should reduce the gonadal dose to a level low enough to preverse spermatogenesis in most patients. (authors). 36 refs.; 4 figs.; 3 tabs
Hansen, P V; Trykker, H; Svennekjaer, I L; Hvolby, J
Gonadal function was evaluated before irradiation and by serial analyses after treatment in 27 patients with seminomas and 24 patients with nonseminomatous germ cell tumors of the testis. During subdiaphragmatic irradiation, a median testicular dose of 1.7 Gy (range, 1.2 to 4.8 Gy) reached the remaining testis. Twenty nonseminoma patients were treated with adjuvant chemotherapy using vincristine and bleomycin (OB) or cisplatin/dactinomycin, vinblastine, and bleomycin (P/DVB). After orchiectomy, 94% had spermatozoa in semen, 49% had a total sperm count exceeding the reference value (80 x 10(6], and in 67% serum follicle-stimulating hormone levels were normal. The corresponding estimated values 5 and 9 years after treatment were 61%, 13%, 14%, and 84%, 35%, 32%, respectively. A Cox regression analysis of recovery, with azoospermia used as an endpoint, showed that (1) recovery depended on the radiation dose, (2) adjuvant chemotherapy prolonged the recovery period, (3) recovery was decreased in patients with low pretreatment total sperm counts and in patients older than 25 years. A prognostic index was derived from the regression model and radiation dose-response curves were calculated (+/- chemotherapy). We conclude that a profound, dose-dependent impairment of spermatogenesis is caused by radiation scatter reaching the testis during subdiaphragmal irradiation. An effective gonadal shield should reduce the gonadal dose to a level low enough to preserve spermatogenesis in most patients.
Iglesias, Jose; Frank, Elliot; Mehandru, Sushil; Davis, John M; Levine, Jerrold S
Background Renal dysfunction occurs commonly in patients awaiting orthotopic liver transplantation (OLT) for end-stage liver disease. The use of simultaneous liver-kidney transplantation has increased in the MELD scoring era. As patients may recover renal function after OLT, identifying factors predictive of renal recovery is a critical issue, especially given the scarcity of available organs. Methods Employing the UNOS database, we sought to identify donor- and patient-related predictors of ...
Peschek, Katelyn; Pritchett, Robert; Bergman, Ethan; Pritchett, Kelly
Dietary flavanols have been associated with reduced oxidative stress, however their efficacy in promoting recovery after exercise induced muscle damage is unclear. This study examined the effectiveness of acute consumption of cocoa-flavanols on indices of muscle recovery including: subsequent exercise performance, creatine kinase, muscle tenderness, force, and self-perceived muscle soreness. Eight endurance-trained athletes (VO2max 64.4 ± 7.6 mL/kg/min) completed a downhill running protocol to induce muscle soreness, and 48-h later completed a 5-K (kilometer) time trial. Muscle recovery measurements were taken at PRE, 24 h-POST, 48 h-POST, and POST-5K. Participants consumed 1.0 g of carbohydrate per kilogram of body weight of a randomly assigned beverage (CHOC: 0 mg flavanols vs. CocoaCHOC: 350 mg flavanols per serving) immediately after the downhill run and again 2 h later. The same protocol was repeated three weeks later with the other beverage. An ANOVA revealed no significant difference (p = 0.97) between trials for 5 K completion time (CHOC 1198.3 ± 160.6 s, CocoaCHOC 1195.5 ± 148.8 s). No significant difference was found for creatine kinase (CK) levels (p = 0.31), or muscle soreness (p = 0.21) between groups over time. These findings suggest that the acute addition of cocoa flavanols to low-fat chocolate milk offer no additional recovery benefits. PMID:24362706
Full Text Available Dietary flavanols have been associated with reduced oxidative stress, however their efficacy in promoting recovery after exercise induced muscle damage is unclear. This study examined the effectiveness of acute consumption of cocoa-flavanols on indices of muscle recovery including: subsequent exercise performance, creatine kinase, muscle tenderness, force, and self-perceived muscle soreness. Eight endurance-trained athletes (VO2max 64.4 ± 7.6 mL/kg/min completed a downhill running protocol to induce muscle soreness, and 48-h later completed a 5-K (kilometer time trial. Muscle recovery measurements were taken at PRE, 24 h-POST, 48 h-POST, and POST-5K. Participants consumed 1.0 g of carbohydrate per kilogram of body weight of a randomly assigned beverage (CHOC: 0 mg flavanols vs. CocoaCHOC: 350 mg flavanols per serving immediately after the downhill run and again 2 h later. The same protocol was repeated three weeks later with the other beverage. An ANOVA revealed no significant difference (p = 0.97 between trials for 5 K completion time (CHOC 1198.3 ± 160.6 s, CocoaCHOC 1195.5 ± 148.8 s. No significant difference was found for creatine kinase (CK levels (p = 0.31, or muscle soreness (p = 0.21 between groups over time. These findings suggest that the acute addition of cocoa flavanols to low-fat chocolate milk offer no additional recovery benefits.
Full Text Available ABSTRACT Post-polio syndrome (PPS is a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus. Most often, polio survivors experience a gradual new weakening in muscles that were previously affected by the polio infection. The actual incidence of cardiovascular diseases (CVDs in individuals suffering from PPS is not known. However, there is a reason to suspect that individuals with PPS might be at increased risk. Method A search for papers was made in the databases Bireme, Scielo and Pubmed with the following keywords: post polio syndrome, cardiorespiratory and rehabilitation in English, French and Spanish languages. Although we targeted only seek current studies on the topic in question, only the relevant (double-blind, randomized-controlled and consensus articles were considered. Results and Discussion Certain features of PPS such as generalized fatigue, generalized and specific muscle weakness, joint and/or muscle pain may result in physical inactivity deconditioning obesity and dyslipidemia. Respiratory difficulties are common and may result in hypoxemia. Conclusion Only when evaluated and treated promptly, somE patients can obtain the full benefits of the use of respiratory muscles aids as far as quality of life is concerned.
Dias, Alexandre Torchio; Zanardo, Évelin Aline; Dutra, Roberta Lelis; Piazzon, Flavia Balbo; Novo-Filho, Gil Monteiro; Montenegro, Marilia Moreira; Nascimento, Amom Mendes; Rocha, Mariana; Madia, Fabricia Andreia Rosa; Costa, Thais Virgínia Moura Machado; Milani, Cintia; Schultz, Regina; Gonçalves, Fernanda Toledo; Fridman, Cintia; Yamamoto, Guilherme Lopes; Bertola, Débora Romeo; Kim, Chong Ae; Kulikowski, Leslie Domenici
Congenital anomalies are the second highest cause of infant deaths, and, in most cases, diagnosis is a challenge. In this study, we characterize patterns of DNA copy number aberrations in different samples of post-mortem tissues from patients with congenital malformations. Twenty-eight patients undergoing autopsy were cytogenomically evaluated using several methods, specifically, Multiplex Ligation-dependent Probe Amplification (MLPA), microsatellite marker analysis with a MiniFiler kit, FISH, a cytogenomic array technique and bidirectional Sanger sequencing, which were performed on samples of different tissues (brain, heart, liver, skin and diaphragm) preserved in RNAlater, in formaldehyde or by paraffin-embedding. The results identified 13 patients with pathogenic copy number variations (CNVs). Of these, eight presented aneuploidies involving chromosomes 13, 18, 21, X and Y (two presented inter- and intra-tissue mosaicism). In addition, other abnormalities were found, including duplication of the TYMS gene (18p11.32); deletion of the CHL1 gene (3p26.3); deletion of the HIC1 gene (17p13.3); and deletion of the TOM1L2 gene (17p11.2). One patient had a pathogenic missense mutation of g.8535C>G (c.746C>G) in exon 7 of the FGFR3 gene consistent with Thanatophoric Dysplasia type I. Cytogenomic techniques were reliable for the analysis of autopsy material and allowed the identification of inter- and intra-tissue mosaicism and a better understanding of the pathogenesis of congenital malformations. Copyright © 2016 Elsevier Inc. All rights reserved.
Wong, Jennifer S.; Brooks, Dina; Inness, Elizabeth L.; Mansfield, Avril
Background Falls are common among community-dwelling stroke survivors. The aim of this study was to (1) compare motor and cognitive outcomes between individuals who fell in the six months post-discharge from in-patient stroke rehabilitation and those who did not fall, and (2) explore potential mechanisms underlying the relationship between falls and recovery of motor and cognitive function. Methods Secondary analysis of a prospective cohort study of individuals discharged home from in-patient rehabilitation was conducted. Participants were recruited at discharge and completed a six-month falls monitoring period using postcards with follow-up. Non-fallers and fallers were compared at the six-month follow-up assessment on the Berg Balance Scale (BBS), Chedoke-McMaster Stroke Assessment (CMSA), gait speed, and Montreal Cognitive Assessment (MoCA). Measures of balance confidence and physical activity were also assessed. Results 23 fallers were matched to 23 non-fallers on age and functional balance scores at discharge. A total of 43 falls were reported during the study period (8 participants fell more than once). At follow-up, BBS scores (p=0.0066) and CMSA foot scores (p=0.0033) were significantly lower for fallers than non-fallers. The two groups did not differ on CMSA leg scores (p=0.049), gait speed (p=0.47) or MoCA (p=0.23). There was no significant association between change in balance confidence scores and change in physical activity levels among all participants from the first and third questionnaire (r=0.27, p=0.08). Conclusions Performance in balance and motor recovery of the foot were compromised in fallers when compared to non-fallers at six months post-discharge from in-patient stroke rehabilitation. PMID:27062418
Antti M Kiviniemi
Full Text Available We tested the hypothesis that acute post-exercise change in blood pressure (BP may predict exercise training responses in BP in patients with coronary artery disease (CAD. Patients with CAD (n=116, age 62±5 years, 85 men underwent BP assessments at rest and during 10-min recovery following a symptom-limited exercise test before and after the 6-month training intervention (one strength and 3-4 aerobic moderate-intensity exercises weekly. Post-exercise change in systolic BP (SBP was calculated by subtracting resting SBP from lowest post-exercise SBP. The training-induced change in resting SBP was -2±13 mmHg (p=0.064, ranging from -42 to 35 mmHg. Larger post-exercise decrease in SBP and baseline resting SBP predicted a larger training-induced decrement in SBP (β=0.46 and β=-0.44, respectively, p<0.001 for both. Acute post-exercise decrease in SBP provided additive value to baseline resting SBP in the prediction of training-induced change in resting SBP (R squared from 0.20 to 0.26, p=0.002. After further adjustments for other potential confounders (sex, age, baseline body mass index, realized training load, post-exercise decrease in SBP still predicted the training response in resting SBP (β=0.26, p=0.015. Acute post-exercise change in SBP was associated with training-induced change in resting SBP in patients with CAD, providing significant predictive information beyond baseline resting SBP.
Manolescu, Bogdan Nicolae; Berteanu, Mihai; Dumitru, Luminița; Dinu, Horațiu; Iliescu, Alina; Fărcășanu, Ileana Cornelia; Oprea, Eliza; Vlădoiu, Suzana; Popa, Oana; Ianăș, Olga
Stroke is a pathological condition associated with an enhanced inflammatory response that has a multifactorial etiology. We evaluated the dynamic of plasma concentrations of IL-1α, IL-6, IL-8, TNF-α, soluble form of intercellular adhesion molecule 1, and lipoprotein (a) [Lp(a)] during the rehabilitation of post-acute stroke patients (n = 20), in parallel with control subjects (n = 24). Stroke patients had significantly increased concentrations of IL-6, TNF-α, and Lp(a) when compared to healthy controls. It was found that the changes in the IL-6, IL-8, and TNF-α concentrations associated with the pathological condition were statistically significant (χ2 = 4.81, p = 0.028, χ2 = 10.40, p = 0.005 and χ2 = 6.73, p = 0.034, respectively). The decrease of Lp(a) during the rehabilitation had statistical significance (p = 0.043), while the decrease of IL-1α had marginal significance (p = 0.071). IL-1α, TNF-α, and Lp(a) concentrations were significantly negatively correlated with the Barthel index values, suggesting that the decrease of these inflammatory markers was beneficial for patients' recovery.
Fagundes, Christopher P; Shi, Qiuling; Vaporciyan, Ara A; Rice, David C; Popat, Keyuri U; Cleeland, Charles S; Wang, Xin Shelley
Measuring patient-reported outcomes (PROs) has become increasingly important for assessing quality of care and guiding patient management. However, PROs have yet to be integrated with traditional clinical outcomes (such as length of hospital stay), to evaluate perioperative care. This study aimed to use longitudinal PRO assessments to define the postoperative symptom recovery trajectory in patients undergoing thoracic surgery for lung cancer. Newly diagnosed patients (N = 60) with stage I or II non-small cell lung cancer who underwent either standard open thoracotomy or video-assisted thoracoscopic surgery lobectomy reported multiple symptoms from before surgery to 3 months after surgery, using the MD Anderson Symptom Inventory. We conducted Kaplan-Meier analyses to determine when symptoms returned to presurgical levels and to mild-severity levels during recovery. The most-severe postoperative symptoms were fatigue, pain, shortness of breath, disturbed sleep, and drowsiness. The median time to return to mild symptom severity for these 5 symptoms was shorter than the time to return to baseline severity, with fatigue taking longer. Recovery from pain occurred more quickly for patients who underwent lobectomy versus thoracotomy (8 vs 18 days, respectively; P = .022). Patients who had poor preoperative performance status or comorbidities reported higher postoperative pain (all P < .05). Assessing symptoms from the patient's perspective throughout the postoperative recovery period is an effective strategy for evaluating perioperative care. This study demonstrates that the MD Anderson Symptom Inventory is a sensitive tool for detecting symptomatic recovery, with an expected relationship among surgery type, preoperative performance status, and comorbid conditions. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
McCully, Belinda H; Connelly, Christopher R; Fair, Kelly A; Holcomb, John B; Fox, Erin E; Wade, Charles E; Bulger, Eileen M; Schreiber, Martin A
Altered coagulation function after trauma can contribute to development of venous thromboembolism (VTE). Severe trauma impairs coagulation function, but the trajectory for recovery is not known. We hypothesized that enhanced, early recovery of coagulation function increases VTE risk in severely injured trauma patients. Secondary analysis was performed on data from the Pragmatic Randomized Optimal Platelet and Plasma Ratio (PROPPR) trial, excluding patients who died within 24 hours or were on pre-injury anticoagulants. Patient characteristics, adverse outcomes, and parameters of platelet function and coagulation (thromboelastography) were compared from admission to 72 hours between VTE (n = 83) and non-VTE (n = 475) patients. A p value value (48 vs 24 hours), α-angle (no recovery), maximum amplitude (24 vs 12 hours), and clot lysis at 30 minutes (48 vs 12 hours). Platelet function recovery mediated by arachidonic acid (72 vs 4 hours), ADP (72 vs 12 hours), and collagen (48 vs 12 hours) was delayed in VTE patients. The VTE patients had lower mortality (4% vs 13%; p < 0.05), but fewer hospital-free days (0 days [interquartile range 0 to 8 days] vs 10 days [interquartile range 0 to 20 days]; p < 0.05) and higher complication rates (p < 0.05). Recovery from platelet dysfunction and coagulopathy after severe trauma were delayed in VTE patients. Suppressed clot lysis and compensatory mechanisms associated with altered coagulation that can potentiate VTE formation require additional investigation. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Planas, Jacques; Celma, Ana; Placer, José; Cuadras, Mercè; Regis, Lucas; Gasanz, Carlos; Trilla, Enrique; Salvador, Carlos; Lorente, David; Morote, Juan
The aim of this study was to evaluate hormonal recovery after cessation of androgen deprivation therapy (ADT) in a group of elderly prostate cancer patients. Forty patients with locally advanced or metastatic prostate cancer, with a mean age of 71.5 years [95% confidence interval (CI) 69.1-73.9], were treated with ADT for a mean duration of 74.6 months (95% CI 59.7-89.5 months). Mean follow-up time after ADT cessation was 36.5 months (95% CI 30.6-42.3 months). Serum testosterone and luteinizing hormone (LH) were determined at 6 month intervals after ADT cessation. After 18 months of follow-up, all patients had recovered normal LH levels, while 38% of patients still presented castration levels of testosterone (50 ng/dl). Neither age at start of ADT nor clinical stage reached statistical significance. Only time under ADT was correlated with testosterone recovery (p = .031). Kaplan-Meier curves were obtained. Mean time for testosterone recovery was 14.5 months (95% CI 6.5-22.6 months) in patients treated with ADT for less than 60 months compared to 29.3 months (95% CI 19.6-39.1 months) in patients treated with ADT for more than 60 months (log-rank p = .029). Age did not correlate with testosterone recovery in a group of elderly prostate cancer patients in whom ADT was stopped. Testosterone recovery after ADT cessation was significantly correlated with time under ADT treatment. Significant implications related to economic aspects of the dosage schedule may be considered.
Grande, Gesine; Romppel, Matthias
: While cardiac rehabilitation has been established as an essential part of comprehensive cardiac care, participation rates for female patients are substantially lower than for male patients. Lower referral rates and higher ages of female patients partly explain this underutilization. Gender differences in recovery goals of cardiac patients have not been examined. : Five hundred ninety patients (22.2% women) admitted to the hospital because of an acute myocardial infarction answered a questionnaire regarding 24 goals in 5 domains of recovery (physical functioning, risk-factor modification, psychological well-being, independence in daily life, and return to work). In addition, psychological symptoms and medical data were assessed. Gender differences were tested by using χ and Student t tests, as well as multivariate logistic and linear regression models. : Gender differences were found in 7 of the 24 recovery goals. After adjustment for psychosocial and clinical characteristics, women still reported a higher importance of "performance of household duties" (odds ratio [OR] = 8.62; 95% confidence interval [CI], 5.43-13.66), "independence in activities of daily living" (OR = 2.38; CI, 1.58-3.59), and "emotional equilibrium" (OR = 1.58, CI, 1.01-2.46). Men rated "physical endurance" and "reducing strain at workplace" as more important goals (OR = 0.64; CI, 0.42-0.97 and OR = 0.39; CI, 0.17-0.93). Except for psychological distress, gender differences in health status were not related to differences in goals. : Gender roles and differences in social-life conditions may have an important influence on the recovery goals of patients after an acute myocardial infarction. Recovery goals should be explored when planning intervention programs for individual patients.
Birmele, Michele N.
The Regenerative, Environmental Control and Life Support System (ECLSS) on the International Space Station (ISS) includes the the Water Recovery System (WRS) and the Oxygen Generation System (OGS). The WRS consists of a Urine Processor Assembly (UPA) and Water Processor Assembly (WPA). This report describes microbial characterization of wastewater and surface samples collected from the WRS and OGS subsystems, returned to KSC, JSC, and MSFC on consecutive shuttle flights (STS-129 and STS-130) in 2009-10. STS-129 returned two filters that contained fluid samples from the WPA Waste Tank Orbital Recovery Unit (ORU), one from the waste tank and the other from the ISS humidity condensate. Direct count by microscopic enumeration revealed 8.38 x 104 cells per mL in the humidity condensate sample, but none of those cells were recoverable on solid agar media. In contrast, 3.32 x lOs cells per mL were measured from a surface swab of the WRS waste tank, including viable bacteria and fungi recovered after S12 days of incubation on solid agar media. Based on rDNA sequencing and phenotypic characterization, a fungus recovered from the filter was determined to be Lecythophora mutabilis. The bacterial isolate was identified by rDNA sequence data to be Methylobacterium radiotolerans. Additional UPA subsystem samples were returned on STS-130 for analysis. Both liquid and solid samples were collected from the Russian urine container (EDV), Distillation Assembly (DA) and Recycle Filter Tank Assembly (RFTA) for post-flight analysis. The bacterium Pseudomonas aeruginosa and fungus Chaetomium brasiliense were isolated from the EDV samples. No viable bacteria or fungi were recovered from RFTA brine samples (N= 6), but multiple samples (N = 11) from the DA and RFTA were found to contain fungal and bacterial cells. Many recovered cells have been identified to genus by rDNA sequencing and carbon source utilization profiling (BiOLOG Gen III). The presence of viable bacteria and fungi from WRS
Chen, Xuexia; Vogelmann, James E.; Rollins, Matt; Ohlen, Donald; Key, Carl H.; Yang, Limin; Huang, Chengquan; Shi, Hua
It is challenging to detect burn severity and vegetation recovery because of the relatively long time period required to capture the ecosystem characteristics. Multitemporal remote sensing data can providemultitemporal observations before, during and after a wildfire, and can improve the change detection accuracy. The goal of this study is to examine the correlations between multitemporal spectral indices and field-observed burn severity, and to provide a practical method to estimate burn severity and vegetation recovery. The study site is the Jasper Fire area in the Black Hills National Forest, South Dakota, that burned during August and September 2000. Six multitemporal Landsat images acquired from 2000 (pre-fire), 2001 (post-fire), 2002, 2003, 2005 and 2007 were used to assess burn severity. The normalized difference vegetation index (NDVI), enhanced vegetation index (EVI), normalized burn ratio (NBR), integrated forest index (IFI) and the differences of these indices between the pre-fire and post-fire years were computed and analysed with 66 field-based composite burn index (CBI) plots collected in 2002. Results showed that differences of NDVI and differences of EVI between the pre-fire year and the first two years post-fire were highly correlated with the CBI scores. The correlations were low beyond the second year post-fire. Differences of NBR had good correlation with CBI scores in all study years. Differences of IFI had low correlation with CBI in the first year post-fire and had good correlation in later years. A CBI map of the burnt area was produced using regression tree models and the multitemporal images. The dynamics of four spectral indices from 2000 to 2007 indicated that both NBR and IFI are valuable for monitoring long-term vegetation recovery. The high burn severity areas had a much slower recovery than the moderate and low burn areas.
Ihsan, Mohammed; Watson, Greig; Abbiss, Chris R
Intense training results in numerous physiological perturbations such as muscle damage, hyperthermia, dehydration and glycogen depletion. Insufficient/untimely restoration of these physiological alterations might result in sub-optimal performance during subsequent training sessions, while chronic imbalance between training stress and recovery might lead to overreaching or overtraining syndrome. The use of post-exercise cold water immersion (CWI) is gaining considerable popularity among athletes to minimize fatigue and accelerate post-exercise recovery. CWI, through its primary ability to decrease tissue temperature and blood flow, is purported to facilitate recovery by ameliorating hyperthermia and subsequent alterations to the central nervous system (CNS), reducing cardiovascular strain, removing accumulated muscle metabolic by-products, attenuating exercise-induced muscle damage (EIMD) and improving autonomic nervous system function. The current review aims to provide a comprehensive and detailed examination of the mechanisms underpinning acute and longer term recovery of exercise performance following post-exercise CWI. Understanding the mechanisms will aid practitioners in the application and optimisation of CWI strategies to suit specific recovery needs and consequently improve athletic performance. Much of the literature indicates that the dominant mechanism by which CWI facilitates short term recovery is via ameliorating hyperthermia and consequently CNS mediated fatigue and by reducing cardiovascular strain. In contrast, there is limited evidence to support that CWI might improve acute recovery by facilitating the removal of muscle metabolites. CWI has been shown to augment parasympathetic reactivation following exercise. While CWI-mediated parasympathetic reactivation seems detrimental to high-intensity exercise performance when performed shortly after, it has been shown to be associated with improved longer term physiological recovery and day to day
Larsen, Anne Bolt
The abstract build on a master thesis submitted to Department of Anthropology, Aarhus University, Denmark. The thesis aims at investigating a new trend in Danish hospitals, where acupuncture increasingly is used in treating post-operative nausea and vomiting (PONV) and pain. It is a novelty...... that patients may receive acupuncture treatment in hospital. No scientific research has been completed to examine patients experience when treated with acupuncture at a modern hospital based on technology and natural science. This study took place in the recovery room at a regional hospital in Denmark, where...... acupuncture during the past 3-4 years has been implemented by nurses as an option for patients with PONV and post-operative pain. The purpose is to analyse the encounter between acupuncture and biomedicine, how patients experience the effect of acupuncture treatment and their view of acupuncture...
Allen, S C; Raut, S
Osteomalacia is not rare in the UK and climatically similar countries, particularly in elderly people and those of Asian descent. Overt clinical osteomalacia is usually treated with a loading dose of vitamin D, followed by a regular supplement. However, little is known of the time taken to reach a stable biochemical state after starting treatment. Such information would shed light on the duration of the bone remineralization phase and guide decisions on the length of follow-up. To address this we conducted a 2-year follow-up study of 42 patients (35 female, mean age 80.8 years) with biopsy proven osteomalacia treated with a standard replacement regimen and general nutritional support. Although normocalcaemia was attained within 4 weeks the mean values continued to rise, to a mid-range plateau at 52 weeks. The phosphate and alkaline phosphatase values also took at least a year to reach a stable mean, with a slight further trend towards the mid-range for the entire 104 weeks. The mean serum albumin also rose throughout the first 52 weeks, indicating an effective response to the general nutritional support measures. Our observations suggest that the dynamic relationship between calcium, phosphate and bone requires at least a year, and probably longer, to reach an equilibrium after treatment for osteomalacia in elderly patients. The findings emphasize the need for close medical and social follow-up in this clinical context. PMID:15520146
Harris, M. S.; Levine, N. S.; Jaume, S. C.; Hendricks, J. K.; Rubin, N. D.; Hernandez, J. L.
The impacts on the Southeastern United States (SEUS, Western Atlantic) from Hurricane Irma in Sept 2017 were felt primarily on the active coastline with the third highest inland storm surge in Charleston and Savannah since the 19th Century. Coastal geometry, waves, and wind duration had a strong influence on the storm surge and coastal erosion impacts regionally. To the North and immediate South, impacts were much less. A full year after the 2016 hurricane season (Hurricane Matthew), the lack of regional recovery reduced protection against Irma. The most devastating impacts of Irma in the SAB occurred from 300 to 500 km away from the eye, on the opposite side of the Floridian peninsula. As Irma devastated the Caribbean, winds started to increases off the SAB on September 8 in the early morning, continuing for the next 3 days and blowing directly towards the SC and GA coasts. Tide gauges started to respond the night of September 8, while waves started arriving in the SEUS around Sept 6. Coastal erosion pre- and post-Irma has been calculated for Central SC using vertical and oblique aerial photos. Citizen Science initiatives through the Charleston Resilience Network have provided on-the-ground data during storms when transportation infrastructures were closed, and allow for ground-truth post-storm of surge and impacts. Said information was collected through Facebook, Google, and other social media. Pictures with timestamps and water heights were collected and are validating inundation flood maps generated for the Charleston SC region. The maps have 1-m horizontal and 7- to 15-cm vertical accuracy. Inundation surfaces were generated at MHHW up to a maximum surge in 6 inch increments. The flood extents of the modeled surge and the photographic evidence show a high correspondence. Storm surge measurements from RTK-GPS provide regional coverage of surge elevations from the coast, inland, and allow for testing of modeled results and model tuning. With Hurricane Irma
Scheenen, Myrthe; de Koning, Myrthe; van der Horn, Harm; van der Naalt, Joukje; Spikman, Jacoba
Objectives. To investigate the incidence of acute alcohol intoxication (AAI) at the time of sustaining mild traumatic brain injury (mTBI), describe the characteristics of this intoxicated subgroup, and evaluate recovery and outcome in comparison to sober mTBI patients. Methods. Multicenter cohort
Koyama, Tetsuo; Matsumoto, Kenji; Okuno, Taiji; Domen, Kazuhisa
To examine the validity and applicability of logarithmic modelling for predicting functional recovery of stroke patients with hemiplegia. Longitudinal postal survey. Stroke patients with hemiplegia staying in a long-term rehabilitation facility, who had been referred from acute medical service 30-60 days after onset. Functional Independence Measure (FIM) scores were periodically assessed during hospitalization. For each individual, a logarithmic formula that was scaled by an interval increase in FIM scores during the initial 2-6 weeks was used for predicting functional recovery. For the study, we recruited 18 patients who showed a wide variety of disability levels on admission (FIM scores 25-107). For each patient, the predicted FIM scores derived from the logarithmic formula matched the actual change in FIM scores. The changes predicted the recovery of motor rather than cognitive functions. Regression analysis showed a close fit between logarithmic modelling and actual FIM scores (across-subject R2 = 0.945). Provided with two initial time-point samplings, logarithmic modelling allows accurate prediction of functional recovery for individuals. Because the modelling is mathematically simple, it can be widely applied in daily clinical practice.
Pawar, Sundeep T; Nath, Soumya S; Ansari, Farrukh
We report a case of hyperglycaemia and ketosis developing in a non-diabetic patient who underwent a neurosurgical procedure under general anaesthesia. A 52-year-old non-diabetic female patient underwent excision of acoustic neuroma under general anaesthesia. Pancreatic function was not disturbed and she received a single dose of dexamethasone (8 mg) and paracetamol (1 g). Delayed recovery from anaesthesia occurred. On investigation, she was found to have hyperglycaemia and ketosis. She was further managed on the line of diabetic ketoacidosis. After 24 hours, when blood glucose had normalised and ketosis abated, she could be weaned from mechanical ventilation and extubated. The patient did not receive any drugs known to cause such a condition. To the best of our knowledge, hyperglycaemia and ketosis developing in a non-diabetic patient causing delayed recovery and extubation is here reported for the first time.
Toussaint, Loren L; Whipple, Mary O; Vincent, Ann
Symptoms of post-traumatic stress disorder are common in fibromyalgia patients. This study compared post-traumatic stress disorder symptoms in fibromyalgia patients and healthy controls and determined whether patient-control differences in post-traumatic stress disorder symptoms mediated differences in mental health. In all, 30 patients and 30 healthy controls completed questionnaires assessing symptoms of post-traumatic stress disorder and mental health. Fibromyalgia patients had greater symptoms of post-traumatic stress disorder and mental health than controls. Patient-control differences in mental health symptoms were fully or partially mediated by differences in post-traumatic stress disorder symptoms. Healthcare providers should understand the role of trauma as management of trauma symptoms may be one strategy for improving mental health.
Nguyen Thanh Danh; Nguyen Kim Luu; Phan Van Dan
CEA serum concentration level of 53 rectal cancer patients was measured at moments pre, post brachytherapy (45 Gy), post surgery one week, 6 months and 12 months. Response to radiation with reduce CEA serum concentration was achieved in 20/53 patients (37,7%), mainly at staging Dukes B, C. Postoperative CEA level of patients significantly decreased, especially in resection group. (author)
van der Wal-Huisman, Hanneke; Dons, Karolien S K; Smilde, Rineke; Heineman, Erik; van Leeuwen, Barbara L
Surgery is an important part of the treatment modalities offered to older patients with cancer. Natural ageing processes lead to deterioration of organ function, making older patients more vulnerable and at risk for experiencing less-favourable outcomes and complications after surgery. Non-pharmaceutical interventions, such as music, may be preferable to medical interventions in older people, who are at risk for adverse effects and drug interactions due to altered physiology and drug metabolism. We aimed to assess the effect of music on postoperative recovery in older patients and to determine the underpinning theoretical models MATERIALS AND METHODS: This systematic review used the databases PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, and Répertoire International de Littérature Musicale (RILM). Clinical studies published, until 2015, investigating music as a single intervention for hospitalised patients postoperative, population mean age 60 years or older were selected. All types of postoperative music interventions, consisting of single or more sessions, which take place at a hospital ward. All patient outcomes were included. The search and screening was performed twice, independently, and seventeen articles were finally selected. Four theoretical models were detected underpinning the effect of music on postoperative recovery. The way the music interventions were shaped, varied strongly. Therefore it remained unclear what is the most effective way of performing the music in the postoperative period. Although evidence is still limited, results do show that music has a positive effect on the recovery of older patients after surgery. Pain and anxiety are reduced, and relaxation, cognitive functioning, and patient satisfaction increase during postoperative recovery. No negative side effects of music as an intervention were found and therefore seems a non-harming and non-invasive intervention. It seems worthwhile to
Wagner, Lis; Carlslund, Anne Mette; Møller, Charlotte
Introduction: The accelerated recovery programme (ARP) is becoming commonplace in surgical specialties and has also been introduced to hysterectomy patients. Diagnostic, prognostic and other clinical indicators are well described. The aim of this article is to relay knowledge about the ARP, through...... of information relay and dialogue between staff and patients/family members. A nursing care ambulatory unit is recommended to support with information for women prior to and following hysterectomy in the ARP....
Full Text Available The incidence and prevalence of cardiovascular disease (CVD are increasing rapidly in developing countries. Most patients with CVD do not respond to medical treatment and have to undergo cardiac surgery. This highly stressful experience results in increased levels of anxiety for patients. The objective of this review was to evaluate the efficacy of massage therapy on postoperative outcomes among patients undergoing cardiac surgery. A comprehensive literature search was made on PubMed-Medline, CINAHL, Science Direct, Scopus, Web of Science and the Cochrane library databases for original research articles published between 2000 and 2015. Original articles that reported the efficacy of massage therapy in patients undergoing cardiac surgery were included. The Cochrane data extraction form was used to extract data. A total of 297 studies were identified in the literature search. However, only seven studies were eligible for analysis. Of the seven studies, six studies demonstrated the effects of massage therapy on improving post-operative outcomes of patients, while one study found no evidence of improvement. Although the methods varied considerably, most of the studies included in this review reported positive results. Therefore, there is some evidence that massage therapy can lead to positive postoperative outcomes. Evidence of the effectiveness of massage therapy in patients undergoing cardiac surgery remains inconclusive. Additional research is needed to provide a strong evidence base for the use of massage therapy to improve post-operative outcomes and recovery among cardiac surgery patients
Southern Californian wildfires can influence climate in a variety of ways, including changes in surface albedo, emission of greenhouse gases and aerosols, and the production of tropospheric ozone. Ecosystem post-fire recovery plays a key role in determining the strength, duration, and relative importance of these climate forcing agents. Southern California's ecosystems vary markedly with topography, creating sharp transitions with elevation, aspect, and slope. Little is known about the ways topography influences ecosystem properties and function, particularly in the context of post-fire recovery. We combined images from the USGS satellite Landsat 5 with flux tower measurements to analyze pre- and post-fire albedo and carbon exchanged by Southern California's ecosystems in the Santa Ana Mountains. We reduced the sources of external variability in Landsat images using several correction methods for topographic and bidirectional effects. We used time series of corrected images to infer the Net Ecosystem Exchange and surface albedo, and calculated the radiative forcing due to CO2 emissions and albedo changes. We analyzed the patterns of recovery and radiative forcing on north- and south-facing slopes, stratified by vegetation classes including grassland, coastal sage scrub, chaparral, and evergreen oak forest. We found that topography strongly influenced post-fire recovery and radiative forcing. Field observations are often limited by the difficulty of collecting ground validation data. Current instrumentation networks do not provide adequate spatial resolution for landscape-level analysis. The deployment of consumer-market technology could reduce the cost of near-surface measurements, allowing the installation of finer-scale instrument networks. We tested the performance of the Microsoft Kinect sensor for measuring vegetation structure. We used Kinect to acquire 3D vegetation point clouds in the field, and used these data to compute plant height, crown diameter, and
Silins, U.; Emelko, M. B.; Bladon, K. D.; Stone, M.; Williams, C.; Martens, A. M.; Wagner, M. J.
Biogeochemical processes reflecting interaction of vegetation and hydrology govern long-term export of nutrients such as nitrogen, phosphorus, and carbon over successional time scales. While management concepts of watershed "recovery" from disturbance back towards pre-disturbance conditions are often considered over much shorter timescales, few studies have directly explored watershed biogeochemical responses to disturbance long enough to directly document the longer-term trajectory of responses to severe land disturbance on nitrogen export. The objectives of this study were to document both the initial magnitude and patterns of longer-term recovery of stream nitrogen after the 2003 Lost Creek wildfire over nine years in front ranges of the Rocky Mountains in south-west Alberta, Canada. The study was conducted in seven instrumented catchments (4-14 km2), including burned, burned and salvage logged, and unburned (reference) conditions since 2004. Total nitrogen (TN) and nitrate (NO3-) concentrations and area-normalized yields were greater and more variable in burned and post-fire salvage logged catchments when compared with unburned catchments. Large initial increases in stream TN and NO3- production 1-3 years after both wildfire and post-fire salvage logging declined strongly to levels similar to, or below that of unburned watersheds 4-6 years after the fire, and continued to decline (although more slowly) 7-9 years after the wildfire. Post-fire salvage logging produced lower impacts on TN and NO3- in streams and these effects declined even more rapidly compared to the effects of wildfire alone. These changes closely corresponded to the early trajectory of establishment and rapid juvenile growth of post-fire regenerating forest vegetation in both catchment groups. While the concept of hydrologic recovery from disturbance is both a practical and meaningful concept for integrated landscape management for protection of forest water resources, the benchmark for
Full Text Available The technique of behaviour management in medical treatment, especially in dental treatment, is needed to eliminate uncooperative children behaviour. The main factor influencing children behaviour is fear of painful that usually related to dental treatment. Children patients who will have their postlabioplasty and palatoplasty stitches removed have more sensitive condition, they cry when the dentist gives treatment. Using general anesthesia is a method to manage uncooperative children behaviour. Inhalational anesthesia is often used in general anesthesia and sevoflurane is a drug of choice. Sevoflurane has low solubility in blood, pleasant odor, nonirritating airway, and has a rapid induction of and recovery from anesthesia. Some researches indicate that sevoflurane gives more calm condition and can be used as a sufficiently ideal induction and maintenance of anesthesia in children. Sevoflurane can therefore made as alternative procedure in the removal of post-labioplasty and palatoplasty stitches.
Forest disturbances around the world have the potential to alter forest type and cover, with impacts on diversity, carbon storage, and landscape composition. These disturbances, especially fire, are common and often large, making ground investigation of forest recovery difficult. Remote sensing offers a means to monitor forest recovery in real time, over the entire landscape. Typically, recovery monitoring via remote sensing consists of measuring vegetation indices (e.g., NDVI) or index-derived metrics, with the assumption that recovery in NDVI (for example) is a meaningful measure of ecosystem recovery. This study tests that assumption using MODIS 16-day imagery from 2000 to 2010 in the area of the Colorado's Routt National Forest Hinman burn (2002) and seedling density counts taken in the same area. Results indicate that NDVI is rarely correlated with forest recovery, and is dominated by annual and perennial forb cover, although topography complicates analysis. Utility of NDVI as a means to delineate areas of recovery or non-recovery are in doubt, as bootstrapped analysis indicates distinguishing power only slightly better than random. NDVI in revegetation analyses should carefully consider the ecology and seasonal patterns of the system in question.
Kikkenborg Berg, Selina; Zwisler, Ann-Dorthe; Pedersen, Birthe D.
Heart valve disease is becoming a public health problem due to increasing life expectancy and new treatment methods. Patients are at risk of developing depression, anxiety or post-traumatic stress disorder after heart valve surgery. To better plan proper care, describing and understanding patients...
Elias, Joëlle; van Dongen, Ivo M; Hoebers, Loes P; Ouweneel, Dagmar M; Claessen, Bimmer E P M; Råmunddal, Truls; Laanmets, Peep; Eriksen, Erlend; van der Schaaf, René J; Ioanes, Dan; Nijveldt, Robin; Tijssen, Jan G; Hirsch, Alexander; Henriques, José P S
The Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) trial did not show a significant benefit of percutaneous coronary intervention (PCI) of the concurrent chronic total occlusion (CTO) in ST-segment elevation myocardial infarction (STEMI) patients on global left ventricular (LV) systolic function. However a possible treatment effect will be most pronounced in the CTO territory. Therefore, we aimed to study the effect of CTO PCI compared to no-CTO PCI on the recovery of regional LV function, particularly in the CTO territory. Using cardiovascular magnetic resonance (CMR) we studied 180 of the 302 EXPLORE patients with serial CMR (baseline and 4 months follow-up). Segmental wall thickening (SWT) was quantified on cine images by an independent core laboratory. Dysfunctional segments were defined as SWT PCI compared to no-CTO PCI (ΔSWT 17 ± 27% vs 11 ± 23%, p = 0.03). This recovery was most pronounced in the dysfunctional but viable segments(TEI PCI compared with no-CTO PCI is associated with a greater recovery of regional systolic function in the CTO territory, especially in the dysfunctional but viable segments. Further research is needed to evaluate the use of CMR in selecting post-STEMI patients for CTO PCI and the effect of regional LV function recovery on clinical outcome. Trialregister.nl NTR1108 , Date registered NTR: 30-okt-2007.
Merrick, D; Sjölund, B H
hospital setting. Demographic data and patient beliefs about recovery recorded on a five-category scale were collected before the program. Pain intensity (VAS), Disability Rating Index (DRI) and life satisfaction (LiSat-11) were collected before, immediately after and one year after the program. Partial....../sports'' improved significantly after rehabilitation (Wilcoxon's test; P=0.0009), and remained improved one year later (P=0.0144). Life satisfaction in the physical and psychological domains increased after the program. A clinically meaningful reduction in pain intensity (10 mm) was reported by 43% of patients...... at the one-year follow-up. This group had significant increases in life satisfaction. Only patients with positive beliefs about recovery before rehabilitation showed a decrease in pain intensity at the one-year follow-up (Plife satisfaction and...
De Luca, Rosaria; Russo, Margherita; Naro, Antonino; Tomasello, Provvidenza; Leonardi, Simona; Santamaria, Floriana; Desireè, Latella; Bramanti, Alessia; Silvestri, Giuseppe; Bramanti, Placido; Calabrò, Rocco Salvatore
Cognitive impairment occurs frequently in post-stroke patients. This study aimed to determine the effects of a virtual reality training (VRT) with BTs-Nirvana (BTsN) on the recovery of cognitive functions in stroke patients, using the Interactive-Semi-Immersive Program (I-SIP). We enrolled 12 subjects (randomly divided into two groups: experimental group (EG); and control group (CG)), who attended the Laboratory of Robotic and Cognitive Rehabilitation of IRCCS Neurolesi of Messina from January to June 2016. The EG underwent a VRT with BTsN, whereas CG received a standard cognitive treatment. Both the groups underwent the same conventional physiotherapy program. Each treatment session lasted 45 minutes and was repeated three times a week for 8 weeks. All the patients were evaluated by a specific clinical-psychometric battery before (T0), immediately (T1), and one month (T2) after the end of the training. At T1, the EG presented a greater improvement in the trunk control test (p = 0.03), the Montreal Cognitive Assessment (p = 0.01), the selective attention assessment scores (p = 0.01), the verbal memory (p = 0.03), and the visuospatial and constructive abilities (p = 0.01), as compared to CG. Moreover, such amelioration persisted at T2 only in the EG. According to these preliminary data, VRT with I-SIP can be considered a useful complementary treatment to potentiate functional recovery, with regard to attention, visual-spatial deficits, and motor function in patients affected by stroke.
Jakobsson, J; Idvall, E; Kumlien, C
Predictors for postoperative recovery after colorectal cancer surgery are usually investigated in relation to length of stay (LoS), readmission, or 30-day morbidity. This study describes patient characteristics and surgery-related factors associated with patient-reported recovery 1 and 6 months after surgery. In total, 153 consecutively included patients who were recovering from colorectal cancer surgery reported their level of recovery using the Postoperative Recovery Profile. Multiple logistic regression analysis was used to calculate associations with recovery, defined as good or poor, divided into five recovery dimensions: physical symptoms, physical functions, psychological, social and activity. Better preoperative health predicted good recovery regarding three dimensions 1 month after surgery. Regarding all dimensions 1 month after surgery, poor recovery was predicted by a poor recovery on the day of discharge within corresponding dimensions. Higher age was associated with good recovery 6 months after surgery, while chemotherapy showed negative associations. Overall, a majority of factors had a negative impact on recovery, but without any obvious relation to one specific dimension or point in time. Those factors were: high Body Mass Index, comorbidity, abdominoperineal resection, loop ileostomy, colostomy and LoS. This study illustrates the complexity of postoperative recovery and a need for individualised follow-up strategies. © 2017 John Wiley & Sons Ltd.
Jang, Sung Ho
We report on a chronic stroke patient who showed motor recovery by improvement of limb-kinetic apraxia (LKA) after undergoing intensive rehabilitation for a period of one month, which was demonstrated by diffusion tensor tractography (DTT) and transcranial magnetic stimulation (TMS). A 50-year-old male patient presented with severe paralysis of the left extremities at the onset of thalamic hemorrhage. At thirty months after onset, the patient exhibited moderate weakness of his left upper and lower extremities. In addition, he exhibited a slow, clumsy, and mutilated movement pattern during grasp-release movements of his left hand. During a one-month period of intensive rehabilitation, which was started at thrity months after onset, the patient showed 22% motor recovery of the left extremities. The slow, clumsy, and mutilated movement pattern of the left hand almost disappeared. DTTs of the corticospinal tract (CST) in both hemispheres originated from the cerebral cortex, including the primary motor cortex, and passed along the known CST pathway. The DTT of the right CST was located anterior to the old hemorrhagic lesion. TMS study performed at thirty and thirty-one months after onset showed normal and similar findings for motor evoked potential in terms of latency and amplitude of the left hand muscle. We think that the motor weakness of the left extremities in this patient was mainly ascribed to LKA and that most of the motor recovery during a one-month period of rehabilitation was attributed to improvement of LKA.
Aquilani, Roberto; Scocchi, Marco; Iadarola, Paolo; Franciscone, Piero; Verri, Manuela; Boschi, Federica; Pasini, Evasio; Viglio, Simona
To determine whether protein supplementation could enhance neurological recovery in subacute patients with ischaemic stroke. Alimentation-independent patients with ischaemic stroke were randomly allocated to either 21 days of protein supplementation (protein-supplemented group; n=20) or to a spontaneous diet only (control group; n=21) in order to investigate the recovery of neurological changes (measured using the National Institute of Health (NIH) Stroke Scale). Tertiary care rehabilitation in Italy. Forty-two patients (27 male and 15 female; 66.4 +/- 11 years) 16 +/-2 days after the acute event. Supplementation with a hyperproteic nutritional formula (10% protein). NIH Stroke Scale and protein intake. At admission to rehabilitation, both groups of patients were homogeneous for demographic, clinical and functional characteristics. After 21 days from the start of the protocol, the NIH Stroke Scale was found to be enhanced in the group with supplemental proteins (-4.4 +/- 1.5 score versus -3 +/- 1.4 of control group; P<0.01). When expressed as difference (triangle up) between baseline and 21 days, the NIH Stroke Scale correlated negatively with change in protein intake (g/day) (r=-0.50, P= 0.001) and positively with change in carbohydrate/protein ratio (r = +0.40, P=0.01) Protein supplementation may enhance neurological recovery in subacute patients with ischaemic stroke.
Assessment of the correlations between gait speed in post-stroke patients and the time from stroke onset, the level of motor control in the paretic lower limb, proprioception, visual field impairment and functional independence
Full Text Available Introduction: Gait recovery is one of the main objectives in the rehabilitation of post-stroke patients. The study aim was to assess the correlations between gait speed in post-stroke hemiparetic patients and the level of motor control in the paretic lower limb, the time from stroke onset, the subjects’ age as well as the impairment of proprioception and visual field.
Byrne, Kelly; Nolan, Aoife; Barnard, John; Tozer, Megan; Harris, David; Sleigh, Jamie
This study aimed to discover whether co-analgesia with tramadol or additional morphine was more effective for patients who still had severe pain despite being given 10 mg intravenous morphine in the post-anesthesia care unit (PACU). All eligible patients were consented and recruited to the trial pre-operatively, but only a small subgroup – whose pain was not successfully controlled (pain score 6/10 or more) after receiving 10 mg of morphine in the PACU—were then randomized to enter the trial and receive, in a double blinded fashion, the analgesic study drug; which consisted of either a further 10 mg of morphine, or 100 mg of tramadol, titrated intravenously to control their pain. The groups were compared as to: the time to readiness for discharge, the patient’s pain scores over time, and the presence of side effects. There was no statistically significant difference in any of the outcomes measured. The time to readiness for discharge from PACU was 119 minutes in the morphine group and 120 minutes in the tramadol group. However in approximately half the cases who entered the trial (i.e., where pain had not been controlled with the pre-enrollment baseline 10 mg of morphine in PACU) neither a further 10 mg of morphine nor 100 mg of tramadol effectively relieved the patient’s pain. We found no difference between additional morphine and co-analgesia with tramadol in this study. Patients who don’t respond to reasonable doses of opioids in PACU are very likely to be unresponsive to further opioids, and other non-opioid analgesic techniques (such as regional anesthesia) should be considered early in this group of patients.
Clonal analysis of L5178Y-S cell populations irradiated with 300 rads of X-rays indicates occurence of cell sublines with considerably prolonged mean doubling times up to 22 h as compared to 10-11 h for control. Subsequent observations of growth of the handicapped sublines derived from single cells showed capability of all more than 100 studied sublines to recover normal proliferative activity. This process of intraclonal recovery required in many cases longer periods of time, corresponding to many tens, sometimes more than 200, generations. Late intraclonal recovery was further analysed by subcloning. It was found that although cytochemically assayed viability of the handicapped sublines was normal, cloning efficiency strongly depended on the stage of the recovery process. The recovery processes occuring in clones isolated from irradiated cell populations were compared with analogous processes occuring in slowly growing sublines isolated from non-irradiated cell cultures. Marked differences in kinetics of these processes show that either they are different in sublines derived from irradiated and non-irradiated cell populations or that the mechanisms of the late intraclonal recovery are affected by radiation. The results presented allow to conclude that gradual post-irradiation recovery of growth depends primarily on formation, in the developing populations, of cells with higher proliferative activities. Possible nature of the recovery processes is discussed in the light of available information on mammalian somatic cell variants with altered drug or temperature sensitivity, or with nutritional requirements. A sequence is proposed of changes leading from radiation-induced disturbance of the normably existing equilibrium between three basic cell subpopulations to ultimate restoration of this equilibrium. (author)
Bear, Danielle E; Wandrag, Liesl; Merriweather, Judith L; Connolly, Bronwen; Hart, Nicholas; Grocott, Michael P W
The lack of benefit from randomised controlled trials has resulted in significant controversy regarding the role of nutrition during critical illness in terms of long-term recovery and outcome. Although methodological caveats with a failure to adequately appreciate biological mechanisms may explain these disappointing results, it must be acknowledged that nutritional support during early critical illness, when considered alone, may have limited long-term functional impact.This narrative review focuses specifically on recent clinical trials and evaluates the impact of nutrition during critical illness on long-term physical and functional recovery.Specific focus on the trial design and methodological limitations has been considered in detail. Limitations include delivery of caloric and protein targets, patient heterogeneity, short duration of intervention, inappropriate clinical outcomes and a disregard for baseline nutritional status and nutritional intake in the post-ICU period.With survivorship at the forefront of critical care research, it is imperative that nutrition studies carefully consider biological mechanisms and trial design because these factors can strongly influence outcomes, in particular long-term physical and functional outcome. Failure to do so may lead to inconclusive clinical trials and consequent rejection of the potentially beneficial effects of nutrition interventions during critical illness.
Engstrand, Christina; Krevers, Barbro; Kvist, Joanna
Prospective cohort study. The evidence of the relationship between functional recovery and impairment after surgery and hand therapy are inconsistent. To explore factors that were most related to functional recovery as measured by DASH in patients with Dupuytren's disease. Eighty-one patients undergoing surgery and hand therapy were consecutively recruited. Functional recovery was measured by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Explanatory variables: range of motion of the finger joints, five questions regarding safety and social issues of hand function, and health-related quality of life (Euroqol). The three variables "need to take special precautions", "avoid using the hand in social context", and health-related quality of life (EQ-5D index) explained 62.1% of the variance in DASH, where the first variable had the greatest relative effect. Safety and social issues of hand function and quality of life had an evident association with functional recovery. IV. Copyright © 2015 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
Huguelet, Philippe; Guillaume, Sébastien; Vidal, Sonia; Mohr, Sylvia; Courtet, Philippe; Villain, Lucile; Girod, Chloé; Hasler, Roland; Prada, Paco; Olié, Emilie; Perroud, Nader
Recovery is a personal process of growth that involves hope, self-identity, meaning in life and responsibility. Determinants of meaning have not been explored among populations of patients with persistent psychiatric conditions. However, an evidence-based approach aiming at assessing such determinants should provide some insight into the psychotherapeutic aspects of recovery. We tested a model hypothesizing that some symptoms and social parameters of patients are related to values, and secondarily to meaning in life, and in turn that meaning is associated with various parameters, such as depressiveness and self-esteem. We assessed 176 patients with schizophrenia, anorexia, borderline personality disorder and bipolar disorder. Overall, our hypotheses proved correct: firstly, characteristics such as depression, hopelessness, self-esteem and the number of relationships influenced values; secondly, the presence and an enactment of values were associated with meaning, and thirdly, meaning was associated with some symptoms and social characteristics. This model was confirmed in the four psychiatric populations under study. These results support the relevance of addressing values and meaning in the recovery-oriented care of patients with persistent psychiatric disorders, in addition to other psychosocial interventions which are more systematically considered in this area.
Calabrò, Rocco Salvatore; Naro, Antonino; Russo, Margherita; Leo, Antonino; Balletta, Tina; Saccá, Ileana; De Luca, Rosaria; Bramanti, Placido
Tilt-table equipped with the dynamic foot-support (ERIGO) and the functional electric stimulation could be a safe and suitable device for stabilization of vital signs, increasing patient's motivation for further recovery, decreasing the duration of hospitalization, and accelerating the adaptation to vertical posture in bedridden patients with brain-injury. Moreover, it is conceivable that verticalization may improve cognitive functions, and induce plastic changes at sensory motor and vestibular system level that may in turn facilitate motor functional recovery. To test the safety and effectiveness of ERIGO treatment on motor and cognitive functions, cortical plasticity within vestibular and sensory-motor systems in a bedridden post-stroke sample. 20 patients were randomly divided in two groups that performed ERIGO training (30 sessions) (G1) or physiotherapist-assisted verticalization training (same duration) (G2), beyond conventional neurorehabilitation treatment. Motor and cognitive functions as well as sensory-motor and vestibular system plasticity were investigated either before (T0) or after (T1) the rehabilitative protocols. Both the verticalization treatments were well-tolerated. Notably, the G1 patients had a significant improvement in cognitive function (p = 0.03), global motor function (p = 0.006), sensory-motor (p vertical position with a better global function improvement, as also suggested by the sensory-motor and vestibular system plasticity induction.
Shi, Dan-Na; Song, Hang; Ding, Tong; Qiu, Wei-Qiang; Wang, Wei
To evaluate the safety of therapeutic bandage contact lens for post-cataract surgery patients and to illustrate its efficacy on post-operative comfort and tear-film stability. A total of 40 participants were recruited and randomly divided into two groups. Group one was instructed to wear bandage contact lenses for a week and use antibiotic eye drops for a month since the first day after surgery. Group two received sub-conjunctival injection of tobramycin and was asked to wear eye pads on the first day after surgery and then were instructed to use antibiotic eye drops as the first group did. Ocular surface disease index (OSDI) questionnaire, slit-lamp microscope examination of tear break-up time (TBUT), corneal fluorescein score (CFS), tear meniscus height (TMH) together with anterior segment optical coherence tomography (AS-OCT) and corneal topography were evaluated preoperatively and postoperatively. The subjective feeling ( P =0.004), TBUT ( P <0.001) and TMH ( P =0.02) post-surgery had improved in patients who used bandage contact lenses compared with those who did not at 1wk post-surgery. Until three month postoperatively, the comfort degree ( P =0.004) and TMH ( P =0.01) of group two were still worse than group one. Moreover, TBUT ( P <0.001) and CFS ( P =0.004) of the group with eye pads got worse than the results before, whereas the group with bandage contact lenses recovered to normal. None of these patients had infections or other complications. Wearing therapeutic bandage contact lens after cataract surgery, compared with traditional eye-pads, is a safe method to improve tear-film stability and reduce post-operative discomfort without hindering corneal incision recovery.
Full Text Available AIM: To evaluate the safety of therapeutic bandage contact lens for post-cataract surgery patients and to illustrate its efficacy on post-operative comfort and tear-film stability. METHODS: A total of 40 participants were recruited and randomly divided into two groups. Group one was instructed to wear bandage contact lenses for a week and use antibiotic eye drops for a month since the first day after surgery. Group two received sub-conjunctival injection of tobramycin and was asked to wear eye pads on the first day after surgery and then were instructed to use antibiotic eye drops as the first group did. Ocular surface disease index (OSDI questionnaire, slit-lamp microscope examination of tear break-up time (TBUT, corneal fluorescein score (CFS, tear meniscus height (TMH together with anterior segment optical coherence tomography (AS-OCT and corneal topography were evaluated preoperatively and postoperatively. RESULTS: The subjective feeling (P=0.004, TBUT (P<0.001 and TMH (P=0.02 post-surgery had improved in patients who used bandage contact lenses compared with those who did not at 1wk post-surgery. Until three month postoperatively, the comfort degree (P=0.004 and TMH (P=0.01 of group two were still worse than group one. Moreover, TBUT (P<0.001 and CFS (P=0.004 of the group with eye pads got worse than the results before, whereas the group with bandage contact lenses recovered to normal. None of these patients had infections or other complications. CONCLUSION: Wearing therapeutic bandage contact lens after cataract surgery, compared with traditional eye-pads, is a safe method to improve tear-film stability and reduce post-operative discomfort without hindering corneal incision recovery.
Griffiths, Frances; Mason, Victoria; Boardman, Felicity; Dennick, Katherine; Haywood, Kirstie; Achten, Juul; Parsons, Nicholas; Griffin, Xavier; Costa, Matthew
To explore what patients consider important when evaluating their recovery from hip fracture and to consider how these priorities could be used in the evaluation of the quality of hip fracture services. Semistructured interviews exploring the experience of recovery from hip fracture at two time points-4 weeks and 4 months postoperative hip fixation. Two approaches to analysis: thematic analysis of data specifically related to recovery from hip fracture; summarising the participant's experience overall. 31 participants were recruited, of whom 20 were women and 12 were cognitively impaired. Mean age was 81.5 years. Interviews were provided by 19 patients, 14 carers and 8 patient/carer dyad; 10 participants were interviewed twice. Single major trauma centre in the West Midlands of the UK. Stable mobility (without falls or fear of falls) for valued activities was considered most important by participants who had some prefracture mobility and were able to articulate what they valued during recovery. Mobility was important for managing personal care, for day-to-day activities such as shopping and gardening, and for maintenance of mental well-being. Some participants used assistive mobility devices or adapted to their limitations. Others maintained their previous limited function through increased care provision. Many participants were unable to articulate what they valued as hip fracture was perceived as part of their decline with age. The fracture and problems from other health conditions were an inseparable part of one health experience. Prefracture mobility, adaptations to reduced mobility before or after fracture, and whether or not patients perceive themselves to be declining with age influence what patients consider important during recovery from hip fracture. No single patient-reported outcome measure could evaluate quality of care for all patients following hip fracture. General health-related quality of life tools may provide useful information within
Willems, Mia; Schröder, Carin; van der Weijden, Trudy; Post, Marcel W; Visser-Meily, Anne M
Although physical activity and exercise for stroke patients is highly recommended for fast recovery, patients in hospitals and rehabilitation centres are insufficiently encouraged to be physically active. In this study, we investigated the impact of knowledge brokers (KBs), enterprising nurses and therapists, on health professionals' (HP) performance to encourage stroke inpatients to be physically active. This multicenter intervention study used a pre-post test design. Two or three KBs were trained in each stroke unit of 12 hospitals and 10 rehabilitation centres in The Netherlands. Questionnaires were completed by patients and HPs before and after the KB-intervention. The primary outcome was encouragement given by HPs to their patients to be physically active, as reported by patients and HPs. After the KB-intervention, many more patients (48%; N=217) reported at least some encouragement by HPs to be physically active than before (26%; N=243, pbrokers (KBs), since the KB-intervention was shown to increase the encouragement felt by stroke patients to be physically active. It seems worthwhile to involve physicians, nurses and patients' families more frequently in efforts to encourage stroke patients to be physically active.
Bilgin, Sevil; Guclu-Gunduz, Arzu; Oruckaptan, Hakan; Kose, Nezire; Celik, Bülent
Fifty-one patients with mild (n = 14), moderate (n = 10) and severe traumatic brain injury (n = 27) received early rehabilitation. Level of consciousness was evaluated using the Glasgow Coma Score. Functional level was determined using the Glasgow Outcome Score, whilst mobility was evaluated using the Mobility Scale for Acute Stroke. Activities of daily living were assessed using the Barthel Index. Following Bobath neurodevelopmental therapy, the level of consciousness was significantly improved in patients with moderate and severe traumatic brain injury, but was not greatly influenced in patients with mild traumatic brain injury. Mobility and functional level were significantly improved in patients with mild, moderate and severe traumatic brain injury. Gait recovery was more obvious in patients with mild traumatic brain injury than in patients with moderate and severe traumatic brain injury. Activities of daily living showed an improvement but this was insignificant except for patients with severe traumatic brain injury. Nevertheless, complete recovery was not acquired at discharge. Multiple regression analysis showed that gait and Glasgow Coma Scale scores can be considered predictors of functional outcomes following traumatic brain injury. PMID:25624828
Naccarella, Lucio; Biuso, Catuscia; Jennings, Amanda; Patsamanis, Harry
Evidence exists for the association between health literacy and heart health outcomes. Cardiac rehabilitation is critical for recovery from heart attack and reducing hospital readmissions. Despite this, literacy. This brief case study reflects and documents practice-based initiatives by Heart Foundation Victoria to improve access to recovery information for patients with low literacy levels. Three key initiatives, namely the Six Steps To Cardiac Recovery resource, the Love Your Heart book and the nurse ambassador program, were implemented informed by mixed methods that assessed need and capacity at the individual, organisational and systems levels. Key outcomes included increased access to recovery information for patients with low health literacy, nurse knowledge and confidence to engage with patients on recovery information, improved education of patients and improved availability and accessibility of information for patients in diverse formats. Given the challenges involved in addressing heart health literacy, multifaceted practice-based approaches are essential to improve access to recovery information for patients with low literacy levels. What is known about the topic? Significant challenges exist for patients with lower health literacy receiving recovery information after a heart attack in hospitals. What does this paper add? This case study provides insights into a practice-based initiative by Heart Foundation Victoria to improve access to recovery information for patients with low literacy levels. What are the implications for practitioners? Strategies to improve recovery through increased heart health literacy must address the needs of patients, nursing staff and the health system within hospitals. Such strategies need to be multifaceted and designed to build the capacity of nurses, heart patients and their carers, as well as support from hospital management.
Full Text Available Gunn Pettersen,1 Kari-Brith Thune-Larsen,2 Jan H Rosenvinge31Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway; 2Oslo University Hospital, Oslo, Norway; 3Department of Psychology, Faculty of Health Sciences, University of Tromsø, Tromsø, NorwayAbstract: Although there are numerous lists of items covering clinically valid aspects of recovery from eating disorders, these lists are on the nominal level: the potential for multidimensional development has not been explored. Such exploration is the purpose of the present study. The subjects included in the study were 152 female clinicians, 1052 females randomly selected from the general population, and 184 eating-disorder patients. All subjects rated 17 recovery items on a 10-point scale in terms of their relevance and importance. They also completed measures of knowledge about eating disorders and their own eating problems, in addition to providing information about their age and personal acquaintance with eating disorders. Fourteen recovery-item scores were sample unspecific, and hence all samples tended to judge the majority of items in a similar manner. The 17 items successfully formed three separate factors covering specific eating-disorder symptoms, as well as social and psychological issues. The clinician and general population sample analyzed together provided a more condensed scale comprising two factors (specific eating-disorder symptoms and psychosocial factors, with each factor having three items. This factor structure was successfully replicated using the patient-validation sample. The findings indicate an empirical basis for a valid recovery measure that may be suitable in future outcome research.Keywords: eating disorders, recovery, outcome, outcome measures
Keller, Thomas; Colombi, Tino; Ruiz, Siul; Grahm, Lina; Reiser, René; Rek, Jan; Oberholzer, Hans-Rudolf; Schymanski, Stanislaus; Walter, Achim; Or, Dani
Soil compaction due to agricultural vehicular traffic alters the geometrical arrangement of soil constituents, thereby modifying mechanical properties and pore spaces that affect a range of soil hydro-ecological functions. The ecological and economic costs of soil compaction are dependent on the immediate impact on soil functions during the compaction event, and a function of the recovery time. In contrast to a wealth of soil compaction information, mechanisms and rates of soil structure recovery remain largely unknown. A long-term (>10-yr) soil structure observatory (SSO) was established in 2014 on a loamy soil in Zurich, Switzerland, to quantify rates and mechanisms of structure recovery of compacted arable soil under different post-compaction management treatments. We implemented three initial compaction treatments (using a two-axle agricultural vehicle with 8 Mg wheel load): compaction of the entire plot area (i.e. track-by-track), compaction in wheel tracks, and no compaction. After compaction, we implemented four post-compaction soil management systems: bare soil (BS), permanent grass (PG), crop rotation without mechanical loosening (NT), and crop rotation under conventional tillage (CT). BS and PG provide insights into uninterrupted natural processes of soil structure regeneration under reduced (BS) and normal biological activity (PG). The two cropping systems (NT and CT) enable insights into soil structure recovery under common agricultural practices with minimal (NT) and conventional mechanical soil disturbance (CT). Observations include periodic sampling and measurements of soil physical properties, earthworm abundance, crop measures, electrical resistivity and ground penetrating radar imaging, and continuous monitoring of state variables - soil moisture, temperature, CO2 and O2 concentrations, redox potential and oxygen diffusion rates - for which a network of sensors was installed at various depths (0-1 m). Initial compaction increased soil bulk density
Ritter, Katrina G; Hussey, Matthew J; Valovich McLeod, Tamara C
Clinical Scenario: Patients who experience prolonged concussion symptoms can be diagnosed with Post-Concussion Syndrome (PCS) when those symptoms persist past 4 weeks. Aerobic exercise protocols have been shown to be effective in improving physical and mental aspects of health. Emerging research suggests that aerobic exercise maybe useful as a treatment for PCS, where exercise allows patients to feel less isolated and more active during the recovery process. Is aerobic exercise more beneficial in reducing symptoms than current standard care in patients with prolonged symptoms or PCS lasting longer than 4 weeks? Summary of Key Findings: After a thorough literature search, 4 studies were selected relevant to the clinical question. Of the 4 studies, 1 was a randomized control trial and 3 were case series. All 4 studies investigate aerobic exercise protocol as treatment for PCS. 1-4 Three articles demonstrated a greater rate of symptom improvement from baseline assessment to follow-up after a controlled sub-symptomatic aerobic exercise program. 2-4 One study showed a decrease in symptoms in the aerobic exercise group compared to the full body stretching group. 1 Clinical Bottom Line: There is moderate evidence to support sub-symptomatic aerobic exercise as a treatment of PCS, therefore it should be considered as a clinical option for reducing PCS and prolonged concussion symptoms. A previously validated protocol, such as the Buffalo Concussion Treadmill Test, Balke Protocol, or Rating of Perceived Exertion (RPE) as mentioned in this critically appraised topic should be used to measure baseline values and treatment progression. Strength of Recommendation: Level C evidence exists that aerobic exercise protocol is more effective than the current standard of care in treating PCS.
Brownsett, Sonia L. E.; Wise, Richard J. S.
The estimated prevalence of aphasia in the UK and the USA is 250 000 and 1 000 000, respectively. The commonest aetiology is stroke. The impairment may improve with behavioural therapy, and trials using cortical stimulation or pharmacotherapy are undergoing proof-of-principle investigation, but with mixed results. Aphasia is a heterogeneous syndrome, and the simple classifications according to the Broca-Wernicke-Lichtheim model inadequately describe the diverse communication difficulties with which patients may present. Greater knowledge of how intact neural networks promote recovery after aphasic stroke, either spontaneously or in response to interventions, will result in clearer hypotheses about how to improve the treatment of aphasia. Twenty-five years ago, a pioneering study on healthy participants heralded the introduction of functional neuroimaging to the study of mechanisms of recovery from aphasia. Over the ensuing decades, such studies have been interpreted as supporting one of three hypotheses, which are not mutually exclusive. The first two predate the introduction of functional neuroimaging: that recovery is the consequence of the reconstitution of domain-specific language systems in tissue around the lesion (the ‘perilesional’ hypothesis), or by homotopic cortex in the contralateral hemisphere (the ‘laterality-shift’ hypothesis). The third is that loss of transcallosal inhibition to contralateral homotopic cortex hinders recovery (the ‘disinhibition’ hypothesis). These different hypotheses at times give conflicting views about rehabilitative intervention; for example, should one attempt to activate or inhibit a contralateral homotopic region with cortical stimulation techniques to promote recovery? This review proposes that although the functional imaging data are statistically valid in most cases, their interpretation has often favoured one explanation while ignoring plausible alternatives. In our view, this is particularly evident when
Tayim, Fadi M; Flashman, Laura A; Wright, Matthew J; Roth, Robert M; McAllister, Thomas W
Episodic memory complaints are commonly reported after traumatic brain injury (TBI). The contributions of specific memory subprocesses (encoding, consolidation, and retrieval), however, are not well understood in mild TBI (mTBI). In the present study, we evaluated subprocesses of episodic memory in patients with mTBI using the item-specific deficit approach (ISDA), which analyzes responses on list learning tasks at an item level. We also conducted exploratory analyses to evaluate the effects of complicated mTBI (comp-mTBI) on memory. We compared episodic verbal memory performance in mTBI (n = 92) at approximately 1 and 12 months post TBI, as well as in a healthy comparison (HC) group (n = 40) at equivalent time points. Episodic memory was assessed using the California Verbal Learning Test-2nd Edition (CVLT-II), and both standard CVLT-II scores and ISDA indices were evaluated. Compared to the HC group, the mTBI group showed significantly poorer encoding and learning across time, as measured by ISDA and CVLT-II. Further analyses of these mTBI subgroups [(noncomplicated mTBI (NC-mTBI, n = 77) and comp-mTBI (n = 15)], indicated that it was the comp-mTBI group who continued to demonstrate poorer encoding ability than the HC group. When the patient groups were directly compared, the NC-mTBI group improved slightly on the ISDA Encoding Deficit Index. While the comp-mTBI group worsened slightly over time, their poorer encoding ability was not likely clinically meaningful. These findings indicate that, while the NC-mTBI and HC groups' performances were comparable by 12 months, a primary, long-term deficit in encoding of auditory verbal information remained problematic in the comp-mTBI group.
Full Text Available It is important to understand the mechanisms that enable peripheral neurons to regenerate after nerve injury in order to identify methods of improving this regeneration. Therefore, we studied nerve regeneration and sensory impairment recovery in the cutaneous lesions of leprosy patients (LPs before and after treatment with multidrug therapy (MDT. The skin lesion sensory test results were compared to the histopathological and immunohistochemical protein gene product (PGP 9.5 and the p75 nerve growth factor receptors (NGFr findings. The cutaneous neural occupation ratio (CNOR was evaluated for both neural markers. Thermal and pain sensations were the most frequently affected functions at the first visit and the most frequently recovered functions after MDT. The presence of a high cutaneous nerve damage index did not prevent the recovery of any type of sensory function. The CNOR was calculated for each biopsy, according to the presence of PGP and NGFr-immunostained fibres and it was not significantly different before or after the MDT. We observed a variable influence of MDT in the recovery from sensory impairment in the cutaneous lesions of LPs. Nociception and cold thermosensation were the most recovered sensations. The recovery of sensation in the skin lesions appeared to be associated with subsiding inflammation rather than with the regenerative activity of nerve fibres.
Tamura, Kazuo; Hashimoto, Kazue; Nishikawa, Kiyohiro
We conducted a post-marketing surveillance to evaluate the safety and efficacy of TKN732, approved as "filgrastim biosimilar 2", in Japanese patients who developed neutropenia in the course of cancer chemotherapy or hematopoietic stem cell transplantation. A total of 653 patients were registered during the 2-year enrollment period starting from May 2013, and 627 and 614 patients were eligible for safety and efficacy analyses of the G-CSF biosimilar, respectively. Forty-three adverse drug reactions were reported in 33 patients (5.26%). Back pain was most frequently observed and reported in 20 patients (3.19%), followed by pyrexia (1.28%) and bone pain (0.96%). Risk factors for adverse reactions identified by logistic regression analyses were younger age, presence of past medical history, and lower total dose at the onset of adverse reactions. Among the 576 cancer patients who developed Grade 2-4 neutropenia after chemotherapy, recovery to Grade 1/0 was reported in 553 patients (96%) following filgrastim biosimilar 2 treatment. The median duration of neutrophil counts below 1500/μL was 5 days. In addition, all 11 patients who underwent hematopoietic stem cell transplantation had good responses to filgrastim biosimilar 2. In conclusion, this study showed that filgrastim biosimilar 2 has a similar safety profile and comparable effects to the original G-CSF product in the real world clinical setting. Copyright © 2018 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Marco-Lattur, Maria D; Payeras, Antoni; Campins, Antoni A; Pons, Jaume; Cifuentes, Carmen; Riera, Melcior
Although paradoxical virological and immunological response after HAART has been well studied, intestinal lymphangiectasia (IL) in HIV-1 infected patients has not previously described. To describe HIV patients who developed IL. Clinical Case series. 4 patients with HIV and IL diagnosis based on clinical, endoscopic and pathological findings. All four cases had prior mycobacterial infections with abdominal lymph node involvement and a very low CD4 cell count nadir. They developed intestinal lymphangiectasia despite appropriate virological suppression with HAART and repeatedly negative mycobacterial cultures. Two patients were clinically symptomatic with oedemas, ascites, diarrhoea, asthenia, weight loss; but the other two were diagnosed with malabsorption as a result of laboratory findings, with hypoproteinemia and hypoalbuminemia. Three of them were diagnosed by video capsule endoscopy. IL should be considered in HIV-1 infected patients who present with clinical or biochemical malabsorption parameters when there is no immunological recovery while on HAART. Copyright © 2010 Elsevier España, S.L. All rights reserved.
Full Text Available The onset of Leber hereditary optic neuropathy is relatively rare in childhood and, interestingly, the rate of spontaneous visual recovery is very high in this group of patients. Here, we report a child harboring a rare pathological mitochondrial DNA mutation, present in heteroplasmy, associated with the disease. A patient follow-up showed a rapid recovery of the vision accompanied by a decrease of the percentage of mutated mtDNA. A retrospective study on the age of recovery of all childhood-onset Leber hereditary optic neuropathy patients reported in the literature suggested that this process was probably related with pubertal changes.
Workers of the concerned company and other persons and teams called 'intervention personnel' (specialized firemen, first aider, etc.) are to be involved in radiological emergency situations. Radiation protection provisions for workers and for intervention personnel complement one another because they cover persons with different statutes (workers under the responsibility of an employer and persons acting within the framework of agreements with the public authorities or within the framework of the requisitions). Work or operations exposing workers to ionizing radiation in radiological emergency situations can be assigned only to workers satisfying all of the following conditions: classification in category A worker; free of any medical unfitness; on a list drawn up in advance for this purpose; having received appropriate information on the risks and the precautions to take during the work or the operation; not having received, during the preceding twelve months, a dose greater than one of the annual limit values for exposures subject to special authorization. In addition, the worker must be a volunteer to carry out the work or the operations concerned in radiological emergency situations and have individual dosimetry means appropriate for the situation. Intervention personnel are possibly composed of personnel from responding organizations, such as police officers, fire-fighters, medical personnel, drivers and crews of evacuation vehicles, or of workers employed by the head of the damaged plant. In order to determine their selection, training and medical and radiological monitoring conditions, intervention personnel are classified into two groups: personnel forming the special technical, medical and health intervention teams readied in advance to deal with radiological emergency situations and persons not belonging to special teams but intervening as part of the tasks within the scope of their competence. In case of an existing exposure situation (post
Márquez, Cristina; Belda, Xavier; Armario, Antonio
Acute immobilization in male rats elicited the same ACTH, corticosterone and glucose response as foot shock when measured immediately after stress. However, post-stress recovery of plasma ACTH, corticosterone and glucose levels were delayed in immobilized versus shocked rats. Similarly, stress-induced anorexia was much greater in the former animals. All these data suggest that post-stress speed of recovery of some physiological variables is positively related to stressor intensity and could be used to evaluate it.
The assessment of the extent of the recovery of hand sensorimotor functions in the group of rehabilitated patients after stroke in the post-acute stage [Hodnocení míry úpravy senzomotorických funkcí ruky u skupiny rehabilitovaných pacientů po CMP v postakutním stádiu
Full Text Available BACKGROUND: Although the deficit of hand sensomotory functions is very common in patients after stroke, the algorithm of their renewal is relatively little known. It is not clear whether the extent or type of somatosensory dysfunction correlates with an impeded process of motorics renewal. OBJECTIVE: This study was focused on observation of hand sensorimotor functions in a group of patients in postacute phase after ischemic stroke, localized in artery cerebri media. The aim was to find out the extent of improvement of somatosensory and motor hand functions. This is the first stage of a research project which will be followed by the observation of an experimental group with therapy targeted to somatosensory functions. METHODS: The observed group of patients was treated at an inpatient department of a rehabilitation clinic and underwent standard therapy lasting 3–4 weeks. To assess hand sensorimotor functions two sensation tests were used: the FMT – the Fabric Matching Test and the RASP – The Rivermead Assessment of Somatosensory Performance. Two tests of fine motor function were also used: the NHPT – The Nine Hole Peg Test and the TMF – The Test of Manipulation Functions by means of a special constructional set Ministav. These tests were performed at the beginning and at the end of therapy. RESULTS: In the observed group of patients, we found impairments of somatosensory functions and fine motor function even on the unimpaired upper limb. Nevertheless, fine motor function is impaired more seriously than the somatosensory functions. The biggest deficits of motor functions were found in tasks which had required a precise grip. The most obvious changes in the assessment of patients were found in ADL assessed by the Barthel Index – the return of functions towards the standard was observed in one third of the subjects. CONCLUSION: After the application of standard therapy, improvement of hand sensorimotor functions was observed in a group
Yadav, Dharmendra Singh; Babu, Sarath; Manoj, B. S.
Spectrum conflict during primary and backup routes assignment in elastic optical networks results in increased resource consumption as well as high Bandwidth Blocking Probability. In order to avoid such conflicts, we propose a new scheme, Quasi Path Restoration (QPR), where we divide the available spectrum into two: (1) primary spectrum (for primary routes allocation) and (2) backup spectrum (for rerouting the data on link failures). QPR exhibits three advantages over existing survivable strategies such as Shared Path Protection (SPP), Primary First Fit Backup Last Fit (PFFBLF), Jointly Releasing and re-establishment Defragmentation SPP (JRDSSPP), and Path Restoration (PR): (1) the conflict between primary and backup spectrum during route assignment is completely eliminated, (2) upon a link failure, connection recovery requires less backup resources compared to SPP, PFFBLF, and PR, and (3) availability of the same backup spectrum on each link improves the recovery guarantee. The performance of our scheme is analyzed with different primary backup spectrum partitions on varying connection-request demands and number of frequency slots. Our results show that QPR provides better connection recovery guarantee and Backup Resources Utilization (BRU) compared to bandwidth recovery of PR strategy. In addition, we compare QPR with Shared Path Protection and Primary First-Fit Backup Last Fit strategies in terms of Bandwidth Blocking Probability (BBP) and average frequency slots per connection request. Simulation results show that BBP of SPP, PFFBLF, and JRDSPP varies between 18.59% and 14.42%, while in QPR, BBP ranges from 2.55% to 17.76% for Cost239, NSFNET, and ARPANET topologies. Also, QPR provides bandwidth recovery between 93.61% and 100%, while in PR, the recovery ranges from 86.81% to 98.99%. It is evident from our analysis that QPR provides a reasonable trade-off between bandwidth blocking probability and connection recoverability.
Passamonti, F; Giorgino, T; Mora, B; Guglielmelli, P; Rumi, E; Maffioli, M; Rambaldi, A; Caramella, M; Komrokji, R; Gotlib, J; Kiladjian, J J; Cervantes, F; Devos, T; Palandri, F; De Stefano, V; Ruggeri, M; Silver, R T; Benevolo, G; Albano, F; Caramazza, D; Merli, M; Pietra, D; Casalone, R; Rotunno, G; Barbui, T; Cazzola, M; Vannucchi, A M
Polycythemia vera (PV) and essential thrombocythemia (ET) are myeloproliferative neoplasms with variable risk of evolution into post-PV and post-ET myelofibrosis, from now on referred to as secondary myelofibrosis (SMF). No specific tools have been defined for risk stratification in SMF. To develop a prognostic model for predicting survival, we studied 685 JAK2, CALR, and MPL annotated patients with SMF. Median survival of the whole cohort was 9.3 years (95% CI: 8-not reached-NR-). Through penalized Cox regressions we identified negative predictors of survival and according to beta risk coefficients we assigned 2 points to hemoglobin level <11 g/dl, to circulating blasts ⩾3%, and to CALR-unmutated genotype, 1 point to platelet count <150 × 10 9 /l and to constitutional symptoms, and 0.15 points to any year of age. Myelofibrosis Secondary to PV and ET-Prognostic Model (MYSEC-PM) allocated SMF patients into four risk categories with different survival (P<0.0001): low (median survival NR; 133 patients), intermediate-1 (9.3 years, 95% CI: 8.1-NR; 245 patients), intermediate-2 (4.4 years, 95% CI: 3.2-7.9; 126 patients), and high risk (2 years, 95% CI: 1.7-3.9; 75 patients). Finally, we found that the MYSEC-PM represents the most appropriate tool for SMF decision-making to be used in clinical and trial settings.
To assist operators and public authorities alike in their advance preparation of emergency plans and in the establishment of emergency preparedness infrastructures, the IAEA has already issued several Safety Series publications dealing with these matters. This Safety Guide complements the technical guidance already published. It provides: a) Information and practical guidance relevant to assessing the off-site consequences during the late phase of a serious accident in a nuclear facility; b) Guidance on recovery operations off the site and the associated decision making process; and c) Proposals for consideration by national authorities regarding the organizational structure for the conduct of recovery operations. 52 refs, 8 figs, 4 tabs.
Sakshi Ojha; Thimmarasa V Bhovi; Prashant P Jaju; Manas Gupta; Neha Singh; Kriti Shrivastava
Aims and Objectives: To determine the effectiveness of transcutaneous electrical nerve stimulation (TENS) in stimulating salivary flow in post-radiated oral cancer patients, and to compare the salivary flow rate between unstimulated saliva and saliva stimulated with TENS in post-radiated oral cancer patients. Materials and Methods: In 30 patients who underwent radiotherapy for oral cancer, unstimulated saliva was collected every minute for 5 min in a graduated test tube. The TENS unit was act...
Asimakopoulou, E; Madianos, M
Recent progress in medicine and technology has produced a significant increase in the survival rate of critically ill patients who have been treated in Intensive Care Units (ICU). Consequently, researchers have become increasingly interested in the relationship between critical illness and psychiatric consequences. The experience of critical illness has been often associated with Major Depression (MD) and Post-Traumatic Stress Disorder (PTSD). There has been no similar study in Greece. The aim of the present study was to investigate the prevalence of MD and PTSD among patients after discharge from ICU in comparison with patients who discharge from pathological or surgical department. The study was conducted on five major hospitals "ATTIKON", "THRIASSIO", "KAT", "GNA GENNIMATAS", "KORGIALENIO - BENAKIO". A standardized instrument was used especially for this study and is based on "ΜΙΝΙ: Mini International Neuropsychiatric Interview" and DSM-IV. The data collection was carried out through personal interviews with the patients. It is a cross-sectional study and also a case-control study. The sample of the research was composed of 198 patients, from whom 102 were in ICU (ICU group) and 96 were not (non-ICU group). The results of the statistical processing have shown that there is a positive and statistically significant correlation between MD-PTSD and hospitalization in ICU, and particular hospitalization in ICU increases the likelihood of developing MD by 1.94 times and PTSD by 3.48 times, compared to treatment in another part of the hospital. Furthermore, the ICU group was found to suffer more than the control group from MD (32.4% vs 19.8%) and PTSD (35,3% vs 13,5%). The investigation of sociodemographic characteristics showed that being a woman discharged from ICU is nearly five times more likely to develop MD and nearly twelve times more likely to develop PTSD compared with men. Old age in ICU acts as a protective factor from PTSD. Regarding the clinical
Full Text Available BACKGROUND AND OBJECTIVES: Patients who survive acute kidney injury (AKI, especially those with partial renal recovery, present a higher long-term mortality risk. However, there is no consensus on the best time to assess renal function after an episode of acute kidney injury or agreement on the definition of renal recovery. In addition, only limited data regarding predictors of recovery are available. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: From 1984 to 2009, 84 adult survivors of acute kidney injury were followed by the same nephrologist (RCRMA for a median time of 4.1 years. Patients were seen at least once each year after discharge until end stage renal disease (ESRD or death. In each consultation serum creatinine was measured and glomerular filtration rate estimated. Renal recovery was defined as a glomerular filtration rate value ≥60 mL/min/1.73 m2. A multiple logistic regression was performed to evaluate factors independently associated with renal recovery. RESULTS: The median length of follow-up was 50 months (30-90 months. All patients had stabilized their glomerular filtration rates by 18 months and 83% of them stabilized earlier: up to 12 months. Renal recovery occurred in 16 patients (19% at discharge and in 54 (64% by 18 months. Six patients died and four patients progressed to ESRD during the follow up period. Age (OR 1.09, p<0.0001 and serum creatinine at hospital discharge (OR 2.48, p = 0.007 were independent factors associated with non renal recovery. The acute kidney injury severity, evaluated by peak serum creatinine and need for dialysis, was not associated with non renal recovery. CONCLUSIONS: Renal recovery must be evaluated no earlier than one year after an acute kidney injury episode. Nephrology referral should be considered mainly for older patients and those with elevated serum creatinine at hospital discharge.
Hvidberg, A; Rasmussen, M H; Christensen, N J
followed by IV infusion of 1 mg/kg/h) was administered from 1 hour before induction of hypoglycemia until the end of the study period. On the other day, NaCl was administered. Plasma glucose before induction of hypoglycemia was equal on the 2 study days. The plasma glucose area under the curve (AUC......). The incremental AUC for cAMP was larger with theophylline for diabetic patients (P = .01). For healthy subjects, cAMP was greater with theophylline 30 minutes after insulin (P = .03). In conclusion, glucose recovery after hypoglycemia is significantly increased when theophylline is administered in an asthma......The principal mediators of glucose counterregulation (glucagon and epinephrine) use intracellular cyclic adenosine monophosphate (cAMP) to mediate glucose release. Since theophylline increases cAMP (by inhibiting its decomposition), we investigated the effect of theophylline on glucose recovery...
Full Text Available The proportion of transfused red blood cells (RBCs that remain in circulation is an important surrogate marker of transfusion efficacy and contributes to predict the potential benefit of a transfusion process. Over the last 50 years, most of the transfusion recovery data were generated by chromium-51 (51Cr-labeling studies and were predominantly performed to validate new storage systems and new processes to prepare RBC concentrates. As a consequence, our understanding of transfusion efficacy is strongly dependent on the strengths and weaknesses of 51Cr labeling in particular. Other methods such as antigen mismatch or biotin-based labeling can bring relevant information, for example, on the long-term survival of transfused RBC. These radioactivity-free methods can be used in patients including from vulnerable groups. We provide an overview of the methods used to measure transfusion recovery in humans, compare their strengths and weaknesses, and discuss their potential limitations. Also, based on our understanding of the spleen-specific filtration of damaged RBC and historical transfusion recovery data, we propose that RBC deformability and morphology are storage lesion markers that could become useful predictors of transfusion recovery. Transfusion recovery can and should be accurately explored by more than one method. Technical optimization and clarification of concepts is still needed in this important field of transfusion and physiology.
D. Max Smith; Deborah M. Finch; Christian Gunning; Roy Jemison; Jeffrey F. Kelly
Wildland fires occur with increasing frequency in southwestern riparian forests, yet little is known about the effects of fire on populations of native and exotic vegetation. From 2003 to 2006, we monitored recovering woody vegetation in wildfire sites in the bosque (riparian forest) along the Middle Rio Grande of central New Mexico, USA. To examine recovery potential...
Ken R. Hubbert; Peter M. Wohlgemuth; Jan L. Beyers
Following the Cedar Fire (one of seven large wildfires that burned in southern California during the autumn of 2003), aerial hydromulch was applied at 50 and 100% cover to reduce hillslope erosion in chaparral shrublands. Our objectives were to determine the effectiveness of hydromulch in preventing erosion, and to see if plant recovery was hindered by treatment. We...
Sakurai, Kenichi; Matsuo, Sadanori; Enomoto, Katsuhisa; Amano, Sadao; Shiono, Motomi
Little is known about the period required for menstruation recovery after long-term luteinizing hormone-releasing hormone (LH-RH) agonist plus tamoxifen therapy following chemotherapy. In this study we investigated the period required for menstruation recovery after the therapy. The subjects comprised 105 premenopausal breast cancer patients who had undergone surgery. All patients were administered an LH-RH agonist for 24 months and tamoxifen for 5 years following the postoperative adjuvant chemotherapy, and the status of menstruation recovery was examined. Menstruation resumed in 16 cases (15.2%) after the last LH-RH agonist treatment session. The mean period from the last LH-RH agonist treatment to the recovery of menstruation was 6.9 months. The rate of menstruation recovery was 35.5% in patients aged 40 years or younger and 8.0% in those aged 41 years or older, and it was significantly higher in those aged 40 years or younger. The period until menstruation recovery tended to be longer in older patients at the end of treatment. This study showed that menstruation resumed after treatment at higher rates in younger patients. However, because it is highly likely that ovarian function will be destroyed by the treatment even in young patients, it is considered necessary to explain the risk to patients and obtain informed consent before introducing this treatment modality.
De Backer, Ole; Arnous, Samer; Lønborg, Jacob
INTRODUCTION: Preoperative anemia is common in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and has been linked to a poorer outcome--including a higher 1-year mortality. The aim of this study was to investigate the impact of successful TAVI...... on baseline anemia. METHODS: A total of 253 patients who survived at least 1 year following TAVI were included in this study. The prevalence, predictors and clinical outcome of hemoglobin (Hb)-recovery were assessed. RESULTS: The prevalence of baseline anemia was 49% (n = 124)--recovery from anemia occurred......-recovery, while blood transfusion (OR 0.31, P = 0.038) and chronic kidney disease (CKD, OR 0.33, P = 0.043) were identified as negative predictors at, respectively, one and two years after TAVI. When compared to patients without baseline anemia, those anemic patients with Hb-recovery had a similar functional...
Søgaard, Mette; Nielsen, Peter Brønnum; Skjøth, Flemming
BACKGROUND: The effectiveness of rivaroxaban to reduce post-thrombotic syndrome in patients with venous thromboembolism is largely unknown. We compared rates of post-thrombotic syndrome in patients given rivaroxaban versus warfarin in a cohort of routine clinical care patients with incident venous...... thromboembolism. METHODS: We linked Danish nationwide registries to identify all patients with incident venous thromboembolism who were new users of rivaroxaban or warfarin and compared rates of post-thrombotic syndrome using an inverse probability of treatment weighting approach to account for baseline...... confounding. RESULTS: We identified 19,939 oral anticoagulation naive patients with incident venous thromboembolism treated with warfarin or rivaroxaban (mean age 64 years, 48% females, 45.5% with pulmonary embolism). The propensity-weighted rate of post-thrombotic syndrome at 3 years follow-up was 0...
Kunikata, Hiroko; Yoshinaga, Naoki; Shiraishi, Yuko; Okada, Yoshie
To design a program targeting recovery of self-esteem in patients with mental disorders, and to clarify the changes after the program to determine its effectiveness. This study employed a one group pre- and post design, which comprised baseline, post-intervention, and 3 month follow-up phases, and recruited 41 Japanese patients with mental disorders living in the community. The authors administered the nurse-led group cognitive-behavioral therapy program for the recovery of self-esteem, which comprised 12 sessions, to the participants. The follow-up investigations were conducted immediately and 3 months after the program. The present authors used the Rosenberg Self-Esteem Scale (RSES), Profile of Mood States (POMS), Subjective Well-Being Inventory (SUBI), and Test to Determine the Characteristics of Ideas as subjective measures and the Brief Psychiatric Rating Scale (BPRS) as an objective measure. After controlling for the factors of medication and use of social services, improvement was observed in all measures of evaluation. The authors identified improvement at post-intervention and follow up. The scores for the RSES, BPRS, confidence in coping, and inadequate mental mastery at post-intervention and follow up were significantly higher than those at baseline, and these beneficial effects were maintained 3 months after the program. The program may aid in recovering and maintaining self-esteem of patients suffering from mental disorders. However, it is necessary to conduct a randomized controlled clinical trial to confirm these findings. © 2016 Japan Academy of Nursing Science.
Rusmini, Rusmini; Suparmi, Suparmi; Musdalifah, Ulfah
The objective of the study is to evaluate the level of anxiety and early mobilization using the Emotional Freedom Technique (EFT): Tapping on patients post partum post secsio Caesaria before and after intervention period both control and experimental group. Design Quasi-experimental two group design was applied in the study. Forty two mothers with primipara post secsio Caesaria were recruited. Data analysis in the study included correlation, paird t-test, and independent t-test. The findings ...
Martinez, E.; Sanchez, M. A.; Torres, M.; Benito, J.; Avila, A.
To describe immune recovery syndrome (IRS) and related radiological findings in HIV-positive patients. To alert radiologists to the ever-increasingly frequent appearance of paradoxical reactions (PR) in granulomatous diseases under antiretroviral treatment. We present a retrospective study of 9 adult HIV-positive patients who showed IRS, 6 cases of tuberculosis (TBC), 2 cases of atypical mycobacterium and a case of sarcoidosis. At the time of IRS/PR diagnosis, any suspicion of infectious activity was excluded through the use of appropriate microbiological tests. clinical and radiological characteristics of the above mentioned cases are analyze here. All patients experienced a clinical and/or radiological worsening of condition following variable periods of antiretroviral and/or anti-tuberculosis treatment, and coinciding with viral load decrease and CD4-T-lymphocyte recovery. Diagnosis of IRS/PR was clinical in five cases and radiological in four. In all but one case, antiretroviral treatment had at some time been previously administered. IRS/PR is a diagnosis of exclusion which must be included in the differential diagnosis of newly appearing lesions or worsening of already existing ones in HIV-positive patients that have recently begun antiretroviral and/or anti-tuberculosis treatment. Such should be done after excluding drug resistance, treatment non-adherence and intercurrent disease. (Author) 8 refs
Jaensson, M; Dahlberg, K; Eriksson, M; Nilsson, U
Many patients undergoing anaesthesia and surgery experience postoperative complications. Our aim was to investigate whether a systematic follow-up smartphone-based assessment, using recovery assessment by phone points (RAPP) compared with standard care, had a positive effect on day surgery patients' postoperative recovery. We also investigated whether there were differences in women and men's recovery and recovery scores. The study was a single-blind, multicentre randomized controlled trial. A total of 997 patients were randomly allocated to either RAPP or standard care. The Swedish web version of a quality of recovery (SwQoR) questionnaire was used to evaluate the patients' postoperative recovery, either on paper or using an application (RAPP) on postoperative days seven and 14. On postoperative day seven the RAPP group reported significantly better values in seven out of 24 items of the SwQoR: sleeping difficulties; not having a general feeling of wellbeing; having difficulty feeling relaxed/comfortable; and dizziness; headache; pain in the surgical wound; and a swollen surgical wound compared with the control group, implying a good postoperative recovery. Both men and women in the RAPP group reported significantly better values (and, hence good postoperative recovery) compared with the control group in the items sleeping difficulties; not having a general feeling of wellbeing and pain in the surgical wound. Measurement of patient-reported outcomes using a smartphone-based application was associated with decreased discomfort from several postoperative symptoms. Systematic e-assessment can thereby increase patients' quality of recovery and identify key areas for improvement in perioperative care. NCT02492191. © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.
Stergiopoulou, A; Birbas, K; Katostaras, T; Mantas, J
Aim of this study is the evaluation of the impact of a multimedia CD (MCD) on preoperative anxiety and postoperative recovery of patients undergoing elective laparoscopic cholecystectomy (LC). Sixty consecutive candidates for elective LC were randomly assigned to four groups. Group A included 15 patients preoperatively informed regarding LC through the MCD presented by Registered Nurse (RN). Patients in group B (n = 15) were informed through a leaflet. Patients in group C (n = 15) were informed verbally from a RN. Finally, the control Group D included 15 patients informed conventionally by the attending surgeon and anesthesiologist, as every other patient included in groups A, B, and C. Preoperative assessment of knowledge about LC was performed after each informative session through a questionnaire. Evaluation of preoperative anxiety was conducted using APAIS scale. Postoperative pain and nausea scores were measured using an NRS scale, 16 hours after the patient had returned to the ward. Statistical processing of the results (single linear regression) showed that patients in groups A, B, and C achieved a higher knowledge score, less preoperative anxiety score and less postoperative pain and nausea, compared to Group D. In multiple regression analysis, group A had a higher knowledge score compared to the four groups (p Informative sessions using MCD is an effective means of improving patient's preoperative knowledge, especially in day-surgery cases, like LC.
Chen, Chun-Kai; Weng, Ming-Cheng; Chen, Tien-Wen; Huang, Mao-Hsiung
This study evaluated the impact of severity of hemiparesis on oxygen uptake (VO2) response in post-acute stroke patients. Sixty-four patients with a mean poststroke interval of 8.6 ± 3.8 days underwent a ramp cardiopulmonary exercise test on a cycling ergometer to volitional termination. Mean peak VO2 (VO2peak) and work efficiency (ΔVO2/ΔWR) were measured by open-circuit spirometry during standard upright ergometer cycling. Severity of the hemiparetic lower limb was assessed by Brunnstrom's motor recovery stages lower extremity (BMRSL). VO2peak was 10% lower in hemiparetic leg with BMRSL V than in that with BMRSL VI, 20% lower in BMRSL IV, and 50% lower in BMRSL III. ΔVO2/ΔWR was higher for the group with increased BMRSL. The relations were consistent after adjustment for age, sex, body mass index, stroke type, hemiparetic side, modified Ashworth Scale, time poststroke, comorbidities, and medications. Our findings revealed that O2peak is dependent on the severity of hemiparesis in leg, and along with ΔO2/ΔWR closely related to the severity of hemiparesis in post-acute stroke patients, regardless of the types and locations of lesion after stroke, as well as the differences in comorbidities and medications. Copyright © 2013. Published by Elsevier B.V.
Bartha, I; Hajdu, J; Bokor, L; Kanyári, Z; Damjanovich, L
The psychosomatic care of patients after surgical treatment must comprise the analysis of quality of life with colostomy. Five different parameters were assessed of 100 colostomy patients. Sixty-one percent of our patients had skin irritation problems. Twenty-eight patients applied regular irrigation. Seventy-two percent of these had daily motions, 20% had bidaily, the remaining 8% had irregular bowel movements. Seventeen percent of the nonirrigating patients observed very irritating fecal discharge around the stoma. Embarrassing noises concomittant with bowel movements were observed by 42% and 45% struggled with bad odors. Irrigating patients had hardly any of these problems. For 65% of the patients the idea of having a colostoma meant the greatest psychological burden before the operation. The stress situation culminated in the immediate postoperative period in 10%. Forty percent of those asked were seriously worried about the reaction of their social environment. In 65% a significant decrease of social relations could be observed. Sixteen percent reported an increased social activity after colostomy had been performed. Sixty percent admitted considering the option of suicide at least once. Thirty-five percent revealed to have any kind of sexual problems after colostomy. Eight of our 100 colostomy patients experienced serious adverse reactions from their family members. In eighty percent of the cases family members showed great sympathy although they acted naively. The quality of life of colostomy patients may be best taken care of by qualified stomatherapists, out-patient proctology departments and the ileo-colostomy movement (ILCO).
Chen, Xiaoli; Emery, Nathan; Garcia, Elizabeth S; Hanan, Erin J; Hodges, Heather E; Martin, Tyronne; Meyers, Matthew A; Peavey, Lindsey E; Peng, Hui; Santamaria, Jaime Sainz; Uyeda, Kellie A; Anderson, Sarah E; Tague, Christina
Environmental regulations frequently mandate the use of "best available" science, but ensuring that it is used in decisions around the use and protection of natural resources is often challenging. In the Western US, this relationship between science and management is at the forefront of post-fire land management decisions. Recent fires, post-fire threats (e.g. flooding, erosion), and the role of fire in ecosystem health combine to make post-fire management highly visible and often controversial. This paper uses post-fire management to present a framework for understanding why disconnects between science and management decisions may occur. We argue that attributes of agencies, such as their political or financial incentives, can limit how effectively science is incorporated into decision-making. At the other end of the spectrum, the lack of synthesis or limited data in science can result in disconnects between science-based analysis of post-fire effects and agency policy and decisions. Disconnects also occur because of the interaction between the attributes of agencies and the attributes of science, such as their different spatial and temporal scales of interest. After offering examples of these disconnects in post-fire treatment, the paper concludes with recommendations to reduce disconnects by improving monitoring, increasing synthesis of scientific findings, and directing social-science research toward identifying and deepening understanding of these disconnects.
Keeley, J.E.; Fotheringham, C.J.; Baer-Keeley, M.
Plant community diversity, measured as species richness, is typically highest in the early post-fire years in California shrublands. However, this generalization is overly simplistic and the present study demonstrates that diversity is determined by a complex of temporal and spatial effects. Ninety sites distributed across southern California were studied for 5 years after a series of fires. Characteristics of the disturbance event, in this case fire severity, can alter post-fire diversity, both decreasing and increasing diversity, depending on life form. Spatial variability in resource availability is an important factor explaining patterns of diversity, and there is a complex interaction between landscape features and life form. Temporal variability in resource availability affects diversity, and the diversity peak in the immediate post-fire year (or two) appears to be driven by factors different from subsequent diversity peaks. Early post-fire diversity is influenced by life-history specialization, illustrated by species that spend the bulk of their life cycle as a dormant seed bank, which is then triggered to germinate by fire. Resource fluctuations, precipitation in particular, may be associated with subsequent post-fire diversity peaks. These later peaks in diversity comprise a flora that is compositionally different from the immediate post-fire flora, and their presence may be due to mass effects from population expansion of local populations in adjacent burned areas. ?? 2005 Blackwell Publishing Ltd.
La, C; Nair, V A; Mossahebi, P; Stamm, J; Birn, R; Meyerand, M E; Prabhakaran, V
Functional networks in resting-state fMRI are identified by characteristics of their intrinsic low-frequency oscillations, more specifically in terms of their synchronicity. With advanced aging and in clinical populations, this synchronicity among functionally linked regions is known to decrease and become disrupted, which may be associated with observed cognitive and behavioral changes. Previous work from our group has revealed that oscillations within the slow-5 frequency range (0.01-0.027 Hz) are particularly susceptible to disruptions in aging and following a stroke. In this study, we characterized longitudinally the changes in the slow-5 oscillations in stroke patients across two different time-points. We followed a group of ischemic stroke patients (n = 20) and another group of healthy older adults (n = 14) over two visits separated by a minimum of three months (average of 9 months). For the stroke patients, one visit occurred in their subacute window (10 days to 6 months after stroke onset), the other took place in their chronic window (> 6 months after stroke). Using a mid-order group ICA method on 10-minutes eyes-closed resting-state fMRI data, we assessed the frequency distributions of a component's representative time-courses for differences in regards to slow-5 spectral power. First, our stroke patients, in their subacute stage, exhibited lower amplitude slow-5 oscillations in comparison to their healthy counterparts. Second, over time in their chronic stage, those same patients showed a recovery of those oscillations, reaching near equivalence to the healthy older adult group. Our results indicate the possibility of an eventual recovery of those initially disrupted network oscillations to a near-normal level, providing potentially a biomarker for stroke recovery of the cortical system. This finding opens new avenues in infra-slow oscillation research and could serve as a useful biomarker in future treatments aimed at recovery.
Full Text Available Functional networks in resting-state fMRI are identified by characteristics of their intrinsic low-frequency oscillations, more specifically in terms of their synchronicity. With advanced aging and in clinical populations, this synchronicity among functionally linked regions is known to decrease and become disrupted, which may be associated with observed cognitive and behavioral changes. Previous work from our group has revealed that oscillations within the slow-5 frequency range (0.01–0.027 Hz are particularly susceptible to disruptions in aging and following a stroke. In this study, we characterized longitudinally the changes in the slow-5 oscillations in stroke patients across two different time-points. We followed a group of ischemic stroke patients (n = 20 and another group of healthy older adults (n = 14 over two visits separated by a minimum of three months (average of 9 months. For the stroke patients, one visit occurred in their subacute window (10 days to 6 months after stroke onset, the other took place in their chronic window (>6 months after stroke. Using a mid-order group ICA method on 10-minutes eyes-closed resting-state fMRI data, we assessed the frequency distributions of a component's representative time-courses for differences in regards to slow-5 spectral power. First, our stroke patients, in their subacute stage, exhibited lower amplitude slow-5 oscillations in comparison to their healthy counterparts. Second, over time in their chronic stage, those same patients showed a recovery of those oscillations, reaching near equivalence to the healthy older adult group. Our results indicate the possibility of an eventual recovery of those initially disrupted network oscillations to a near-normal level, providing potentially a biomarker for stroke recovery of the cortical system. This finding opens new avenues in infra-slow oscillation research and could serve as a useful biomarker in future treatments aimed at recovery.
Landolt, Markus A.; Ystrom, Eivind; Sennhauser, Felix H.; Gnehm, Hanspeter E.; Vollrath, Margarete E.
Background: Previous studies found notable rates of post-traumatic stress symptoms (PTSS) and post-traumatic stress disorder (PTSD) in pediatric patients and their parents and suggest a significant association between child and parent PTSS. However, little is known about mutual influences between child and parental PTSS over time. This study…
Post-abortion syndrome is a type of post-traumatic disorder and is characterised by a stressor (the abortion), the event being re-experienced, avoidance and/or numbing of general responsiveness, and physical symptoms such as insomnia and depression. The question was asked whether the patients at Kalafong Hospital ...
Cancer-related post-traumatic stress can occur any time from diagnosis to after treatment ends. Shock, fear, helplessness, or horror can be felt by cancer patients and lead to cancer-related post-traumatic stress. Learn about the causes and ways doctors can help manage these symptoms of distress in this expert-reviewed summary.
Nedved, Adrienne N; DeFrates, Sean R; Hladnik, Lindsay M; Stockerl-Goldstein, Keith E
Assess the effects of linezolid on hematologic outcomes in newly diagnosed patients with acute myeloid leukemia (AML) following induction chemotherapy. Single-center, retrospective, observational, cohort study. Large, tertiary care academic medical center. A total of 225 patients ≥ 18 years admitted between December 2010 and 2013 with newly diagnosed AML were assessed for inclusion. Patients were identified through the use of ICD-9 codes and chemotherapy ordered via the computerized physician order entry system. Sixty-eight patients met inclusion criteria and were grouped into two arms based on antimicrobial treatment: LZD group (linezolid plus gram-negative antimicrobial, n=21) or control group (vancomycin or daptomycin plus gram-negative antimicrobial, n=47). The LZD group received linezolid ≥ 72 hours. The control group received vancomycin or daptomycin ≥ 72 hours. If patients switched extended gram-positive therapy, they were included in the LZD group as long as they had received ≥ 72 hours of linezolid. The primary end point of time to neutrophil recovery was not statistically different (28 days for LZD group vs 26 days for control group; p=0.675). The preplanned subgroup analysis of patients who received ≥ 14 days of linezolid demonstrated statistically similar median times to neutrophil recovery (29 days for LZD group vs 26 days for control group; p=0.487). Total duration of extended gram-positive antimicrobial therapy was significantly longer in the LZD group (27 days vs 16 days; plinezolid for extended gram-positive antimicrobial coverage following induction chemotherapy. This study provides new insight with a primary focus on the effects of hematologic outcomes when using linezolid in a well-defined acute leukemia population. Further study is warranted with larger populations to assess the potential adverse effects linezolid may have in patients with acute leukemia. © 2016 Pharmacotherapy Publications, Inc.
Bille, Todd W; Cromartie, Carter; Farr, Matthew
This study investigated the effects of time, cyanoacrylate fuming, and location of the biological material on DNA analysis of post-blast pipe bomb fragments. Multiple aliquots of a cell suspension (prepared by soaking buccal swabs in water) were deposited on components of the devices prior to assembly. The pipe bombs were then deflagrated and the fragments recovered. Fragments from half of the devices were cyanoacrylate fumed. The cell spots on the fragments were swabbed and polymerase chain reaction/short tandem repeat analysis was performed 1 week and 3 months after deflagration. A significant decrease in the amount of DNA recovered was observed between samples collected and analyzed within 1 week compared with the samples collected and analyzed 3 months after deflagration. Cyanoacrylate fuming did not have a measurable effect on the success of the DNA analysis at either time point. Greater quantities of DNA were recovered from the pipe nipples than the end caps. Undeflagrated controls showed that the majority (>95%) of the DNA deposited on the devices was not recovered at a week or 3 months.
Hedo, J.; Lucas-Borja, M. E.; Wic, C.; Andrés-Abellán, M.; de Las Heras, J.
Wildfires affecting forest ecosystems and post-fire silvicultural treatments may cause considerable changes in soil properties. The capacity of different microbial groups to recolonise soil after disturbances is crucial for proper soil functioning. The aim of this work was to investigate some microbial soil properties and enzyme activities in semiarid and dry Aleppo pine (Pinus halepensis M.) forest stands. Different plots affected by a wildfire event 17 years ago without or with post-fire silvicultural treatments 5 years after the fire event were selected. A mature Aleppo pine stand, unaffected by wildfire and not thinned was used as a control. Physicochemical soil properties (soil texture, pH, carbonates, organic matter, electrical conductivity, total N and P), soil enzymes (urease, phosphatase, β-glucosidase and dehydrogenase activities), soil respiration and soil microbial biomass carbon were analysed in the selected forests areas and plots. The main finding was that long time after this fire event produces no differences in the microbiological soil properties and enzyme activities of soil after comparing burned and thinned, burned and not thinned, and mature plots. Moreover, significant site variation was generally seen in soil enzyme activities and microbiological parameters. We conclude that total vegetation recovery normalises post-fire soil microbial parameters, and that wildfire and post-fire silvicultural treatments are not significant factors affecting soil properties after 17 years.
O uso de manta térmica no intra-operatório de pacientes submetidos à prostatectomia radical está relacionado com a diminuição do tempo de recuperação pós-anestésica El uso de manta térmica en el intraoperatorio de pacientes sometidos a la prostatectomía radical está relacionado con la disminución del tiempo de recuperación pos anestésica The intraoperative use of warming blankets in patients undergoing radical prostatectomy is related with a reduction in post-anesthetic recovery time
manta térmica en el período intraoperatorio. MÉTODO: Fueron estudiados pacientes, ASA PS I, II, III, entre 45 y 75 años, sometidos a prostatectomía radical con anestesia general en el año 2004. Los datos recolectados incluyeron: edad, peso, estado físico, técnica anestésica, uso de manta térmica y tiempo de permanencia en la RPA, esos fueron puestos en una planilla Excel y analizados por la prueba de Mann-Whitney. RESULTADOS: Los pacientes en que la manta térmica fue utilizada en el período intraoperatorio permanecieron en promedio 139,66 ± 58,6 minutos en la RPA, ya en los pacientes en que la manta térmica no fue utilizada el general de permanencia fue como promedio de 208,28 ± 65,8 minutos en la RPA (p BACKGROUND AND OBJECTIVES: Anesthesia and the surgeries cause substantial thermal changes, and hypothermia can lead to cardiovascular complications, clotting disorders, immunologic changes, and disruption of water and electrolyte balances, besides decreasing drug metabolism and, therefore, increasing post-anesthetic recovery time (PART. Circulation of warm air (forced-air warming blanket is the most effective non-invasive warming method currently available. The objective of the present study was to compare the time spent in the recovery room of patients undergoing radical prostatectomy with and without the intraoperative use of a forced-air warming blanket. METHODS: Male patients between 45 and 75 years, ASA PS I, II, and III undergoing radical prostatectomy under general anesthesia during 2004 were studied. Data gathered included: age, weight, physical status, anesthetic technique, use of warming blanket, and time spent in the recovery room. The data was recorded on an Excel chart and analyzed by the Mann-Whitney test. RESULTS: Patients in whom the warming blanket was used intraoperatively remained a mean of 139.66 ± 58.6 minutes in the recovery room, while patients without the warming blanket spent a mean of 208.28 ± 65.8 minutes in the recovery room
Langhorn, Leanne; Sorensen, Jens C; Pedersen, Preben U
A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care......A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care...
Bahorik, Amber L; Leibowitz, Amy; Sterling, Stacy A; Travis, Adam; Weisner, Constance; Satre, Derek D
Depression is associated with substance-related problems that worsen depression-related disability. Marijuana is frequently used by those with depression, yet whether its use contributes to significant barriers to recovery in this population has been understudied. Participants were 307 psychiatry outpatients with depression; assessed at baseline, 3-, and 6-months on symptom (PHQ-9 and GAD-7), functioning (SF-12) and past-month marijuana use for a substance use intervention trial. Longitudinal growth models examined patterns and predictors of marijuana use and its impact on symptom and functional outcomes. A considerable number of (40.7%; n=125) patients used marijuana within 30-days of baseline. Over 6-months, marijuana use decreased (B=-1.20, pmarijuana use over the follow-up, and those aged 50+(B=0.44, pmarijuana use compared to the youngest age group. Marijuana use worsened depression (B=1.24, pmarijuana use led to poorer mental health (B=-2.03, p=.010) functioning. Medical marijuana (26.8%; n=33) was associated with poorer physical health (B=-3.35, p=.044) functioning. Participants were psychiatry outpatients, limiting generalizability. Marijuana use is common and associated with poor recovery among psychiatry outpatients with depression. Assessing for marijuana use and considering its use in light of its impact on depression recovery may help improve outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.
Parikh, Darshit; De Ieso, Paolo; Garvey, Gail; Thachil, Thanuja; Ramamoorthi, Ramya; Penniment, Michael; Jayaraj, Rama
Breast cancer (BC) is potentially a traumatic stressor which may be associated with negative outcomes, such as post-traumatic stress disorder (PTSD) or positive changes, such as post-traumatic growth (PTG). This study aims to identify the core issues of BC related PTSD, PTG and psychological distress by interrogating the literature in BC survivors. We have also highlighted issues related to the assessment, diagnosis and clinical management of PTSD and PTG. The authors systematically reviewed studies published from 1985 to 2014 pertaining to PTSD, psychological distress and PTG in BC survivors with particular attention paid to incidence rates and causative factors. Multiple studies intimated that women with BC have evidence of PTSD at the initial stages of diagnosis, whereas PTG develops once patients undergo treatment. Early diagnosis and treatment of PTSD/PTG is paramount from literature review but the previously mentioned relationship between PTSD and PTG in BC patients could not be verified. It is evident from the literature that a small percentage of BC patients experience PTSD, while the majority experience PTG after BC diagnosis and treatment. Future research should include prospective studies focusing on high-risk patients, causative factors and the development of psychological interventions.
Berti, L; Vannini, F; Lullini, G; Caravaggi, P; Leardini, A; Giannini, S
Severe post-traumatic ankle arthritis poses a reconstructive challenge in active patients. Whereas traditional surgical treatments, i.e. arthrodesis and arthroplasty, provide good pain relief, arthrodesis is associated to functional and psychological limitations, and arthroplasty is prone to failure in the active patient. More recently the use of bipolar fresh osteochondral allografts transplantation has been proposed as a promising alternative to the traditional treatments. Preliminary short- and long-term clinical outcomes for this procedure have been reported, but no functional evaluations have been performed to date. The clinical and functional outcomes of a series of 10 patients who underwent allograft transplantation at a mean follow-up of 14 months are reported. Clinical evaluation was performed with the AOFAS score, functional assessment by state-of-the-art gait analysis. The clinical score significantly improved from a median of 54 (range 12-65) pre-op to 76.5 (range 61-86) post-op (p=0.002). No significant changes were observed for the spatial-temporal parameters, but motion at the hip and knee joints during early stance, and the range of motion of the ankle joint in the frontal plane (control: 13.8°±2.9°; pre-op: 10.4°±3.1°, post-op: 12.9°±4.2°; p=0.02) showed significant improvements. EMG signals revealed a good recovery in activation of the biceps femoris. This study showed that osteochondral allograft transplantation improves gait patterns. Although re-evaluation at longer follow-ups is required, this technique may represent the right choice for patients who want to delay the need for more invasive joint reconstruction procedures. Copyright © 2013 Elsevier B.V. All rights reserved.
Paxson, Christina; Fussell, Elizabeth; Rhodes, Jean; Waters, Mary
Hurricane Katrina, which struck the Gulf Coast of the United States in August 2005, exposed area residents to trauma and extensive property loss. However, little is known about the long-run effects of the hurricane on the mental health of those who were exposed. This study documents long-run changes in mental health among a particularly vulnerable group—low income mothers—from before to after the hurricane, and identifies factors that are associated with different recovery trajectories. Longi...
urinary tract infection, neurological injury and dural tears. Methods: One hundred consecutive patients undergoing ... muscle mass in the human body, in which weight in kilograms is divided by height in meters2). The current .... complications with the exception of one dural tear occurred in the obese patient group. Table 3.
Bennett, Katelyn G; Vercler, Christian J
Social media is characterized by online spaces for rapid communication, advertising, professional development, and advocacy, and these platforms have revolutionized the way we interact with people and our culture. In plastic surgery, platforms like Facebook, Snapchat, and Instagram are especially attractive for practice promotion and instantaneous connection with potential patients. However, considerable risks and ethical dilemmas lie in wait for the plastic surgeon who attempts to use patient photographs and videos for advertising. It is critical for plastic surgeons who use patient images for this purpose to facilitate fully informed consent, consider both context of use and the patient-physician power differential, and put patients' interests ahead of their own. © 2018 American Medical Association. All Rights Reserved.
I. N. Voloshyna
Full Text Available The evaluation of neuropeptide Y plasma concentration and LF/ HF ratio in post-stroke hypertensive patients has been done. The prognostic significance of sympathetic nervous system activity markers for complications development was established.
Smans, L C C J; Zelissen, P M J
To our knowledge, no case of remission in autoimmune Addison's disease has previously been reported. We describe a patient with primary adrenal insufficiency caused by autoimmune adrenalitis in whom partial remission was observed after 7 yr. A 39-yr-old male was referred because of extreme fatigue, weight loss, anorexia, nausea, and bouts of fever. During physical examination hyperpigmentation was seen. Laboratory tests showed a plasma cortisol of 0.02 micromol/l (08:30 h). Cortisol failed to increase during the ACTH stimulation test (0.02 to 0.03 micromol/l) and ACTH was markedly elevated (920 pmol/l). Adrenal auto-antibodies were weakly positive. A CT-scan showed no evidence of calcifications or other abnormalities of the adrenal glands. The diagnosis of autoimmune Addison's disease was made and replacement therapy with hydrocortisone and fludrocortisone was started. During the following years the dose of hydrocortisone was gradually decreased. Eventually, the patient decided to stop his medication completely. A repeated ACTH-stimulation test revealed a basal cortisol of 0.25 micromol/l and a peak cortisol of 0.30 micromol/l with a basal ACTH of 178 pmol/l. The patient did not have any complaints. Recovery of adrenal insufficiency, due to causes other than autoimmune adrenalitis, has been reported in the past. If our case of partial recovery of autoimmune adrenalitis is not unique this could have profound effects on treatment and follow-up of Addison's disease.
Michael, Scott; Graham, Kenneth S.; Davis, Glen M.
Cardiac parasympathetic activity may be non-invasively investigated using heart rate variability (HRV), although HRV is not widely accepted to reflect sympathetic activity. Instead, cardiac sympathetic activity may be investigated using systolic time intervals (STI), such as the pre-ejection period. Although these autonomic indices are typically measured during rest, the “reactivity hypothesis” suggests that investigating responses to a stressor (e.g., exercise) may be a valuable monitoring approach in clinical and high-performance settings. However, when interpreting these indices it is important to consider how the exercise dose itself (i.e., intensity, duration, and modality) may influence the response. Therefore, the purpose of this investigation was to review the literature regarding how the exercise dosage influences these autonomic indices during exercise and acute post-exercise recovery. There are substantial methodological variations throughout the literature regarding HRV responses to exercise, in terms of exercise protocols and HRV analysis techniques. Exercise intensity is the primary factor influencing HRV, with a greater intensity eliciting a lower HRV during exercise up to moderate-high intensity, with minimal change observed as intensity is increased further. Post-exercise, a greater preceding intensity is associated with a slower HRV recovery, although the dose-response remains unclear. A longer exercise duration has been reported to elicit a lower HRV only during low-moderate intensity and when accompanied by cardiovascular drift, while a small number of studies have reported conflicting results regarding whether a longer duration delays HRV recovery. “Modality” has been defined multiple ways, with limited evidence suggesting exercise of a greater muscle mass and/or energy expenditure may delay HRV recovery. STI responses during exercise and recovery have seldom been reported, although limited data suggests that intensity is a key
Barnes, Kayla G; Kindrachuk, Jason; Lin, Aaron E; Wohl, Shirlee; Qu, James; Tostenson, Samantha D; Dorman, William R; Busby, Michele; Siddle, Katherine J; Luo, Cynthia Y; Matranga, Christian B; Davey, Richard T; Sabeti, Pardis C; Chertow, Daniel S
In one patient over time, we found that concentration of Ebola virus RNA in semen during recovery is remarkably higher than blood at peak illness. Virus in semen is replication-competent with no change in viral genome over time. Presence of sense RNA suggests replication in cells present in semen. Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.
Bibb, Jennifer; Castle, David; Newton, Richard
Background It is well known that mealtime is anxiety provoking for patients with Anorexia Nervosa. However, there is little research into effective interventions for reducing meal related anxiety in an inpatient setting. Methods This study compared the levels of distress and anxiety of patients with Anorexia Nervosa pre and post music therapy, in comparison to standard post meal support therapy. Data was collected using the Subjective Units of Distress (SUDS) scale which was administered pre ...
Badowiec, Anna; Swigonska, Sylwia; Weidner, Stanisław
Amongst many factors restricting geographical distribution of plants and crop productivity, low temperature is one of the most important. To gain better understanding of the molecular response of germinating pea (Pisum sativum L.) to low temperature, we investigated the influence of long and short chilling stress as well as post-stress recovery on the alterations in the root proteomes. The impact of long stress was examined on the pea seeds germinating in the continuous chilling conditions of 10 °C for 8 days (LS). To examine the impact of short stress, pea seeds germinating for 72 h in the optimal temperature of 20 °C were subjected to 24-h chilling (SS). Additionally, both stress treatments were followed by 24 h of recovery in the optimal conditions (accordingly LSR and SR). Using the 2D gel electrophoresis and MALDI-TOF MS protein identification, it was revealed, that most of the proteins undergoing regulation under the applied conditions were implicated in metabolism, protection against stress, cell cycle regulation, cell structure maintenance and hormone synthesis, which altogether may influence root growth and development in the early stages of plant life. The obtained results have shown that most of detected alterations in the proteome patterns of pea roots are dependent on stress duration. However, there are some analogical response pathways which are triggered regardless of stress length. The functions of proteins which accumulation has been changed by chilling stress and post-stress recovery are discussed here in relation to their impact on pea roots development. Copyright © 2013 Elsevier Masson SAS. All rights reserved.
Bajpai, Lakshmikant; Naidu, Harshavardhan; Asokan, Kathiravan; Shaik, Khaja Mohiddin; Kaspady, Mahammed; Arunachalam, Piramanayagam; Wu, Dauh-Rurng; Mathur, Arvind; Sarabu, Ramakanth
Purification of many pharmaceutical compounds by supercritical fluid chromatography (SFC) has always been challenging because of degradation of compound during the isolation step in the presence of acidic or basic modifiers in the mobile phase. Stability of such acid or base-sensitive compounds could be improved by post-column addition of a solvent containing base or acid modifier as counter ion through a make-up pump respectively to neutralize the compound fraction without affecting the resolution. One such case study has been presented in this work where the stability of a base-sensitive compound was addressed by the addition of acidic co-solvent through the make-up pump. Details of this setup and the investigation of degradation of the in-house base-sensitive compound are discussed in this paper. In addition, poor retentivity and low recovery of many non-polar compounds in SFC eluting under low co-solvent percentage is another major concern. Even though the desired separation could be achieved with low percentage of co-solvent, it's difficult to get the proper recovery after purification due to precipitation of the sample and significant aerosol formation inside the cyclone. We have demonstrated the first-time use of a post-column make-up pump on SFC 350 system to introduce additional solvent prior to cyclone to avoid the precipitation, reduce the aerosol formation and thus improve the recovery of non-polar compounds eluting under less than 10% of co-solvent. Copyright © 2017 Elsevier B.V. All rights reserved.
Mitri, George H.; Gitas, Ioannis Z.
Careful evaluation of forest regeneration and vegetation recovery after a fire event provides vital information useful in land management. The use of remotely sensed data is considered to be especially suitable for monitoring ecosystem dynamics after fire. The aim of this work was to map post-fire forest regeneration and vegetation recovery on the Mediterranean island of Thasos by using a combination of very high spatial (VHS) resolution (QuickBird) and hyperspectral (EO-1 Hyperion) imagery and by employing object-based image analysis. More specifically, the work focused on (1) the separation and mapping of three major post-fire classes (forest regeneration, other vegetation recovery, unburned vegetation) existing within the fire perimeter, and (2) the differentiation and mapping of the two main forest regeneration classes, namely, Pinus brutia regeneration, and Pinus nigra regeneration. The data used in this study consisted of satellite images and field observations of homogeneous regenerated and revegetated areas. The methodology followed two main steps: a three-level image segmentation, and, a classification of the segmented images. The process resulted in the separation of classes related to the aforementioned objectives. The overall accuracy assessment revealed very promising results (approximately 83.7% overall accuracy, with a Kappa Index of Agreement of 0.79). The achieved accuracy was 8% higher when compared to the results reported in a previous work in which only the EO-1 Hyperion image was employed in order to map the same classes. Some classification confusions involving the classes of P. brutia regeneration and P. nigra regeneration were observed. This could be attributed to the absence of large and dense homogeneous areas of regenerated pine trees in the study area.
Cho, Chul-Ku; Choi, Soo Yong; Rhyu, Sung Ryeol; Kim, Ki Wha; Kim, Ji Yun; Yun, Na Ra [Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of)
We evaluate the clinical efficacy of pilot product (HemoHIM) on recovery from hematopoiesis damage in cancer patients who received radiotherapy and chemotherapy. The cancer patients studied were as follows : cancer of the breast(47 intakers and 136 non-intakers), uterine cervix(38 intakers and 73 non-intakers), and head and neck(7 intakers and 15 non-intakers). The clinical efficacy of pilot product(HemoHIM) in cancer patients who received radiotherapy and chemotherapy was analyzed. In breast cancer patients, the number of leukocytes decreased according to duration of treatment in both groups. However, intakers showed a less decreasing trend compared with non-intakers. Especially, under limiting value in range of leukocyte number of intakers was significantly higher than that of non-intakers. This result incicates that HemoHIM reduce the severe leukopenia. Values of lymphocyte in both groups decreased similarly after treatment, and it was similar to that of leukocyte. Values of erythrocyte in both groups decreased similarly after treatment, but the values were within normal range. In cervix cancer patients, the results were similar to that of breast cancer patients. In cancer of head and neck, values of leukocyte slightly decreased according to duration of treatment in both group. However, it needs to collect more subjects continuously because of small number of cancer patients. No toxicological side effects of HemoHIM were observed in serological analysis, and possibility to alleviate fatigue and inflammation was investigated in some cases.
Cho, Chul-Ku; Choi, Soo Yong; Rhyu, Sung Ryeol; Kim, Ki Wha; Kim, Ji Yun; Yun, Na Ra
We evaluate the clinical efficacy of pilot product (HemoHIM) on recovery from hematopoiesis damage in cancer patients who received radiotherapy and chemotherapy. The cancer patients studied were as follows : cancer of the breast(47 intakers and 136 non-intakers), uterine cervix(38 intakers and 73 non-intakers), and head and neck(7 intakers and 15 non-intakers). The clinical efficacy of pilot product(HemoHIM) in cancer patients who received radiotherapy and chemotherapy was analyzed. In breast cancer patients, the number of leukocytes decreased according to duration of treatment in both groups. However, intakers showed a less decreasing trend compared with non-intakers. Especially, under limiting value in range of leukocyte number of intakers was significantly higher than that of non-intakers. This result incicates that HemoHIM reduce the severe leukopenia. Values of lymphocyte in both groups decreased similarly after treatment, and it was similar to that of leukocyte. Values of erythrocyte in both groups decreased similarly after treatment, but the values were within normal range. In cervix cancer patients, the results were similar to that of breast cancer patients. In cancer of head and neck, values of leukocyte slightly decreased according to duration of treatment in both group. However, it needs to collect more subjects continuously because of small number of cancer patients. No toxicological side effects of HemoHIM were observed in serological analysis, and possibility to alleviate fatigue and inflammation was investigated in some cases
Kang, Jieun; Kim, Seon Ok; Oh, Yeon-Mok; Lee, Sang-Do; Lee, Jae Seung
Malignancy is associated with an increased risk of venous thromboembolism. Inferior vena cava filters are a viable alternative when anticoagulation is infeasible because of the risk of bleeding. Although the current guidelines recommend that all patients with a vena cava filter be treated with anticoagulation treatment when the risk of bleeding is reduced, studies concerning the role of concomitant anticoagulation after vena cava filter insertion in high-risk patients are scarce. Since many cancer patients suffer from a high risk of hemorrhagic complications, we aimed to determine the effect of post-filter anticoagulation on mortality in patients with a malignant solid tumor. A retrospective cohort study of patients with pulmonary embolism was performed between January 2010 and May 2016. Patients with a solid tumor and vena cava filter inserted because of pulmonary embolism were included. Using Cox proportional hazards model, the prognostic effect of clinical variables was analyzed. A total of 180 patients were analyzed, with 143 patients receiving and 37 patients not receiving post-filter anticoagulation treatment. Mortality was not significantly different between the two groups. The presence of metastatic cancer and that of pancreatobiliary cancer were significant risk factors for mortality. However, post-filter anticoagulation did not show significant effect on mortality regardless of the stage of cancer. In patients with cancer-associated pulmonary embolism, the effect of post-filter anticoagulation on mortality may not be critical, especially in patients with a short life expectancy.
Bibb, Jennifer; Castle, David; Newton, Richard
It is well known that mealtime is anxiety provoking for patients with Anorexia Nervosa. However, there is little research into effective interventions for reducing meal related anxiety in an inpatient setting. This study compared the levels of distress and anxiety of patients with Anorexia Nervosa pre and post music therapy, in comparison to standard post meal support therapy. Data was collected using the Subjective Units of Distress (SUDS) scale which was administered pre and post each condition. A total of 89 intervention and 84 control sessions were recorded. Results from an unpaired t-test analysis indicated statistically significant differences between the music therapy and supported meal conditions. Results indicated that participation in music therapy significantly decreases post meal related anxiety and distress in comparison to standard post meal support therapy. This research provides support for the use of music therapy in this setting as an effective clinical intervention in reducing meal related anxiety.
Garth, A K; Newsome, C M; Simmance, N; Crowe, T C
Malnutrition and its associated complications are a considerable issue for surgical patients with upper gastrointestinal and colorectal cancer. The present study aimed to determine whether specific perioperative nutritional practices and protocols are associated with improved patient outcomes in this group. Patients admitted for elective upper gastrointestinal or colorectal cancer surgery (n = 95) over a 19-month period underwent a medical history audit assessing weight changes, nutritional intake, biochemistry, post-operative complications and length of stay. A subset of patients (n = 25) underwent nutritional assessment by subjective global assessment prior to surgery in addition to assessment of post-operative medical outcomes, nutritional intake and timing of dietetic intervention. Mean (SD) length of stay for patients was 14.0 (12.2) days, with complication rates at 35%. Length of stay was significantly longer in patients who experienced significant preoperative weight loss compared to those who did not [17.0 (15.8) days versus 10.0 (6.8) days, respectively; P nutritional assessment, 32% were classified as mild-moderately malnourished and 16% severely malnourished. Malnourished patients were hospitalised twice as long as well-nourished patients [15.8 (12.8) days versus 7.6 (3.5) days; P nutrition post surgery was a factor in post-operative outcomes, with a positive correlation with length of stay (r = 0.493; P cancer. Poor nutritional status coupled with delayed and inadequate post-operative nutrition practices are associated with worse clinical outcomes.
Nii, Maria; Maeda, Keisuke; Wakabayashi, Hidetaka; Nishioka, Shinta; Tanaka, Atsuko
Malnutrition affects the activities of daily living (ADLs) in convalescent patients with cerebrovascular disorders. We investigated the relationship between nutritional improvement, energy intake at admission, and recovery of ADLs. We evaluated 67 patients with cerebrovascular disorders admitted to our rehabilitation hospital between April 2013 and April 2015. These patients received interventions from the rehabilitation nutritional support team according to the following criteria: weight loss of 2 kg or more and body mass index of 19 kg/m(2) or lower. Exclusion criteria included a body mass index of 25 kg/m(2) or higher, duration of intervention of less than 14 days, or transfer to an acute care hospital because of clinical deterioration. We assessed nutritional status using the Geriatric Nutritional Risk Index (GNRI) and ADL using the Functional Independence Measure (FIM) score, FIM gain, and FIM efficiency. The mean age of the patients was 78.7 ± 8.0 years. The numbers of patients in each category of cerebrovascular disorder were 39 with cerebral infarction, 16 with intracerebral hemorrhage, 8 with subarachnoid hemorrhage, and 4 others. Compared with the counterpart group, the group with an improvement in GNRI had a greater gain in FIM (median 17 and 20, respectively; P = .036) and a higher FIM efficiency (.14 and .22, respectively; P = .020). Multivariate stepwise regression analysis showed that an improvement in GNRI, increasing energy intake at admission, and intracerebral hemorrhage were associated independently with greater FIM efficiency. This study suggested that nutritional improvement and energy intake at admission are associated with recovery of ADL after cerebrovascular disorders. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Garcia, Daniel D.; van de Pol, Corina; Barsky, Brian A.; Klein, Stanley A.
Many current corneal topography instruments (called videokeratographs) provide an `acuity index' based on corneal smoothness to analyze expected visual acuity. However, post-refractive surgery patients often exhibit better acuity than is predicted by such indices. One reason for this is that visual acuity may not necessarily be determined by overall corneal smoothness but rather by having some part of the cornea able to focus light coherently onto the fovea. We present a new method of representing visual acuity by measuring the wavefront aberration, using principles from both ray and wave optics. For each point P on the cornea, we measure the size of the associated coherence area whose optical path length (OPL), from a reference plane to P's focus, is within a certain tolerance of the OPL for P. We measured the topographies and vision of 62 eyes of patients who had undergone the corneal refractive surgery procedures of photorefractive keratectomy (PRK) and photorefractive astigmatic keratectomy (PARK). In addition to high contrast visual acuity, our vision tests included low contrast and low luminance to test the contribution of the PRK transition zone. We found our metric for visual acuity to be better than all other metrics at predicting the acuity of low contrast and low luminance. However, high contrast visual acuity was poorly predicted by all of the indices we studied, including our own. The indices provided by current videokeratographs sometimes fail for corneas whose shape differs from simple ellipsoidal models. This is the case with post-PRK and post-PARK refractive surgery patients. Our alternative representation that displays the coherence area of the wavefront has considerable advantages, and promises to be a better predictor of low contrast and low luminance visual acuity than current shape measures.
Full Text Available OBJECTIVE: We aim to compare selective spinal anesthesia and general anesthesia with regard to postoperative recovery and fast-track eligibility in day surgeries. MATERIALS AND METHOD: Sixty geriatric outpatient cases, with ASA II-III physical status and requiring shortduration transurethral intervention, were enrolled in the study. The cases were split into 2 groups: as general anesthesia (Group GA and selective spinal anesthesia (Group SSA. Group GA (n = 30 received propofol 2 mg kg-1 (until loss of eyelash reflex, remifentanil induction 0.5-1 µg kg-1, and laryngeal mask. Maintenance was achieved by 4-6% desflurane in 60% N2O and 40% O2 along with remifentanil infusion at 0.05 µg /kg-1 /min-1. Drugs were discontinued after the withdrawal of the ureteroscope, and extubation was carried out with 100% O2. Group SSA (n = 30 received 0.5% spinal anesthesia via L4-5 space by 0.5% hyperbaric bupivacaine 5 mg. Anesthesia preparation time, time to surgical anesthesia level, postoperative fast-tracking, and time to White-Song recovery score of 12, were noted. In the operating room, we evaluated hemodynamics, nausea/vomiting, surgeon and patient satisfaction with anesthesia, perioperative midazolam-fentanyl administration, postoperative pain, and discharge time. RESULTS: Anesthesia preparation time, length of surgery, anesthesia-related time in the operating room, time to sit, and time to walk were significantly low in Group GA (p < 0.05, whereas time to fast-track eligibility, length of stay in the PACU, discharge time, and other parameters were similar in both of the groups. CONCLUSION: While anesthesia preparation time, length of surgery, start time of surgery, time to sit, and time to walk were shorter in the General Anesthesia group, time to fast-track eligibility, phase 1 recovery time, and discharge time were similar among patients subjected to selective spinal anesthesia.
Toft, Søren; Nielsen, Søren Achim
, because it is better than lipid-rich food that allows concurrent rebuilding of fat stores and lean mass, which may benefit preparation for spring migration and reproduction. We propose that overwintered fruits may be highly preferred post-diapause food for these otherwise mostly carnivorous beetles....
Grodzinskij, D.M.; Evstyukhina, T.A.; Kol'tover, V.K.; Korolev, V.G.; Kutlakhmedov, Yu.A.; Grodzinskij, D.M.; Evstyukhina, T.A.; Kol'tover, V.K.; Korolev, V.G.; Kutlakhmedov, Yu.A.; Grodzinskij, D.M.; Evstyukhina, T.A.; Kol'tover, V.K.; Korolev, V.G.; Kutlakhmedov, Yu.A.
Among three stable magnesium isotopes, 24 Mg, 25 Mg, and 26 Mg with natural abundance 79, 10, and 11%, only 25 Mg has the nuclear spin (I=5/2) and, therefore, the nuclear magnetic moment. Two other isotopes are spinless (I=0) and, hence, have no magnetic moment. We have revealed that magnetic isotope 25 Mg, by comparison to nonmagnetic isotope 24 Mg, essentially stimulates the recovery process in the yeast cells, Saccharomyces cerevisiae, after UV irradiation. Thus, we have first documented the magnetic isotope effect in radiation biology. This finding opens up the way to the development of novel radio-protectors based on the stable magnetic isotopes.
Poulios, Athanasios; Fatouros, Ioannis G; Mohr, Magni
The effects of protein supplementation on performance recovery and inflammatory responses during a simulated one-week in-season microcycle with two games (G1, G2) performed three days apart were examined. Twenty football players participated in two trials, receiving either milk protein concentrat...... short-lived reduction after G2 in PRO compared to PLA. In summary, these results provide evidence that protein feeding may more efficiently restore football-specific performance and strength and provide antioxidant protection during a congested game fixture....
Full Text Available BACKGROUND: In HIV-infected individuals, mechanisms underlying unsatisfactory immune recovery during effective combination antiretroviral therapy (cART have yet to be fully understood. We investigated whether polymorphism of genes encoding immune-regulating molecules, such as killer immunoglobulin-like receptors (KIR and their ligands class I human leukocyte antigen (HLA, could influence immunological response to cART. METHODS: KIR and HLA frequencies were analyzed in 154 HIV-infected and cART-treated patients with undetectable viral load divided into two groups: 'immunological non responders' (INR, N = 50, CD4(+ T-cell count 350/mm(3. Molecular KIR were typed using polymerase chain reaction-based genotyping. Comparisons were adjusted for baseline patient characteristics. RESULTS: The frequency of KIR2DL3 allele was significantly higher in FR than in INR (83.7% vs. 62%, P = 0.005. The functional compound genotype HLA-C1(+/KIR2DL3(+, even at multivariable analysis, when adjusted for nadir CD4(+ T-cell count, was associated with reduced risk of INR status: odds ratio (95% Confidence Intervals 0.34 (0.13-0.88, P = 0.03. CONCLUSIONS: Reduced presence of the inhibitory KIR2DL3 genotype detected in INR might provoke an imbalance in NK function, possibly leading to increased immune activation, impaired killing of latently infected cells, and higher proviral burden. These factors would hinder full immune recovery during therapy.
Full Text Available The aim was to evaluate the visual recovery after managing traumatic cataracts and determine the predictors of a better visual prognosis. This was a prospective study. We enrolled patients with specific inclusion criteria, examined their eyes to review the comorbidities due to trauma, performed surgery for traumatic cataracts, and implanted lenses. The patients were reexamined 6 weeks postoperatively. We divided the cases of traumatic cataract into two groups, the "open globe" (Group 1 and "closed globe" (Group 2 groups, according to the ocular trauma based on the Birmingham Eye Trauma Terminology System (BETTS and compared the determinants of visual acuity. Our cohort of 555 eyes with traumatic cataracts included 394 eyes in Group 1 and 161 in Group 2. Six weeks postoperatively, the visual acuity in the operated eye was >20/60 in 193 (48% and 49 (29% eyes in Groups 1 and 2, respectively (P = 0.002, ANOVA. At follow-up, >20/60 vision was significantly higher in Group 1 than in Group 2 (OR = 1.61; 95% CI, 0.85-3.02. Overall 242 (43.5% eyes gained a final visual acuity of >20/60. Open globe injury has a favorable prognosis for satisfactory (>20/60 visual recovery after the management of traumatic cataracts.
Gottrup, Hanne; Andersen, Jørn; Arendt-Nielsen, Lars
and contralateral sides in 15 women with spontaneous pain and sensory abnormalities and 11 pain-free women. Testing included the VAS score of spontaneous pain, detection and pain threshold to thermal and mechanical stimuli, temporal summation to repetitive heat and pinprick stimuli, and assessment of skin blood...... to side difference was seen in pressure pain threshold in the pain-free group. Evoked pain intensity to repetitive stimuli at 0.2 and 2.0 Hz was significantly higher on the operated side in pain patients compared to the control area while no such difference was seen in pain-free patients. Cutaneous blood...
Abrahamsen, Jenny Foss; Haugland, Cathrine; Ranhoff, Anette Hylen
The objective of the present study was to investigate 1) the role of different admission diagnoses and 2) the degree of functional loss, on the rate of recovery of older patients after acute hospitalization. Furthermore, to compare the predictive value of simple assessments that can be carried out in a hospital lacking geriatric service, with assessments including geriatric screening tests. Prospective, observational cohort study, including 961community dwelling patients aged ≥ 70 years, transferred from medical, cardiac, pulmonary and orthopedic acute hospital departments to intermediate care in nursing home. Functional assessment with Barthel index (BI) was performed at admission to the nursing home and further geriatric assessment tests was performed during the first week. Logistic regression models with and without geriatric assessment were compared concerning the patients having 1) slow recovery (nursing home stay up to 2 months before return home) or, 2) poor recovery (dead or still in nursing home at 2 months). Slow recovery was independently associated with a diagnosis of non-vertebral fracture, BI subgroups 50-79 and model including geriatric assessment, also with cognitive impairment. Poor recovery was more complex, and independently associated both with BI model, cognitive impairment. Geriatric assessment is optimal for determining the recovery potential of older patients after acute hospitalization. As some hospitals lack geriatric services and ability to perform geriatric screening tests, a simpler assessment based on admission diagnoses and ADL function (BI), gives good information regarding the possible rehabilitation time and possibility to return home.
Thakkar, R S; Thakkar, S C; Srikumaran, U; Fayad, L M
When pain or disability occurs after rotator cuff surgery, post-operative imaging is frequently performed. Post-operative complications and expected post-operative imaging findings in the shoulder are presented, with a focus on MRI, MR arthrography (MRA) and CT arthrography. MR and CT techniques are available to reduce image degradation secondary to surgical distortions of native anatomy and implant-related artefacts and to define complications after rotator cuff surgery. A useful approach to image the shoulder after surgery is the standard radiography, followed by MRI/MRA for patients with low “metal presence” and CT for patients who have a higher metal presence. However, for the assessment of patients who have undergone surgery for rotator cuff injuries, imaging findings should always be correlated with the clinical presentation because post-operative imaging abnormalities do not necessarily correlate with symptoms. PMID:24734935
Garland, Sheila N; Rouleau, Codie R; Campbell, Tavis; Samuels, Charles; Carlson, Linda E
Insomnia is an important but often overlooked side effect of cancer. Dysfunctional sleep beliefs have been identified as an important perpetuating factor for insomnia. Mindfulness practice has been demonstrated to improve sleep quality but it is unknown whether these effects relate to changes in dysfunctional sleep beliefs. This study is a secondary analysis of a randomized controlled trial comparing mindfulness-based cancer recovery (MBCR) to cognitive behavior therapy for insomnia (CBT-I) in cancer patients with insomnia. This present analysis compares program impact on mindfulness, dysfunctional sleep beliefs, and insomnia severity clinical cutoffs. Patients (MBCR, n = 32; CBT-I, n = 40) were assessed at baseline, post-program, and 3-month follow-up. Across both groups, patients showed improvements over time in acting with awareness (P = .021) and not judging experiences (P = .023). Changes in dysfunctional sleep beliefs produced by the CBT-I group exceeded those produced by MBCR at post-program and follow-up (P insomnia severity clinical cutoffs at post-program or follow-up. This study supports the use of both CBT-I and MBCR to reduce insomnia severity and suggests the development of mindfulness facets as a method of reducing dysfunctional sleep beliefs. Copyright © 2015 Elsevier Inc. All rights reserved.
Tepley, A. J.; Thompson, J. R.; Epstein, H. E.; Anderson-Teixeira, K. J.
In the context of ongoing climatic warming, certain landscapes could be near a tipping point where relatively small changes to their fire regimes or post-fire forest recovery dynamics could bring about extensive conversion of forests to shorter-statured, more fire-prone vegetation, with associated changes in biodiversity, carbon dynamics, and climate feedbacks. Such concerns are particularly valid in the Klamath Region of northern California and southwestern Oregon, where montane landscapes support conifer forests, but severe fire converts them to systems dominated by broadleaf trees and shrubs that rapidly resprout or germinate from a dormant seedbank. Conifers eventually overtop the competing vegetation, but until they do, these systems are highly fire prone and susceptible to perpetuation through a cycle of reburning. To assess the vulnerability to fire-driven loss of conifer forests in a warming climate, we characterized the trajectories of post-fire forest recovery in 57 sites that burned severely within the last three decades and span the aridity gradient of montane conifer forests. Post-fire conifer regeneration was limited to a surprisingly narrow window, with 89% of all seedlings established in the first four years after fire. Early establishment conferred a competitive growth advantage such that the longer the lag between the fire year and the year of seedling establishment, the slower its height growth. A substantial portion of variation in post-fire conifer seedling density was driven by an interaction between propagule pressure and site moisture status (climatic water deficit). Mesic sites had abundant regeneration except where seed sources were nearly absent across large (ca. 50 ha) high-severity patches. Toward the dry end of the moisture gradient, much higher propagule pressure was required to support even moderate levels of conifer regeneration. The present distribution of conifer forests falls largely within the portion of the moisture gradient
Muhtz, Christoph; Wiedemann, Klaus; Kellner, Michael
Symptom provocation has proved its worth for understanding the pathophysiology of diseases and in general for the development of new therapeutic approaches in the medical field. In the research of anxiety disorders, investigations using experimentally induced panic attacks by various agents, such as sodium lactate, carbon dioxide, cholezystokinine-tetrapetid etc., have a long tradition and allow the exploration of usually naturally occuring spontaneous psychopathological phenomena under controlled conditions. Post-Traumatic Stress Disorder (PTSD) is a prevalent disorder that can develop following exposure to an extreme traumatic event. In DSM-IV it is currently classified as an anxiety disorder and shares phenomenological similarities with panic disorder. The use of panicogenic challenge tests is also an interesting neurobiological approach to learn more about the nature of PTSD and may be a possibility to develop new therapeutic strategies for the treatment of PTSD symptoms. Not only panic anxiety, but also flashbacks and other dissociative symptoms can be provoked by several panicogens in PTSD. The purpose of this review is to evaluate studies using panicogens in PTSD. Methodological short-comings of current studies and needed directions of further research are discussed.
Harville, Emily; Savage, Jane; Giarratano, Gloria
Purpose The objective of this study was to determine if complementary and alternative medicine (CAM) therapies are associated with mental health in post-disaster environments. Design Pregnant women (N=402) were interviewed between 2010-2012 as part of a larger cross-sectional study on hurricane recovery and models of prenatal care. Methods Symptoms of depression (Edinburgh Postnatal Depression Screen), prenatal anxiety (Revised prenatal distress questionnaire), post-traumatic stress (PCL-S), and perceived stress (PSS) were examined. Logistic regression was used to adjust for income, race, education, parity and age. The most commonly reported therapies were prayer, music, multivitamins, massage, and aromatherapy. Findings Mental illness symptoms were common (30.7% had likely depression, 17.4% had anxiety, and 9.0% had post-traumatic stress). Massage was protective for depression (EDSI>8) (aOR 0.6, 95% CI 0.3-0.9), while use of aromatherapy (aOR 1.9, 95% CI 1.1-3.2) and keeping a journal (aOR 1.9, 95% CI 1.1-3.2) were associated with increased odds of depression. Aromatherapy was associated with symptoms of pregnancy-related anxiety (aOR 2.0, 95% CI 1.1-3.8). Conclusions Symptoms of mental illness persist after disaster, when untreated. Nurses should consider assessing for CAM utilization in pregnancy as a potentially protective factor for mental health symptoms. PMID:26503992
Sparks, A. M.; Kolden, C.; Smith, A. M.
Fire activity, in terms of intensity, frequency, and total area burned, is expected to increase with changing climate. A challenge for landscape level assessment of fire effects, termed burn severity, is that current assessments provide very little information regarding vegetation physiological performance and recovery, limiting our understanding of fire effects on ecosystem services such as carbon storage/cycling. To address these limitations, we evaluated an alternative dose-response methodology for quantifying fire effects that attempts to bridge fire combustion dynamics and ecophysiology. Specifically, we conducted a highly controlled, laboratory assessment of seedling response to increasing doses of fire radiative energy applied through surface fires, for two western U.S. conifer species. Seedling physiology and spectral reflectance were acquired pre- and up to 1 year post-fire. Post-fire mortality, physiological performance, and spectral reflectance were strongly related with fire radiative energy density (FRED: J m-2) dose. To examine how these relationships change with tree size and age, we conducted small prescribed fires at the tree scale (35 m2) in a mature conifer stand. Radial growth and resin duct defenses were assessed on the mature conifer trees following the prescribed fires. Differences in dose-response relationships between seedlings and mature trees indicate the importance of fire behavior (e.g., flaming-dominated versus smoldering-dominated combustion) in characterizing these relationships. Ultimately, these results suggest that post-fire impacts on growth of surviving seedlings and mature trees require modes of heat transfer to impact tree canopies.
Kelleher, Erin; Giampietro, Philip F; Moreno, Megan A
Marfan syndrome (MS) is a connective tissue disorder that affects thousands of adolescents [Population Reference Bureau, 2013]. Some adolescent patients with MS may use social media to express their experiences and emotions, but little is known about what patients choose to share online. To investigate social media content related to Marfan syndrome we used search terms "Marfan syndrome" and "Marfans" on six different social media sites. The top five recent and popular posts for each site were collected and coded weekly for five weeks. Posts were excluded if they were reshared content or not in English. A codebook was developed using an iterative process to categorize posts and comments. Out of 300 posts collected 147 posts (49.0%) were included for evaluation. Categories of displayed content included personal pictures, memes and pictures featuring symptoms of MS (41.5%) and personal MS experiences (27.1% of posts). One quarter of the posts specifically mentioned a positive experience or how thankful the profile owner was for their life. A unique category of posts (13.7%) referenced Austin Carlile, a celebrity singer with MS, as a role model. Physicians and healthcare providers may consider using social media to understand common MS concerns and to place future health education materials. © 2015 Wiley Periodicals, Inc.
component influencing the recovery from burns trauma, it still remains a broad construct within the burns framework. Regular assessment of resilience in burn-injured patients is recommended in clinical practice in addition to longitudinal and intervention studies to best inform patient care. Keywords: resilience, burn injury, rehabilitation, optimism, tenacity, review
Full Text Available The tested material consisted of grapevine Vitis californica stratified seeds germinated under optimum conditions (+25°C in water, under osmotic stress (-0.2 MPa in PEG solution and submitted to recovery after stress (+25°C in water. The germinating seeds were determined to contain tannins, catechins and the following phenolic acids: gallic, caffeic, p-coumaric and ferulic. The acids occurred in free, ester- and glycoside-bound forms. The dominant form of phenolic acids was the ester-bound fraction. Gallic acid was the most abundant phenolic acid in germinating seeds, while ferulic acid appeared in the smallest amounts. Our analysis of tannins demonstrated that osmotic stress depressed their concentration. Presence of catechin group compounds such as catechin and epicatechin was also determined. In each sample epicatechin was dominant. The total concentration of catechin increased under stress conditions and declined during post-stress recovery. Catechins are a constituent of tannins and their increase under osmotic stress is most probably caused by the breakdown of some tannins in seeds germinating under stress conditions. Samples submitted to osmotic stress were also found to contain less of total phenolic compounds, whereas in samples which underwent post-stress recovery the total level of phenolic compounds increased. Compared to extracts from seeds germinating under optimum conditions, osmotic stress depressed the capacity of extract to scavenge DPPH● (2,2-diphenyl-1-picrylhydrazyl and ABTS●+ – 2,2-Azino-bis (3-etylbenzothiazoline-6-sulfonic acid free radicals, but the antioxidant activity rose in seeds submitted to recovery after stress. Positive correlation was therefore demonstrated between the total content of phenolic acids in germinating grapevine seeds and the reducing power of extracts obtained from these seeds and their free radical scavenging activity. The results suggest that osmotic stress inhibits the activity of
Villaverde-Morcillo, S; Esteso, M C; Castaño, C; Santiago-Moreno, J
Many post-mortem sperm collection techniques have been described for mammalian species, but their use in birds is scarce. This paper compares the efficacy of two post-mortem sperm retrieval techniques - the flushing and float-out methods - in the collection of rooster sperm, in conjunction with the use of two extenders, i.e., L&R-84 medium and Lake 7.1 medium. To determine whether the protective effects of these extenders against refrigeration are different for post-mortem and ejaculated sperm, pooled ejaculated samples (procured via the massage technique) were also diluted in the above extenders. Post-mortem and ejaculated sperm variables were assessed immediately at room temperature (0 h), and after refrigeration at 5°C for 24 and 48 h. The flushing method retrieved more sperm than the float-out method (596.5 ± 75.4 million sperm vs 341.0 ± 87.6 million sperm; p < 0.05); indeed, the number retrieved by the former method was similar to that obtained by massage-induced ejaculation (630.3 ± 78.2 million sperm). For sperm collected by all methods, the L&R-84 medium provided an advantage in terms of sperm motility variables at 0 h. In the refrigerated sperm samples, however, the Lake 7.1 medium was associated with higher percentages of viable sperm, and had a greater protective effect (p < 0.05) with respect to most motility variables. In conclusion, the flushing method is recommended for collecting sperm from dead birds. If this sperm needs to be refrigerated at 5°C until analysis, Lake 7.1 medium is recommended as an extender. © 2015 Blackwell Verlag GmbH.
Seaby, L. P.; Tague, C. L.; Hope, A. S.
The Mediterranean type environments (MTEs) of California are characterized by a distinct wet and dry season and high variability in inter-annual climate. Water limitation in MTEs makes eco-hydrological processes highly sensitive to both climate variability and frequent fire disturbance. This research modeled post-fire eco- hydrologic behavior under historical and moderate and extreme scenarios of future climate in a semi-arid chaparral dominated southern California MTE. We used a physically-based, spatially-distributed, eco- hydrological model (RHESSys - Regional Hydro-Ecologic Simulation System), to capture linkages between water and vegetation response to the combined effects of fire and historic and future climate variability. We found post-fire eco-hydrologic behavior to be strongly influenced by the episodic nature of MTE climate, which intensifies under projected climate change. Higher rates of post-fire net primary productivity were found under moderate climate change, while more extreme climate change produced water stressed conditions which were less favorable for vegetation productivity. Precipitation variability in the historic record follows the El Niño Southern Oscillation (ENSO) and the Pacific Decadal Oscillation (PDO), and these inter-annual climate characteristics intensify under climate change. Inter-annual variation in streamflow follows these precipitation patterns. Post-fire streamflow and carbon cycling trajectories are strongly dependent on climate characteristics during the first 5 years following fire, and historic intra-climate variability during this period tends to overwhelm longer term trends and variation that might be attributable to climate change. Results have implications for water resource availability, vegetation type conversion from shrubs to grassland, and changes in ecosystem structure and function.
Syeda, T.; Rizvi, H.A.; Hashim, A.S.
Objective: To determine the concentration of C-reactive protein in pre- and post-operative serum samples of brain tumour patients in order to detect the potential risks of post-operative infections. Methods: Serum C-reactive protein was measured on pre- and post-operative Day 1, Day 2 and Day 7 in 18 patients who underwent surgery for brain tumours. The study was performed at the Neurosurgical Ward, Jinnah Postgraduate Medical Centre, Karachi, from May 2007 to April 2008. Mean pre-operative patients and control values were compared using Mann-Whitney or Wilcoxon tests for comparing between pre- and post-operative values. P-value was considered significant at 5.0mg/L but no statistically significant difference was found when compared with healthy controls, with mean 4.4+-6.6 and 0.9+-0.7, respectively. Significantly raised serum concentrations were observed in all post-operative samples when compared with pre-operative samples. Serum CRP concentrations significantly increased post-operatively on Day 1, with mean value of 102.9+-82.0mg/L (p<0.0005), and further increased on Day 2 with mean value of 166.9+-128.1mg/L (p<0.0005), but declined on Day 7, with mean value of 42.7+-63.6mg/L (p<0.005). Conclusion: Pre-operative serum C-reactive protein concentrations of 28% of the patients were elevated, suggesting an association with brain tumours. Post-operative serum concentrations were significantly higher than those noted before the surgery. Absence of a fall of concentration from peak value on post-operative Day 2 or a secondary rise from post-operative Day 7 could be alarming for inter-current infection. (author)
Talbot, S. S.; Talbot, S.L.; Walker, L.R.
We studied the vegetation of Kasatochi Island, central Aleutian Islands, to provide a general field assessment regarding the survival of plants, lichens, and fungi following a destructive volcanic eruption that occurred in 2008. Plant community data were analyzed using multivariate methods to explore the relationship between pre- and post-eruption plant cover; 5 major vegetation types were identified: Honckenya peploides beach, Festuca rubra cliff shelf, Lupinus nootkatensisFestuca rubra meadow, Leymus mollis bluff ridge (and beach), and Aleuria aurantia lower slope barrens. Our study provided a very unusual glimpse into the early stages of plant primary succession on a remote island where most of the vegetation was destroyed. Plants that apparently survived the eruption dominated early plant communities. Not surprisingly, the most diverse post-eruption community most closely resembled a widespread pre-eruption type. Microhabitats where early plant communities were found were distinct and apparently crucial in determining plant survival. Comparison with volcanic events in related boreal regions indicated some post-eruption pattern similarities. ?? 2010 Regents of the University of Colorado.
Chavan, Pooja; Kumar, Rajesh; Kirubagaran, Ramalingam; Venugopalan, Vayalam P
Antifouling biocides are commonly used in coastal electric power stations to prevent biofouling in their condenser cooling systems. However, the environmental impact of the chemical biocides is less understood than the thermal stress effects caused by the condenser effluents. In this study, Chaetoceros lorenzianus, a representative marine diatom, was used to analyse the toxicity of two antifouling biocides, chlorine and chlorine dioxide. The diatom cells were subjected to a range of concentrations of the biocides (from 0.05 to 2mg/L, as total residual oxidants, TRO) for contact time of 30min. They were analysed for viability, genotoxicity, chlorophyll a and cell density endpoints. The cells were affected at all concentrations of the biocides (0.05-2mg/L), showing dose-dependent decrease in viability and increase in DNA damage. The treated cells were later incubated in filtered seawater devoid of biocide to check for recovery. The cells were able to recover in terms of overall viability and DNA damage, when they had been initially treated with low concentrations of the biocides (0.5mg/L of Cl 2 or 0.2mg/L of ClO 2 ). Chlorophyll a analysis showed irreparable damage at all concentrations, while cell density showed increasing trend of reduction, if treated above 0.5mg/L of Cl 2 and 0.2mg/L of ClO 2 . The data indicated that in C. lorenzianus, cumulative toxic effects and recovery potential of ClO 2 up to 0.2mg/L were comparable with those of Cl 2 , up to 0.5mg/L concentration in terms of the studied endpoints. The results indicate that at the biocide levels currently being used at power stations, recovery of the organism is feasible upon return to ambient environment. Similar studies should be carried out on other planktonic and benthic organisms, which will be helpful in the formulation of future guidelines for discharge of upcoming antifouling biocides such as chlorine dioxide. Copyright © 2017 Elsevier Inc. All rights reserved.
Full Text Available Introduction. The relationship between intellectual disability (ID and hand motor coordination and speed-accuracy, as well as the effect of aging on fine motor performance in patients with ID, has been previously investigated. However, only a few data are available on the impact of the nonpharmacological interventions in adult patients with long-term hand motor deficit. Methods. Fifty adults with mild ID were enrolled. A group of thirty patients underwent a two-month intensive ergotherapic treatment that included hand motor rehabilitation and visual-perceptual treatment (group A; twenty patients performing conventional motor rehabilitation alone (group B served as a control group. Data on attention, perceptual abilities, hand dexterity, and functional independence were collected by a blind operator, both at entry and at the end of the study. Results. After the interventions, group A showed significantly better performance than group B in all measures related to hand movement from both sides and to independence in activities of daily living. Discussion. Multimodal integrated interventions targeting visual-perceptual abilities and motor skills are an effective neurorehabilitative approach in adult patients with mild ID. Motor learning and memory-mediated mechanisms of neural plasticity might underlie the observed recovery, suggesting the presence of plastic adaptive changes even in the adult brain with ID.
Ahn, J.; Cha, K.S.; Oh, J.H.; Lee, H.C.
Neurologic impairments are very common among patients who get a recovery of spontaneous circulation after suffering from out-of-hospital cardiac arrest. Therapeutic hypothermia is established as a standardized therapeutic strategy for those patients in whom it decreases mortality rate and improves neurologic outcome. Herein, we report a case of patient who experienced out-of-hospital cardiac arrest with ischaemic heart disease and ventricular arrhythmia and got a full recovery without any neurologic impediments 2 months after being managed with therapeutic hypothermia. (author)
Jang, Sung Ho; Ha, Ji Wan; Kim, Hyun Young; Seo, You Sung
Abstract Rationale: Recovery of injured AF in patients with traumatic brain injury (TBI) has not been reported. In this study, we report on a patient with TBI who recovered from an injury to Broca's portion of AF in the dominant hemisphere, diagnosed by diffusion tensor tractography (DTT). Patient concerns: A 28-year-old right-handed male patient suffered head trauma resulting from sliding while riding a motorcycle. Diagnoses: He was diagnosed with a traumatic contusional hemorrhage in the le...
Khan, S.; Zahoor, M.U.; Zaid, A.Y.; Buland, K.
The purpose of the study was to determine the association between of preoperative heart rate and post spinal hypotension in women undergoing cesarean section, Two hundred patients undergoing caesarean were included in the study selected on non probability convenience sampling technique, The patients were divided into two groups depending upon their pre operative heart rate. Spinal anesthesia was administered and number of patients developing hypotension was noted. Among 200 patients, who were included in the study; 112 were placed in group A and 88 were placed in group B depending on mean heart rate of 90 beats per minute or less or 91 beats per minute or more respectively. In group A 14 (11.86%) patients developed hypotension where as in group B 28 (31,82%) patients developed hypotension. Pre operative heart rate is significantly associated with post spinal hypotension in obstetric patients undergoing cesarean section. (author)
Patel, Payal K; Mantey, Julia; Mody, Lona
We assessed multidrug-resistant organism (MDRO) patient hand colonization in relation to the environment in post-acute care to determine risk factors for MDRO hand colonization. Patient hand colonization was significantly associated with environmental contamination. Risk factors for hand colonization included disability, urinary catheter, recent antibiotic use, and prolonged hospital stay. Infect Control Hosp Epidemiol 2017;38:1110-1113.
Conclusion: Analysis of the results indicates that health professionals need to obtain information regarding the use of herbal products by cancer patients during both pre- and post- surgery periods, as well as during chemotherapy. Patients should be provided with information and guidance about the advantages and ...
Fitzpatrick, David; O'Meara, Patrick; Cunningham, Andrew
This short report describes the case of a young adult male who had smoked a synthetic cannabinoid legal high product called 'Exodus Damnation'. The patient's presentation was atypical from that described in the literature, with hypotension and hypoxaemia. Of note was the rapid recovery after pre-hospital intervention with high-flow oxygen therapy and intravenous fluids. The patient refused on-going care, despite repeated advice to attend the Emergency Department. The distinct lack of specialist support and referral to drug treatment for this patient population, with whom ambulance services are coming into contact with increasing frequency, is reported. For those patients with the capacity to refuse on-going care, ambulance services may be in an opportune position to actively promote referral to support services for these vulnerable individuals. © The Author(s) 2016.
Stiekema, Anna Petronella Maria
Many patients with severe mental illness experience difficulties with adapting to the impact of their illness and with developing new meaning and purpose in life. This process of adapting to the consequences of the illness is called recovery. Patients in residential facilities often have stagnated
Full Text Available Sedation permits patients to tolerate the various treatment modalities to which they are subjected. However it may sometimes cause prolonged sedation in critically ill patients. Flumazenil, a benzo¬diazepine antagonist, reverses midazolam-induced sedation and amnesia. We prospectively designed a double-blind randomized study to evaluate the effects of flumazenil on thirty (30 Iranian General Intensive Care Unit (ICU patients. They were requiring mechanical ventilation for more than 12 hours and they were sedated by midazolam infusions. Sedation levels were measured hourly during the infusion, at the end of the infusion, and at 5, 15, 30, 60, and 120 min after cessation of the mida¬zolam infusion. Reversal of sedation was observed in all patients who received flumazenil, and re-sedation occurred in seven of these patients. Reversal was not seen in any of the patients who receiv-ed placebo.
Full Text Available Background and aims: Adults with acquired neurological disorders (stroke, Traumatic Brain Injury ... develop their verbal communication and literacy capabilities as typical speakers and writers. They use these skills to participate academically, vocationally, recreationally, and socially. Depending upon their neurological condition, they gradually or suddenly lose their speech or language capabilities and are required to rely on Augmentative and Alternative Communication (AAC systems to meet their communication needs. In addition to the loss of their spoken communication, the impact of their neurological condition on their participation patterns is potentially profound with reduced ability to care for themselves, a reduction or loss of employment, and usually a sudden or gradual restriction of their social networks. AAC is an umbrella term that encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language. During the past five decades, AAC technologies have been developed to compensate for these natural communication losses. Stroke is one of the main causes of disability in the world. About 20% of stroke patients experience aphasia, with 20-30% of these individuals exhibiting severe communication deficits for at least a portion of their recovery period. Augmentative and Alternative Communication (AAC encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production of spoken or written language. Specifically designed Human Computer Interfaces (HCI, as an assistive technology, provides new channels of communication for patients with aphasia, dysarthria, and dyspraxia, when accompanied by movement impairments. In this workshop after stating a science review of the following types of issues: AAC acceptance (individually, culturally; AAC availability
Abola, Ramon E; Bennett-Guerrero, Elliott; Kent, Michael L; Feldman, Liane S; Fiore, Julio F; Shaw, Andrew D; Thacker, Julie K M; Gan, Tong J; Miller, Timothy E; Hedrick, Traci L; McEvoy, Matthew D; Mythen, Michael G; Bergamaschi, Roberto; Gupta, Ruchir; Holubar, Stefan D; Senagore, Anthony J; Wischmeyer, Paul E; Carli, Franco; Evans, David C; Guilbert, Sarah; Kozar, Rosemary; Pryor, Aurora; Thiele, Robert H; Everett, Sotiria; Grocott, Mike
Patient-reported outcomes (PROs) are measures of health status that come directly from the patient. PROs are an underutilized tool in the perioperative setting. Enhanced recovery pathways (ERPs) have primarily focused on traditional measures of health care quality such as complications and hospital length of stay. These measures do not capture postdischarge outcomes that are meaningful to patients such as function or freedom from disability. PROs can be used to facilitate shared decisions between patients and providers before surgery and establish benchmark recovery goals after surgery. PROs can also be utilized in quality improvement initiatives and clinical research studies. An expert panel, the Perioperative Quality Initiative (POQI) workgroup, conducted an extensive literature review to determine best practices for the incorporation of PROs in an ERP. This international group of experienced clinicians from North America and Europe met at Stony Brook, NY, on December 2-3, 2016, to review the evidence supporting the use of PROs in the context of surgical recovery. A modified Delphi method was used to capture the collective expertise of a diverse group to answer clinical questions. During 3 plenary sessions, the POQI PRO subgroup presented clinical questions based on a literature review, presented evidenced-based answers to those questions, and developed recommendations which represented a consensus opinion regarding the use of PROs in the context of an ERP. The POQI workgroup identified key criteria to evaluate patient-reported outcome measures (PROMs) for their incorporation in an ERP. The POQI workgroup agreed on the following recommendations: (1) PROMs in the perioperative setting should be collected in the framework of physical, mental, and social domains. (2) These data should be collected preoperatively at baseline, during the immediate postoperative time period, and after hospital discharge. (3) In the immediate postoperative setting, we recommend using
Arigo, Danielle; Juth, Vanessa; Trief, Paula; Wallston, Kenneth; Ulbrecht, Jan; Smyth, Joshua M
This study examined reported post-traumatic stress disorder symptoms in adults with poorly controlled type 2 diabetes who had no history of psychiatric diagnosis or treatment ( n = 184, M HbA1c = 9.13%, standard deviation = 1.68). Participants reported moderate to severe intensity of post-traumatic stress disorder symptoms ( M = 19.17, SD = 17.58). Together, depressive and post-traumatic stress disorder symptoms accounted for 10-40 percent of the variance in type 2 diabetes outcomes; post-traumatic stress disorder symptoms were associated with elevated diabetes distress and more frequent exercise and self-blood glucose testing (unique R 2 ~ 3%). Post-traumatic stress disorder symptoms may be overlooked in type 2 diabetes among patients without formal psychiatric diagnoses, and warrant increased attention.
Full Text Available Orexin-A (a neuropeptide in the hypothalamus plays an important role in many physiological functions, including the regulation of glucose metabolism. We have previously found that the development of post-ischemic glucose intolerance is one of the triggers of ischemic neuronal damage, which is suppressed by hypothalamic orexin-A. Other reports have shown that the communication system between brain and peripheral tissues through the autonomic nervous system (sympathetic, parasympathetic and vagus nerve is important for maintaining glucose and energy metabolism. The aim of this study was to determine the involvement of the hepatic vagus nerve on hypothalamic orexin-A-mediated suppression of post-ischemic glucose intolerance development and ischemic neuronal damage. Male ddY mice were subjected to middle cerebral artery occlusion (MCAO for 2 h. Intrahypothalamic orexin-A (5 pmol/mouse administration significantly suppressed the development of post-ischemic glucose intolerance and neuronal damage on day 1 and 3, respectively after MCAO. MCAO-induced decrease of hepatic insulin receptors and increase of hepatic gluconeogenic enzymes on day 1 after was reversed to control levels by orexin-A. This effect was reversed by intramedullary administration of the orexin-1 receptor antagonist, SB334867, or hepatic vagotomy. In the medulla oblongata, orexin-A induced the co-localization of cholin acetyltransferase (cholinergic neuronal marker used for the vagus nerve with orexin-1 receptor and c-Fos (activated neural cells marker. These results suggest that the hepatic branch vagus nerve projecting from the medulla oblongata plays an important role in the recovery of post-ischemic glucose intolerance and mediates a neuroprotective effect by hypothalamic orexin-A.
Harada, Shinichi; Yamazaki, Yui; Koda, Shuichi; Tokuyama, Shogo
Orexin-A (a neuropeptide in the hypothalamus) plays an important role in many physiological functions, including the regulation of glucose metabolism. We have previously found that the development of post-ischemic glucose intolerance is one of the triggers of ischemic neuronal damage, which is suppressed by hypothalamic orexin-A. Other reports have shown that the communication system between brain and peripheral tissues through the autonomic nervous system (sympathetic, parasympathetic and vagus nerve) is important for maintaining glucose and energy metabolism. The aim of this study was to determine the involvement of the hepatic vagus nerve on hypothalamic orexin-A-mediated suppression of post-ischemic glucose intolerance development and ischemic neuronal damage. Male ddY mice were subjected to middle cerebral artery occlusion (MCAO) for 2 h. Intrahypothalamic orexin-A (5 pmol/mouse) administration significantly suppressed the development of post-ischemic glucose intolerance and neuronal damage on day 1 and 3, respectively after MCAO. MCAO-induced decrease of hepatic insulin receptors and increase of hepatic gluconeogenic enzymes on day 1 after was reversed to control levels by orexin-A. This effect was reversed by intramedullary administration of the orexin-1 receptor antagonist, SB334867, or hepatic vagotomy. In the medulla oblongata, orexin-A induced the co-localization of cholin acetyltransferase (cholinergic neuronal marker used for the vagus nerve) with orexin-1 receptor and c-Fos (activated neural cells marker). These results suggest that the hepatic branch vagus nerve projecting from the medulla oblongata plays an important role in the recovery of post-ischemic glucose intolerance and mediates a neuroprotective effect by hypothalamic orexin-A. PMID:24759941
Alexopoulos, Natalie I; French, Andrew J
The reliable collection of peri-implantation embryos in the bovine has important ramifications to post-transfer consequences, particularly in the elucidation of mechanisms associated with post-hatching embryo development and to perturbations in developmental growth following transfer. This study analyzed both in vitro produced (IVP) and somatic cell nuclear transfer (SCNT) embryo-like structures (ELS) recovered at Day (D) 14 and D21. The recovered ELS were subsequently processed for histological examination. At D14 and D21, many of the embryos recovered in the IVP group conformed to the appropriate stage of development. However, a significant number of anomalies were present in the SCNT groups when examined in more detail. Histological examination revealed that irrespective of whether these embryos had undergone trophoblast expansion to an ovoid, tubular or filamentous morphology, many had a degenerated hypoblast layer and a large proportion did not possess an epiblast and therefore could not differentiate into any of the three germ layers as would be expected at the neural groove or somite stage. The prevalence of this developmental pattern was random and did not correlate with treatment (IVP or SCNT) or with types of structures recovered. The rapid embryo elongation period also coincides with the time of greatest embryonic loss and these observations could have important implications for assessing the recovery of embryos post-transfer where incorrect morphological assessment could lead to false implantation and pregnancy determination rates. The implementation of additional methodology is required to adequately characterize the quality of IVP and SCNT-derived embryos collected post-transfer.
Full Text Available Abstract Background Contralateral acupuncture (CAT involves inserting needles in the meridian on the side opposite the disease location and is often used in post-stroke rehabilitation. The aim of this systematic review is to summarize and critically evaluate the evidence for and against the effectiveness of CAT for post-stroke rehabilitation as compared to ipsilateral acupuncture (IAT. Methods Seventeen databases were searched from their inceptions through June 2010. Prospective clinical trials were included if CAT was tested as the sole treatment or as an adjunct to other treatments for post-stroke rehabilitation and compared to IAT. Results Eight randomized clinical trials (RCTs met our inclusion criteria. Four of them reported favorable effects of CAT compared to IAT for at least one outcome. A meta-analysis showed superior effects of CAT compared to IAT on recovery rate (n = 361; risk ratio (RR, 1.12; 95% confidence intervals (CIs, 1.04 to 1.22, P = 0.005. Subgroup analysis also showed favorable effects of using CAT on patients with cerebral infarction (n = 261; RR, 1.15; 95% CIs, 1.04 to 1.27, P = 0.006. Further analysis including patients with cerebral infarction and intracranial hemorrhage, however, failed to show these advantages (n = 100; RR, 1.11; 95% CIs, 0.85 to 1.46, P = 0.43. Conclusion The results of our systematic review and meta-analysis suggest that there is limited evidence for CAT being superior to IAT in the treatment of cerebral infarction. The total number of RCTs included in our analysis was low, however, and the RCTs included had a high risk of bias. Future RCTs appear to be warranted.
Steinmetz, J.; Rasmussen, L.S.
BACKGROUND: Post-operative cognitive dysfunction (POCD) is detected by administration of a neuropsychological test battery. Reaction time testing is at present not included as a standard test. Choice reaction time (CRT) data from the first International Study of Post-operative Cognitive Dysfunction...... in nine countries. CRT was measured 52 times using the four boxes test. Patients performed the test before surgery (n=1083), at 1 week (n=926) and at 3 months (n=852) post-operatively. CRT for the individual patient was determined as the median time of correct responses. The usefulness of the CRT...... had a significantly longer CRT. ROC curves revealed that a reaction time of 813 ms was the most appropriate cut-off at 1 week and 762 ms at 3 months but the positive predictive value for POCD was low: 34.4% and 14.7%, respectively. CONCLUSIONS: Post-operative cognitive dysfunction is associated...
Alnasser, Qasem; Abu Kharmah, Salahel Deen; Attia, Manal; Aljafari, Akram; Agyekum, Felicia; Ahmed, Falak Aftab
To explore the lived experience of the patients post-haematopoietic stem cell transplantation and specifically after engraftment and before discharge. Patients post-stem cell transplantation experience significant changes in all life aspects. Previous studies carried out by other researchers focused mainly on the postdischarge experience, where patients reported their perceptions that have always been affected by the life post-transplantation and influenced by their surroundings. The lived experience of patients, specifically after engraftment and prior to discharge (the "transition" phase), has not been adequately explored in the literature. Doing so might provide greater insight into the cause of change post-haematopoietic stem cell transplantation. This study is a phenomenological description of the participants' perception about their lived experience post-haematopoietic stem cell transplantation. The study used Giorgi's method of analysis. Through purposive sampling, 15 post-haematopoietic stem cell transplantation patients were recruited. Data were collected by individual interviews. Data were then analysed based on Giorgi's method of analysis to reveal the meaning of a phenomenon as experienced through the identification of essential themes. The analysis process revealed 12 core themes covered by four categories that detailed patients lived experience post-haematopoietic stem cell transplantation. The four categories were general transplant experience, effects of transplantation, factors of stress alleviation and finally life post-transplantation. This study showed how the haematopoietic stem cell transplantation affected the patients' physical, psychological and spiritual well-being. Transplantation also impacted on the patients' way of thinking and perception of life. Attending to patients' needs during transplantation might help to alleviate the severity of the effects and therefore improve experience. Comprehensive information about transplantation needs
Petit, Clemence; Bezemer, Rick; Atallah, Louis
Most deaths occurring due to a surgical intervention happen postoperatively rather than during surgery. The current standard of care in many hospitals cannot fully cope with detecting and addressing post-surgical deterioration in time. For millions of patients, this deterioration is left unnoticed, leading to increased mortality and morbidity. Postoperative deterioration detection currently relies on general scores that are not fully able to cater for the complex post-operative physiology of surgical patients. In the last decade however, advanced risk and warning scoring techniques have started to show encouraging results in terms of using the large amount of data available peri-operatively to improve postoperative deterioration detection. Relevant literature has been carefully surveyed to provide a summary of the most promising approaches as well as how they have been deployed in the perioperative domain. This work also aims to highlight the opportunities that lie in personalizing the models developed for patient deterioration for these particular post-surgical patients and make the output more actionable. The integration of pre- and intra-operative data, e.g. comorbidities, vitals, lab data, and information about the procedure performed, in post-operative early warning algorithms would lead to more contextualized, personalized, and adaptive patient modelling. This, combined with careful integration in the clinical workflow, would result in improved clinical decision support and better post-surgical care outcomes.
Gray, R T
INTRODUCTION: Patients undergoing selective minor emergency and elective procedures are followed up by a nurse-led structured telephone review six weeks post-operatively in our hospital. Our study objectives were to review patients\\' satisfaction, assess cost-effectiveness and compare our practice with other surgical units in Northern Ireland (NI). PATIENTS AND METHODS: Completed telephone follow-up forms were reviewed retrospectively for a three-year period and cost savings calculated. Fifty patients were contacted prospectively by telephone using a questionnaire to assess satisfaction of this follow-up. A postal questionnaire was sent to 68 general and vascular surgeons in NI, assessing individual preferences for patient follow-up. RESULTS: A total of 1378 patients received a telephone review from September 2005 to September 2008. One thousand one hundred and seventy-seven (85.4%) were successfully contacted, while 201 (14.6%) did not respond despite multiple attempts. One hundred and forty-seven respondents (10.7%) required further outpatient follow-up, thereby saving 1231 outpatient reviews, equivalent to pound41,509 per annum. Thirty-nine (78%) patients expected post-operative follow-up, with 29 (58%) expecting this in the outpatient department. However, all patients were satisfied with the nurse-led telephone review. Fifty-three (78%) consultants responded. Those who always, or occasionally, review patients post-operatively varies according to the operation performed, ranging from 2.2% appendicectomy patients to 40.0% for varicose vein surgery. CONCLUSION: Current practice in NI varies, but a significant proportion of patients are not routinely reviewed. This study confirmed that patients expect post-operative follow-up. A nurse-led telephone review service is acceptable to patients, cost-effective and reduces the number of unnecessary outpatient reviews.
Yamazaki, Masahiro; Naganawa, Shinji; Kawai, Hisashi; Nihashi, Takashi [Nagoya University, Department of Radiology, Graduate School of Medicine, Nagoya (Japan); Fukatsu, Hiroshi [Aichi Medical University Hospital, Department of Medical Informatics, Nagakute (Japan); Nakashima, Tsutomu [Nagoya University, Department of Otorhinolaryngology, Graduate School of Medicine, Nagoya (Japan)
In the vestibular schwannoma patients, the pathophysiologic mechanism of inner ear involvement is still unclear. We investigated the status of the cochleae in patients with vestibular schwannoma by evaluating the signal intensity of cochlear fluid on pre- and post-contrast enhanced thin section three-dimensional fluid-attenuated inversion recovery (3D-FLAIR). Twenty-eight patients were retrospectively analyzed. Post-contrast images were obtained in 18 patients, and 20 patients had the records of their pure-tone audiometry. Regions of interest of both cochleae (C) and of the medulla oblongata (M) were determined on 3D-FLAIR images by referring to 3D heavily T2-weighted images on a workstation. The signal intensity ratio between C and M on the 3D-FLAIR images (CM ratio) was then evaluated. In addition, correlation between the CM ratio and the hearing level was also evaluated. The CM ratio of the affected side was significantly higher than that of the unaffected side (p < 0.001). In the affected side, post-contrast signal elevation was observed (p < 0.005). In 13 patients (26 cochleae) who underwent both gadolinium injection and the pure-tone audiometry, the post-contrast CM ratio correlated with hearing level (p < 0.05). The results of the present study suggest that alteration of cochlear fluid composition and increased permeability of the blood-labyrinthine barrier exist in the affected side in patients with vestibular schwannoma. Furthermore, although weak, positive correlation between post-contrast cochlear signal intensity on 3D-FLAIR and hearing level warrants further study to clarify the relationship between 3D-FLAIR findings and prognosis of hearing preservation surgery. (orig.)
Yamazaki, Masahiro; Naganawa, Shinji; Kawai, Hisashi; Nihashi, Takashi; Fukatsu, Hiroshi; Nakashima, Tsutomu
In the vestibular schwannoma patients, the pathophysiologic mechanism of inner ear involvement is still unclear. We investigated the status of the cochleae in patients with vestibular schwannoma by evaluating the signal intensity of cochlear fluid on pre- and post-contrast enhanced thin section three-dimensional fluid-attenuated inversion recovery (3D-FLAIR). Twenty-eight patients were retrospectively analyzed. Post-contrast images were obtained in 18 patients, and 20 patients had the records of their pure-tone audiometry. Regions of interest of both cochleae (C) and of the medulla oblongata (M) were determined on 3D-FLAIR images by referring to 3D heavily T2-weighted images on a workstation. The signal intensity ratio between C and M on the 3D-FLAIR images (CM ratio) was then evaluated. In addition, correlation between the CM ratio and the hearing level was also evaluated. The CM ratio of the affected side was significantly higher than that of the unaffected side (p < 0.001). In the affected side, post-contrast signal elevation was observed (p < 0.005). In 13 patients (26 cochleae) who underwent both gadolinium injection and the pure-tone audiometry, the post-contrast CM ratio correlated with hearing level (p < 0.05). The results of the present study suggest that alteration of cochlear fluid composition and increased permeability of the blood-labyrinthine barrier exist in the affected side in patients with vestibular schwannoma. Furthermore, although weak, positive correlation between post-contrast cochlear signal intensity on 3D-FLAIR and hearing level warrants further study to clarify the relationship between 3D-FLAIR findings and prognosis of hearing preservation surgery. (orig.)
Bernhardt, Gerwin A; Zollner, Gernot; Cerwenka, Herwig; Kornprat, Peter; Fickert, Peter; Bacher, Heinz; Werkgartner, Georg; Müller, Gabriele; Zatloukal, Kurt; Mischinger, Hans-Jörg; Trauner, Michael
Post-operative hyperbilirubinaemia in patients undergoing liver resections is associated with high morbidity and mortality. Apart from different known factors responsible for the development of post-operative jaundice, little is known about the role of hepatobiliary transport systems in the pathogenesis of post-operative jaundice in humans after liver resection. Two liver tissue samples were taken from 14 patients undergoing liver resection before and after Pringle manoeuvre. Patients were retrospectively divided into two groups according to post-operative bilirubin serum levels. The two groups were analysed comparing the results of hepatobiliary transporter [Na-taurocholate cotransporter (NTCP); multidrug resistance gene/phospholipid export pump(MDR3); bile salt export pump (BSEP); canalicular bile salt export pump (MRP2)], heat shock protein 70 (HSP70) expression as well as the results of routinely taken post-operative liver chemistry tests. Patients with low post-operative bilirubin had lower levels of NTCP, MDR3 and BSEP mRNA compared to those with high bilirubin after Pringle manoeuvre. HSP70 levels were significantly higher after ischaemia-reperfusion (IR) injury in both groups resulting in 4.5-fold median increase. Baseline median mRNA expression of all four transporters prior to Pringle manoeuvre tended to be lower in the low bilirubin group whereas expression of HSP70 was higher in the low bilirubin group compared to the high bilirubin group. Higher mRNA levels of HSP70 in the low bilirubin group could indicate a possible protective effect of high HSP70 levels against IR injury. Although the exact role of hepatobiliary transport systems in the development of post-operative hyper bilirubinemia is not yet completely understood, this study provides new insights into the molecular aspects of post-operative jaundice after liver surgery. © 2011 John Wiley & Sons A/S.
Akanksha, S.; Athiyaman, M.; Hemalatha, A.; Kumar, H.S.
Breast cancer (BC) is most common cancer in women worldwide. External beam radiotherapy (EBRT) is used as adjuvant in most post operative BC cases for loco-regional control. Present study is concerned about dose received by contralateral breast (CLB) during EBRT which results due to scatter from treatment head. Dose to CLB in 18 post operative BC patients were evaluated using CaSO_4-Dy thermoluminiscence dosimeters (TLDs) and effect of superflab is also investigated for dose reduction
Valdir M. Stefenon
Full Text Available Up to date, little is known about the relationship between historical demography and the current genetic structure of A. Angus As a first effort towards overcoming this lack, microsatellite data scored in six populations and isozyme allele frequencies published for 11 natural stands of this species were analysed in order to assess molecular signatures of populations' demographic history. Signatures of genetic bottlenecks were captured in all analysed populations of southeastern Brazil. Among southern populations, signatures of small effective population size were observed in only three out of 13 populations. Southern populations likely experienced faster recovery of population size after migration onto highlands. Accordingly, current genetic diversity of the southern populations gives evidence of fast population size recovery. In general, demographic history of A. Angusmatches climatic dynamics of southern and southeastern Brazil during the Pleistocene and Holocene. Palynological records and reconstruction of the past climatic dynamics of southeastern and southern Brazil support the hypothesis of different population size recovery dynamics for populations from these regions.Até o momento, pouco se conhece sobre a relação entre história demográfica e a presente estrutura genética da A. Angus Como uma primeira tentativa em transpor esta deficiência, dados de microssatélites coletados em seis populações e freqüências alélicas de isoenzimas publicadas para 11 populações naturais desta espécie foram analisadas com o objetivo de acessar assinaturas moleculares da história demográfica populacional. Assinaturas de gargalos genéticos foram capturadas em todas as populações analisadas provenientes do Sudeste do Brasil. Entre as populações do Sul, assinaturas de pequeno tamanho populacional efetivo foram observadas em somente três entre 13 populações. Populações do Sul provavelmente apresentaram uma rápida recuperação do
Benton, Katie; Thomson, Iain; Isenring, Elisabeth; Mark Smithers, B; Agarwal, Ekta
Enhanced Recovery After Surgery (ERAS) protocols have been effectively expanded to various surgical specialities including oesophagectomy. Despite nutrition being a key component, actual nutrition outcomes and specific guidelines are lacking. This cohort comparison study aims to compare nutritional status and adherence during implementation of a standardised post-operative nutritional support protocol, as part of ERAS, compared to those who received usual care. Two groups of patients undergoing resection of oesophageal cancer were studied. Group 1 (n = 17) underwent oesophagectomy between Oct 2014 and Nov 2016 during implementation of an ERAS protocol. Patients in group 2 (n = 16) underwent oesophagectomy between Jan 2011 and Dec 2012 prior to the implementation of ERAS. Demographic, nutritional status, dietary intake and adherence data were collected. Ordinal data was analysed using independent t tests, and categorical data using chi-square tests. There was no significant difference in nutrition status, dietary intake or length of stay following implementation of an ERAS protocol. Malnutrition remained prevalent in both groups at day 42 post surgery (n = 10, 83% usual care; and n = 9, 60% ERAS). A significant difference was demonstrated in adherence with earlier initiation of oral free fluids (p nutrition protocol, within an ERAS framework, results in earlier transition to oral intake; however, malnutrition remains prevalent post surgery. Further large-scale studies are warranted to examine individualised decision-making regarding nutrition support within an ERAS protocol.
Henneman, Elizabeth A; Roche, Joan P; Fisher, Donald L; Cunningham, Helene; Reilly, Cheryl A; Nathanson, Brian H; Henneman, Philip L
This study examined types of errors that occurred or were recovered in a simulated environment by student nurses. Errors occurred in all four rule-based error categories, and all students committed at least one error. The most frequent errors occurred in the verification category. Another common error was related to physician interactions. The least common errors were related to coordinating information with the patient and family. Our finding that 100% of student subjects committed rule-based errors is cause for concern. To decrease errors and improve safe clinical practice, nurse educators must identify effective strategies that students can use to improve patient surveillance. Copyright 2010 Elsevier Inc. All rights reserved.
Wang, Qiongzhang; Zhao, Kai; Cai, Yan; Tu, Xinjie; Liu, Yuntao; He, Jincai
Diabetes mellitus is associated with post-stroke cognitive impairment. To the best of our knowledge, no study has explored the relationship between prediabetes and post-stroke cognitive impairment. The purpose of this study is to explore the association between prediabetes and cognitive impairment in ischaemic stroke patients at 1 month. Two hundred one acute ischaemic stroke patients were consecutively recruited within the first 24 h after admission and were followed up for 1 month. Patients were divided into a diabetes mellitus group, prediabetes group and non-diabetes mellitus group by fasting glucose levels, 2-h postprandial blood glucose levels and glycosylated haemoglobin levels at admission. Cognitive function was evaluated by the Mini-Mental State Examination at 1 month after stroke. The prediabetes group had a higher risk of post-stroke cognitive impairment than the non-diabetes group (35.7% vs. 18.1%, χ 2 = 4.252, P = .039). In logistical analyses, prediabetes was associated with post-stroke cognitive impairment after adjusting for potential confounding factors (odds ratio 3.062, 95% confidence interval 1.130-8.299, P = .028). Our findings show that prediabetes is associated with post-stroke cognitive impairment and may predict its development at 1 month post-stroke. Copyright © 2018 Elsevier B.V. All rights reserved.
Leivonen, Marja Kaarina; Juuti, Anne; Jaser, Nabil; Mustonen, Harri
Bariatric surgery has shown to be safe for patients over 60 years with good results especially considering resolving of comorbidities. Sleeve gastrectomy is considered to be safer than gastric bypass (GBP) and more effective than gastric banding with less adverse symptoms. Weight loss may be more modest than after GBP, but the effect on vitamins may also be milder. Since 2007, we collected prospectively 12-month follow-up data from 55 sleeve gastrectomy patients of whom 12 were over 59 years of age. Vitamin and calcium supplements were used postoperatively. The recovery from the operation was recorded during hospital stay, at 1- and 12-month follow-up visits using a standard protocol including laboratory tests. The results between patients over and under 59 years were compared. The preoperative weight and weight loss were comparable between the groups. Operation time was shorter and hospital stay was longer for older patients, p = ns. There was no operative mortality. Early major complications were seen more often in the older age group, 42% vs 9% (p = 0.02), but late complications were more common in younger patients, 17% vs 44%, p = ns. Early complications were mostly bleedings, which did not lengthen the hospital stay, neither were re-operations nor endoscopic procedures needed. Excess weight loss and resolving of comorbidities after 12 months was comparable between the groups. However, vitamin deficiencies and hypoalbuminemia were more common in the older age group, 42% and 23% for vitamins and 44% and 29% for proteins, p = ns. The older patients had more adverse effects related to surgery, 25% vs 9%, and younger had more adverse psychiatric effects, p = ns. Sleeve gastrectomy is effective and safe for older bariatric patients. Weight loss is comparable to younger patients and enough to resolve the comorbidities in most of the patients. With standardized nutritional supplementation, the older patients had more often vitamin deficiencies and
Fage-Butler, Antoinette Mary; Nisbeth Jensen, Matilde
Abstract: The interpersonal dimension of patient forums: How patients share their knowledge and experiences in response to posted questions Antoinette Fage-Butler & Matilde Nisbeth Jensen The internet has revolutionized the way that patients acquire medical information, freeing them of reliance...... on their doctor; seeking out health information online is now the third most popular activity after internet searches and e-mail (Timimi 2012). This paper examines one of these sources of online information, namely, the patient forum where patients provide other patients with information and support...... of implications for existing models of health communication which have yet to catch up with the impact of recent technological developments such as online patient forums. Keywords • Online patient forums • Patient-patient communication • Relationship formation References Braun, V., & Clarke, V. (2006). Using...
Gabbe, Belinda J; Braaf, Sandra; Fitzgerald, Mark; Judson, Rodney; Harrison, James E; Lyons, Ronan A; Ponsford, Jennie; Collie, Alex; Ameratunga, Shanthi; Attwood, David; Christie, Nicola; Nunn, Andrew; Cameron, Peter A
Traumatic injury is a leading contributor to the overall global burden of disease. However, there is a worldwide shortage of population data to inform understanding of non-fatal injury burden. An improved understanding of the pattern of recovery following trauma is needed to better estimate the burden of injury, guide provision of rehabilitation services and care to injured people, and inform guidelines for the monitoring and evaluation of disability outcomes. To provide a comprehensive overview of patient outcomes and experiences in the first 5 years after serious injury. This is a population-based, nested prospective cohort study using quantitative data methods, supplemented by a qualitative study of a seriously injured participant sample. All 2547 paediatric and adult major trauma patients captured by the Victorian State Trauma Registry with a date of injury from 1 July 2011 to 30 June 2012 who survived to hospital discharge and did not opt-off from the registry. To analyse the quantitative data and identify factors that predict poor or good outcome, whether there is change over time, differences in rates of recovery and change between key participant subgroups, multilevel mixed effects regression models will be fitted. To analyse the qualitative data, thematic analysis will be used to identify important themes and the relationships between themes. The results of this project have the potential to inform clinical decisions and public health policy, which can reduce the burden of non-fatal injury and improve the lives of people living with the consequences of severe injury. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Liu, Hsin-Yun; Tseng, Ming-Yueh; Li, Hsiao-Juan; Wu, Chi-Chuan; Cheng, Huey-Shinn; Yang, Ching-Tzu; Chou, Shih-Wei; Chen, Ching-Yen; Shyu, Yea-Ing L
The effects of nutritional management among other intervention components have not been examined for hip-fractured elderly persons with poor nutritional status. Accordingly, this study explored the intervention effects of an in-home program using a comprehensive care model that included a nutrition-management component on recovery of hip-fractured older persons with poor nutritional status at hospital discharge. A secondary analysis of data from a randomized controlled trial with 24-month follow-up. A 3000-bed medical center in northern Taiwan. Subjects were included only if they had "poor nutritional status" at hospital discharge, including those at risk for malnutrition or malnourished. The subsample included 80 subjects with poor nutritional status in the comprehensive care group, 87 in the interdisciplinary care group, and 85 in the usual care group. The 3 care models were usual care, interdisciplinary care, and comprehensive care. Usual care provided no in-home care, interdisciplinary care provided 4 months of in-home rehabilitation, and comprehensive care included management of depressive symptoms, falls, and nutrition as well as 1 year of in-home rehabilitation. Data were collected on nutritional status and physical functions, including range of motion, muscle power, proprioception, balance and functional independence, and analyzed using a generalized estimating equation approach. We also compared patients' baseline characteristics: demographic characteristics, type of surgery, comorbidities, length of hospital stay, cognitive function, and depression. Patients with poor nutritional status who received comprehensive care were 1.67 times (95% confidence interval 1.06-2.61) more likely to recover their nutritional status than those who received interdisciplinary and usual care. Furthermore, the comprehensive care model improved the functional independence and balance of patients who recovered their nutritional status over the first year following discharge
Kasahara, Taissa M; Hygino, Joana; Andrade, Regis M; Monteiro, Clarice; Sacramento, Priscila M; Andrade, Arnaldo F B; Bento, Cleonice A M
Aging is now a well-recognized characteristic of the HIV-infected population and both AIDS and aging are characterized by a deficiency of the T-cell compartment. The objective of the present study was to evaluate the impact of antiretroviral (ARV) therapy in recovering functional response of T cells to both HIV-1-specific ENV peptides (ENV) and tetanus toxoid (TT), in young and aged AIDS patients who responded to ARV therapy by controlling virus replication and elevating CD4(+) T cell counts. Here, we observed that proliferative response of T-cells to either HIV-1-specific Env peptides or tetanus toxoid (TT) was significantly lower in older antiretroviral (ARV)-treated patients. With regard to cytokine profile, lower levels of IFN-γ, IL-17 and IL-21, associated with elevated IL-10 release, were produced by Env- or TT-stimulated T-cells from older patients. The IL-10 neutralization by anti-IL-10 mAb did not elevate IFN-γ and IL-21 release in older patients. Finally, even after a booster dose of TT, reduced anti-TT IgG titers were quantified in older AIDS patients and it was related to both lower IL-21 and IFN-γ production and reduced frequency of central memory T-cells. Our results reveal that ARV therapy, despite the adequate recovery of CD4(+) T cell counts and suppression of viremia, was less efficient in recovering adequate immune response in older AIDS patients. Copyright © 2015 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.
White-Dzuro, Gabrielle A; Maynard, Ken; Zuckerman, Scott L; Weaver, Kyle D; Russell, Paul T; Clavenna, Matthew J; Chambless, Lola B
Patients undergoing transsphenoidal surgery (TSS) have an anterior skull base defect that limits the use of positive pressure ventilation post-operatively. Obstructive sleep apnea (OSA) can be seen in these patients and is treated with continuous positive airway pressure (CPAP). In our study we documented the incidence of pre-existing OSA and reported the incidence of diagnosed pneumocephalus and its relationship to OSA. A retrospective review was conducted from a surgical outcomes database. Electronic medical records were reviewed, with an emphasis on diagnosis of OSA and documented symptomatic pneumocephalus. A total of 324 patients underwent 349 TSS for sellar mass resection. The average body mass index of the study cohort was 32.5kg/m(2). Sixty-nine patients (21%) had documented OSA. Only 25 out of 69 (36%) had a documented post-operative CPAP plan. Out of all 349 procedures, there were two incidents of pneumocephalus diagnosed. Neither of the patients had pre-existing OSA. One in five patients in our study had pre-existing OSA. Most patients returned to CPAP use within several weeks of TSS for resection of a sellar mass. Neither of the patients with pneumocephalus had pre-existing OSA and none of the patients with early re-initiation of CPAP developed this complication. This study provides preliminary evidence that resuming CPAP early in the post-operative period might be less dangerous than previously assumed. Copyright © 2016 Elsevier Ltd. All rights reserved.
Roccetti, Marco; Marfia, Gustavo; Salomoni, Paola; Prandi, Catia; Zagari, Rocco Maurizio; Gningaye Kengni, Faustine Linda; Bazzoli, Franco; Montagnani, Marco
Data concerning patients originates from a variety of sources on social media. The aim of this study was to show how methodologies borrowed from different areas including computer science, econometrics, statistics, data mining, and sociology may be used to analyze Facebook data to investigate the patients' perspectives on a given medical prescription. To shed light on patients' behavior and concerns, we focused on Crohn's disease, a chronic inflammatory bowel disease, and the specific therapy with the biological drug Infliximab. To gain information from the basin of big data, we analyzed Facebook posts in the time frame from October 2011 to August 2015. We selected posts from patients affected by Crohn's disease who were experiencing or had previously been treated with the monoclonal antibody drug Infliximab. The selected posts underwent further characterization and sentiment analysis. Finally, an ethnographic review was carried out by experts from different scientific research fields (eg, computer science vs gastroenterology) and by a software system running a sentiment analysis tool. The patient feeling toward the Infliximab treatment was classified as positive, neutral, or negative, and the results from computer science, gastroenterologist, and software tool were compared using the square weighted Cohen's kappa coefficient method. The first automatic selection process returned 56,000 Facebook posts, 261 of which exhibited a patient opinion concerning Infliximab. The ethnographic analysis of these 261 selected posts gave similar results, with an interrater agreement between the computer science and gastroenterology experts amounting to 87.3% (228/261), a substantial agreement according to the square weighted Cohen's kappa coefficient method (w2K=0.6470). A positive, neutral, and negative feeling was attributed to 36%, 27%, and 37% of posts by the computer science expert and 38%, 30%, and 32% by the gastroenterologist, respectively. Only a slight agreement was
Lai, Jiun-Yang; Huang, Tiao-Lai
The purpose of the present study was to investigate the prevalence, distribution of psychiatric diagnoses, and treatment responses of patients with post-partum mental illness at an emergency unit at Chang Gung Memorial Hospital at Kaohsiung in Taiwan. During a 1 year period a total of 636 Taiwanese women received psychiatric consultation on their visits to the emergency room. Fifteen of these were noted to have post-partum mental illnesses. All subjects were followed up for a minimum of 3-6 months. The prevalence of patients with post-partum mental illness at an emergency unit at Chang Gung Memorial Hospital at Kaohsiung was 2.4% (15/636). The distribution of psychiatric diagnoses according to Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria included eight cases of major depressive disorders (53.3%), three cases of bipolar I disorder (20%), three cases of schizophrenia (20%), and one case of psychotic disorder due to a general medical condition (6.7%). Four subjects manifested catatonic features. Of these four, three had complete remission in catatonic symptoms after receiving intramuscular injection of lorazepam. The fourth subject died of multiple medical diseases. The treatment results suggest that most of the clinical presentations in patients with post-partum mental illness could be relieved by antipsychotics, mood stabilizers or antidepressants. In addition, it was found that intramuscular injection of lorazepam was also effective in patients with catatonic features and post-partum depression or psychosis.
Full Text Available Abstract Background Post-thymectomy pain in myasthenia gravis (MG patients can inhibit breathing and coughing. Inappropriate usage of analgesics may exacerbate respiratory inhibition and even cause myasthenic crisis. Flurbiprofen is a non-steroidal anti-inflammatory drug (NSAID that is commonly used to control moderate postoperative pain and is not associated with respiratory inhibition. We hypothesized that flurbiprofen may provide post-thymectomy pain relief without increasing the risk of complications in MG patients. Methods Two hundred MG patients underwent extended thymectomy from March 2006 to December 2010 and were randomly allocated to a flurbiprofen group (110 patients, 50 mg intravenous flurbiprofen axetil or a control group (90 patients, 100 mg intramuscular tramadol as postoperative analgesia. Visual analog scale (VAS pain score, heart rate, blood pressure, respiratory rate, pulse oximetry (SpO2, and adverse effects were recorded before and up to 24 h after drug administration. Results There were no significant differences in the preoperative clinical characteristics of the flurbiprofen and control (tramadol groups. Both flurbiprofen and tramadol significantly alleviated post-thymectomy pain (p p 2 in either group at all time points. Conclusions Post-thymectomy intravenous administration of flurbiprofen axetil provides safe and effective analgesia for MG patients.
Berezutsky, V I
This review of the scientific literature was designed to consider the prospects for the application of kinesiotaping for the rehabilitation of the post-stroke patients. The relevance of the work arises from the absence of a systemic analysis of the large number of investigations that have been carried out during the past two years. The objective of the present review article was to evaluate the influence of kinesiotaping on the health status of the post-stroke patients and the course of their rehabilitative treatment based on the results of analysis of the scientific reports published during the period from 2015 to 2017. The analysis has demonstrated that the method under consideration makes it possible to effectively reduce spasticity, increase the paretic limb power, improve the static and dynamic balance, and alleviate the pain syndrome by virtue of the ability to improve the articulation proprioception and to regulate the muscle tone. Such effects are known to promote the reduction of muscle tone asymmetry in the patients suffering from hemiparesis and articulation instability which in its turn improves the patients' gait and walking ability, hightens their living standards, and allows to tolerate enhanced physical exertion. Kinesiotaping actually improves the locomotor function in the post-stroke patients Taken together, the advantages of the approach in question give reason to recommend kinesiotaping for the wide application for the combined rehabilitative treatment of the post-stroke patients.
Khalid H. Al-Samadani
Full Text Available Objectives: To investigate the effectiveness of topical anesthetic, 20% benzocaine in relieving pain and stress in patients following deep cavity restoration and extraction of teeth under local anesthesia (LA. Methods: A prospective clinical trial was conducted from October 2014 until April 2015 at Taibah University, Al Madinah Al Munawarah, Kingdom of Saudi Arabia. Forty-five patients were included in the 20% benzocaine group, and 46 in the normal saline group. Evaluation of the dental stress was made pre-operatively and immediately post-operative treatment using the visual analogue scale (VAS. Furthermore, discomfort of the injections were recorded by the patients after each treatment on standard 100 mm VAS, tagged at the endpoints with “no pain” (0 mm and “unbearable pain” (100 mm. Results: Ther