Best Practices for Use of Blended Learning

PubMed Central

Porter, Andrea L.; Pitterle, Michael E.

2017-01-01

Objective. To determine instructional best practice recommendations for use of blended learning from the students’ perspective. Methods. Three focus groups were created, one for each of the first three years at a school of pharmacy. The focus group discussions were audio recorded and transcribed for content analysis. Results. Ten instructional best practices were identified from the focus groups: setting the stage, consistency when team teaching, timeliness in posting materials, time on task, accountability for online activities, use of structured active learning, instructor use of feedback on student preparation, incorporation of student feedback into the course, short reviews of online material during class, and ensuring technologies are user friendly. Conclusion. Instructors using blended learning should consider incorporating these best practices into their course design and management. More evaluation is needed to see if implementation of these practices affects student performance. PMID:28496269

Best Practices for Use of Blended Learning.

PubMed

Margolis, Amanda R; Porter, Andrea L; Pitterle, Michael E

2017-04-01

Objective. To determine instructional best practice recommendations for use of blended learning from the students' perspective. Methods. Three focus groups were created, one for each of the first three years at a school of pharmacy. The focus group discussions were audio recorded and transcribed for content analysis. Results. Ten instructional best practices were identified from the focus groups: setting the stage, consistency when team teaching, timeliness in posting materials, time on task, accountability for online activities, use of structured active learning, instructor use of feedback on student preparation, incorporation of student feedback into the course, short reviews of online material during class, and ensuring technologies are user friendly. Conclusion. Instructors using blended learning should consider incorporating these best practices into their course design and management. More evaluation is needed to see if implementation of these practices affects student performance.

[Observation on the transient analgesic effect of abdominal acupuncture TENS on pain of neck, shoulder, loin and legs].

PubMed

Wang, Zhang-lian; Chen, Li-fang; Zhu, Wei-ming

2007-09-01

To observe on the transient analgesic effect of abdominal points transcutaneous electrical nerve stimulation (TENS) combined with abdominal acupuncture according to the holographic theory on pain of neck, shoulder, loin and legs. One hundred and twenty cases of pain of neck, shoulder, loin and legs were randomly divided into 4 groups: abdominal acupuncture TENS group, acupoints TENS group, electroacupuneture (EA) group, non-abdominal acupuncture TENS group, 30 cases in each group. All the cases were treated by the same stimulation parameters, but different stimulation points. The VAS scores were recorded before and after treatment. The VAS scores were significantly different before and after treatment in abdominal acupuncture TENS group (P < 0.01); the total effective rate of the transient analgesic effec t was 96.7% in the abdominal acupuncture TENS group, 93.3% in the acupoints TENS group, 96.7% in the EA group with no significant difference among the 3 groups, but with a very significant difference between the abdominal acupuncture TENS group and the non-abdominal acupunctureTENS group (10.0%), P < 0.01. Abdominal acupuncture TENS has a better transient analgesic effect and can use less stimulation points to increase the analgesic effect.

Does the Manitoba science curriculum help teach teens to be more environmentally-minded?

NASA Astrophysics Data System (ADS)

Kraljevic, Gabriel M.

Manitoba does not have a specific course in environmental education (EE) but has related outcomes within the current science and social studies curricula. Has the curriculum created a populace with the knowledge, attitudes and skills to begin to act for environmental change? Do students and teachers perceive science to be the course that should teach EE? This mixed-method study used surveys, student focus groups, observations of recycling habits and teacher interviews to determine if grade 10 students (last year of required science) are acting in positive ways toward the environment. Students from grades nine and ten exhibited almost the same environmental knowledge and attitudes, but the grade tens were more alarmed about the state of the environment and less naive about their abilities to have individual impact. While both groups reported pro-environmental behaviours, neither recycled materials after a luncheon. Where EE should be taught differed between all groups studied.

What is safety culture and risk-taking like at a large steel manufacturing company?

PubMed

Nordlöf, Hasse

2012-01-01

Focus group interviews were conducted at a large steel manufacturing company with 1000 employees, in order to answer the research question: what is the safety culture and risk-taking like at the company, according to employees? Ten focus groups were used for data collection consisting of 6-8 employees each. The participants were operators from production. The interviews lasted 75 min and were digitally recorded and thereafter verbatim transcribed. Descriptive data was also collected from all participants by allowing them to fill out a short questionnaire. The results of this study will be presented at the conference as a poster presentation.

The Experience of Deep Learning by Accounting Students

ERIC Educational Resources Information Center

Turner, Martin; Baskerville, Rachel

2013-01-01

This study examines how to support accounting students to experience deep learning. A sample of 81 students in a third-year undergraduate accounting course was studied employing a phenomenographic research approach, using ten assessed learning tasks for each student (as well as a focus group and student surveys) to measure their experience of how…

New Hampshire Charter Schools Parent Study 2011

ERIC Educational Resources Information Center

Julius, Tom

2011-01-01

This study was conducted in Spring 2011 with the purpose of better understanding the nature and experiences of New Hampshire charter school parents. Nine out of ten operating NH charter schools participated. Parents were invited to participate in an on-line survey and on-site focus group interviews. Results provide a profile of NH charter school…

Educating Students in Rural America: Capitalizing on Strengths, Overcoming Barriers

ERIC Educational Resources Information Center

National Association of State Boards of Education, 2016

2016-01-01

In 2004, the National Association of State Boards of Education (NASBE) released a "State Education Standard" focused on the issues and challenges facing rural schools. Ten years later, NASBE facilitated a study group on rural education to discuss what has changed and what new challenges require the attention of state education…

Case Study of Tenure-Track Early Career Faculty in a College of Education

ERIC Educational Resources Information Center

Esping, Gretchen Revay

2010-01-01

This dissertation examines an understudied group according to the American Council on Education: the tenure-track early career faculty (ECF). The focus is on the culturalization, socialization, academic culture, and emergent themes discerned from ten semi-structured interviews with tenure-track ECF. This qualitative bounded system case study…

Understanding History through the Visual Images in Historical Fiction

ERIC Educational Resources Information Center

Youngs, Suzette

2012-01-01

In the last ten years, historical fiction picturebooks have won numerous children's literature awards and have assumed a prominent role in the literacy landscape of elementary and middle school classrooms. Whether read in read-alouds, study groups, as a focus of genre study, or as a supplement to the social studies curriculum, historical fiction…

First year nursing students' experiences of social media during the transition to university: a focus group study.

PubMed

Ferguson, Caleb; DiGiacomo, Michelle; Saliba, Bernard; Green, Janet; Moorley, Calvin; Wyllie, Aileen; Jackson, Debra

2016-10-01

Social media platforms are useful for creating communities, which can then be utilised as a mean for supportive, professional and social learning. To explore first year nursing student experiences with social media in supporting student transition and engagement into higher education. Qualitative focus groups. Ten 1st year Bachelor of Nursing students were included in three face-to-face focus groups. Data were analysed using qualitative thematic content analysis. Three key themes emerged that illustrates the experiences of transition and engagement of first year student nurses using social media at university. (1) Facilitating familiarity and collaboration at a safe distance, (2) promoting independent learning by facilitating access to resources, and (3) mitigating hazards of social media. This study has demonstrated the importance of social media in supporting informal peer-peer learning and support, augmenting online and offline relationships, and building professional identity as a nurse.

State of the States '92: Bridging Troubled Finance Waters. Proceedings of the Fiscal Issues, Policy, and Education Finance Special Interest Group of the American Educational Research Association (San Francisco, California, April 20-24, 1992).

ERIC Educational Resources Information Center

Westbrook, Kathleen C., Ed.

This document contains the proceedings of presentations made by the Fiscal Issues, Policy and Education Finance Special Interest Group of the American Education Research Association (AERA). Ten articles focus on equitable funding systems for K-12 education and examine school financing in the following states: Florida, Illinois, New York,…

Tourism, Transnationality and Ethnolinguistic Vitality: The Welsh in the Chubut Province, Argentina

ERIC Educational Resources Information Center

Johnson, Ian

2010-01-01

This article aims to develop the concept of ethnolinguistic vitality by adopting a qualitative approach to vitality rather than the statistical approach traditionally used. Ten small-size focus group style interviews were held with members of the Welsh-Argentinean community in the Chubut Province in the south of Argentina in order to explore…

Putting Adaptive Management into Monitoring: Retrospective and Prospective Views of Northwest Forest Plan Monitoring

Treesearch

David E. Busch; Jon R. Martin

2006-01-01

Based on ten years of Northwest Forest Plan implementation, we focus on key scientifically-oriented questions relating to improving Plan monitoring. The questions, which fall into groups concerning issues of scale, integration, and efficiency, have applicability to monitoring programs being designed and implemented throughout the world. Progress toward answering such...

Sexual Abuse in a Classroom of Ten Male Students: A Group Victimization

ERIC Educational Resources Information Center

Celik, Gonca Gul; Tahiroglu, Aysegul Yolga; Avci, Ayse; Cekin, Necmi; Evliyaoglu, Nurdan; Yoruldu, Belgin

2012-01-01

The term "professional perpetrator" is used to describe individuals who commit sexual abuse in the capacity of a position of trust such as a teacher, household member, or employer. There is an increasing body of evidence focusing on educator sexual abuse in the school environment. However, data are limited about this topic. The aim of…

The Process of Curriculum Innovations in the Army

DTIC Science & Technology

2016-08-01

Ten Army courses were included: advanced individual training , noncommissioned officer professional development courses, and an officer basic...course. Course managers, training developers, and instructors completed questionnaires and participated in focus groups. Graduates of one revised course...positively affected by a quick feedback loop between training developers and instructors. The ALM concepts were viewed positively, although some ALM

Children's Rough and Tumble Play: Perspectives of Teachers in Northern Canadian Indigenous Communities

ERIC Educational Resources Information Center

Peterson, Shelley Stagg; Madsen, Audrey; San Miguel, Jayson; Jang, Soon Young

2018-01-01

Ten teachers in kindergarten and grade one classrooms in remote northern Canadian Ojibway communities, and two consultants from a First Nations Student Success Program participated in focus group discussions about the place of rough and tumble and superhero play, and teachers' roles in preventing relational and physically aggressive play in…

"Junkies, Wasters and Thieves": School-Based Drug Education and the Stigmatisation of People Who Use Drugs

ERIC Educational Resources Information Center

Meehan, Claire

2017-01-01

People who use illicit drugs often experience stigma that manifests in systemic discrimination, marginalisation and social exclusion. Drug education, which is underpinned by the information model, and often includes fear-based tactics. Eleven focus groups were conducted with sixty-six young people (14-16 years old) in ten schools in Northern…

Soils Alive! From Tiny Rocks to Composting. Cycling Back to Nature.

ERIC Educational Resources Information Center

Horton, Robert L.; And Others

This environmental sourcebook contains activities focusing on the living and nonliving components of soil and their relationship to the earth's natural cycles. The materials contained in this guide are for use with youth ages ten and older and are designed to stimulate a sense of stewardship for the environment through group discussion, role…

3D splint prototype system for applications in muscular rehab by transcutaneous electrical nerve stimulation (TENS)

NASA Astrophysics Data System (ADS)

Saldaña-Martínez, M. I.; Guzmán-González, J. V.; Barajas-González, O. G.; Guzman-Ramos, V.; García-Garza, A. K.; González-García, R. B.; García-Ramírez, M. A.

2017-03-01

It is quite common that patients with ligamentous ruptures, tendonitis, tenosynovitis or sprains are foreseen the use of ad hoc splints for a swift recovery. In this paper, we propose a rehabilitation split that is focused on upper-limb injuries. By considering that upper-limb patient shows a set of different characteristics, our proposal personalizes and prints the splint custom made though a digital model that is generated by a 3D commercial scanner. To fabricate the 3D scanned model the Stereolithography material (SLA) is considered due to the properties that this material offers. In order to complement the recovery process, an electronic system is implemented within the splint design. This system generates a set of pulses for a fix period of time that focuses mainly on a certain group of muscles to allow a fast recovery process known as Transcutaneous Electrical Nerve Stimulation Principle (TENS).

Quality improvement of interdisciplinary rounds by leadership training based on essential quality indicators of the Interdisciplinary Rounds Assessment Scale.

PubMed

Ten Have, Elsbeth C M; Nap, Raoul E; Tulleken, Jaap E

2013-10-01

The implementation of interdisciplinary teams in the intensive care unit (ICU) has focused attention on leadership behavior. Daily interdisciplinary rounds (IDRs) in ICUs integrate leadership behavior and interdisciplinary teamwork. The purpose of this intervention study was to measure the effect of leadership training on the quality of IDRs in the ICU. A nonrandomized intervention study was conducted in four ICUs for adults. The intervention was a 1-day training session in a simulation environment and workplace-based feedback sessions. Measurement included 28 videotaped IDRs (total, 297 patient presentations) that were assessed with 10 essential quality indicators of the validated IDR Assessment Scale. Participants were 19 intensivists who previously had no formal training in leading IDRs. They were subdivided by cluster sampling into a control group (ten experienced intensivists) and intervention group (nine intensive care fellows). Mann-Whitney U test was used to compare results between control and intervention groups. Baseline measurements of control and intervention groups revealed two indicators that differed significantly. The frequency of yes ratings for the intervention group significantly increased for seven of the ten indicators from before to after intervention. The frequency of yes ratings after training was significantly greater in the intervention than control groups for eight of the ten essential quality indicators. The leadership training improved the quality of the IDRs performed in the ICUs. This may improve quality and safety of patient care.

Hypoalgesia in response to transcutaneous electrical nerve stimulation (TENS) depends on stimulation intensity.

PubMed

Moran, Fidelma; Leonard, Tracey; Hawthorne, Stephanie; Hughes, Ciara M; McCrum-Gardner, Evie; Johnson, Mark I; Rakel, Barbara A; Sluka, Kathleen A; Walsh, Deirdre M

2011-08-01

Transcutaneous electrical nerve stimulation (TENS) is an electrophysical modality used for pain management. This study investigated the dose response of different TENS intensities on experimentally induced pressure pain. One hundred and thirty TENS naïve healthy individuals (18-64 years old; 65 males, 65 females) were randomly allocated to 5 groups (n = 26 per group): Strong Non Painful TENS; Sensory Threshold TENS; Below Sensory Threshold TENS; No Current Placebo TENS; and Transient Placebo TENS. Active TENS (80 Hz) was applied to the forearm for 30 minutes. Transient Placebo TENS was applied for 42 seconds after which the current amplitude automatically reset to 0 mA. Pressure pain thresholds (PPT) were recorded from 2 points on the hand and forearm before and after TENS to measure hypoalgesia. There were significant differences between groups at both the hand and forearm (ANOVA; P = .005 and .002). At 30 minutes, there was a significant hypoalgesic effect in the Strong Non Painful TENS group compared to: Below Sensory Threshold TENS, No Current Placebo TENS and Transient Placebo TENS groups (P < .0001) at the forearm; Transient Placebo TENS and No Current Placebo TENS groups at the hand (P = .001). There was no significant difference between Strong Non Painful TENS and Sensory Threshold TENS groups. The area under the curve for the changes in PPT significantly correlated with the current amplitude (r(2) = .33, P = .003). These data therefore show that there is a dose-response effect of TENS with the largest effect occurring with the highest current amplitudes. This study shows a dose response for the intensity of TENS for pain relief with the strongest intensities showing the greatest effect; thus, we suggest that TENS intensity should be titrated to achieve the strongest possible intensity to achieve maximum pain relief. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

Using ePortfolios to Measure Student Learning in a Graduate Preparation Program in Higher Education

ERIC Educational Resources Information Center

Janosik, Steven M.; Frank, Tara E.

2013-01-01

Ten second-year master's students in a higher education program participated in this study, which was designed to assess their experience with an electronic portfolio that had been introduced recently as a primary component of their comprehensive exam. This qualitative study used a focus group and long-interview methods for data collection.…

Healthful eating and physical activity in the home environment: results from multifamily focus groups.

PubMed

Berge, Jerica M; Arikian, Aimee; Doherty, William J; Neumark-Sztainer, Dianne

2012-01-01

To explore multiple family members' perceptions of risk and protective factors for healthful eating and physical activity in the home. Ten multifamily focus groups were conducted with 26 families. Community setting with primarily black and white families. Family members (n = 103) were aged 8 to 61 years. Risk and protective factors for healthful eating and physical activity in the home environment. A grounded hermeneutic approach. Ten major themes were identified by family members related to health behaviors in the home environment, including accessibility to healthful foods and activity, time constraints, stage of youth development, individual investment in health behaviors, family investment in health behaviors, family meals and shared activities, parent modeling, making health behaviors fun, making health behaviors part of the family lifestyle, and community investment in family health behaviors. This study identified the importance of the family system and the reciprocal influences within the home environment on health behaviors. In addition, individual and community-level suggestions were identified. Insights from the families provide leads for future research and ideas for the prevention of youth obesity. Copyright © 2012 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

The challenge of electronic health records (EHRs) design and implementation: responses of health workers to drawing a 'big and rich picture' of a future EHR programme using animated tools.

PubMed

Jenkings, K Neil; Wilson, Robert G

2007-01-01

To investigate the use of animation tools to aid visualisation of problems for discussion within focus groups, in the context of healthcare workers discussing electronic health records (EHRs). Ten healthcare staff focus groups, held in a range of organisational contexts. Each focus group was in four stages: baseline discussion, animator presentation, post-animator discussion and questionnaire. Audio recordings of the focus groups were transcribed and coded and the emergent analytic themes analysed for issues relating to EHR design and implementation. The data allowed a comparison of baseline and post-animator discussion. The animator facilitated discussion about EHR issues and these were thematically coded as: Workload; Sharing Information; Access to Information; Record Content; Confidentiality; Patient Consent; and Implementation. We illustrate that use of the animator in focus groups is one means to raise understanding about a proposed EHR development. The animator provided a visual 'probe' to support a more proactive and discursive localised approach to end-user concerns, which could be part of an effective stakeholder engagement and communication strategy crucial in any EHR or health informatics implementation programme. The results of the focus groups were to raise salient issues and concerns, many of which anticipated those that have emerged in the current NHS Connecting for Health Care Records programme in England. Potentially, animator-type technologies may facilitate the user ownership which other forms of dissemination appear to be failing to achieve.

Effect of modulated-frequency and modulated-intensity transcutaneous electrical nerve stimulation after abdominal surgery: a randomized controlled trial.

PubMed

Tokuda, Mitsunori; Tabira, Kazuyuki; Masuda, Takashi; Nishiwada, Takashi; Shomoto, Koji

2014-07-01

This study aimed to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) for treatment of postoperative pain and pulmonary functions (vital capacity [VC]; cough peak flow, [CPF]) in patients who underwent abdominal surgery. Forty-eight patients were randomly allocated to receive TENS, placebo TENS, or no TENS (control) 1 hour a day for 3 days postoperatively. A 0-100 visual analog scale was used to assess pain at preintervention, mid-intervention, and postintervention on the third postoperative day. Pulmonary functions (VC, CPF) were evaluated by spirometer at preoperation (baseline) and at preintervention, mid-intervention, and postintervention on the third postoperative day. One-way analysis of variance was used to assess differences between groups at baseline. Mann-Whitney test was used to compare the control group with the placebo-TENS and TENS group, at each assessment timepoint. Two-way analysis of variance and Bonferroni post hoc test assessed the difference between the 2 (placebo-TENS×TENS) groups. A value of P<0.01 was considered statistically significant. The baselines were not significantly different between any groups. The TENS group had significant reductions in postoperative pain compared with the placebo group (P<0.01) and control group (P<0.01). There was also improvement in pulmonary functions (VC, CPF) at mid-TENS and post-TENS, but not in the placebo-TENS (P<0.01) or control groups (P<0.01). TENS is a valuable treatment to alleviate postoperative pain and improve pulmonary functions (ie, VC, CPF) in patients following abdominal surgery.

A pilot study on using acupuncture and transcutaneous electrical nerve stimulation to treat chronic non-specific low back pain.

PubMed

Itoh, Kazunori; Itoh, Satoko; Katsumi, Yasukazu; Kitakoji, Hiroshi

2009-02-01

The present study tests whether a combined treatment of acupuncture and transcutaneous electrical nerve stimulation (TENS) is more effective than acupuncture or TENS alone for treating chronic low back pain (LBP). Thirty-two patients with chronic LBP were randomly allocated to four groups. The acupuncture group (ACP) received only acupuncture treatment at selected acupoints for low back pain; the TENS group (TENS) received only TENS treatment at pain areas; the acupuncture and TENS group (A&T) received both acupuncture and TENS treatments; the control group (CT) received topical poultice (only when necessary). Each group received specific weekly treatment five times during the study. Outcome measures were pain intensity in terms of visual analogue scale (VAS) and QOL of low back in terms of Roland-Morris Disability Questionnaire (RDQ). The ACP, TENS and A&T groups all reported lower VAS and RDQ scores. Significant reduction in pain intensity (P<0.008) and significant improvement in QOL (P<0.008) were shown in the A&T group. Combined acupuncture and TENS treatment is effective in pain relief and QOL of low back improvement for the sampled patients suffering from chronic LBP.

"You've Got to Love Yourself": Photovoice Stories From African Americans and Hispanic/Latinos Living With Diabetes.

PubMed

Peña-Purcell, Ninfa C; Cutchen, Lauren; McCoy, Traechel

2018-05-01

Health disparities persist among African Americans (AAs) and Latino adults with type 2 diabetes. The purpose of this research was to use PhotoVoice to examine AAs and Latinos' daily experiences of managing diabetes. An exploratory, descriptive study using PhotoVoice and focus groups was conducted over a 3-week period: Week 1 orientation session, Week 2 photo taking and returning cameras, and Week 3 focus group to share and discuss photos. Ten AAs and nine Latino adults were enrolled, forming four focus groups. Four categories emerged: (1) daily life living with type 2 diabetes mellitus, (2) negative and positive emotions, (3) supports and barriers, and (4) needs. The social determinants of health influencing diabetes self-care were observed in discussions and photos-this included the built environment to promote a healthy lifestyle, social support, and education. PhotoVoice promotes culturally congruent care to better understand AA and Latinos' experience living with type 2 diabetes mellitus.

Listen to the children: kids' impressions of Who Do You Tell ™.

PubMed

Tutty, Leslie M

2014-01-01

School-based programs have been the central strategy to educate children about the serious nature of child sexual abuse in the hope of prevention or early intervention. Virtually all evaluations have been quantitative, seldom allowing children to directly comment on their experiences. This article presents the results of qualitative research with 116 students (51 boys and 65 girls) ranging from age 6 to 12 who had participated in the Who Do You Tell child sexual abuse education program. Ten focus groups were conducted with students in separate grades, from kindergarten through sixth grade, two to three months after program participation. The core themes that emerged from the focus group interviews are presented, as are implications for child sexual abuse prevention programs.

Second International Conference on Near-Field Optical Analysis: Photodynamic Therapy and Photobiology Effects

NASA Technical Reports Server (NTRS)

Bulgher, Debra L. (Editor); Morrison, Dennis

2002-01-01

The International NASA/DARPA Photobiology Conference held at the Johnson Space Center in Houston/TX demonstrated where low level laser therapy (LLLT), respectively low intensity light activated biostimulation (LILAB) and nanotechnological applications employing photobiomodulation techniques will presumably go in the next ten years. The conference was a continuation of the 1st International Conference on Nearfield Optical Analysis organized by Andrei Sommer (ENSOMA Lab, University of Ulm, Germany) in November 2000 at Castle Reisenburg, Germany, which started with a group of ten scientists from eight different countries. The 1st conference was co-sponsored by the American Chemical Society to evaluate the molecular mechanism of accelerated and normal wound healing processes. The 2nd conference was co-sponsored by DARPA, NASA-JSC and the Medical College of Wisconsin. Despite the short time between events, the 2nd conference hosted 40 international experts form universities, research institutes, agencies and the industry. The materials published here are expected to become milestones forming a novel platform in biomedical photobiology. The multidisciplinary group of researchers focused on LLLT/LILAB-applications under extreme conditions expected to have beneficial effects particularly in space, on submarines, and under severe battlefield conditions. The group also focused on novel technologies with possibilities allowing investigating the interaction of light with biological systems, molecular mechanisms of wound healing, bone regeneration, nerve regeneration, pain modulation, as well as biomineralization and biofilm formulation processes induced by nanobacteria.

Education Politics for the New Century: The Twentieth Anniversary Yearbook of the Politics of Education Association. Falmer Press Education Policy Perspectives Series.

ERIC Educational Resources Information Center

Mitchell, Douglas E., Ed.; Goertz, Margaret E., Ed.

This book focuses on the forces that will shape education politics and policy into the 21st century. Ten chapters written by prominent educators center on the roles to be played by education professionals, local citizen groups, government agencies, and business leaders in shaping education policy, responses to racial and ethnic segregation, school…

A qualitative analysis of beginning mindfulness experiences for women with post-traumatic stress disorder and a history of intimate partner violence.

PubMed

Bermudez, Diana; Benjamin, Michelle T; Porter, Sarah E; Saunders, Pamela A; Myers, Neely Anne Laurenzo; Dutton, Mary Ann

2013-05-01

This article presents the beginning mindfulness experiences of low income, minority women with a history of intimate partner violence. Ten women participated in a Mindfulness-Based Stress Reduction group, three interviews and a focus group over 15 months. Using an interpretive phenomenological analysis approach, we derived the following themes: struggles to practice meditation; a vision of growing and helping; personal improvements, and interpersonal improvements. We share recommendations for clinical practice. Copyright © 2013 Elsevier Ltd. All rights reserved.

Prolonged Reduction in Shoulder Strength after Transcutaneous Electrical Nerve Stimulation Treatment of Exercise-Induced Acute Muscle Pain.

PubMed

Butera, Katie A; George, Steven Z; Borsa, Paul A; Dover, Geoffrey C

2018-03-05

Transcutaneous electrical nerve stimulation (TENS) is commonly used for reducing musculoskeletal pain to improve function. However, peripheral nerve stimulation using TENS can alter muscle motor output. Few studies examine motor outcomes following TENS in a human pain model. Therefore, this study investigated the influence of TENS sensory stimulation primarily on motor output (strength) and secondarily on pain and disability following exercise-induced delayed-onset muscle soreness (DOMS). Thirty-six participants were randomized to a TENS treatment, TENS placebo, or control group after completing a standardized DOMS protocol. Measures included shoulder strength, pain, mechanical pain sensitivity, and disability. TENS treatment and TENS placebo groups received 90 minutes of active or sham treatment 24, 48, and 72 hours post-DOMS. All participants were assessed daily. A repeated measures analysis of variance and post-hoc analysis indicated that, compared to the control group, strength remained reduced in the TENS treatment group (48 hours post-DOMS, P < 0.05) and TENS placebo group (48 hours post-DOMS, P < 0.05; 72 hours post-DOMS, P < 0.05). A mixed-linear modeling analysis was conducted to examine the strength (motor) change. Randomization group explained 5.6% of between-subject strength variance (P < 0.05). Independent of randomization group, pain explained 8.9% of within-subject strength variance and disability explained 3.3% of between-subject strength variance (both P < 0.05). While active and placebo TENS resulted in prolonged strength inhibition, the results were nonsignificant for pain. Results indicated that higher pain and higher disability were independently related to decreased strength. Regardless of the impact on pain, TENS, or even the perception of TENS, may act as a nocebo for motor output. © 2018 World Institute of Pain.

Comparison of effectiveness of Transcutaneous Electrical Nerve Stimulation and Kinesio Taping added to exercises in patients with myofascial pain syndrome.

PubMed

Azatcam, Gokmen; Atalay, Nilgun Simsir; Akkaya, Nuray; Sahin, Fusun; Aksoy, Sibel; Zincir, Ozge; Topuz, Oya

2017-01-01

Although there are several studies of Transcutaneous Electrical Nerve Stimulation (TENS) and exercise in myofascial pain syndrome, there are no studies comparing the effectiveness of Kinesio Taping (KT) and TENS in myofascial pain syndrome patients. To compare the early and late effects of TENS and KT on pain, disability and range of motion in myofascial pain syndrome patients. Sixty-nine patients were divided into three groups randomly as TENS+Exercise, KT+Exercise and exercise groups. Visual Analogue Scale (VAS), pain threshold, Neck Disability Index and cervical contralateral lateral flexion were employed in the evaluation of the patients performed before treatment, after treatment and 3rd month after treatment. The VAS, pain threshold, Neck Disability Index and contralateral lateral flexion values were improved in all groups both in after treatment and 3rd month after treatment (p< 0.01). In the comparison of after treatment vs. before treatment evaluations, VAS score was decreased in KT group compared to the TENS and control group (p= 0.001), in the TENS group compared to control group (p= 0.011). In the comparison of 3rd month and before treatment evaluations, VAS score was decreased in the TENS group compared to control group (p= 0.001) and in the KT group compared to the control group (p= 0.001). There was no significant difference between TENS and KT groups. All other parameters did not differ between the groups. TENS and KT added exercises can decrease pain severity and increase pain threshold, function and cervical range of motion in myofascial pain syndrome patients. Addition of TENS or KT to the exercise therapy resulted in more significant improvement compared to exercise therapy alone with a more pronounced improvement in KT group compared to the TENS group in the early period. Because KT was found to be more effective in decreasing the pain and had the advantage of being used in every 3 days, it seems to be beneficial in acute painful periods in myofascial pain syndrome patients.

Australian adult consumers' beliefs about plant foods: a qualitative study.

PubMed

Lea, Emma; Worsley, Anthony; Crawford, David

2005-12-01

This exploratory qualitative study examined consumers' perceived barriers and benefits of plant food (fruits, vegetables, grains, legumes, nuts, seeds) consumption and views on the promotion of these foods. Ten focus groups were conducted in Melbourne, Australia. Groups consisted of employees of various workplaces, community group members, university students, and inner-city residents. Health-related benefits predominated, particularly relating to the properties of plant foods (e.g., vitamins). Taste, variety, versatility, and environmental benefits were also considered important. The main barriers to eating plant foods were lack of knowledge and skills and length of preparation time. The poor quality of plant foods was also an issue for consumers. Awareness of the promotion of plant foods was generally high. Participants noted that promotions require a stronger practical emphasis with a focus on quick, easy-to-prepare foods and meals. These findings provide insight into effective ways to promote a higher consumption of plant foods.

Ten Years of Mi'gmaq Language Revitalization Work: A Non-Indigenous Applied Linguist Reflects on Building Research Relationships

ERIC Educational Resources Information Center

Sarkar, Mela

2017-01-01

Language revitalization work at one First Nation in eastern Canada has been ongoing for over two decades. Several approaches have been put in place: core teaching of Mi'gmaq as a primary school subject, language documentation and the creation of an online dictionary, and an Elders' focus group on language, as well other shorter-term projects. In…

Picturing Policy in Addressing Water and Sanitation: The Voices of Girls Living in Abject Intergenerational Hardship in Mozambique

ERIC Educational Resources Information Center

Sajan Virgi, Zainul; Mitchell, Claudia

2011-01-01

Abject generational hardship is a systemic phenomenon which denies people a higher quality of life by limiting their access to basic life necessities. The article focuses on a group of ten girls between the ages of 10 and 14 living in a peri-urban community outside of Maputo. The first part outlines the importance of engaging girls through…

Healthful Eating and Physical Activity in the Home Environment: Results from Multi-Family Focus Groups

PubMed Central

Berge, Jerica M.; Arikian, Aimee; Doherty, William J.; Neumark-Sztainer, Dianne

2012-01-01

Objective To explore multiple family members’ perceptions of risk and protective factors for healthy eating and physical activity in the home. Design Ten multi-family focus groups were conducted with 26 families. Setting Community setting. Participants Primarily Black and White families. Family members (n = 103) were between the ages of 8–61 years. Analysis A grounded hermeneutic approach. Phenomenon of Interest Risk and protective factors for healthy eating and physical activity in the home environment. Results Ten major themes were identified by family members related to health behaviors in the home environment, including: (a) accessibility to healthy foods and activity, (b) time constraints, (c) stage of youth development, (d) individual investment in health behaviors, (e) family investment in health behaviors, (f) family meals and shared activities, (g) parent modeling, (h) making health behaviors fun, (i) making health behaviors part of the family lifestyle, and (j) community investment in family health behaviors. Conclusions and Implications This study identified the importance of the family system and the reciprocal influences within the home environment on health behaviors. In addition, individual and community-level suggestions were identified. Insights from the families provide leads for future research and ideas for the prevention of youth obesity. PMID:22192951

Maternity Nurses' Perceptions of Implementation of the Ten Steps to Successful Breastfeeding.

PubMed

Cunningham, Emilie M; Doyle, Eva I; Bowden, Rodney G

The purpose of this study was to determine maternity nurses' perceptions of implementing the Ten Steps to Successful Breastfeeding. An online survey and a focus group were used to evaluate perceptions of maternity nurses of implementing the Ten Steps to Successful Breastfeeding in an urban Texas hospital at the onset of the project initiation. Responses were transcribed and coded using Nvivo software. Thematic analysis was conducted and consensus was reached among the research team to validate themes. Twenty-eight maternity nurses participated. Nurses perceived a number of barriers to implementing the Ten Steps to Successful Breastfeeding including nurse staffing shortages, variations in practice among nurses, different levels of nurse education and knowledge about breastfeeding, lack of parental awareness and knowledge about breastfeeding, culture, and postpartum issues such as maternal fatigue, visitors, and routine required procedures during recovery care that interfered with skin-to-skin positioning. Maternity nurses desired more education about breastfeeding; specifically, a hands-on approach, rather than formal classroom instruction, to be able to promote successful implementation of the Ten Steps. More education on breastfeeding for new mothers, their families, and healthcare providers was recommended. Nurse staffing should be adequate to support nurses in their efforts to promote breastfeeding. Skin-to-skin positioning should be integrated into the recovery period. Hospital leadership support for full implementation and policy adherence is essential. Challenges in implementing the Ten Steps were identified along with potential solutions.

High- and low-frequency transcutaneous electrical nerve stimulation does not reduce experimental pain in elderly individuals

PubMed Central

Bergeron-Vézina, Kayla; Corriveau, Hélène; Martel, Marylie; Harvey, Marie-Philippe; Léonard, Guillaume

2015-01-01

Abstract Despite its widespread clinical use, the efficacy of transcutaneous electrical nerve stimulation (TENS) remains poorly documented in elderly individuals. In this randomized, double-blind crossover study, we compared the efficacy of high-frequency (HF), low-frequency (LF), and placebo (P) TENS in a group of 15 elderly adults (mean age: 67 ± 5 years). The effect of HF-, LF-, and P-TENS was also evaluated in a group of 15 young individuals (26 ± 5 years; same study design) to validate the effectiveness of the TENS protocols that were used in the elderly group. Each participant came to the laboratory on 3 separate occasions to receive, in random order, HF-, LF-, and P-TENS. Pain intensity and pain perception thresholds were assessed before, during, and after TENS, using an experimental heat pain paradigm. For the young group, there was a significant decrease in pain intensity during and after HF- and LF-TENS when compared with baseline, with both HF- and LF-TENS being superior to P-TENS. In the older group, HF- and LF-TENS did not reduce pain when compared with baseline and no difference was observed between the 2 active TENS sessions and P-TENS. High-frequency, LF-, and P-TENS all increased pain thresholds in young individuals, whereas in older individuals, only LF-TENS increased pain thresholds. Taken together, these results suggest that TENS is effective in young, but not in older, individuals. Future studies should be conducted to confirm these results in pain populations and to identify strategies that could enhance the effect of TENS in the elderly. PMID:26101836

Interdisciplinary Social Science: An Example of Vertical and Horizontal Integrative Strategies

NASA Astrophysics Data System (ADS)

Durlabhji, Subhash

2005-03-01

A "Concept-Centered" strategy for Integrative Studies was proposed and implemented in the creation of the book Power in Focus: Perspectives from Multiple Disciplines. Essays on the ubiquitous concept of Power were solicited internationally and a final cut of ten essays from ten different disciplines, written specifically for this project, were included. This provides an example of what might be called Horizontal Integration, as it cut across multiple disciplines. One of the essays in the volume provides an example of Vertical Integration, as it applies a psychodynamic hypothesis concerning the development of Power relations among humans across hierarchical levels, from the child to the family to other groups and institutions in society, including finally entire nations and regions of the world.

Effects of transcutaneous electrical nerve stimulation (TENS) and interferential currents (IFC) in patients with nonspecific chronic low back pain: randomized clinical trial.

PubMed

Facci, Ligia Maria; Nowotny, Jean Paulus; Tormem, Fabio; Trevisani, Virgínia Fernandes Moça

2011-01-01

Transcutaneous electrical nerve stimulation (TENS) and interferential current are the most used electrotherapy methods, although there is little scientific evidence to support their use. The aim of this study was to compare the effects of TENS and interferential current among patients with nonspecific chronic low back pain. Single-blind randomized controlled trial in the Department of Physiotherapy, Centro Universitário de Maringá. One hundred and fifty patients were randomly divided into three groups: TENS (group 1), interferential current (group 2) and controls (group 3). The patients designated for electrotherapy received ten 30-minute sessions, while the control group remained untreated. All patients and controls were evaluated before and after treatment using a visual analog scale and the McGill Pain and Roland Morris questionnaires, and regarding their use of additional medications. There was a mean reduction on the visual analog scale of 39.18 mm with TENS, 44.86 mm with interferential current and 8.53 mm among the controls. In the Roland Morris questionnaire, group 1 had a mean reduction of 6.59; group 2, 7.20; and group 3, 0.70 points. In group 1, 84% of the patients stopped using medications after the treatment; in group 2, 75%; and in group 3, 34%. There was no statistically significant difference between the TENS and interferential current groups (P > 0.05); a difference was only found between these groups and the controls (P < 0.0001). There was no difference between TENS and interferential current for chronic low back pain treatment. NCT01017913.

Transcutaneous electrical nerve stimulation (TENS) improves the diabetic cytopathy (DCP) via up-regulation of CGRP and cAMP.

PubMed

Ding, Liucheng; Song, Tao; Yi, Chaoran; Huang, Yi; Yu, Wen; Ling, Lin; Dai, Yutian; Wei, Zhongqing

2013-01-01

The objective of this study was to investigate the effects and mechanism of Transcutaneous Electrical Nerve Stimulation (TENS) on the diabetic cytopathy (DCP) in the diabetic bladder. A total of 45 rats were randomly divided into diabetes mellitus (DM)/TENS group (n=15), DM group (n=15) and control group (n=15). The rats in the DM/TENS and TENS groups were electronically stimulated (stimulating parameters: intensity-31 V, frequency-31 Hz, and duration of stimulation of 15 min) for three weeks. Bladder histology, urodynamics and contractile responses to field stimulation and carbachol were determined. The expression of calcitonin gene-related peptide (CGRP) was analyzed by RT-PCR and Western blotting. The results showed that contractile responses of the DM rats were ameliorated after 3 weeks of TENS. Furthermore, TENS significantly increased bladder wet weight, volume threshold for micturition and reduced PVR, V% and cAMP content of the bladder. The mRNA and protein levels of CGRP in dorsal root ganglion (DRG) in the DM/TENS group were higher than those in the DM group. TENS also significantly up-regulated the cAMP content in the bladder body and base compared with diabetic rats. We conclude that TENS can significantly improve the urine contractility and ameliorate the feeling of bladder fullness in DM rats possibly via up-regulation of cAMP and CGRP in DRG.

Transcutaneous electrical nerve stimulation (TENS) for pain control after vaginal delivery and cesarean section.

PubMed

Kayman-Kose, Seda; Arioz, Dagistan Tolga; Toktas, Hasan; Koken, Gulengul; Kanat-Pektas, Mine; Kose, Mesut; Yilmazer, Mehmet

2014-10-01

The present study aims to determine the efficiency and reliability of transcutaneous electrical nerve stimulation (TENS) in the management of pain related with uterine contractions after vaginal delivery and the pain related with both abdominal incision uterine contractions after cesarean section. A hundred healthy women who underwent cesarean section under general anesthesia were randomly assigned to the placebo group (Group 1) or the TENS group (Group 2), while 100 women who delivered by vaginal route without episiotomy were randomized into the placebo group (Group 3) or the TENS group (Group 4). The patients in Group 2 had statistically lower visual analog scale (VAS) and verbal numerical scale (VNS) scores than the patients in Group 1 (p < 0.001 for both). The patients in Group 4 had statistically lower VAS and VNS scores than the patients in Group 3 (p = 0.022 and p = 0.005, respectively). The analgesic requirement at the eighth hour of cesarean section was significantly lower in the patients who were treated with TENS (p = 0.006). The need for analgesics at the eighth hour of vaginal delivery was statistically similar in the patients who were treated with TENS and the patients who received placebo (p = 0.830). TENS is an effective, reliable, practical and easily available modality of treatment for postpartum pain.

"If donors woke up tomorrow and said we can't fund you, what would we do?" A health system dynamics analysis of implementation of PMTCT option B+ in Uganda.

PubMed

Doherty, Tanya; Besada, Donnela; Goga, Ameena; Daviaud, Emmanuelle; Rohde, Sarah; Raphaely, Nika

2017-07-26

In October 2012 Uganda extended its prevention of mother to child HIV transmission (PMTCT) policy to Option B+, providing lifelong antiretroviral treatment for HIV positive pregnant and breastfeeding women. The rapid changes and adoptions of new PMTCT policies have not been accompanied by health systems research to explore health system preparedness to implement such programmes. The implementation of Option B+ provides many lessons which can inform the shift to 'Universal Test and Treat', a policy which many sub-Saharan African countries are preparing to adopt, despite fragile health systems. This qualitative study of PMTCT Option B+ implementation in Uganda three years following the policy adoption, uses the health system dynamics framework to explore the impacts of this programme on ten elements of the health system. Qualitative data were gathered through rapid appraisal during in-country field work. Key informant interviews and focus group discussions (FGDs) were undertaken with the Ministry of Health, implementing partners, multilateral agencies, district management teams, facility-based health workers and community cadres. A total of 82 individual interviews and 16 focus group discussions were completed. We conducted a simple manifest analysis, using the ten elements of a health system for grouping data into categories and themes. Of the ten elements in the health system dynamics framework, context and resources (finances, infrastructure & supplies, and human resources) were the most influential in the implementation of Option B+ in Uganda. Support from international actors and implementing partners attempted to strengthen resources at district level, but had unintended consequences of creating dependence and uncertainty regarding sustainability. The health system dynamics framework offers a novel approach to analysis of the effects of implementation of a new policy on critical elements of the health system. Its emphasis on relationships between system elements, population and context is helpful in unpacking impacts of and reactions to pressures on the system, which adds value beyond some previous frameworks.

An Investigation of the Hypoalgesic Effects of TENS Delivered by a Glove Electrode

PubMed Central

Cowan, Stephen; McKenna, Joanne; McCrum-Gardner, Evie; Johnson, Mark I.; Sluka, Kathleen A.; Walsh, Deirdre M.

2009-01-01

This randomized, placebo-controlled, blinded study investigated the hypoalgesic effects of high-frequency transcutaneous electrical nerve stimulation (TENS) delivered via a glove electrode compared with standard self-adhesive electrodes. Fifty-six TENS-naïve, healthy individuals (18 to 50 years old; 28 men, 28 women) were randomly allocated to 1 of 4 groups (n = 14 per group): glove electrode; placebo TENS using a glove electrode; standard electrode; and no treatment control. Active TENS (continuous stimulus, 100 Hz, strong but comfortable intensity) was applied to the dominant forearm/hand for 30 minutes. Placebo TENS was applied using a burst stimulus, 100-Hz frequency, 5-second cycle time for 42 seconds, after which the current amplitude was automatically reset to 0 mA. Pressure pain thresholds (PPTs) were recorded from 3 points on the dominant and nondominant upper limbs before and after TENS. Statistical analyses of dominant PPT data using between-within groups ANOVA showed significant differences between groups at all 3 recording points (P = .01). Post hoc Scheffe tests indicated no significant difference between the standard electrode and glove electrode groups. There was a significant hypoalgesic effect in the standard electrode group compared with the control group and between the glove electrode group and both the control and placebo TENS groups. There was no significant interactive effect between time and group at any of the recording points (P > .05). Perspective This study presents a comparison of the hypoalgesic effects of 2 different types of TENS electrode, a novel glove electrode and standard self-adhesive rectangular electrodes. The glove electrode provides a larger contact area with the skin, thereby stimulating a greater number of nerve fibers. The results show that both electrodes have similar hypoalgesic effects and therefore give the clinician another choice in electrode. PMID:19398378

Comparison of Transcutaneous Electrical Nerve Stimulation and Parasternal Block for Postoperative Pain Management after Cardiac Surgery

PubMed Central

Ozturk, Nilgun Kavrut; Baki, Elif Dogan; Kavakli, Ali Sait; Sahin, Ayca Sultan; Ayoglu, Raif Umut; Karaveli, Arzu; Emmiler, Mustafa; Inanoglu, Kerem; Karsli, Bilge

2016-01-01

Background. Parasternal block and transcutaneous electrical nerve stimulation (TENS) have been demonstrated to produce effective analgesia and reduce postoperative opioid requirements in patients undergoing cardiac surgery. Objectives. To compare the effectiveness of TENS and parasternal block on early postoperative pain after cardiac surgery. Methods. One hundred twenty patients undergoing cardiac surgery were enrolled in the present randomized, controlled prospective study. Patients were assigned to three treatment groups: parasternal block, intermittent TENS application, or a control group. Results. Pain scores recorded 4 h, 5 h, 6 h, 7 h, and 8 h postoperatively were lower in the parasternal block group than in the TENS and control groups. Total morphine consumption was also lower in the parasternal block group than in the TENS and control groups. It was also significantly lower in the TENS group than in the control group. There were no statistical differences among the groups regarding the extubation time, rescue analgesic medication, length of intensive care unit stay, or length of hospital stay. Conclusions. Parasternal block was more effective than TENS in the management of early postoperative pain and the reduction of opioid requirements in patients who underwent cardiac surgery through median sternotomy. This trial is registered with Clinicaltrials.gov number NCT02725229. PMID:27445610

Does transcutaneous nerve stimulation have effect on sympathetic skin response?

PubMed

Okuyucu, E Esra; Turhanoğlu, Ayşe Dicle; Guntel, Murat; Yılmazer, Serkan; Savaş, Nazan; Mansuroğlu, Ayhan

2018-01-01

This study examined the effects of transcutaneous electrical nerve stimulation (TENS) on the sympathetic nerve system by sympathetic skin response test. Fifty-five healthy volunteers received either: (i) 30minutes TENS (25 participants) (ii) 30minutes sham TENS (30 participants) and SSR test was performed pre- and post-TENS. The mean values of latency and peak-to-peak amplitude of five consecutive SSRs were calculated. A significant amplitude difference was found between TENS and sham TENS group both in right and left hand (p=0.04, p=0.01, respectively). However there was no significant latancy difference between two groups (p>0.05 ). TENS has an inhibitory effect on elicited SNS responses when compared with sham TENS control group. Copyright © 2017 Elsevier Ltd. All rights reserved.

Analysis of Shiphandlers’ Eye-Gaze and Simulation Data for Improvements in COVE-ITS System

DTIC Science & Technology

2017-06-01

study . For experts, we mainly focused on recruiting the instructors stationed at SWOS to volunteer for the study . Students attending...experience on a DDG-51 destroyer were also considered for the expert group. Eleven SWOs volunteered for the study , ten males and one female. One student ...failure on the eye tracking glasses. Hence, we had nine participants who completed the study : five ADOC students , one ADOC instructor, two

Spatially Nonlinear Interdependence of Alpha-Oscillatory Neural Networks under Chan Meditation

PubMed Central

Chang, Chih-Hao

2013-01-01

This paper reports the results of our investigation of the effects of Chan meditation on brain electrophysiological behaviors from the viewpoint of spatially nonlinear interdependence among regional neural networks. Particular emphasis is laid on the alpha-dominated EEG (electroencephalograph). Continuous-time wavelet transform was adopted to detect the epochs containing substantial alpha activities. Nonlinear interdependence quantified by similarity index S(X∣Y), the influence of source signal Y on sink signal X, was applied to the nonlinear dynamical model in phase space reconstructed from multichannel EEG. Experimental group involved ten experienced Chan-Meditation practitioners, while control group included ten healthy subjects within the same age range, yet, without any meditation experience. Nonlinear interdependence among various cortical regions was explored for five local neural-network regions, frontal, posterior, right-temporal, left-temporal, and central regions. In the experimental group, the inter-regional interaction was evaluated for the brain dynamics under three different stages, at rest (stage R, pre-meditation background recording), in Chan meditation (stage M), and the unique Chakra-focusing practice (stage C). Experimental group exhibits stronger interactions among various local neural networks at stages M and C compared with those at stage R. The intergroup comparison demonstrates that Chan-meditation brain possesses better cortical inter-regional interactions than the resting brain of control group. PMID:24489583

Transcutaneous electrical nerve stimulation improves low back pain during pregnancy.

PubMed

Keskin, E A; Onur, O; Keskin, H L; Gumus, I I; Kafali, H; Turhan, N

2012-01-01

To compare the efficiency of transcutaneous electrical nerve stimulation (TENS) with those of exercise and acetaminophen for the treatment of pregnancy-related low back pain (LBP) during the third trimester of pregnancy. This prospective study included 79 subjects (≥32 gestational weeks) with visual analog scale (VAS) pain scores ≥5. Participants were divided randomly into a control group (n = 21) and three treatment groups [exercise (n = 19); acetaminophen (n = 19); TENS (n = 20)]. The VAS and the Roland-Morris disability questionnaire (RMDQ) were completed before and 3 weeks after treatment to assess the impact of pain on daily activities. During the study period, pain intensity increased in 57% of participants in the control group, whereas pain decreased in 95% of participants in the exercise group and in all participants in the acetaminophen and TENS groups. Post-treatment VAS and RMDQ values were significantly lower in the treatment groups (p < 0.001). VAS and RMDQ scores indicated a significantly greater degree of pain relief in the TENS group than in the exercise and acetaminophen groups (p < 0.001). No adverse effect of TENS application on pregnant women was observed during the study. TENS is an effective and safe treatment modality for LBP during pregnancy. TENS improved LBP more effectively than did exercise and acetaminophen. Copyright © 2012 S. Karger AG, Basel.

[Comparison of the analgesic effect of interferential current (IFC) and TENS in patients with low back pain].

PubMed

Grabiańska, Ewa; Leśniewicz, Joanna; Pieszyński, Ireneusz; Kostka, Joanna

2015-01-01

Electrotherapy, including theTENS and interferential current (IFC) is one of the most frequently used treatments in physical therapy in patients with low back pain. The aim of this study was to assess the influence of TENS and IFC on pain relief and to compare the analgesic efficacy of the two currents. Sixty patients aged 53.5 ± 12.5, with low back pain, were randomly divided into two groups: IFC (gr. I) and TENS (gr. II). Depending on the groups, patients were given series of ten 20-minute sessions using either IF orTENS currents. In all patients VAS and Laitinen modified scale were taken before and after treatment. After 2-weeks therapy there was improvement in the VAS and Laitinen scale (all components) in both groups, except for the part of the Laitinen scale on the reduction of activity in the group II (TENS). There was no statistically significant difference between the TENS and IF groups in reducing the intensity and other aspects of pain (frequency, pain medication and activity limitation) under the influence of therapy (p > 0.05). Interferential current and TENS therapy are effective for pain relief in patients with low back pain. The study showed equal analgesic efficacy of both treatments.

The influence of Task-Related Training combined with Transcutaneous Electrical Nerve Stimulation on paretic upper limb muscle activation in patients with chronic stroke.

PubMed

Jung, Kyoungsim; Jung, Jinhwa; In, Taesung; Kim, Taehoon; Cho, Hwi-Young

2017-01-01

This study investigated the efficacy of Task-Related Training (TRT) Combined with Transcutaneous Electrical Nerve Stimulation (TENS) on the improvement of upper limb muscle activation in chronic stroke survivors with mild or moderate paresis. A single-blind, randomized clinical trial was conducted with 46stroke survivors with chronic paresis. They were randomly allocated two groups: the TRT+TENS group (n = 23) and the TRT+ placebo TENS (TRT+PLBO) group (n = 23). The TRT+TENS group received 30 minutes of high-frequency TENS on wrist and elbow extensors, while the TRT+PLBO group received placebo TENS that was not real ES. Both groups did 30 minutes of TRT after TENS application. Intervention was given five days a week for four weeks. The primary outcomes of upper limb muscle activation were measured by integrated EMG (IEMG), a digital manual muscle tester for muscle strength, active range of motion (AROM) and Fugl-Meyer Assessment of the upper extremity (FMA-UE). The measurements were performed before and after the 4 weeks intervention period. Both groups demonstrated significant improvements of outcomes in IEMG, AROM, muscle strength and FMA-UE during intervention period. When compared with the TRT+PLBO group, the TRT+TENS group showed significantly greater improvement in muscle activation (wrist extensors, P = 0.045; elbow extensors, P = 0.004), muscle strength (wrist extensors, P = 0.044; elbow extensors, P = 0.012), AROM (wrist extension, P = 0.042; elbow extensors, P = 0.040) and FMA-UE (total, P < 0.001; shoulder/elbow/forearm, P = 0.001; wrist, P = 0.002; coordination, P = 0.008) at the end of intervention. Our findings indicate that TRT Combined with TENS can improve paretic muscle activity in upper limb paresis, highlighting the benefits of somatosensory stimulation from TENS.

A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain.

PubMed

Deyo, R A; Walsh, N E; Martin, D C; Schoenfeld, L S; Ramamurthy, S

1990-06-07

A number of treatments are widely prescribed for chronic back pain, but few have been rigorously evaluated. We examined the effectiveness of transcutaneous electrical nerve stimulation (TENS), a program of stretching exercises, or a combination of both for low back pain. Patients with chronic low back pain (median duration, 4.1 years) were randomly assigned to receive daily treatment with TENS (n = 36), sham TENS (n = 36), TENS plus a program of exercises (n = 37), or sham TENS plus exercises (n = 36). After one month no clinically or statistically significant treatment effect of TENS was found on any of 11 indicators of outcome measuring pain, function, and back flexion; there was no interactive effect of TENS with exercise. Overall improvement in pain indicators was 47 percent with TENS and 42 percent with sham TENS (P not significant). The 95 percent confidence intervals for group differences excluded a major clinical benefit of TENS for most outcomes. By contrast, after one month patients in the exercise groups had significant improvement in self-rated pain scores, reduction in the frequency of pain, and greater levels of activity as compared with patients in the groups that did not exercise. The mean reported improvement in pain scores was 52 percent in the exercise groups and 37 percent in the nonexercise groups (P = 0.02). Two months after the active intervention, however, most patients had discontinued the exercises, and the initial improvements were gone. We conclude that for patients with chronic low back pain, treatment with TENS is no more effective than treatment with a placebo, and TENS adds no apparent benefit to that of exercise alone.

Evaluation of an exercise concept focusing on eccentric strength training of the rotator cuff for patients with subacromial impingement syndrome.

PubMed

Bernhardsson, Susanne; Klintberg, Ingrid Hultenheim; Wendt, Gunilla Kjellby

2011-01-01

To evaluate the effect on pain intensity and function of an exercise concept focusing on specific eccentric strength training of the rotator cuff in patients with subacromial impingement syndrome. Single-subject research design with baseline and treatment phases (AB design). Home-based training programme supervised and supported by visits to physiotherapy clinic. Ten patients, mean (SD) age 54 (8.6) years, symptom duration 12 (9.1) months. Daily eccentric strengthening exercises of the rotator cuff during 12 weeks. Pain intensity, assessed with a visual analogue scale, and function, using the Patient-Specific Functional Scale. Shoulder function evaluated with the Constant score, and shoulder-related quality of life evaluated with the Western Ontario Rotator Cuff Index. Pain intensity decreased significantly in eight of the ten subjects. Function improved significantly in all ten subjects. Constant score increased in nine subjects and Western Ontario Rotator Cuff Index increased in seven subjects. Mean Constant score for the whole group increased significantly from 44 to 69 points (P = 0.008). Mean Western Ontario Rotator Cuff Index increased from 51 to 71% (P = 0.021). A 12-week eccentric strengthening programme targeting the rotator cuff and incorporating scapular control and correct movement pattern can be effective in decreasing pain and increasing function in patients with subacromial impingement syndrome. A randomized controlled trial is necessary to provide stronger evidence of the method.

Less deep vein thrombosis due to transcutaneous fibular nerve stimulation in total knee arthroplasty: a randomized controlled trial.

PubMed

Izumi, Masashi; Ikeuchi, Masahiko; Aso, Koji; Sugimura, Natsuki; Kamimoto, Yuko; Mitani, Tetsuya; Ueta, Tadashi; Sato, Takayuki; Yokoyama, Masataka; Sugiura, Tetsuro; Tani, Toshikazu

2015-11-01

It has been known for years that deep vein thrombi (DVT) start to develop during total joint arthroplasty. Previously, we reported effective prevention of venous stasis by transcutaneous electrical nerve stimulation (TENS). It is hypothesized that TENS might be a thromboprophylactic tool for the limb undergoing surgery. The purpose of this study is to clarify the clinical efficacy and safety of TENS in patients during total knee arthroplasty (TKA). Ninety patients undergoing primary TKA were involved and randomly allocated to the TENS or control group. In the TENS group, electrical stimulation of the common fibular nerve, which produced a brisk dorsiflexion of the ankle, was performed for the operated leg during surgery. In the control group, no electrical stimulation was applied. Serum D-dimer and soluble fibrin monomer complex (SFMC) levels were measured before surgery, immediately after surgery, and post-operative day (POD) 1. Ultrasonography was performed on POD 1. Immediately after surgery, D-dimer and SFMC levels of each group were significantly lower in the TENS group compared with control (p < 0.05). The incidence of DVT was 11 % (five cases) in the TENS group while 31 % (14 cases) in control (p = 0.02). There were no adverse effects related to TENS. TENS during TKA showed significant effects on preventing DVT. Sustaining muscle pump activation during surgery prevented not only venous stasis, but also hypercoagulability of blood. Intraoperative TENS is a safe and novel strategy against early post-operative thromboembolism, which is difficult to be completed through existing prophylaxis after total joint arthroplasty. Randomized controlled trial, Level I.

Teaching medical students to discern ethical problems in human clinical research studies.

PubMed

Roberts, Laura Weiss; Warner, Teddy D; Green Hammond, Katherine A; Brody, Janet L; Kaminsky, Alexis; Roberts, Brian B

2005-10-01

Investigators and institutional review boards are entrusted with ensuring the conduct of ethically sound human studies. Assessing ethical aspects of research protocols is a key skill in fulfilling this duty, yet no empirically validated method exists for preparing professionals to attain this skill. The authors performed a randomized controlled educational intervention, comparing a criteria-based learning method, a clinical-research- and experience-based learning method, and a control group. All 300 medical students enrolled at the University of New Mexico School of Medicine in 2001 were invited to participate. After a single half-hour educational session, a written posttest of ability to detect ethical problems in hypothetical protocol vignettes was administered. The authors analyzed responses to ten protocol vignettes that had been evaluated independently by experts. For each vignette, a global assessment of the perceived significance of ethical problems and the identification of specific ethical problems were evaluated. Eighty-three medical students (27%) volunteered: 50 (60%) were women and 55 (66%) were first- and second-year students. On global assessments, the criteria-focused group perceived ethical problems as more significant than did the other two groups (p < .02). Students in the criteria-focused group were better able than students in the control group (p < .03) to discern specific ethical problems, more closely resembling expert assessments. Unexpectedly, the group focused on clinical research participants identified fewer problems than did the control group (p < .05). The criteria-focused intervention produced enhanced ethical evaluation skills. This work supports the potential value of empirically derived methods for preparing professionals to discern ethical aspects of human studies.

Teaching pain recognition through art: the Ramsay-Caravaggio sedation scale.

PubMed

Poropat, Federico; Cozzi, Giorgio; Magnolato, Andrea; Monasta, Lorenzo; Borrometi, Fabio; Krauss, Baruch; Ventura, Alessandro; Barbi, Egidio

2018-01-31

Clinical observation is a key component of medical ability, enabling immediate evaluation of the patient's emotional state and contributing to a clinical clue that leads to final decision making. In medical schools, the art of learning to look can be taught using medical humanities and especially visual arts. By presenting a Ramsay sedation score (RSS) integrated with Caravaggio's paintings during a procedural sedation conference for pediatric residents, we want to test the effectiveness of this approach to improve the quality of learning. In this preliminary study, we presented videos showing sedated pediatric patients in the setting of a procedural sedation lesson to two randomized groups of residents, one attending a lesson on RSS explained through the masterpieces of Caravaggio, the other without artistic support. A week later we tested their learning with ten multi-choice questions focused on theoretical questions about sedation monitoring and ten more questions focused on recognizing the appropriate RSS viewing the videos. The primary outcome was the comparison of the total number of RSS layers properly recognized in both groups. We also evaluated the appreciation of the residents of the use of works of art integrated with the lesson. Eleven students were randomized to each group. Two residents in the standard lesson did not attend the test. The percentage of correct answers on the theoretical part was similar, 82% in the art group and 89% in the other (p > 0.05). No difference was found in the video recognition part of the RSS recognition test. Residents exposed to paintings shown great appreciation for the integration of the lesson with the Caravaggio's masterpieces. Adding artwork to a standard medical conference does not improve the performance of student tests, although this approach has been greatly appreciated by residents.

Absolute risk representation in cardiovascular disease prevention: comprehension and preferences of health care consumers and general practitioners involved in a focus group study.

PubMed

Hill, Sophie; Spink, Janet; Cadilhac, Dominique; Edwards, Adrian; Kaufman, Caroline; Rogers, Sophie; Ryan, Rebecca; Tonkin, Andrew

2010-03-04

Communicating risk is part of primary prevention of coronary heart disease and stroke, collectively referred to as cardiovascular disease (CVD). In Australia, health organisations have promoted an absolute risk approach, thereby raising the question of suitable standardised formats for risk communication. Sixteen formats of risk representation were prepared including statements, icons, graphical formats, alone or in combination, and with variable use of colours. All presented the same risk, i.e., the absolute risk for a 55 year old woman, 16% risk of CVD in five years. Preferences for a five or ten-year timeframe were explored. Australian GPs and consumers were recruited for participation in focus groups, with the data analysed thematically and preferred formats tallied. Three focus groups with health consumers and three with GPs were held, involving 19 consumers and 18 GPs. Consumers and GPs had similar views on which formats were more easily comprehended and which conveyed 16% risk as a high risk. A simple summation of preferences resulted in three graphical formats (thermometers, vertical bar chart) and one statement format as the top choices. The use of colour to distinguish risk (red, yellow, green) and comparative information (age, sex, smoking status) were important ingredients. Consumers found formats which combined information helpful, such as colour, effect of changing behaviour on risk, or comparison with a healthy older person. GPs preferred formats that helped them relate the information about risk of CVD to their patients, and could be used to motivate patients to change behaviour.Several formats were reported as confusing, such as a percentage risk with no contextual information, line graphs, and icons, particularly those with larger numbers. Whilst consumers and GPs shared preferences, the use of one format for all situations was not recommended. Overall, people across groups felt that risk expressed over five years was preferable to a ten-year risk, the latter being too remote. Consumers and GPs shared preferences for risk representation formats. Both groups liked the option to combine formats and tailor the risk information to reflect a specific individual's risk, to maximise understanding and provide a good basis for discussion.

The use of conventional transcutaneous electrical nerve stimulation in chronic facial myalgia patients.

PubMed

De Giorgi, Ilaria; Castroflorio, Tommaso; Sartoris, Barbara; Deregibus, Andrea

2017-01-01

The aim of this study was to evaluate the efficacy of conventional TENS in women affected by chronic facial myalgia. The study was performed on 49 women affected by chronic facial myalgia randomly allocated in the TENS group (34 women) and the control group (15 women). The subjective level of pain was assessed by the Visual Analogue Scale indicating the mean (VAS MEAN), the maximum (VAS MAX) and the current intensity of pain (VAS NOW). The level of pain at the muscular palpation sites was assessed by the Pericranial Muscle Tenderness Score (PTS) and the Cervical Muscle Tenderness Score (CTS). The TENS therapy lasted for 10 weeks, and data were collected at baseline, after 5, 10, 15 and 25 weeks. The differences between groups before and after treatment were compared with the Mann-Whitney and the Kolmogorov-Smirnov tests. The intra-group differences were compared with the one-way ANOVA test. The results showed that the VAS MEAN, VAS MAX, PTS and CTS were significantly reduced in the TENS group compared to the control group after 10 weeks of TENS (p < 0.05). The intra-group analysis revealed a decreasing tendency of VAS MEAN, VAS MAX, VAS NOW, PTS and CTS in the TENS group in a 25-week period (p < 0.05). The study demonstrated the efficacy of conventional TENS in patients with chronic facial myalgia and the decrease in both subjective and objective pain. Conventional TENS is a safe, non-invasive, easy-to-administer therapy for chronic facial myalgia.

Effectiveness of high-frequency transcutaneous electrical nerve stimulation at tender points as adjuvant therapy for patients with fibromyalgia.

PubMed

Carbonario, F; Matsutani, L A; Yuan, S L K; Marques, A P

2013-04-01

Fibromyalgia is a chronic pain syndrome associated with sleep disorders, fatigue and psychological symptoms. Combinations therapies, such as electrotherapy and therapeutic exercises have been used in the clinical practice. To assess the efficacy of high-frequency transcutaneous electrical nerve stimulation (TENS) as an adjuvant therapy to aerobic and stretching exercises, for the treatment of fibromyalgia. Controlled clinical trial. Unit of rehabilitation of a public hospital. Twenty-eight women aged 52.4±7.5 years, with fibromyalgia. A visual analogue scale measured pain intensity; tender points pain threshold, by dolorimetry; and quality of life, by the Fibromyalgia Impact Questionnaire. All subjects participated in an eight-week program consisting of aerobic exercises, followed by static stretching of muscle chains. In TENS group, high-frequency (150 Hz) was applied on bilateral tender points of trapezium and supraspinatus. TENS group had a greater pain reduction (mean change score=-2.0±2.9 cm) compared to Without TENS group (-0.7±3.7 cm). There was a difference between mean change scores of each group for pain threshold (right trapezium: 0.2±1 kg/cm² in TENS group and -0.2±1.2 kg/cm² in Without TENS group). In the evaluation of clinically important changes, patients receiving TENS had relevant improvement of pain, work performance, fatigue, stiffness, anxiety and depression compared to those not receiving TENS. It has suggested that high-frequency TENS as an adjuvant therapy is effective in relieving pain, anxiety, fatigue, stiffness, and in improving ability to work of patients with fibromyalgia. High-frequency TENS may be used as a short-term complementary treatment of fibromyalgia.

Upper trapezius relaxation induced by TENS and interferential current in computer users with chronic nonspecific neck discomfort: An electromyographic analysis.

PubMed

Acedo, Adriano Alexandre; Luduvice Antunes, Ana Carolina; Barros dos Santos, André; Barbosa de Olveira, Cintia; Tavares dos Santos, Claudia; Colonezi, Gustavo Lacreta Toledo; Fontana, Felipe Antonio Medeiros; Fukuda, Thiago Yukio

2015-01-01

Recent studies have shown that a transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) application reduces pain in subjects with musculoskeletal disorders. However there are no clinical trials evaluating or comparing the muscle relaxation generated for these devices. To compare the muscle relaxation of the upper trapezius induced by the application of TENS and IFC in females with chronic nonspecific neck discomfort. Sixty-four females between 18 and 40 years of age and a history of nonspecific neck discomfort were randomly assigned to a TENS or an IFC group. The women in the TENS (N = 32; mean age 22 years) and IFC (N = 32, mean age 23 years) group were submitted to current application during 3 consecutive days and were assessed by electromyography (EMG) in different times aiming to quantify the muscular tension of the upper trapezius. A visual analogue scale (VAS) was used as pain measure at baseline (before TENS or IFC application) and at the end of the study. At baseline, demographic, pain, and EMG assessment data were similar between groups. Those in the IFC group had a significant trapezius relaxation after 3 IFC applications when compared to baseline and intermediate evaluations (P < 0.05). In contrast, the same analysis showed no significant difference between all assessments in the TENS group (P >0.05). In relation to pain relief, both groups showed an improvement at the end of the study when compared to baseline (both,P <0.05). The between-group analysis showed no difference for the subjects who received such IFC as TENS application (P <0.05). IFC induced the upper trapezius relaxation after 3 sessions in females with neck discomfort, but the TENS application did not change the muscular tension. However, these results should be carefully interpreted due to the lack of differences between groups. A significant pain decrease was found in the subjects of both groups, however, only the IFC application presented a clinically important improvement.

How does poverty affect children's nutritional status in Nairobi slums? A qualitative study of the root causes of undernutrition.

PubMed

Goudet, Sophie M; Kimani-Murage, Elizabeth W; Wekesah, Frederick; Wanjohi, Milka; Griffiths, Paula L; Bogin, Barry; Madise, Nyovani J

2017-03-01

Children in slums are at high risk of undernutrition, which has long-term negative consequences on their physical growth and cognitive development. Severe undernutrition can lead to the child's death. The present paper aimed to understand the causes of undernutrition in children as perceived by various groups of community members in Nairobi slums, Kenya. Analysis of ten focus group discussions and ten individual interviews with key informants. The main topic discussed was the root causes of child undernutrition in the slums. The focus group discussions and key informant interviews were recorded and transcribed verbatim. The transcripts were coded in NVivo by extracting concepts and using a constant comparison of data across the different categories of respondents to draw out themes to enable a thematic analysis. Two slum communities in Nairobi, Kenya. Women of childbearing age, community health workers, elders, leaders and other knowledgeable people in the two slum communities (n 90). Participants demonstrated an understanding of undernutrition in children. Findings inform target criteria at community and household level that can be used to identify children at risk of undernutrition. To tackle the immediate and underlying causes of undernutrition, interventions recommended should aim to: (i) improve maternal health and nutrition; (ii) promote optimal infant and young children feeding practices; (iii) support mothers in their working role; (iv) increase access to family planning; (v) improve water, sanitation and hygiene (WASH); (vi) address alcohol problems at all levels; and (vii) address street food issues with infant feeding counselling.

Effect of transcutaneous electrical nerve stimulation therapy for the treatment of primary dysmenorrheal.

PubMed

Bai, Hai-Yan; Bai, Hong-Yan; Yang, Zhi-Qin

2017-09-01

This study aimed to investigate the effect and safety of transcutaneous electrical nerve stimulation (TENS) therapy for relieving pain in women with primary dysmenorrhea (PD). In this study, 134 participants with PD were randomly divided into the intervention group and the sham group, with 67 participants in each group. Participants in the intervention group received TENS, whereas those in the sham group received sham TENS. The primary outcome was measured by the Numeric Rating Scale (NRS). The secondary outcomes were measured by the duration of relief from dysmenorrheal pain, number of ibuprofen tablets taken, and the World Health Organization quality of life (WHOQOL)-BREF score, as well as the adverse events. A total of 122 participants completed the study. Compared to sham TENS, TENS showed a greater effect in pain relief with regard to the NRS (P < .01), duration of relief from dysmenorrheal pain (P < .01), and number of ibuprofen tablets taken (P < .01). However, no significant differences in the quality of life, measured by the WHOQOL-BREF score, were found between 2 groups. The adverse event profiles were also similar between 2 groups. TENS was efficacious and safe in relieving pain in participants with PD.

Areca (Betel) Nut Chewing Practices in Micronesian Populations.

PubMed

Paulino, Yvette C; Novotny, Rachel; Miller, Mary Jane; Murphy, Suzanne P

2011-03-01

To describe the areca nut/betel quid chewing practices of Micronesian chewers living in Guam. Two studies were conducted using qualitative data from focus groups and quantitative cross-sectional data from the 2007 Guam Behavioral Risk Factor Surveillance System (BRFSS). Ten focus groups included 49 men and women aged 18-60 years living in Guam in 2007. Participants were areca nut/betel quid chewers selected to reflect Guam's age and ethnic group (Chamorro, Chuukese, Palauan, and Yapese) distributions. Salient themes were extracted from transcripts of the sessions by three expert reviewers. A second method, latent class analysis, was used to identify unique groups of chewers. The groups were then compared on demographics and chewing-related behaviors. Areca nut and betel quid recipes collected from the focus groups showed that Chamorros had a preference for the ripe nut and swallowed the nut, whereas, the Chuukese, Palauan, and Yapese groups preferred the unripe nut and did not swallow it. Similarly, latent class analysis resulted in the identification of two groups of areca nut/betel quid chewers. Group 1 was all Chamorros. Compared to Group 2, the chewers in Group 1 preferred red and ripe nuts, did not add slake lime (calcium hydroxide) or tobacco, and swallowed the masticated areca nut (with or without Piper betle leaf). The quantitative analysis confirmed the qualitative exploration of areca nut/betel quid chewers in Guam, thus providing evidence that chewing practices vary among Micronesian populations. If future research should include an intervention, the differences in chewing practices among Micronesian populations should be taken into consideration to ensure programmatic success.

Areca (Betel) Nut Chewing Practices in Micronesian Populations

PubMed Central

Paulino, Yvette C.; Novotny, Rachel; Miller, Mary Jane; Murphy, Suzanne P.

2014-01-01

Objective To describe the areca nut/betel quid chewing practices of Micronesian chewers living in Guam. Design Two studies were conducted using qualitative data from focus groups and quantitative cross-sectional data from the 2007 Guam Behavioral Risk Factor Surveillance System (BRFSS). Ten focus groups included 49 men and women aged 18–60 years living in Guam in 2007. Participants were areca nut/betel quid chewers selected to reflect Guam's age and ethnic group (Chamorro, Chuukese, Palauan, and Yapese) distributions. Salient themes were extracted from transcripts of the sessions by three expert reviewers. A second method, latent class analysis, was used to identify unique groups of chewers. The groups were then compared on demographics and chewing-related behaviors. Results Areca nut and betel quid recipes collected from the focus groups showed that Chamorros had a preference for the ripe nut and swallowed the nut, whereas, the Chuukese, Palauan, and Yapese groups preferred the unripe nut and did not swallow it. Similarly, latent class analysis resulted in the identification of two groups of areca nut/betel quid chewers. Group 1 was all Chamorros. Compared to Group 2, the chewers in Group 1 preferred red and ripe nuts, did not add slake lime (calcium hydroxide) or tobacco, and swallowed the masticated areca nut (with or without Piper betle leaf). Conclusion The quantitative analysis confirmed the qualitative exploration of areca nut/betel quid chewers in Guam, thus providing evidence that chewing practices vary among Micronesian populations. Implication If future research should include an intervention, the differences in chewing practices among Micronesian populations should be taken into consideration to ensure programmatic success. PMID:25678943

Transcutaneous electrical nerve stimulation (TENS) accelerates cutaneous wound healing and inhibits pro-inflammatory cytokines.

PubMed

Gürgen, Seren Gülşen; Sayın, Oya; Cetin, Ferihan; Tuç Yücel, Ayşe

2014-06-01

The purpose of this study was to evaluate transcutaneous electrical nerve stimulation (TENS) and other common treatment methods used in the process of wound healing in terms of the expression levels of pro-inflammatory cytokines. In the study, 24 female and 24 male adult Wistar-Albino rats were divided into five groups: (1) the non-wounded group having no incision wounds, (2) the control group having incision wounds, (3) the TENS (2 Hz, 15 min) group, (4) the physiological saline (PS) group and (5) the povidone iodine (PI) group. In the skin sections, interleukin-1 beta (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were assessed with enzyme-linked immunosorbent assay and immunohistochemical methods. In the non-wounded group, the expression of IL-1β, IL-6, and TNF-α signaling molecules was weaker in the whole tissue; however, in the control group, significant inflammatory response occurred, and strong cytokine expression was observed in the dermis, granulation tissue, hair follicles, and sebaceous glands (P < 0.05). In the TENS group, the decrease in TNF-α, IL-1β, and IL-6 immunoreaction in the skin was significant compared to the other forms of treatment (P < 0.05). Distinctive decreases of pro-inflammatory cytokines observed in the dermis in the TENS group suggest that TENS shortened the healing process by inhibating the inflammation phase.

High frequency transcutaneous electrical nerve stimulation with diphenidol administration results in an additive antiallodynic effect in rats following chronic constriction injury.

PubMed

Lin, Heng-Teng; Chiu, Chong-Chi; Wang, Jhi-Joung; Hung, Ching-Hsia; Chen, Yu-Wen

2015-03-04

The impact of coadministration of transcutaneous electrical nerve stimulation (TENS) and diphenidol is not well established. Here we estimated the effects of diphenidol in combination with TENS on mechanical allodynia and tumor necrosis factor-α (TNF-α) expression. Using an animal chronic constriction injury (CCI) model, the rat was estimated for evidence of mechanical sensitivity via von Frey hair stimulation and TNF-α expression in the sciatic nerve using the ELISA assay. High frequency (100Hz) TENS or intraperitoneal injection of diphenidol (2.0μmol/kg) was applied daily, starting on postoperative day 1 (POD1) and lasting for the next 13 days. We demonstrated that both high frequency TENS and diphenidol groups had an increase in mechanical withdrawal thresholds of 60%. Coadministration of high frequency TENS and diphenidol gives better results of paw withdrawal thresholds in comparison with high frequency TENS alone or diphenidol alone. Both diphenidol and coadministration of high frequency TENS with diphenidol groups showed a significant reduction of the TNF-α level compared with the CCI or HFS group (P<0.05) in the sciatic nerve on POD7, whereas the CCI or high frequency TENS group exhibited a higher TNF-α level than the sham group (P<0.05). Our resulting data revealed that diphenidol alone, high frequency TENS alone, and the combination produced a reduction of neuropathic allodynia. Both diphenidol and the combination of diphenidol with high frequency TENS inhibited TNF-α expression. A moderately effective dose of diphenidol appeared to have an additive effect with high frequency TENS. Therefore, multidisciplinary treatments could be considered for this kind of mechanical allodynia. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Racial/ethnic preferences, sex preferences, and perceived discrimination related to end-of-life care.

PubMed

Duffy, Sonia A; Jackson, Frances C; Schim, Stephanie M; Ronis, David L; Fowler, Karen E

2006-01-01

This study investigated racial/ethnic preferences, sex preferences, and perceived discrimination related to end-of-life care. Ten focus groups and a follow-up survey were conducted to obtain in-depth information on end-of-life preferences across five racial/ethnic groups in Michigan stratified by sex. There were 73 focus group participants, including Arab Muslims, Arab Christians, Hispanics, blacks, and whites. The mean age+/-standard deviation was 67+/-8.5 (range 50-83). A focus group screener was used to recruit participants. A moderator discussion guide was used to guide the focus groups. A take-home questionnaire asked about demographic information and end-of-life issues. Arab Americans were in favor of making peace on earth and were against assisted suicide, extending life artificially, nursing homes, and telling the patient "bad news." Hispanic and black women were against assisted suicide and in favor of extending life, whereas the men in these groups felt the opposite. Hispanic women spoke of not wanting a feeding tube and would consider alternative medicine. Blacks were least opposed to nursing homes. For whites, it was important to have choices. When asked about discrimination related to end-of-life care, Muslim women spoke of cultural barriers, blacks spoke of inequities in the past, and whites spoke of age discrimination and abandonment when dying. As the population becomes more diverse and continues to age, it will be important to provide culturally and sex-sensitive end-of-life interventions to increase patient/family satisfaction and allocate resources appropriately.

Respiratory, physical, and psychological benefits of breath-focused yoga for adults with severe traumatic brain injury (TBI): a brief pilot study report.

PubMed

Silverthorne, Colin; Khalsa, Sat Bir S; Gueth, Robin; DeAvilla, Nicole; Pansini, Janie

2012-01-01

This pilot study was designed to identify the potential benefits of breath-focused yoga on respiratory, physical, and psychological functioning for adults with severe traumatic brain injury (TBI). Ten individuals with severe TBI who self-selected to attend weekly yoga classes and 4 no-treatment controls were evaluated. Participants were assessed at pretreatment baseline and at 3-month intervals for a total of 4 time points over 40 weeks. Outcomes of interest included observed exhale strength, ability to hold a breath or a tone, breathing rate, counted breaths (inhale and exhale), and heart rate, as well as self-reported physical and psycho-logical well-being. Repeated within-group analyses of variance revealed that the yoga group demonstrated significant longitudinal change on several measures of observed respiratory functioning and self-reported physical and psychological well-being over a 40-week period. Those in the control group showed marginal improvement on 2 of the 6 measures of respiratory health, physical and social functioning, emotional well-being, and general health. The small sample sizes precluded the analysis of between group differences. This study provides preliminary evidence that breath-focused yoga may improve respiratory functioning and self-perceived physical and psychological well-being of adults with severe TBI.

An innovative community organizing campaign to improve mental health and wellbeing among Pacific Island youth in South Auckland, New Zealand.

PubMed

Han, Hahrie; Nicholas, Alexandra; Aimer, Margaret; Gray, Jonathon

2015-12-01

To examine whether being an organizer in a community organizing program improves personal agency and self-reported mental health outcomes among low-income Pacific Island youth in Auckland, New Zealand. Counties Manukau Health initiated a community organizing campaign led and run by Pacific Island youth. We used interviews, focus groups and pre- and post-campaign surveys to examine changes among 30 youths as a result of the campaign. Ten youths completed both pre- and post-campaign surveys. Eleven youths participated in focus groups, and four in interviews. Overall, youths reported an increased sense of agency and improvements to their mental health. Community organizing has potential as a preventive approach to improving mental health and developing agency over health among disempowered populations. © The Royal Australian and New Zealand College of Psychiatrists 2015.

[Concepts of a multidisciplinar team on runaway patients].

PubMed

Vieira, Sílvio Antônio; Dall'agnol, Clarice Maria

2009-01-01

A qualitative study that aimed at learning the way an emergency care multidisciplinary team at a public university hospital conceives and deals with the problem of patients who run away from hospital was carried out. Data were collected using the focus groups technique, whose sample was constituted by ten individuals, approached by non-directive group dynamics. Three thematic classes resulted from content analysis: a certain ambivalence; emergency, a place of (lack of) control; fears and insecurities. The study indicates the chaotic situation encountered by emergency services and, in this context, when patients run away, the health care team is imminently subject to a triple judgment: social, legal and institutional.

Ten Reasons to Still Keep the Focus on Teen Childbearing. Research Brief, Publication #2009-10

ERIC Educational Resources Information Center

Holcombe, Emily; Peterson, Kristen; Manlove, Jennifer; Scarupa, Harriet J., Ed.

2009-01-01

In 2002, Child Trends drew on statistics and research findings to produce a report called "Ten Reasons to Keep the Focus on Teen Childbearing." That report took note of the steady decline in the nation's teenage pregnancy and childbearing rates, beginning in 1991, while citing multiple reasons to continue to be concerned about teen childbearing.…

Direct and Indirect Benefits Reported by Users of Transcutaneous Electrical Nerve Stimulation for Chronic Musculoskeletal Pain: Qualitative Exploration Using Patient Interviews.

PubMed

Gladwell, Peter William; Badlan, Kathryn; Cramp, Fiona; Palmer, Shea

2015-11-01

There is no consensus regarding the effectiveness of transcutaneous electrical nerve stimulation (TENS) for management of chronic musculoskeletal pain or chronic low back pain. A recent review of previous trial methodology identified significant problems with low treatment fidelity. There is little information available to guide selection of patient-reported outcome measures appropriate for TENS evaluation. The purpose of this study was to explore the experiences of patients at a secondary care pain clinic who successfully used TENS to help manage chronic musculoskeletal pain. These key informants were selected because they had the potential to generate knowledge that could inform research design and clinical practice. A qualitative method using individual semistructured interviews with open questions was selected for its capacity to generate rich data. A mini focus group informed the development of a discussion guide for semistructured interviews with 9 patients (6 women, 3 men). Thematic analysis was used as the primary data analysis method, and this analysis was enhanced by a case-level analysis of the context and processes of TENS use of each individual. Data analysis indicated that distraction from pain and a reduction in the sensations associated with muscle tension or spasm should be considered as separate outcomes from pain relief. These direct benefits led to a wide range of indirect benefits dependent on patient decision making, including medication reduction, enhanced function, psychological benefits, and enhanced ability to rest. The findings indicate that evaluating TENS using a unidimensional pain scale is likely to overlook potential benefits. The complex pattern of TENS usage, as well as multiple direct and indirect outcomes, indicates that TENS could be considered as a complex intervention. © 2015 American Physical Therapy Association.

Living with chronic pain: Evaluating patient experiences with a medical group visit focused on mindfulness and non-pharmacological strategies.

PubMed

Lestoquoy, Anna Sophia; Laird, Lance D; Mitchell, Suzanne; Gergen-Barnett, Katherine; Negash, N Lily; McCue, Kelly; Enad, Racquel; Gardiner, Paula

2017-12-01

Little is known about the acceptance of non-pharmacological group strategies delivered to low income racially diverse patients with chronic pain and depression. This paper examines how the Integrative Medical Group Visit (IMGV) addresses many of the deficits identified with usual care. Six IMGVs cohorts were held at a safety net hospital and two federally funded community health centres. Data was gathered through focus groups. Transcripts were analysed using both a priori codes and inductive coding. The intervention included ten sessions of Integrative Medical Group Visits with a primary care provider and a meditation instructor. The curriculum uses principles of Mindfulness Based Stress Reduction and evidence based integrative medicine. The visit is structured similarly to other group medical visits. Data was gathered through four focus groups held after the cohorts were completed. Participants (N=20) were largely low income minority adults with chronic pain and comorbid depression. Six themes emerged from the coding including: chronic pain is isolating; group treatment contributes to better coping with pain; loss of control and autonomy because of the unpredictability of pain as well as dependence on medication and frequent medical appointments; groups improve agency and control over one's health condition; navigating the healthcare system and unsatisfactory treatment options; and changes after the IMGV due to non-pharmacological health management. The IMGV is a promising format of delivering integrative care for chronic pain and depression which addresses many of the problems identified by patients in usual care. Copyright © 2017 Elsevier Ltd. All rights reserved.

Somali women's view of physical activity--a focus group study.

PubMed

Persson, Gerthi; Mahmud, Amina Jama; Hansson, Eva Ekvall; Strandberg, Eva Lena

2014-10-23

Physical inactivity presents a major public health challenge and is estimated to cause six to ten percent of the major non-communicable diseases. Studies show that immigrants, especially women, have an increased risk of non-communicable diseases compared to ethnic Swedes. Somali immigrant women have increased rates of overweight and obesity, low fitness levels and low levels of cardiorespiratory fitness compared to non-immigrant women. These findings suggest that Somali women are at increased risk of developing lifestyle-related diseases. Few studies explore determinants of physical activity among Somali women. The aim of this study was to explore Somali women's views and experiences of physical activity after migration to Sweden. A qualitative focused ethnographic approach was used in this study. Four focus groups were conducted with twenty-six Somali women ranging from 17 to 67 years of age. Focus group discussions were recorded, transcribed verbatim and analysed using qualitative content analysis. The analysis resulted in four main themes and ten categories: Life in Somalia and Life in Sweden, Understanding and enhancing health and Facilitators and barriers to physical activity. Great differences were seen between living in Somalia and in Sweden but also similarities such as finding time to manage housework, the family and the health of the woman. The extended family is non-existent in Sweden, making life more difficult. Health was considered a gift from God but living a healthy life was perceived as the responsibility of the individual. Misconceptions about enhancing health occurred depending on the woman's previous life experience and traditions. There was an awareness of the importance of physical activity among the participants but lack of knowledge of how to enhance activity on an individual basis. Enhancing factors to an active lifestyle were identified as being a safe and comfortable environment. Some barriers, such as climate, lack of motivation and time are universal barriers to an active lifestyle, but some factors, such as tradition and religion, are distinctive for Somali women. Since traditional Somali life never involves leisure-time physical activity, one cannot expect to compensate for the low daily activity level with leisure-time activity the Swedish way. Immigrant Somali women are a heterogeneous group with individual needs depending on age, education and background. Tailored interventions with respect to Somali traditions are necessary to achieve an actual increase in physical activity among migrant women of Somalian origin.

Does transcutaneous electrical nerve stimulation (TENS) alleviate the pain experienced during bone marrow sampling in addition to standard techniques? A randomised, double-blinded, controlled trial.

PubMed

Tucker, David L; Rockett, Mark; Hasan, Mehedi; Poplar, Sarah; Rule, Simon A

2015-06-01

Bone marrow aspiration and trephine (BMAT) biopsies remain important tests in haematology. However, the procedures can be moderately to severely painful despite standard methods of pain relief. To test the efficacy of transcutaneous electrical nerve stimulation (TENS) in alleviating the pain from BMAT in addition to standard analgesia using a numerical pain rating scale (NRS). 70 patients requiring BMAT were randomised (1:1) in a double-blind, placebo-controlled trial. -35 patients received TENS impulses at a strong but comfortable amplitude (intervention group) and 35 patients received TENS impulses just above the sensory threshold (control group) (median pulse amplitude 20 and 7 mA, respectively). Patients and operators were blinded to group allocation. Pain assessments were made using a numerical pain scale completed after the procedure. No significant difference in NRS pain recalled after the procedure was detected (median pain score 5.7 (95% CI 4.8 to 6.6) in control vs 5.6 (95% CI 4.8 to 6.4) in the intervention group). However, 100% of patients who had previous experience of BMAT and >94% of participants overall felt they benefited from using TENS and would recommend it to others for this procedure. There were no side effects from the TENS device, and it was well tolerated. TENS is a safe, non-invasive adjunct to analgesia for reducing pain during bone marrow biopsy and provides a subjective benefit to most users; however, no objective difference in pain scores was detected when using TENS in this randomised controlled study. NCT02005354. 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.

The Life Science Exchange: a case study of a sectoral and sub-sectoral knowledge exchange programme.

PubMed

Perkins, Brian Lee; Garlick, Rob; Wren, Jodie; Smart, Jon; Kennedy, Julie; Stephens, Phil; Tudor, Gwyn; Bisson, Jonathan; Ford, David V

2016-04-27

Local and national governments have implemented sector-specific policies to support economic development through innovation, entrepreneurship and knowledge exchange. Supported by the Welsh Government through the European Regional Development Fund, The Life Science Exchange® project was created with the aim to increase interaction between stakeholders, to develop more effective knowledge exchange mechanisms, and to stimulate the formation and maintenance of long-term collaborative relationships within the Welsh life sciences ecosystem. The Life Science Exchange allowed participants to interact with other stakeholder communities (clinical, academic, business, governmental), exchange perspectives and discover new opportunities. Six sub-sector focus groups comprising over 200 senior stakeholders from academia, industry, the Welsh Government and National Health Service were established. Over 18 months, each focus group provided input to inform healthcare innovation policy and knowledge mapping exercises of their respective sub-sectors. Collaborative projects identified during the focus groups and stakeholder engagement were further developed through sandpit events and bespoke support. Each sub-sector focus group produced a report outlining the significant strengths and opportunities in their respective areas of focus, made recommendations to overcome any 'system failures', and identified the stakeholder groups which needed to take action. A second outcome was a stakeholder-driven knowledge mapping exercise for each area of focus. Finally, the sandpit events and bespoke support resulted in participants generating more than £1.66 million in grant funding and inward investment. This article outlines four separate outcomes from the Life Science Exchange programme. The Life Science Exchange process has resulted in a multitude of collaborations, projects, inward investment opportunities and special interest group formations, in addition to securing over ten times its own costs in funding for Wales. The Life Science Exchange model is a simple and straightforward mechanism for a regional or national government to adapt and implement in order to improve innovation, skills, networks and knowledge exchange.

A single trial of transcutaneous electrical nerve stimulation (TENS) improves spasticity and balance in patients with chronic stroke.

PubMed

Cho, Hwi-young; In, Tae Sung; Cho, Ki Hun; Song, Chang Ho

2013-03-01

Spasticity management is pivotal for achieving functional recovery of stroke patients. The purpose of this study was to investigate the effects of a single trial of transcutaneous electrical nerve stimulation (TENS) on spasticity and balance in chronic stroke patients. Forty-two chronic stroke patients were randomly allocated into the TENS (n = 22) or the placebo-TENS (n = 20) group. TENS stimulation was applied to the gastrocnemius for 60 min at 100 Hz, 200 µs with 2 to 3 times the sensory threshold (the minimal threshold in detecting electrical stimulation for subjects) after received physical therapy for 30 min. In the placebo-TENS group, electrodes were placed but no electrical stimulation was administered. For measuring spasticity, the resistance encountered during passive muscle stretching of ankle joint was assessed using the Modified Ashworth Scale, and the Hand held dynamometer was used to assess the resistive force caused by spasticity. Balance ability was measured using a force platform that measures postural sway generated by postural imbalance. The TENS group showed a significantly greater reduction in spasticity of the gastrocnemius, compared to the placebo-TENS group (p < 0.05). TENS resulted in greater balance ability improvements, especially during the eyes closed condition (p < 0.05). However, these effects returned to baseline values within one day. This study shows that TENS provides an immediately effective means of reducing spasticity and of improving balance in chronic stroke patients. The present data may be useful to establish the standard parameters for TENS application in the clinical setting of stroke.

Is TENS purely a placebo effect? A controlled study on chronic low back pain.

PubMed

Marchand, S; Charest, J; Li, J; Chenard, J R; Lavignolle, B; Laurencelle, L

1993-07-01

Although high-frequency low-intensity transcutaneous electric nerve stimulation (TENS) has been extensively used to relieve low back pain, experimental studies of its effectiveness have yielded contradictory findings mainly due to methodological problems in pain evaluation and placebo control. In the present study, separate visual analog scales (VAS) were used to measure the sensory-discriminative and motivational-affective components of low back pain. Forty-two subjects were randomly assigned to 1 of 3 groups: TENS, placebo-TENS, and no treatment (control). In order to measure the short-term effect of TENS, VAS pain ratings were taken before and after each treatment session. Also, to measure long-term effects, patients rated their pain at home every 2 h throughout a 3-day period before and 1 week, 3 months and 6 months after the treatment sessions. In comparing the pain evaluations made immediately before and after each treatment session, TENS and placebo-TENS significantly reduced both the intensity and unpleasantness of chronic low back pain. TENS was significantly more efficient than placebo-TENS in reducing pain intensity but not pain unpleasantness. TENS also produced a significant additive effect over repetitive treatment sessions for pain intensity and relative pain unpleasantness. This additive effect was not found for placebo-TENS. When evaluated at home, pain intensity was significantly reduced more by TENS than placebo-TENS 1 week after the end of treatment, but not 3 months and 6 months later. At home evaluation of pain unpleasantness in the TENS group was never different from the placebo-TENS group.(ABSTRACT TRUNCATED AT 250 WORDS)

Exploring the Life Course Perspective in Maternal and Child Health through Community-Based Participatory Focus Groups: Social Risks Assessment.

PubMed

Salinas-Miranda, Abraham A; King, Lindsey M; Salihu, Hamisu M; Berry, Estrellita; Austin, Deborah; Nash, Susan; Scarborough, Kenneth; Best, Evangeline; Cox, Lillian; King, Georgette; Hepburn, Carrie; Burpee, Conchita; Richardson, Eugene; Ducket, Marlo; Briscoe, Richard; Baldwin, Julie

2017-01-01

Little is known about the patterns of risk factors experienced by communities of color and how diverse community contexts shape the health trajectory of women from the early childhood period to the time of their pregnancies. Thus, we conducted a focus group study to identify social risks over the life course that contribute to maternal and child health from the perspective of community members residing in low income urban areas. Ten community-based participatory focus groups were conducted with residents from selected communities in Tampa, Florida, from September to November 2013. We used the life course perspective to illuminate and explain the experiences reported by the interviewees. A total of 78 residents participated in the focus groups. Children and adolescents' health risks were childhood obesity, lack of physical activity, and low self-esteem. Women's health risks were low self-esteem, low educational level, low health literacy, inadequate parenting skills, and financial problems. Risks during pregnancy included stress, low self-esteem, inadequate eating patterns, lack of physical activity, healthcare issues, lack of social support, and lack of father involvement during pregnancy. Multiple risk factors contribute to maternal and child health in low income communities in Tampa Bay. The intersection of risk factors in different life periods suggest possible pathways, cumulative, and latent effects, which must be considered in future longitudinal studies and when developing effective maternal and child health programs and policies.

Experiences and challenges of informal caregiving for Korean immigrants.

PubMed

Han, Hae-Ra; Choi, Yun Jung; Kim, Miyong T; Lee, Jong Eun; Kim, Kim B

2008-09-01

This paper is a report of a study designed to explore the caregiving experiences of Korean Americans. Increasing numbers of older people in the Asian population place important long-term care demands on Asian caregivers, yet minimal attention has been given to the issue of caregiving in this group. The current study attempts to fill the gap by describing Korean American caregivers' unique caregiving experiences from their perspectives. A qualitative research design using a focus group approach was employed to discuss caregiving experiences in a cultural context. Data were collected over an 8-month period in 2005. Twenty-four informants, mostly women, at varying points surrounding caregiving participated in a focus group interview. Each focus group lasted about 1 (1/2)-2 hours. Thematic analysis was conducted by two bilingual researchers. Three key themes were identified: the caregiver role - competing priorities and beliefs, the extent and impact of caregiving, and the need for education and culturally-tailored support systems. Ten subthemes were identified within the three major themes: (1) facing double challenges; (2) changing attitudes about filial piety (Hyo); (3) providing care; (4) feeling out of control; (5) going through changing family dynamics; (6) being connected vs. providing connection; (7) paying back; (8) learning by themselves; (9) recognizing differences and (10) reconsidering geriatric care systems. The caregiving experiences described by Korean American families point to the need to identify and develop more focused outreach programmes as well as more culturally appropriate support services for this rapidly increasing population.

The short-term effects of TENS plus therapeutic ultrasound combinations in chronic neck pain.

PubMed

Sayilir, Selcuk

2018-05-01

To investigate the effects of TENS plus therapeutic ultrasound combinations on symptom relief, physical functionality, perceived stress levels, daytime sleepiness and neck mobility in patients with chronic neck pain (CNP). A total of 64 patients were divided into two groups as the TENS plus ultrasound group (n = 39) and the control CNP group (n = 25). The therapy comprised TENS and therapeutic ultrasound applications for 10 sessions. The control subjects were discouraged from using analgesics but were allowed to use paracetamol daily, if necessary. The Neck Disability Index (NDI), Epworth Sleepiness Scale (ESS), Perceived Stress Scale (PSS), visual analog scale (VAS) and tragus-wall/chin-manubrium distances were recorded at the baseline and after therapy. Significant improvements were detected in the TENS plus ultrasound group compared to the control CNP subjects in respect of VAS, PSS and NDI scores after the TENS plus therapeutic ultrasound therapies (all p < 0.05). The combination of therapeutic ultrasound plus TENS can be an effective modality for relieving pain/stress levels and improving functionality in the short-term of CNP. Copyright © 2018 Elsevier Ltd. All rights reserved.

Low- and high-frequency transcutaneous electrical nerve stimulation have no deleterious or teratogenic effects on pregnant mice.

PubMed

Yokoyama, L M; Pires, L A; Ferreira, E A Gonçalves; Casarotto, R A

2015-06-01

To evaluate the effects of application of transcutaneous electrical nerve stimulation (TENS) at low and high frequencies to the abdomens of Swiss mice throughout pregnancy. Experimental animal study. Research laboratory. Thirty Swiss mice received TENS throughout pregnancy. They were divided into three groups (n=10): placebo, low-frequency TENS (LF group) and high-frequency TENS (HF group). In the placebo group, the electrodes were applied to the abdominal region without any electrical current. In the LF group, the frequency was 10 Hz, pulse duration was 200 μs and intensity started at 2 mA. In the HF group, the same parameters were applied and the frequency was 150 Hz. All stimulation protocols were applied for 20 min/day from Day 0 until Day 20. The pregnant mice were weighed on Days 0, 7, 14 and 20 to verify weekly weight gain by two-way analysis of variance. The numbers of fetuses, placentas, implantations, resorptions and major external fetal malformations on Day 20 were analysed using the Kruskal-Wallis test. No significant differences were found between the placebo and TENS groups (P>0.05). Application of low- and high-frequency TENS to the abdomens of pregnant mice did not cause any deleterious or major teratogenic effects. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Transcutaneous Electrical Nerve Stimulation (TENS) and Laryngeal Manual Therapy (LMT): Immediate Effects in Women With Dysphonia.

PubMed

Conde, Mariana de Cásisa Macedo; Siqueira, Larissa Thaís Donalonso; Vendramini, José Eduardo; Brasolotto, Alcione Ghedini; Guirro, Rinaldo Roberto de Jesus; Silverio, Kelly Cristina Alves

2018-05-01

This study aimed to verify the immediate effect of low-frequency transcutaneous electrical nerve stimulation (TENS) and laryngeal manual therapy (LMT) in musculoskeletal pain, voice quality, and self-reported signs in women with dysphonia. Thirty women with behavioral dysphonia were randomly divided into the TENS group and the LMT group. All participants fulfilled the pain survey and had their voices recorded to posterior perceptual and acoustic analysis before and after intervention. The TENS group received a unique low-frequency TENS session (20 minutes). The LMT group received LMT (20 minutes) with soft and superficial massage in the sternocleidomastoid muscle, suprahyoid muscles, and larynx. Afterward, the volunteers reported their voice, larynx, breathing, and articulatory signs. Pre and post data were compared by parametric and nonparametric tests. After TENS, a decrease in pain intensity in the posterior or anterior region of the neck, shoulders, upper or lower back, and masseter was observed. After LMT, a decrease in pain intensity in the neck anterior region, shoulders, lower back, and temporal region was observed. Also, after TENS, there was an improvement in vowel /a/ instability; after LMT, there was a general improvement in voice quality, decrease in tension, and decrease in breathiness in speech. Positive voice and laryngeal signs were reported after TENS, and positive laryngeal signs and articulation were reported after LMT. TENS and LMT may be used in voice treatment of women with behavioral dysphonia, and both may be considered important therapy resources that reduce musculoskeletal pain and cause positive laryngeal signs. Both TENS and LMT are able to partially improve voice quality, but TENS presented better results. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Effects of transcutaneous electrical nerve stimulation on pain intensity during application of carboxytherapy in patients with cellulite: A randomized placebo-controlled trial.

PubMed

Sadala, Adria Y; Machado, Aline F P; Liebano, Richard E

2018-01-16

Carboxytherapy may generate local pain that is considered the main limiting factor in clinical practice. Transcutaneous electric nerve stimulation (TENS) is widely used in the control of acute pain; however, the effect of TENS on pain relief during carboxytherapy has not been studied to date. To assess the effect of TENS on pain intensity during carboxytherapy in patients with cellulite in the gluteal region. This randomized clinical trial was conducted with 84 patients, 18-44 years of age, who had moderate cellulite in the gluteal region, according to Cellulite Severity Scale, but never received carboxytherapy. Patients were randomized into 3 groups: active TENS, placebo TENS, and control group. For the intervention, skin depressions with cellulite were outlined, and the gluteal area to be treated was defined. The subcutaneous injection of CO 2 was performed using 0.30 × 13 mm-needles at a 45° angle, with a controlled flow rate of 100 mL/min maintained for 1 minute at each puncture site. The parameters for TENS were as follows: frequency of 100 Hz and pulse duration of 200 μs; TENS intensity was adjusted until the patient reported strong paresthesia. The visual numeric pain rating scale was used to assess pain intensity after each puncture. The active TENS group reported lower pain intensity compared to the placebo TENS (P < .0001) and control (P < .0001) groups. Transcutaneous electric nerve stimulation (TENS) was effective in reducing pain intensity during carboxytherapy in patients with cellulite in the gluteal region. © 2018 Wiley Periodicals, Inc.

Age Group Comparisons of TENS Response Among Individuals With Chronic Axial Low Back Pain.

PubMed

Simon, Corey B; Riley, Joseph L; Fillingim, Roger B; Bishop, Mark D; George, Steven Z

2015-12-01

Chronic low back pain (CLBP) is a highly prevalent and disabling musculoskeletal pain condition among older adults. Transcutaneous electrical nerve stimulation (TENS) is commonly used to treat CLBP, however response to TENS in older adults compared with younger adults is untested. In a dose-response study stratified by age, 60 participants with axial CLBP (20 young, 20 middle-aged, 20 older) received four 20-minute sessions of high-frequency high-intensity TENS over a 2- to 3-week period in a laboratory-controlled setting. Experimental measures of pain sensitivity (mechanical pressure pain detection threshold) and central pain excitability (phasic heat temporal summation and heat aftersensations) were assessed before and after TENS. Episodic or immediate axial CLBP relief was assessed after TENS via measures of resting pain, movement-evoked-pain, and self-reported disability. Cumulative or prolonged axial CLBP relief was assessed by comparing daily pain reports across sessions. Independent of age, individuals experienced episodic increase in the pressure pain detection threshold and reduction in aftersensation after TENS application. Similarly, all groups, on average, experienced episodic axial CLBP relief via improved resting pain, movement-evoked pain, and disability report. Under this design, no cumulative effect was observed as daily pain did not improve for any age group across the 4 sessions. However, older adults received higher TENS amplitude across all sessions to achieve TENS responses similar to those in younger adults. These findings suggest that older adults experience similar episodic axial CLBP relief to that of younger individuals after high-frequency, high-intensity TENS when higher dose parameters are used. This study examined age group differences in experimental and axial CLBP response to TENS, delivered under the current recommended parameters of strong, but tolerable amplitude. Older adults had comparable TENS response although at higher TENS amplitude than younger adults, which may have important mechanistic and clinical implications. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.

Visual Analysis Based on the Data of Chinese Surveying and Mapping Journals

NASA Astrophysics Data System (ADS)

Li, Jing; Liu, Haiyan; Guo, Wenyue; Yu, Anzhu

2016-06-01

Taking four influential Chinese surveying and mapping journals as the data source, 5863 papers published during the period of 2003-2013 were obtained. Using the method of bibliometrics and visual analysis, summarizing the surveying and mapping papers in the past ten years (2003-2013), research themes, authors, and geographical distribution were analyzed. In the study, the papers of geodesy, cartography and GIS are 59.9%, more than half of all the papers. We also determine that the core author group has 131 authors, mainly of whom are from big cities. 90% of top ten cities on the number of publishing papers are capital cities or municipalities directly under the central government.In conclusion, we found that the research focus was different every year, and the research content was richness, the content of geodesy, cartography and GIS were widely researched, and the development of surveying and mapping is imbalanced in China.

Psychosocial Needs Assessment among Earthquake Survivors in Lorestan Province with an Emphasis on the Vulnerable Groups

PubMed Central

Forouzan, A.; Eftekhari, M. Baradaran; Falahat, K.; Dejman, M.; Heidari, N.; Habibi, E.

2013-01-01

Introduction: Iran is one of the ten most earthquake prone countries in the world. Earthquakes not only cause new psychological needs among the population but particularly so when one considers vulnerable groups. This in - depth study was conducted with the aim of assessing psychosocial needs six months after an earthquake happened in the west of the county in Lorestan province. Methods: This is a qualitative study using focus group discussion that focuses mainly on the vulnerable groups (women, children, elderly and disabled people) after an earthquake in Boz-azna; a village in Lorestan province in western part of Iran. Findings: Results of the psychosocial assessment indicated feelings of anxiety and worries in four vulnerable groups. Horror, hyper-excitement, avoidance and disturbing thoughts were observed in all groups with the exception of the elderly. Educational failures, loneliness and isolation were highlighted in children. All groups encountered socio-economic needs that included loss of assets and sense of insecurity and also reproductive problems were reported in women's group. Discussion and Conclusion: Modification of a protocol on psychosocial support considering the context of the rural and urban areas with emphasis on the specific needs of the vulnerable groups is an appropriate strategy in crisis management. It seems that appropriate public awareness regarding assistance programs can be effective in reducing stress and needs of disaster survivors. PMID:23777724

Ten new and emerging trends in residential group living environments.

PubMed

Regnier, Victor; Denton, Alexis

2009-01-01

Residential styled environments for physically challenged people with neuro disabilities are rapidly replacing the standard institutional skilled nursing home. Ten trends are described that utilize residential design approaches to the physical environment while relying on home-care style methods for service delivery. Combined these two forces create powerful differentiators which make group residential settings more friendly and humane. Northern European, as well as, US best practices and prototypes are described that combine housing with services in a range of contexts. The success of northern Europeans in promulgating models of aging-in-place that keep those at risk more independent in the community or within family settings are remarkable. Topics like the impact of small group living clusters, interior design treatments, access to landscape gardens, life skill management methods, movement systems for circulation and exercise, shared space priorities, unit design trends and innovative care giving techniques are introduced. The focus of the article is on specific practices gleaned from cultures and exemplars that appear to increase autonomy, independence and privacy for those who are threatened because of their disabilities with the loss of these lifestyle attributes. Promising concepts of service organization and community outreach are combined with detailed recommendations that address the need for lift technology and safety features in bathrooms and kitchens.

Decreased Opioid Utilization and Cost at One Year in Chronic Low Back Pain Patients Treated with Transcutaneous Electric Nerve Stimulation (TENS).

PubMed

Pivec, Robert; Minshall, Michael E; Mistry, Jaydev B; Chughtai, Morad; Elmallah, Randa K; Mont, Michael A

2015-11-01

Chronic low back pain (CLBP) may be treated without opioids through the use of transcutaneous electrical nerve stimulation (TENS). However, no study has evaluated its clinical effect and economic impact as measured by opioid utilization and costs. The purpose of this study was to evaluate patients who were given TENS for CLBP compared to a matched group without TENS at one-year follow-up, to determine differences between opioid consumption. Opioid utilization and costs in patients who did and did not receive TENS were extracted from a Medicare supplemental administrative claims database. Patients were selected if they had at least two ICD-9-CM coded claims for low back pain in a three-month period and were then propensity score matched at a 1:1 ratio between patients who received TENS and those who did not. There were 22,913 patients in each group who had a minimum follow-up of one year. There were no significant demographic or comorbidity differences with the exception that TENS patients had more episodes of back pain. Significantly fewer patients in the TENS group required opioids at final follow-up (57.7 vs. 60.3%). TENS patients also had significantly fewer annual per-patient opioid costs compared to non-TENS patients ($169 vs. $192). There were significantly lower event rates in TENS patients compared to non-TENS patients when measured by opioid utilization (characterized by frequency of prescription refills) (3.82 vs. 4.08, respectively) or pharmacy utilization (31.67 vs. 32.25). The TENS group also demonstrated a significantly lower cost of these utilization events ($44 vs. $49) and avoided more opioid events (20.4 events fewer per 100 patients annually). Treatment of CLBP with TENS demonstrated significantly fewer patients requiring opioids, fewer events where a patient required an opioid prescription, and lower per-patient costs. Since TENS is both non-invasive and a non-narcotic, it may potentially allow physicians to be more aggressive in treating CLBP patients.

Effect of Transcutaneous Electric Nerve Stimulation on Pain after Total Knee Arthroplasty: A Blind Randomized Controlled Trial.

PubMed

Beckwée, David; Bautmans, Ivan; Lefeber, Nina; Lievens, Pierre; Scheerlinck, Thierry; Vaes, Peter

2018-02-01

Transcutaneous electric nerve stimulation (TENS) has proven to be effective for postsurgical pain relief. However, there is a lack of well-constructed clinical trials investigating the effect of TENS after total knee arthroplasty (TKA). In addition, previous investigations reported that low- and high-frequency TENSs produced analgesic tolerance after 4 or 5 days of treatment. The aim of this study is to explore the effect of burst TENS on pain during hospitalization after TKA and to investigate whether burst TENS produces analgesic tolerance after 4 or 5 days of treatment. This stratified, triple blind, randomized controlled trial was approved by the University Hospital Brussels. Sixty-eight subjects were screened for eligibility before surgery; 54 were found eligible and 53 were included in the analyses. Patients were allocated to either a burst TENS or sham burst TENS group. TENS was applied daily during continuous passive mobilization. Knee pain intensity, knee range of motion, and analgesic consumption were assessed daily. Patients received burst TENS ( N  = 25) or sham burst TENS ( N  = 28). No significant differences in knee pain intensity were found between the groups ( p  > 0.05). Within the TENS and the sham TENS groups, the difference in knee pain before and after treatment did not evolve over time ( p  > 0.05). This study found no effects of burst TENS compared with sham burst TENS on pain during hospitalization after TKA. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Transcutaneous Electrical Nerve Stimulation Regulates Organ Blood Flow and Apoptosis during Controlled Hypotension in Dogs

PubMed Central

Zhang, Lele; Shao, Xiaomei; Zhou, Chuanlong; Guo, Xiaoqing; Jin, Ling; Lian, Linli; Yu, Xiaojing; Dong, Zhenhua; Mo, Yadi; Fang, Jianqiao

2014-01-01

Transcutaneous electrical nerve stimulation (TENS) is commonly used in clinical practice for alleviating pains and physiological disorders. It has been reported that TENS could counteract the ischemic injury happened in some vital organs. To determine the protective effect of TENS on internal organs during CH in dogs, target hypotension was maintained for 60 min at 50% of the baseline mean arterial pressure (MAP). The perfusion to the brain, liver, stomach, and kidney was recorded and apoptosis within these organs was observed. Results showed that when arriving at the target MAP, and during the maintaining stage for 10 min, perfusion to the stomach and liver in the CH+TENS group was much higher than in the CH group (P<0.05). Perfusion to the cerebral cortex greatly declined in both the controlled pressure groups when compared with the general anesthesia (GA) group (P<0.05). After withdrawing CH, the hepatic blood flow in both the CH and CH+TENS groups, and the gastric and cerebral cortical blood flow in the CH+TENS group, were rapidly increased. By the end of MAP restoration, gastric blood flow in the CH group was still low. At 72 h after applying CH, terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL)-positive cells in stomach and kidney tissue from the CH group were significantly increased compared with those in the GA group (P<0.05). There was no significant difference in TUNEL-positive cells in the liver and hippocampus among the three groups. Our results demonstrated that CH with a 50% MAP level could cause lower perfusion to the liver, stomach, cerebral cortex, and kidney, with apoptosis subsequently occurring in the stomach and kidney. TENS combined GA is able to improve the blood flow to the liver, stomach, and reduce the apoptosis in the stomach and kidney. PMID:24732970

The Parameters of Transcutaneous Electrical Nerve Stimulation Are Critical to Its Regenerative Effects When Applied Just after a Sciatic Crush Lesion in Mice

PubMed Central

Martins Lima, Êmyle; Teixeira Goes, Bruno; Zugaib Cavalcanti, João; Vannier-Santos, Marcos André; Martinez, Ana Maria Blanco; Baptista, Abrahão Fontes

2014-01-01

We investigated the effect of two frequencies of transcutaneous electrical nerve stimulation (TENS) applied immediately after lesion on peripheral nerve regeneration after a mouse sciatic crush injury. The animals were anesthetized and subjected to crushing of the right sciatic nerve and then separated into three groups: nontreated, Low-TENS (4 Hz), and High-TENS (100 Hz). The animals of Low- and High-TENS groups were stimulated for 2 h immediately after the surgical procedure, while the nontreated group was only positioned for the same period. After five weeks the animals were euthanized, and the nerves dissected bilaterally for histological and histomorphometric analysis. Histological assessment by light and electron microscopy showed that High-TENS and nontreated nerves had a similar profile, with extensive signs of degeneration. Conversely, Low-TENS led to increased regeneration, displaying histological aspects similar to control nerves. High-TENS also led to decreased density of fibers in the range of 6–12 μm diameter and decreased fiber diameter and myelin area in the range of 0–2 μm diameter. These findings suggest that High-TENS applied just after a peripheral nerve crush may be deleterious for regeneration, whereas Low-TENS may increase nerve regeneration capacity. PMID:25147807

Effect of Transcutaneous Electrical Nerve Stimulation on Plantar Flexor Muscle Spasticity and Walking Speed in Stroke Patients.

PubMed

Laddha, Darshan; Ganesh, G Shankar; Pattnaik, Monalisa; Mohanty, Patitapaban; Mishra, Chittaranjan

2016-12-01

Spasticity is a major disabling symptom in patients post stroke. Although studies have demonstrated that transcutaneous electrical nerve stimulation (TENS) can reduce spasticity, the duration of single session TENS is a subject of debate. The purpose of this study was to determine the sustainability of the effects of TENS applied over common peroneal nerve in the reduction of ankle plantar-flexor spasticity and improving gait speed in patients post stroke. Thirty patients (11 women and 19 men) (mean age of 46.46 years) were randomly assigned to group 1 (task oriented exercises), group 2 (TENS for 30 min and task oriented exercises) and group 3 (TENS for 60 min and task oriented exercises) for a period of five sessions per week for 6 weeks. All patients were assessed for ankle plantar-flexor spasticity, passive ankle dorsi-flexion range of motion, clonus and timed up and go test at the time of recruitment to study, at 3 and 6 weeks of therapeutic intervention. The overall results of the study suggest that there was a decrease in ankle plantar flexor spasticity, ankle clonus and timed up and go score in all the groups. A greater reduction of spasticity was seen in TENS groups (groups 2 and 3) when compared to control. No significant improvement was found in timed up and go test (TUG) scores between groups. Both 30 min and 60 min of application of TENS are effective in reducing spasticity of ankle plantar flexors, improving walking ability and increase the effectiveness of task related training. Based on the effect size, we would recommend a longer duration application for the reduction of spasticity. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Feasibility of an International Multiple Sclerosis Rehabilitation Data Repository

PubMed Central

Bradford, Elissa Held; Baert, Ilse; Finlayson, Marcia; Feys, Peter

2018-01-01

Abstract Background: Multiple sclerosis (MS) rehabilitation evidence is limited due to methodological factors, which may be addressed by a data repository. We describe the perceived challenges of, motivators for, interest in participating in, and key features of an international MS rehabilitation data repository. Methods: A multimethod sequential investigation was performed with the results of two focus groups, using nominal group technique, and study aims informing the development of an online questionnaire. Percentage agreement and key quotations illustrated questionnaire findings. Subgroup comparisons were made between clinicians and researchers and between participants in North America and Europe. Results: Rehabilitation professionals from 25 countries participated (focus groups: n = 21; questionnaire: n = 166). The top ten challenges (C) and motivators (M) identified by the focus groups were database control/management (C); ethical/legal concerns (C); data quality (C); time, effort, and cost (C); best practice (M); uniformity (C); sustainability (C); deeper analysis (M); collaboration (M); and identifying research needs (M). Percentage agreement with questionnaire statements regarding challenges to, motivators for, interest in, and key features of a successful repository was at least 80%, 85%, 72%, and 83%, respectively, across each group of statements. Questionnaire subgroup analysis revealed a few differences (P < .05), including that clinicians more strongly identified with improving best practice as a motivator. Conclusions: Findings support clinician and researcher interest in and potential for success of an international MS rehabilitation data repository if prioritized challenges and motivators are addressed and key features are included. PMID:29507539

Feasibility of an International Multiple Sclerosis Rehabilitation Data Repository: Perceived Challenges and Motivators for Sharing Data.

PubMed

Bradford, Elissa Held; Baert, Ilse; Finlayson, Marcia; Feys, Peter; Wagner, Joanne

2018-01-01

Multiple sclerosis (MS) rehabilitation evidence is limited due to methodological factors, which may be addressed by a data repository. We describe the perceived challenges of, motivators for, interest in participating in, and key features of an international MS rehabilitation data repository. A multimethod sequential investigation was performed with the results of two focus groups, using nominal group technique, and study aims informing the development of an online questionnaire. Percentage agreement and key quotations illustrated questionnaire findings. Subgroup comparisons were made between clinicians and researchers and between participants in North America and Europe. Rehabilitation professionals from 25 countries participated (focus groups: n = 21; questionnaire: n = 166). The top ten challenges (C) and motivators (M) identified by the focus groups were database control/management (C); ethical/legal concerns (C); data quality (C); time, effort, and cost (C); best practice (M); uniformity (C); sustainability (C); deeper analysis (M); collaboration (M); and identifying research needs (M). Percentage agreement with questionnaire statements regarding challenges to, motivators for, interest in, and key features of a successful repository was at least 80%, 85%, 72%, and 83%, respectively, across each group of statements. Questionnaire subgroup analysis revealed a few differences (P < .05), including that clinicians more strongly identified with improving best practice as a motivator. Findings support clinician and researcher interest in and potential for success of an international MS rehabilitation data repository if prioritized challenges and motivators are addressed and key features are included.

Transcutaneous Nerve Stimulation for Pain Relief During Office Hysteroscopy: A Randomized Controlled Trial.

PubMed

Lisón, Juan F; Amer-Cuenca, Juan J; Piquer-Martí, Silvia; Benavent-Caballer, Vicente; Biviá-Roig, Gemma; Marín-Buck, Alejandro

2017-02-01

To evaluate the pain-relieving effect of transcutaneous electrical nerve stimulation (TENS) during office-based hysteroscopy without sedation. We conducted a randomized, double-blind, placebo-controlled trial. Participants were randomly assigned to the active TENS, placebo TENS, or control group. The active TENS intervention consisted of a varying high-frequency (80-100 Hz), 400-microseconds, individually adjusted, high-intensity TENS application with two self-adhesive electrodes placed parallel to the spinal cord at the T10-L1 and S2-S4 levels. In the placebo group, participants were connected to the TENS unit but delivering no electrical stimulation. The primary outcome was self-reported pain intensity (0-100 mm) measured on a visual analog scale at several stages (entry, contact, biopsy, and residual). The minimum clinically relevant difference for the visual analog scale has been previously reported as 10 mm. Sample size was calculated to provide 80% power to show a 10-mm difference (α=0.0125) in the primary outcome. Secondary outcomes included duration of the procedure, vital parameters, vasovagal symptoms, and participant satisfaction index (0-10 rating scale). A total of 138 women (46 per group) participated in the study between January 2016 and April 2016. No differences were found between groups regarding age, weight, body mass index, parity status, menopausal status, or previous hysteroscopy status. Visual analog scale scores highlighted a decrease in pain in the active TENS group compared with the placebo group (entry: -11 mm, 95% confidence interval [CI] -17 to -5; contact: -21.9 mm, 95% CI -30 to -13.9; biopsy: -30.5 mm, 95% CI -47.1 to -13.8, P<.001). Moreover, the reduction in pain reached the minimum clinically relevant difference. Regarding satisfaction, results also revealed differences between active TENS and placebo groups (1.3, 95% CI 0.5-2.2, P=.001). Transcutaneous electrical nerve stimulation reduces pain and increases patient satisfaction during office hysteroscopy without sedation. ClinicalTrials.gov, www.clinicaltrials.gov, NCT02647008.

Randomised controlled trial comparing the effectiveness of electroacupuncture and TENS for low back pain: a preliminary study for a pragmatic trial.

PubMed

Tsukayama, Hiroshi; Yamashita, Hitoshi; Amagai, Hitoshi; Tanno, Yasuo

2002-12-01

The objective of this study was to compare the effectiveness of electroacupuncture and TENS for low back pain when the electroacupuncture is applied in a clinically realistic manner. The study was designed as an evaluator-blinded randomised controlled trial (RCT). The study was performed at the Tsukuba College of Technology Clinic in Japan. Twenty subjects, who suffered from low back pain (LBP) without sciatica, were recruited, using leaflets in Tsukuba city. Subjects were allocated to either an electroacupuncture (EA) group (10 patients) or a transcutaneous electrical nerve stimulation (TENS) group (10 patients). The procedure for EA was in accordance with standard practice at our clinic. The main outcome measures were a pain relief scale (100 mm visual analogue scale: VAS) and a LBP score recommended by the Japanese Orthopaedic Association (JOA Score). Mean VAS value during the 2-weeks experimental period of the EA group was significantly smaller than that of the TENS group (65 mm vs 86 mm; 95% CI, 4.126 - 37.953). JOA Score in the EA group improved significantly while that in the TENS group showed no change. Although some placebo effect may be included, EA appeared more useful than TENS in the short-term effect on low back pain. We suggest that more realistic acupuncture interventions based on standard practice should be employed in pragmatic RCTs.

Efficacy of transcutaneous electrical nerve stimulation (tens) for chronic low-back pain in a multiple sclerosis population: a randomized, placebo-controlled clinical trial.

PubMed

Warke, Kim; Al-Smadi, Jamal; Baxter, David; Walsh, Deirdre M; Lowe-Strong, Andrea S

2006-01-01

This study was designed to investigate the hypoalgesic effects of self-applied transcutaneous electrical nerve stimulation (TENS) on chronic low-back pain (LBP) in a multiple sclerosis (MS) population. Ninety participants with probable or definite MS (aged 21 to 78 y) presenting with chronic LBP were recruited and randomized into 3 groups (n=30 per group): (1) low-frequency TENS group (4 Hz, 200 micros); (2) high-frequency TENS group (110 Hz, 200 micros); and (3) placebo TENS. Participants self-applied TENS for 45 minutes, a minimum of twice daily, for 6 weeks. Outcome measures were recorded at weeks 1, 6, 10, and 32. Primary outcome measures included: Visual Analog Scale for average LBP and the McGill Pain Questionnaire. Secondary outcome measures included: Visual Analog Scale for worst and weekly LBP, back and leg spasm; Roland Morris Disability Questionnaire; Barthel Index; Rivermead Mobility Index; Multiple Sclerosis Quality of Life-54 Instrument, and a daily logbook. Data were analyzed blind using parametric and nonparametric tests, as appropriate. Results indicated a statistically significant interactive effect between groups for average LBP (P=0.008); 1-way analysis of covariance did not show any significant effects at any time point once a Bonferonni correction was applied (P>0.05). However, clinically important differences were observed in some of the outcome measures in both active treatment groups during the treatment and follow-up periods. Although not statistically significant, the observed effects may have implications for the clinical prescription and the use of TENS within this population.

Transcutaneous electrical nerve stimulation combined with task-related training improves lower limb functions in subjects with chronic stroke.

PubMed

Ng, Shamay S M; Hui-Chan, Christina W Y

2007-11-01

Previous studies have shown that repeated sensory inputs could enhance brain plasticity and cortical motor output. The purpose of this study was to investigate whether combining electrically induced sensory inputs through transcutaneous electrical nerve stimulation (TENS) with task-related training (TRT) in a home-based program would augment voluntary motor output in chronic stroke survivors better than either treatment alone or no treatment. Eighty-eight patients with stroke were assigned randomly to receive a home-based program of (1) TENS, (2) TENS+TRT, (3) placebo TENS+TRT, or (4) no treatment (control) 5 days a week for 4 weeks. Outcome measurements included Composite Spasticity Scale, peak torques generated during maximum isometric voluntary contraction of ankle dorsiflexors and plantarflexors, and gait velocity recorded at baseline, after 2 and 4 weeks of treatment, and 4 weeks after treatment ended. When compared with TENS, the combined TENS+TRT group showed significantly greater improvement in ankle dorsiflexion torque at follow-up and in ankle plantarflexion torque at week 2 and follow-up (P<0.01). When compared with placebo+TRT, the TENS+TRT group produced earlier and greater reduction of plantarflexor spasticity and improvement in ankle dorsiflexion torque at week 2 (P<0.01). When compared with all 3 groups, the TENS+TRT group showed significantly greater improvement in gait velocity (P<0.01). In patients with chronic stroke, 20 sessions of a combined TENS+TRT home-based program decreased plantarflexor spasticity, improved dorsiflexor and plantarflexor strength, and increased gait velocity significantly more than TENS alone, placebo+TRT, or no treatment. Such improvements can even be maintained 4 weeks after treatment ended.

Emotional intimate partner violence experienced by men in same-sex relationships

PubMed Central

Woodyatt, Cory R.; Stephenson, Rob

2016-01-01

Intimate partner violence research has focused almost exclusively on physical and sexual intimate partner violence in opposite-sex relationships, paying little attention to the intimate partner violence experienced by men in same-sex relationships. Emerging research focusing on intimate partner violence among male-male couples has focused largely on physical and sexual violence, with little consideration of the unique forms of emotional violence experienced by gay men. Ten focus group discussions with gay and bisexual men (n=64) were conducted to examine perceived typologies, antecedents, and experiences of emotional violence that occur between male partners. Participants described emotional violence as the most threatening form of intimate partner violence, driven largely by factors including power differentials, gender roles, and internalised homophobia. Results indicate that gay and bisexual men perceive emotional intimate partner violence to be commonplace. A better understanding of emotional violence within male-male relationships is vital to inform intimate partner violence prevention efforts and the more accurate measurement of intimate partner violence for gay men. PMID:27109769

Comparison of the therapeutic efficacy of TENS versus intra-articular hyaluronic acid injection in patients with knee osteoarthritis: a prospective randomized study.

PubMed

Paker, Nurdan; Tekdös, Demet; Kesiktas, Nur; Soy, Derya

2006-01-01

Knee osteoarthritis (OA) is perceived as a major public health problem, and today, various treatment modalities are used to manage this condition. The purpose of this study was to assess and compare the efficacy of transcutaneous electrical nerve stimulation (TENS) and intra-articular hylan G-F 20 (Synvisc; Genzyme Corporation, Ridgefield, NJ) in patients with symptomatic knee OA. A total of 60 patients with primary knee OA were randomized into 2 treatment groups. TENS was applied for 3 weeks in the first group, and in the second group, hylan G-F 20 was injected intra-articularly once a week for 3 weeks. Patients were then followed for 6 months. Disease severity was measured with the Lequesne Index. Efficacy in terms of pain, functional status, and quality of life was assessed through analysis of changes in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and short Form 36 Health Survey (SF-36) scores. Adverse events were monitored throughout the study. WOMAC pain scores were improved at the first control visit in the TENS group and in the viscosupplementation group; this improvement was statistically significant. WOMAC stiffness scores showed a statistically significant decrease in the TENS group at the first control visit. Stiffness did not decrease during the first month in the second group; however, these patients exhibited improvement during the sixth month after injection. Physical function scores and SF-36 total scores did not change in either group after treatment. Pain relief was observed at the first month and continued throughout the 6-month follow-up period in both groups. Stiffness decreased by the sixth month in both groups. Improvement in WOMAC physical function scores was greater in the intra-articular hylan group than in the TENS group at the end of follow-up; however, quality of life was not improved in either group. These therapies used in combination may alleviate symptoms in patients with OA.

Experiences and challenges of informal caregiving for Korean immigrants

PubMed Central

Han, Hae-Ra; Choi, Yun Jung; Kim, Miyong T.; Lee, Jong Eun; Kim, Kim B.

2010-01-01

Aim This paper is a report of a study designed to explore the caregiving experiences of Korean Americans. Background Increasing numbers of older people in the Asian population place important long-term care demands on Asian caregivers, yet minimal attention has been given to the issue of caregiving in this group. The current study attempts to fill the gap by describing Korean American caregivers’ unique caregiving experiences from their perspectives. Method A qualitative research design using a focus group approach was employed to discuss caregiving experiences in a cultural context. Data were collected over an 8-month period in 2005. Twenty-four informants, mostly women, at varying points surrounding caregiving participated in a focus group interview. Each focus group lasted about 1 ½-2 hours. Thematic analysis was conducted by two bilingual researchers. Findings Three key themes were identified: the caregiver role – competing priorities and beliefs, the extent and impact of caregiving, and the need for education and culturally-tailored support systems. Ten subthemes were identified within the three major themes: (1) facing double challenges; (2) changing attitudes about filial piety (Hyo); (3) providing care; (4) feeling out of control; (5) going through changing family dynamics; (6) being connected vs. providing connection; (7) paying back; (8) learning by themselves; (9) recognizing differences and (10) reconsidering geriatric care systems. Conclusion The caregiving experiences described by Korean American families point to the need to identify and develop more focused outreach programmes as well as more culturally appropriate support services for this rapidly increasing population. PMID:18727754

Barriers to seeking care for accidental bowel leakage: a qualitative study

PubMed Central

Rogers, Rebecca G.; Wise, Meg E.

2016-01-01

Introduction and hypothesis Fewer than 50 % of women with urinary incontinence (UI) and 30 % of women with accidental bowel leakage (ABL) seek care. We sought to describe barriers to care seeking for ABL to inform development of an instrument to measure these barriers. Methods We recruited women with ABL with varied prior care-seeking experiences to participate in focus groups and cognitive interviews so we could understand factors that may have prevented or delayed care seeking. Focus groups continued until thematic saturation was reached using conventional content analysis. Final themes were established and characterized by comparing within and across the focus groups and with previously described UI and ABL care-seeking barriers. Cognitive interviews were confirmatory. Results Thirty-nine women (aged 46–85) participated in six focus groups and ten cognitive interviews; 89 % were white, 8 % African American, and 3 % Latina. We identified 12 barriers to seeking care for ABL: (1) Lack of knowledge about the condition; (2) Lack of knowledge about treatment; (3) Fear of testing/treatment; (4) Normative thinking; (5) Avoidance/ denial; (6) Life impact; (7) Embarrassment/shame; (8) Self-blame; (9) Stigma; (10) Isolation; (11) Provider barriers; (12) Access limitations. These 12 barriers encompassed three overarching themes: the internalized self in relation to ABL; perceptions about ABL and its treatments; and interaction with the healthcare system. Conclusions ABL care-seeking barriers are similar to those described for UI, with the notable addition of lack of knowledge that ABL is a medical condition experienced by others. Interventions to promote access to effective treatments for ABL should include information about prevalence and treatability. PMID:27844123

Barriers to seeking care for accidental bowel leakage: a qualitative study.

PubMed

Brown, Heidi Wendell; Rogers, Rebecca G; Wise, Meg E

2017-04-01

Fewer than 50 % of women with urinary incontinence (UI) and 30 % of women with accidental bowel leakage (ABL) seek care. We sought to describe barriers to care seeking for ABL to inform development of an instrument to measure these barriers. We recruited women with ABL with varied prior care-seeking experiences to participate in focus groups and cognitive interviews so we could understand factors that may have prevented or delayed care seeking. Focus groups continued until thematic saturation was reached using conventional content analysis. Final themes were established and characterized by comparing within and across the focus groups and with previously described UI and ABL care-seeking barriers. Cognitive interviews were confirmatory. Thirty-nine women (aged 46-85) participated in six focus groups and ten cognitive interviews; 89 % were white, 8 % African American, and 3 % Latina. We identified 12 barriers to seeking care for ABL: (1) Lack of knowledge about the condition; (2) Lack of knowledge about treatment; (3) Fear of testing/treatment; (4) Normative thinking; (5) Avoidance/denial; (6) Life impact; (7) Embarrassment/shame; (8) Self-blame; (9) Stigma; (10) Isolation; (11) Provider barriers; (12) Access limitations. These 12 barriers encompassed three overarching themes: the internalized self in relation to ABL; perceptions about ABL and its treatments; and interaction with the healthcare system. ABL care-seeking barriers are similar to those described for UI, with the notable addition of lack of knowledge that ABL is a medical condition experienced by others. Interventions to promote access to effective treatments for ABL should include information about prevalence and treatability.

Young Men’s Preferences for Design and Delivery of Physical Activity and Nutrition Interventions: A Mixed-Methods Study

PubMed Central

Ashton, Lee M.; Morgan, Philip J.; Hutchesson, Melinda J.; Rollo, Megan E.; Collins, Clare E.

2017-01-01

Young adult men are under-represented in health research, and little is known about how to reach and engage them in lifestyle interventions. This mixed-methods study aimed to explore young males’ preferences for recruitment strategies, content, format (delivery mode and program duration and frequency), and facilitator characteristics for future physical activity and nutrition interventions. Ten focus groups involving 61 men (aged 18–25 years) in the Hunter region, New South Wales, Australia and an online survey distributed within Australia were completed by 282 males (aged 18–25 years). Key focus group themes included a preference for recruitment via multiple sources, ensuring images and recruiters were relatable; intervention facilitators to be engaging and refrain from discussing negative consequences of being unhealthy. Key program content preferences included skill development and individualized goals and feedback. Focus groups and the survey confirmed a preference for multiple delivery modes, including; face-to-face (group and individual), with support using eHealth technologies. Survey results confirmed the most favored program content as: “healthy eating on a budget,” “quick and easy meals,” and “resistance training.” Focus group responses suggested a program duration of ≥6 months, with 2–3 combined face-to-face and supportive eHealth sessions per week. Survey intervention duration preference was 3 months with 4 face-to-face sessions per month. Findings can guide the design, conduct, and evaluation of relevant contemporary physical activity and or nutrition interventions for young men. There is a need to identify the most effective ways to address young men’s individual preferences in intervention research. PMID:28675118

Increasing intensity of TENS prevents analgesic tolerance in rats

PubMed Central

Sato, Karina L.; Sanada, Luciana S.; Rakel, Barbara A.; Sluka, Kathleen A.

2012-01-01

Transcutaneous electrical nerve stimulation (TENS) reduces hyperalgesia and pain. Both low frequency (LF) and high frequency (HF) TENS, delivered at the same intensity (90% motor threshold (MT)) daily, result in analgesic tolerance with repeated use by the 5th day of treatment. Thecurrentstudytestedif 1) increasingintensityby 10% per daypreventsthedevelopmentoftolerance to repeated TENS, and 2) iflowerintensity TENS (50 % MT) produces an equivalentreduction in hyperalgesia when compared to 90% MT TENS. Sprague-Dawley rats with unilateral knee joint inflammation (3% carrageenan) were separated according to the intensity of TENS used: Sham, 50% LF, 50% HF, 90% LF, 90% HF, and increased intensity by 10% per day (LF and HF). The reduced mechanical withdrawal threshold following the induction of inflammation was reversed by application of TENS applied at 90% MT and increasing intensity for the first 4 days. On the 5th day, the groups that received 90% MT intensity showed tolerance. Nevertheless, the group that received an increased intensity on each day still showed a reversal of the mechanical withdrawal threshold with TENS. These results show that the development of tolerance can be delayed by increasing intensity of TENS. PMID:22858165

High-frequency TENS in post-episiotomy pain relief in primiparous puerpere: a randomized, controlled trial.

PubMed

Pitangui, Ana Carolina Rodarti; de Sousa, Ligia; Gomes, Flávia Azevedo; Ferreira, Cristine Homsi Jorge; Nakano, Ana Márcia Spanó

2012-07-01

We evaluated the effectiveness of high-frequency transcutaneous electrical nerve stimulation (TENS) as a pain relief resource for primiparous puerpere who had experienced natural childbirth with an episiotomy. A controlled, randomized clinical study was conducted in a Brazilian maternity ward. Forty puerpere were randomly divided into two groups: TENS high frequency and a no treatment control group. Post-episiotomy pain was assessed in the resting and sitting positions and during ambulation. An 11-point numeric rating scale was performed in three separate evaluations (at the beginning of the study, after 60 min and after 120 min). The McGill pain questionnaire was employed at the beginning and 60 min later. TENS with 100 Hz frequency and 75 µs pulse for 60 min was employed without causing any pain. Four electrodes ware placed in parallel near the episiotomy site, in the area of the pudendal and genitofemoral nerves. An 11-point numeric rating scale and McGill pain questionnaire showed a significant statistical difference in pain reduction in the TENS group, while the control group showed no alteration in the level of discomfort. Hence, high-frequency TENS treatment significantly reduced pain intensity immediately after its use and 60 min later. TENS is a safe and viable non-pharmacological analgesic resource to be employed for pain relief post-episiotomy. The routine use of TENS post-episiotomy is recommended. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

A home-based program of transcutaneous electrical nerve stimulation and task-related trunk training improves trunk control in patients with stroke: a randomized controlled clinical trial.

PubMed

Chan, Bill K S; Ng, Shamay S M; Ng, Gabriel Y F

2015-01-01

Impaired trunk motor control is common after stroke. Combining transcutaneous electrical nerve stimulation (TENS) with task-related trunk training (TRTT) has been shown to enhance the recovery of lower limb motor function. This study investigated whether combining TENS with TRTT would enhance trunk control after stroke. Methods. Thirty-seven subjects with stroke were recruited into a randomized controlled clinical trial. Subjects were randomly assigned to any one of the three 6-week home-based training groups: (1) TENS + TRTT, (2) placebo TENS + TRTT, or (3) control without active training. The outcome measures included isometric peak trunk flexion torque and extension torque; forward seated and lateral seated reaching distance to the affected and unaffected side; and Trunk Impairment Scale (TIS) scores. All outcome measures were assessed at baseline, after 3 and 6 weeks of training, and 4 weeks after training ended at follow-up. Both the TENS + TRTT and the placebo-TENS + TRTT groups had significantly greater improvements in isometric peak trunk flexion torque and extension torque, lateral seated reaching distance to affected and unaffected side, and TIS score than the control group after 3 weeks of training. The TENS + TRTT group had significantly greater and earlier improvement in its mean TIS score than the other 2 groups. Home-based TRTT is effective for improving trunk muscle strength, sitting functional reach and trunk motor control after stroke in subjects without somatosensory deficits. The addition of TENS to the trunk augments the effectiveness of the exercise in terms of TIS scores within the first 3 weeks of training. © The Author(s) 2014.

High-frequency, high-intensity transcutaneous electrical nerve stimulation as treatment of pain after surgical abortion.

PubMed

Platon, B; Andréll, P; Raner, C; Rudolph, M; Dvoretsky, A; Mannheimer, C

2010-01-01

The aim of the study was to compare the pain-relieving effect and the time spent in the recovery ward after treatment with high-frequency, high-intensity transcutaneous electrical nerve stimulation (TENS) or intravenous (IV) conventional pharmacological treatment after surgical abortion. Two-hundred women who underwent surgical abortion and postoperatively reported a visual analogue scale (VAS) pain score3 were included. The patients were randomised to TENS or conventional pharmacological treatment for their postoperative pain. The TENS treatment was given with a stimulus intensity between 20 and 60 mA during 1 min and repeated once if insufficient pain relief (VAS3). In the conventional pharmacological treatment group, a maximum dose of 100 microg fentanyl was given IV. There was no difference between the groups with regard to pain relief according to the VAS pain score (TENS=VAS 1.3 vs. IV opioids=VAS 1.6; p=0.09) upon discharge from the recovery ward. However, the patients in the TENS group spent shorter time (44 min) in the recovery ward than the conventional pharmacological treatment group (62 min; p<0.0001). The number of patients who needed additional analgesics in the recovery ward was comparable in both groups, as was the reported VAS pain score upon leaving the hospital (TENS=2.0 vs. conventional pharmacological treatment=1.8, NS). These results suggest that the pain-relieving effect of TENS seems to be comparable to conventional pharmacological treatment with IV opioids. Hence, TENS may be a suitable alternative to conventional pain management with IV opioids after surgical abortion. Copyright 2009 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Hydrodynamic focusing investigation in a micro-flow cytometer.

PubMed

Yang, An-Shik; Hsieh, Wen-Hsin

2007-04-01

Hydrodynamic focusing behavior is characterized by two fluids coflowing at different velocities inside a micro-flow cytometer. In this study, a two-fluid model has been established to describe the flow transport behavior and interaction of sample and sheath fluids. The analysis treats the sample and sheath fluids as two-dimensional, laminar, incompressible, and isothermal. The theoretical model comprises two groups of transient conservation equations of mass and momentum with consideration of the interfacial momentum exchange. The governing equations are solved numerically through an iterative SIMPLEC algorithm to determine the flow properties. Since the ratio of the sheath velocity to the sample velocity varies from 5 to 70, the predicted focusing width and length are in good agreement with the experimental data in the literature. In addition, the present study explored the hydrodynamic focusing flowfield as well as the pressure drop across a micro-flow cytometer and the time needed for the completion of one focusing event in detail. To enhance the understanding of hydrodynamic focusing in the design of cytometers, ten numerical experiments were conducted to examine the effects of the inner nozzle length, inner nozzle exit width, inner nozzle shape, and fluid properties on the width of the focused sample stream.

Comparison of intra-articular hyaluronic acid injections with transcutaneous electric nerve stimulation for the management of knee osteoarthritis: a randomized controlled trial.

PubMed

Chen, Wen-Ling; Hsu, Wei-Chun; Lin, Yi-Jia; Hsieh, Lin-Fen

2013-08-01

To compare the effects of intra-articular hyaluronic acid (HA; ARTZ) and transcutaneous electric nerve stimulation (TENS) in the treatment of patients with knee osteoarthritis. A prospective, randomized controlled trial. Rehabilitation clinic of a teaching hospital. Patients with knee osteoarthritis (N=50; aged 51-80y) were randomly assigned to the HA group (n=27) or the TENS group (n=23). The HA group received intra-articular HA injection into the affected knee once a week for 5 consecutive weeks, and the TENS group received a 20- minute session of TENS 3 times a week for 4 consecutive weeks. The primary outcome measures used were the visual analog scale (VAS) for pain and the Lequesne index. The secondary outcome measures were range of motion of the knee, walking time, pain threshold, patient global assessment, and disability in activities of daily living. All subjects were assessed at baseline, and at 2 weeks, 2 months, and 3 months after the treatments were completed. The TENS group exhibited a significantly greater improvement in VAS than the HA group at 2 weeks' follow-up (4.17 ± 1.98 vs 5.31 ± 1.78, respectively; P=.03). In addition, the TENS group also exhibited a significantly greater improvement in the Lequesne index than the HA group at 2 weeks' follow-up (7.78 ± 2.08 vs 9.85 ± 3.54, respectively; P=.01) and at 3 months' follow-up (7.07 ± 2.85 vs 9.24 ± 4.04, respectively; P=.03). TENS with silver spike point electrodes was observed to be more effective than intra-articular HA injection for patients with knee osteoarthritis in improving the VAS for pain at 2 weeks' follow-up as well as the Lequesne index at 2 weeks' and 3 months' follow-up. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Assessing the responsiveness of chronic disease care - is the World Health Organization's concept of health system responsiveness applicable?

PubMed

Röttger, Julia; Blümel, Miriam; Fuchs, Sabine; Busse, Reinhard

2014-07-01

The concept of health system responsiveness is an important dimension of health system performance assessment. Further efforts have been made in recent years to improve the analysis of responsiveness measurements, yet few studies have applied the responsiveness concept to the evaluation of specific health care delivery structures. The objective of this study was to test the World Health Organization's (WHO's) responsiveness concept for an application in the evaluation of chronic disease care. In September and October 2012 we conducted four focus groups of chronically ill people (n = 38) in Germany, in which participants discussed their experiences and expectations regarding health care. The data was analyzed deductively (on the basis of the WHO responsiveness concept) and inductively using directed content analysis. Ten themes related to health system responsiveness and one theme (finances) not directly related to health system responsiveness, but of high importance to the focus group participants, could be identified. Eight of the ten responsiveness themes are consistent with the WHO concept. Additionally, two new themes were identified: trust (consultation and treatment are not led by any motive other than the patients' wellbeing) and coordination (treatment involving different providers is coordinated and different actors communicate with each other). These findings indicate the suitability of the WHO responsiveness concept for the evaluation of chronic disease care. However, some amendments, in particular an extension of the concept to include the two domains trust and coordination, are necessary for a thorough assessment of the responsiveness of chronic disease care. Copyright © 2014 Elsevier Ltd. All rights reserved.

Effects of acupuncture and placebo TENS in addition to exercise in treatment of rotator cuff tendinitis.

PubMed

Razavi, Mahnaz; Jansen, Gunilla Brodda

2004-12-01

To compare the effect of acupuncture with placebo transcutaneous electrical nerve stimulation (TENS) when added to the exercise treatment of rotator cuff tendinitis with respect to pain, shoulder movements and function. Prospective alternate allocation controlled trial. Outpatient department. Thirty-three patients (12 women and 21 men) were included in the study. All had clinically diagnosed rotator cuff tendinitis. Both groups underwent a standardized training programme. Each patient received in addition either 10 treatments with acupuncture or placebo TENS, 1-2 times per week. The parameters investigated were intensity of pain (measured with visual analogue scale), active, passive as well as functional movements in the shoulder (hand in neck (HIN) and pour out of a pot (POP)). Patients were tested before treatment, after treatment and at a six-month follow-up. Medicine intake, ability to lie on the affected side and sleep disturbances were evaluated. A subjective assessment was made after the treatment and at follow-up. Sixteen patients had acupuncture, 17 placebo TENS. Eight patients endured pain at rest in the placebo TENS group, and 10 in the acupuncture group. After treatment both groups improved, the improvement persisted at the six-month follow-up. Both groups increased range of movement. Except for the functional test HIN in the acupuncture group, there were no differences between the groups regarding other parameters investigated directly after treatment or at six-month follow-up. There is no difference between the effect of additional acupuncture treatment and placebo TENS in the treatment of rotator cuff tendinitis.

Mexican-American children's perspectives: neighborhood characteristics and physical activity in Texas-Mexico border colonias.

PubMed

Mier, Nelda; Lee, Chanam; Smith, Matthew Lee; Wang, Xiaohui; Irizarry, David; Avila-Rodriguez, Elias H; Trevino, Laura; Ory, Marcia G

2013-10-01

The qualitative study described in this article investigated perceptions about environmental factors influencing physical activity (PA) among children from underserved neighborhoods known as colonias in the U.S.-Mexico border. Ten focus groups were conducted with 67 Mexican-American colonia children ages 8 to 13 living in one of the poorest border counties in the U.S. Analyses indicated that PA among children was influenced by neighborhood characteristics, including litter, speeding cars, unleashed dogs, and dark streets. The children also underlined intrapersonal and social environmental factors. Findings may inform policy makers and public health professionals about ways to promote PA among underserved children through urban planning and programs focusing on PA-supportive infrastructure, neighborhood safety, and family- and home-based physical activities.

Effects of electroacupuncture on stress-related symptoms in medical students: a randomised placebo-controlled study.

PubMed

Dias, Marcio; Vellarde, Guillermo Coca; Olej, Beni; Teófilo Salgado, Ana Emília; de Barros Rezende, Ighor

2014-02-01

To assess the effects of electroacupuncture (EA) on relieving stress-related symptoms-sleep disorders, anxiety, depression and burnout-in medical students. Eighty-two students were randomised into an EA treatment group (n=30), a sham TENS group (n=18) and an untreated control group (n=34). EA was applied at a continuous frequency of 2 Hz to the limbs, face, ears and scalp for 20 min once a week, over 6-8 weeks. Sham transcutaneous electrical nerve stimulation (TENS) was performed on similar sites for the same number of times in each session and for the same length of time. Outcome measurements included a comparison of the indices obtained by different self-applied questionnaires before and after treatment. The surveys used were the Mini-Sleep Questionnaire (MSQ), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), the Beck Depression and Anxiety Inventories (BDI and BAI) and the Maslach Burnout Inventory-Student Survey (MBI-SS), in addition to the Quality of Life Questionnaire-abbreviated version (WHOQOL-bref). EA significantly improved scores on the MSQ, PSQI, BDI and the cynicism and academic efficacy (AE) dimensions of the MBI-SS in relation to the control. Sleep quality (MSQ) improved from 36.9 (SD 7.6) to 25.0 (5.7) with EA, 37.6 (6.0) to 32.1 (6.9) with sham TENS, and 36.5 (5.9) to 33.6 (6.7) in the controls (p=0.0000). Compared with the sham TENS group, EA significantly reduced scores on the PSQI. Score improvements in the sham TENS group in relation to control group were significant in the MSQ, BDI and AE. In the EA group, the number of students with better scores after intervention was significantly higher for the MSQ, PSQI, ESS and BAI. This only occurred for the MSQ in the sham TENS group and for the MSQ and ESS in the control group. EA significantly reduced stress-related mental symptoms. The improvement obtained by sham TENS compared with the control group confirmed the presence of a placebo effect resulting from the treatment ritual.

Perceptions of Informal and Formal Coping Strategies for Intimate Partner Violence Among Gay and Bisexual Men.

PubMed

Freeland, Ryan; Goldenberg, Tamar; Stephenson, Rob

2018-03-01

The prevalence of intimate partner violence (IPV) in same-sex male relationships has been reported to be at least as prevalent as is observed in female-male relationships. Though research has focused on understanding the prevalence and antecedents of IPV in male-male relationships, there is a paucity of data describing perceptions of coping strategies adopted by gay and bisexual men who may experience IPV. Ten focus group discussions were conducted with 64 gay and bisexual men in Atlanta, Georgia, between September 2013 and November 2013. Focus groups examined perceptions of how gay and bisexual men would respond to IPV and the IPV-coping services they would utilize. Thematic analysis was conducted to identify themes that describe how gay and bisexual men perceive existing IPV services and how they would use these services, if gay and bisexual men were to experience IPV. The results indicate that men experiencing IPV in male-male relationships do not have adequate access to IPV services that are tailored to their unique needs. As a result, there is a strong reliance on informal sources of support. Services are urgently needed to meet the unique needs of men experiencing IPV in same-sex relationships.

Incidence of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Nationwide Population-Based Study Using National Health Insurance Database in Korea.

PubMed

Yang, Min-Suk; Lee, Jin Yong; Kim, Jayeun; Kim, Gun-Woo; Kim, Byung-Keun; Kim, Ju-Young; Park, Heung-Woo; Cho, Sang-Heon; Min, Kyung-Up; Kang, Hye-Ryun

2016-01-01

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening diseases; however, it is hard to estimate their incidence due to the rarity of these diseases. We evaluated the incidence of SJS and TEN using a nationwide administrative database. We used a national medical insurance review system (Health Insurance Review and Assessment) database which contained the claim data of the entire nation from 2009 to 2013 to estimate the accurate incidence of SJS and TEN in Korea. The diagnostic codes of L511 (SJS) or L512 (TEN) from the International Classification of Diseases-10th revision were used to define the target study population. We also retrospectively followed up a 2011 SJS and TEN cohort for 24 months in order to assess the in-hospital mortality, related complications and total claims cost due to SJS and TEN. A total of 1,167 (938 SJS and 229 TEN) cases were newly diagnosed from 2010 to 2013. The age- and sex-standardized annual incidences estimated in this study were 3.96 to 5.03 in SJS and 0.94 to 1.45 in TEN per million. There was no significant change in annual incidence throughout the study periods. When analyzed by 10-year age groups, the annual incidence was the lowest in group 20-29 years and the highest in group 70 for both SJS and TEN. Based on the 2011 cohort analysis, the in-hospital mortality were 5.7 and 15.1% for SJS and TEN, respectively. The mortality increased with age, particularly, after 40 years of age. Among the complications related with SJS or TEN, ocular sequelae was the most common (43.1 and 43.4% of SJS and TEN patients, respectively) followed by urethral sequelae (5.7 and 9.4% of SJS and TEN patients, respectively). Overall, our data suggest that SJS, and TEN are infrequent but constantly arise throughout the years.

Phenytoin-induced toxic epidermal necrolysis: Review and recommendations

PubMed Central

Al-Quteimat, Osama M.

2016-01-01

Toxic epidermal necrolysis (TEN) is a serious, life-threatening skin reaction characterized by severe exfoliation and destruction of the epidermis of the skin. In most TEN cases, drugs are believed to be the causative agent; antipsychotics, antiepileptics, and other medications such as sulfonamides are among the most common causes of drug-induced TEN. Phenytoin, a commonly prescribed medication for seizure, was found to cause TEN. Evidence-based treatment guidelines are lacking, so the best strategy is to identify and avoid potential risk factors and to provide intensive supportive care. The aim of this literature review is to focus on phenytoin-induced TEN, to explore the risk factors, and to highlight the possible treatment options once phenytoin-induced TEN is confirmed. PMID:27651708

Stakeholder perceptions and operational barriers in the training and distribution of take-home naloxone within prisons in England.

PubMed

Sondhi, Arun; Ryan, George; Day, Ed

2016-02-03

The aim of the study was to assess potential barriers and challenges to the implementation of take-home naloxone (THN) across ten prisons in one region of England. Qualitative interviews deploying a grounded theory approach were utilised over a 12- to 18-month period that included an on-going structured dialogue with strategic and operational prison staff from the ten prisons and other key stakeholders (n = 17). Prisoner perceptions were addressed through four purposive focus groups belonging to different establishments (n = 26). Document analysis also included report minutes and access to management information and local performance reports. The data were thematically interpreted using visual mapping techniques. The distribution and implementation of THN in a prison setting was characterised by significant barriers and challenges. As a result, four main themes were identified: a wide range of negative and confused perceptions of THN amongst prison staff and prisoners; inherent difficulties with the identification and engagement of eligible prisoners; the need to focus on individual prison processes to enhance the effective distribution of THN; and the need for senior prison staff engagement. The distribution of THN within a custodial setting requires consideration of a number of important factors which are discussed.

Expression of heat shock protein 72 in atrophied rat skeletal muscles

NASA Technical Reports Server (NTRS)

Oishi, Y.; Ishihara, A.; Talmadge, R. J.; Ohira, Y.; Taniguchi, K.; Matsumoto, H.; Roy, R. R.; Edgerton, V. R.

2001-01-01

Changes in the expression of heat shock protein 72 (HSP72) in response to atrophic-inducing perturbations of muscle involving chronic mechanical unloading and denervation were determined. Adult male Wistar rats were assigned randomly to a sedentary cage control (CON), hind limb unloading (HU, via tail suspension), HU plus tenotomy (HU + TEN), HU plus denervation (HU + DEN), or HU + TEN + DEN group. Tenotomy and DEN involved cutting the Achilles tendon and removing a segment of the sciatic nerve, respectively. After 5 days, HSP72 levels in the soleus of the HU + DEN and HU + TEN + DEN groups were 42 (P < 0.05) and 53% (P < 0.01) less than CON, respectively. Soleus weight decreased in both groups. Heat shock protein 72 levels in the plantaris of the HU + TEN, HU + DEN, and HU + TEN + DEN groups were 31, 25, and 30% lower than CON, respectively (P < 0.05). Plantaris weight decreased in the HU + DEN and HU + TEN + DEN, but not in the HU + TEN group. Hind limb unloading alone had little effect on the HSP72 level in either muscle. Reduced levels of HSP72 were associated with a decreased soleus (r=0.62, P < 0.01) and plantaris (r=0.78, P < 0.001) weight. These results indicate that the levels of HSP72 in both a slow and a fast rat plantarflexor are responsive to a chronic decrease in the levels of loading and/or activation and suggest that the neuromuscular activity level and the presence of innervation of a muscle are important factors that induce HSP72 expression.

Ten common errors beginning substance abuse workers make in group treatment.

PubMed

Greif, G L

1996-01-01

Beginning therapists sometimes make mistakes when working with substance abusers in groups. This article discusses ten common errors that the author has observed. Five center on the therapist's approach and five center on the nuts and bolts of group leadership. Suggestions are offered for how to avoid them.

A 13-year retrospective study evaluating the efficacy of using air-fluidised beds for toxic epidermal necrolysis patients.

PubMed

Xia, Weidong; Mao, Cong; Luo, Xu; Xu, Jianjun; Chen, Xiaofeng; Lin, Cai

2016-08-01

Toxic epidermal necrolysis (TEN) is a potentially life-threatening dermatological disease involving large areas of skin loss with systemic symptoms. This study evaluated the efficacy of air-fluidised bed therapy for TEN patients. Of 27 people with TEN, 11 used air-fluidised beds (the air-fluidised group) and 16 used standard beds (the control group). Days to complete re-epithelialisation, re-epithelialisation rate, incidence of complications, mortality, pain measured by visual analogue score and the incidence of cutaneous infection were compared in these groups. The mean body surface area of involvement was 77.0 ± 11.8% and baseline mean severity-of-illness score for TEN (SCORTEN) was 2.81 ± 1.08. The re-epithelialisation rate in the air-fluidised group was 100% but was only 56.3% in the control group (P < 0.05). There was a significant difference in the time taken to complete re-epithelialisation between the air-fluidised group (13 days [95% CI: 9.0-17.0]) and the control group (21 days [16.5-25.5], P < 0.05). Furthermore, the incidence of complications was 18% in the air-fluidised group versus 75% in the control group, including fewer cutaneous infections (P < 0.05). There was a significant reduction in pain among the air-fluidised group compared with the control group (P < 0.05). There were no deaths in the air-fluidised group while 19% of the control group died. Air-fluidised beds can reduce the time to complete re-epithelialisation, relieve pain and increase the re-epithelialisation rate of TEN patients, but there was no significant difference between them in mortality rate in our study. © 2015 The Australasian College of Dermatologists.

Diabetes Care Management Teams Did Not Reduce Utilization When Compared With Traditional Care: A Randomized Cluster Trial.

PubMed

Kearns, Patrick

2017-10-01

PURPOSE: Health services research evaluates redesign models for primary care. Care management is one alternative. Evaluation includes resource utilization as a criterion. Compare the impact of care-manager teams on resource utilization. The comparison includes entire panes of patients and the subset of patients with diabetes. DESIGN: Randomized, prospective, cohort study comparing change in utilization rates between groups, pre- and post-intervention. METHODOLOGY: Ten primary care physician panels in a safety-net setting. Ten physicians were randomized to either a care-management approach (Group 1) or a traditional approach (Group 2). Care managers focused on diabetes and the cardiovascular cluster of diseases. Analysis compared rates of hospitalization, 30-day readmission, emergency room visits, and urgent care visits. Analysis compared baseline rates to annual rates after a yearlong run-in for entire panels and the subset of patients with diabetes. RESULTS: Resource utilization showed no statistically significant change between baseline and Year 3 (P=.79). Emergency room visits and hospital readmission increased for both groups (P=.90), while hospital admissions and urgent care visits decreased (P=.73). Similarly, utilization was not significantly different for patients with diabetes (P=.69). CONCLUSIONS: A care-management team approach failed to improve resource utilization rates by entire panels and the subset of diabetic patients compared to traditional care. This reinforces the need for further evidentiary support for the care-management model's hypothesis in the safety net.

Transcutaneous electrical nerve stimulation (TENS) for chronic low back pain.

PubMed

Milne, S; Welch, V; Brosseau, L; Saginur, M; Shea, B; Tugwell, P; Wells, G

2001-01-01

Low back pain (LBP) affects a large proportion of the population. Transcutaneous electrical nerve stimulation (TENS) was introduced more than 30 years ago as an alternative therapy to pharmacological treatments for chronic pain. However, despite its widespread use, the effectiveness of TENS is still controversial. The aim of this systematic review was to determine the efficacy of TENS in the treatment of chronic LBP. We searched MEDLINE, EMBASE, PEDro and the Cochrane Controlled Trials Register up to June 1, 2000. Only randomized controlled clinical trials of TENS for the treatment of patients with a clinical diagnosis of chronic LBP were included. Abstracts were excluded unless further data could be obtained from the authors. Two reviewers independently selected trials and extracted data using predetermined forms. Heterogeneity was tested with Cochran's Q test. A fixed effects model was used throughout for continuous variables, except where heterogeneity existed, in which case, a random effects model was used. Results are presented as weighted mean differences (WMD) with 95% confidence intervals (95% CI), where the difference between the treated and control groups was weighted by the inverse of the variance. Standardized mean differences (SMD) were calculated by dividing the difference between the treated and control by the baseline variance. SMD were used when different scales were used to measure the same concept. Dichotomous outcomes were analyzed with odds ratios. Five trials were included, with 170 subjects randomized to the placebo group receiving sham-TENS and 251 subjects receiving active TENS (153 for conventional mode, 98 for acupuncture-like TENS). The schedule of treatments varied greatly between studies ranging from one treatment/day for two consecutive days, to three treatments/day for four weeks. There were no statistically significant differences between the active TENS group when compared to the placebo TENS group for any outcome measures. Subgroup analysis performed on TENS application and methodological quality did not demonstrate a significant statistical difference. Remaining pre-planned subgroup analysis was not conducted due to the small number of included trials and the variety of outcome measures reported. The results of the meta-analysis present no evidence to support the use of TENS in the treatment of chronic low back pain. Clinicians and researchers should consistently report the characteristics of the TENS device and the application techniques used. New trials on TENS should make use of standardized outcome measures. This meta-analysis lacked data on how TENS effectiveness is affected by four important factors: type of applications, site of application, treatment duration of TENS, optimal frequencies and intensities.

Evaluation of five full-text drug databases by pharmacy students, faculty, and librarians: do the groups agree?

PubMed

Kupferberg, Natalie; Jones Hartel, Lynda

2004-01-01

The purpose of this study is to assess the usefulness of five full-text drug databases as evaluated by medical librarians, pharmacy faculty, and pharmacy students at an academic health center. Study findings and recommendations are offered as guidance to librarians responsible for purchasing decisions. Four pharmacy students, four pharmacy faculty members, and four medical librarians answered ten drug information questions using the databases AHFS Drug Information (STAT!Ref); DRUGDEX (Micromedex); eFacts (Drug Facts and Comparisons); Lexi-Drugs Online (Lexi-Comp); and the PDR Electronic Library (Micromedex). Participants noted whether each database contained answers to the questions and evaluated each database on ease of navigation, screen readability, overall satisfaction, and product recommendation. While each study group found that DRUGDEX provided the most direct answers to the ten questions, faculty members gave Lexi-Drugs the highest overall rating. Students favored eFacts. The faculty and students found the PDR least useful. Librarians ranked DRUGDEX the highest and AHFS the lowest. The comments of pharmacy faculty and students show that these groups preferred concise, easy-to-use sources; librarians focused on the comprehensiveness, layout, and supporting references of the databases. This study demonstrates the importance of consulting with primary clientele before purchasing databases. Although there are many online drug databases to consider, present findings offer strong support for eFacts, Lexi-Drugs, and DRUGDEX.

Evaluation of five full-text drug databases by pharmacy students, faculty, and librarians: do the groups agree?

PubMed Central

Kupferberg, Natalie; Hartel, Lynda Jones

2004-01-01

Objectives: The purpose of this study is to assess the usefulness of five full-text drug databases as evaluated by medical librarians, pharmacy faculty, and pharmacy students at an academic health center. Study findings and recommendations are offered as guidance to librarians responsible for purchasing decisions. Methods: Four pharmacy students, four pharmacy faculty members, and four medical librarians answered ten drug information questions using the databases AHFS Drug Information (STAT!Ref); DRUGDEX (Micromedex); eFacts (Drug Facts and Comparisons); Lexi-Drugs Online (Lexi-Comp); and the PDR Electronic Library (Micromedex). Participants noted whether each database contained answers to the questions and evaluated each database on ease of navigation, screen readability, overall satisfaction, and product recommendation. Results: While each study group found that DRUGDEX provided the most direct answers to the ten questions, faculty members gave Lexi-Drugs the highest overall rating. Students favored eFacts. The faculty and students found the PDR least useful. Librarians ranked DRUGDEX the highest and AHFS the lowest. The comments of pharmacy faculty and students show that these groups preferred concise, easy-to-use sources; librarians focused on the comprehensiveness, layout, and supporting references of the databases. Conclusion: This study demonstrates the importance of consulting with primary clientele before purchasing databases. Although there are many online drug databases to consider, present findings offer strong support for eFacts, Lexi-Drugs, and DRUGDEX. PMID:14762464

Age Group Comparisons of TENS Response among Individuals with Chronic Axial Low Back Pain

PubMed Central

Simon, Corey B.; Riley, Joseph L.; Fillingim, Roger B.; Bishop, Mark D.; George, Steven Z.

2015-01-01

Chronic low back pain (CLBP) is a highly prevalent and disabling musculoskeletal pain condition among older adults. Transcutaneous electrical nerve stimulation (TENS) is commonly used to treat CLBP, however, TENS response for older adults compared to younger adults is untested. In a dose-response study stratified by age, sixty participants with axial CLBP (20 young, 20 middle-aged, 20 older) received four 20-minute sessions of high frequency, high intensity TENS over a two to three-week period in a laboratory-controlled setting. Experimental measures of pain sensitivity (mechanical pressure pain detection threshold, PPT) and central pain excitability (phasic heat temporal summation, TS; heat aftersensations, AS) were assessed before and after TENS. Episodic or immediate axial CLBP relief was assessed after TENS via measures of resting pain, movement-evoked-pain, and self-reported disability. Cumulative or prolonged axial CLBP relief was assessed by comparing daily pain report across sessions. Independent of age, individuals experienced episodic increase in PPT and reduction in AS following TENS application. Similarly, all groups, on average, experienced episodic axial CLBP relief via improved resting pain, movement-evoked pain, and disability report. Under this design, no cumulative effect was observed as daily pain did not improve for any age group across the four sessions. However, older adults received higher TENS amplitude across all sessions in achieving similar TENS responses to younger adults. These findings suggest that older adults experience similar episodic axial CLBP relief as younger individuals following high frequency, high intensity TENS when higher dosage parameters are used. PMID:26342650

Relationships between Concentrations of Phytoplankton Chlorophyll a and Total Nitrogen in Ten U.S. Estuaries

EPA Science Inventory

This presentation focuses on the summertime response of phytoplankton chlorophyll to nitrogen concentrations in the upper water columns of ten U.S. estuaries. Using publicly available data from monitoring programs, regression relationships have been developed between summer surfa...

Pre-trial inter-laboratory analytical validation of the FOCUS4 personalised therapy trial.

PubMed

Richman, Susan D; Adams, Richard; Quirke, Phil; Butler, Rachel; Hemmings, Gemma; Chambers, Phil; Roberts, Helen; James, Michelle D; Wozniak, Sue; Bathia, Riya; Pugh, Cheryl; Maughan, Timothy; Jasani, Bharat

2016-01-01

Molecular characterisation of tumours is increasing personalisation of cancer therapy, tailored to an individual and their cancer. FOCUS4 is a molecularly stratified clinical trial for patients with advanced colorectal cancer. During an initial 16-week period of standard first-line chemotherapy, tumour tissue will undergo several molecular assays, with the results used for cohort allocation, then randomisation. Laboratories in Leeds and Cardiff will perform the molecular testing. The results of a rigorous pre-trial inter-laboratory analytical validation are presented and discussed. Wales Cancer Bank supplied FFPE tumour blocks from 97 mCRC patients with consent for use in further research. Both laboratories processed each sample according to an agreed definitive FOCUS4 laboratory protocol, reporting results directly to the MRC Trial Management Group for independent cross-referencing. Pyrosequencing analysis of mutation status at KRAS codons12/13/61/146, NRAS codons12/13/61, BRAF codon600 and PIK3CA codons542/545/546/1047, generated highly concordant results. Two samples gave discrepant results; in one a PIK3CA mutation was detected only in Leeds, and in the other, a PIK3CA mutation was only detected in Cardiff. pTEN and mismatch repair (MMR) protein expression was assessed by immunohistochemistry (IHC) resulting in 6/97 discordant results for pTEN and 5/388 for MMR, resolved upon joint review. Tumour heterogeneity was likely responsible for pyrosequencing discrepancies. The presence of signet-ring cells, necrosis, mucin, edge-effects and over-counterstaining influenced IHC discrepancies. Pre-trial assay analytical validation is essential to ensure appropriate selection of patients for targeted therapies. This is feasible for both mutation testing and immunohistochemical assays and must be built into the workup of such trials. ISRCTN90061564. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Different effects of transcutaneous electric nerve stimulation and electroacupuncture at ST36-ST37 on the cerebral cortex.

PubMed

Kang, Yu-Tien; Liao, Yi-Sheng; Hsieh, Ching-Liang

2015-02-01

The effects of transcutaneous electric nerve stimulation (TENS) and electroacupuncture (EA) on the cerebral cortex are largely unclear. The purpose of the present study was to investigate the effect of TENS and EA on the cerebral cortex by examining their effect on the median nerve-somatosensory evoked potentials (MN-SEPs). Twenty volunteers were studied. The cortical and cervical spinal potentials were recorded by median nerve stimulation at the left wrist. Sham TENS, 2 Hz TENS and 2 Hz EA were applied to both ST36 and ST37. MN-SEPs were recorded during sham TENS, 2 Hz TENS and 2 Hz EA, with at least 1 week interval for each subject. One-way analysis of variance was used to determine the differences in latency and amplitude of the MN-SEPs observed in the stimulation and post-stimulation periods compared with baseline. Scheffe's post hoc correction was employed to identify pairwise differences. No differences in mean latency were found between the stimulation procedures during the stimulation and post-stimulation periods. 2 Hz EA but not sham TENS or 2 Hz TENS caused higher mean amplitudes in N20 and N30 during the stimulation and post-stimulation periods. EA, but not TENS, induces changes in certain components of the signal. 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.

[Management of displaced radial neck fractures in children: elastic stable intramedullary nailing vs K-wire fixation].

PubMed

Wu, Quan-Zhou; Huang, Shu-Ming; Cai, Qi-Xun; Chu, Xu-Feng

2017-01-25

To compare the complications and clinical outcome of titanium elastic nail(TEN) versus K-wire fixation(KW) for the treatment of displaced radial neck fractures in children. From January 2009 to December 2014, 56 children with displaced radial neck fractures were studied retrospectively according to the inclusion criteria. Based on the different methods of internal fixation, patients were divided into two groups: titanium elastic nail (TEN group) and K-wire fixation (KW group). Among 25 patients(15 males and 11 females, aged from 3 to 12 years old with an average of 8.6±2.1) treated with TEN, 16 patients had type III fractures, 19 patients had type IV fractures according to Metaizeau-Judet modified classification; 20 patients were treated with closed reduction and 5 patients were treated with open reduction; the time from injury to treatment ranged from 1 to 8 days with an average of (3.6±1.7) days. Among 31 patients (20 males and 11 females, aged from 3 to 11 years old with an average of 9.1±1.9 years old) treated with KW, 19 patients had type III fractures, 12 patients had type IV fractures; 22 patients were treated with closed reduction, and 9 patients were treated with open reduction; the time from injury to treatment ranged from 2 to 7 days with an average of (3.7±1.5) days. No significant differences between two groups were found in general data. Operative time, hospitalization time, healing time of fracture, internal fixation time, postoperative complications and function recovery of the two groups were compared and evaluated. The average follow-up period of the patients was 22.1 months in TEN group(ranged, 16 to 48 months), and 21.9 months in KW group(ranged, 13 to 48 months). There were no significant differences between these 2 groups in follow-up duration, average hospitalization time and fracture healing time. The operation time, hospital costs and internal fixation time in TEN group were (56.6±11.8) min, (18 000±3 000) Yuan(RMB), (9.1±2.5) weeks respectively; and in KW group were(45.5±10.3) min, (8 000±1 000) Yuan(RMB), (4.8±1.6) weeks respectively, there were significant differences between two groups( P <0.05). Outcome scores according to Metaizeau and Tibone-Stoltz had no significant differences between two groups( P >0.05). There is no significant difference of therapeutic effects between TEN and KW for children with displaced radial neck fractures. Because the removal of TEN fixation requires the secondary anesthesia, and the TEN costs significantly more than KW, TEN still can't replace the traditional KW for the treatment of radial neck fracture in children.

Effect of TENS on pain relief in patients with degenerative disc disease in lumbosacral spine.

PubMed

Pop, Teresa; Austrup, Heiner; Preuss, Rudolf; Niedziałek, Marta; Zaniewska, Anna; Sobolewski, Marek; Dobrowolski, Tomasz; Zwolińska, Jolanta

2010-01-01

The study sought to evaluate the impact of long-term TENS therapy on pain relief in patients with degenerative disc disease in the lumbosacral spine. The study involved 39 patients with lumbosacral pain who were receiving treatment in the Regional Hospital No 2 in Rzeszów and in Winsen Hospital. The experimental group consisted of 16 patients who were fitted with L-S orthoses with a built-in OmniTens plus mini-device for long-term application (3 times a day, for 20 minutes) of TENS currents with a frequency of 35 Hz and impulse duration of 150µsec. The control group consisted of 23 patients who received conventional TENS therapy once a day for 20 minutes, with a frequency of 35 Hz and impulse duration of 150 µsec. The results were assessed with the Oswestry Questionnaire, a visual analogue scale (VAS), as well as Schober's Test. Tests were performed before and on completion of the therapy. All participants reported pain relief and improved spinal function and mobility. Statistically significant differences were obtained in the group of patients treated with low frequency pulsed TENS currents administered via the orthosis. 1. TENS therapy contributed to pain relief and improvement of function and mobility of the lumbosacral spine 2. Representing an appropriate and effective technique, TENS stimulation via an orthosis should be more commonly prescribed.

Evaluating efficacy and feasibility of transcutaneous electrical nerve stimulation for postoperative pain after video-assisted thoracoscopic surgery: A randomized pilot trial.

PubMed

Engen, Deborah J; Carns, Paul E; Allen, Mark S; Bauer, Brent A; Loehrer, Laura L; Cha, Stephen S; Chartrand, Christine M; Eggler, Eric J; Cutshall, Susanne M; Wahner-Roedler, Dietlind L

2016-05-01

Transcutaneous electrical nerve stimulation (TENS) has been applied for pain relief after surgical procedures. This study evaluated whether TENS after video-assisted thoracoscopic surgery (VATS), in addition to opioid administration, decreased postoperative pain and pain medication use. In a controlled trial, 56 patients scheduled to undergo VATS were randomly assigned to TENS plus opioids (Group 1) or opioids alone (Group 2) for 48 h. Forty patients completed the study. Pain scores and use of oral morphine equivalents (OMEs) were not significantly different between the groups during the first and second 24 h. A decreased use of OMEs between the first and second 24 h was significant for Group 1 (P = .005) but not for Group 2 (P = .11); a decreased use of OMEs between groups was not significant (P = .35). A larger, well-powered clinical trial is indicated to evaluate the effects of TENS for pain control after a VATS procedure. Clinical Trial No.: NCT01046695. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Experiencing Civil Unrest: Elder Voices on Ferguson.

PubMed

Morrow-Howell, Nancy; Jackson, Clarissa; Lewis-Harris, Jacquelyn; Clark, Richelle; Clarke Ekong, Sheilah; Bostic, Briana

2017-01-01

Ferguson, Missouri became the center of the nation's attention when an unarmed African American teenager was killed by a Caucasian police officer. Civic unrest continued for weeks. The aim of this study was to learn how older adults experienced the social unrest. Ten focus groups were conducted with 73 participants. Eight themes were identified. Issues related to safety were most commonly discussed. Participants reported a breakdown in intergenerational communications and expressed a desire for more exchange. Findings are being discussed with relevant organizations to increase the involvement of older adults in on-going community development efforts and to provide opportunities for intergenerational dialogue.

The Earth is our lab: Ten years of geoscience school lab in Potsdam

NASA Astrophysics Data System (ADS)

Nikolaus Küppers, Andreas

2016-04-01

Starting in 2004, a geoscientific school lab for senior high school students was developed in the historical "Großer Refraktor" premises on the Telegraphenberg in Potsdam. Based on a one-day course architecture, laboratory days were developed covering singular themes: - Magnetic field of the Earth - Geographical Information Systems and geodata - Gravity field of the Earth - Geodynamics: seismology and seismics - Geoscience math - Geodata Brandenburg (Geological mapping with aerophotographs, remote sensing, underground data processing) With a focus on geophysical methodologies, course days generally focused on the field work around the Telegraphenberg site while introducing into the art of handling original professional equipment. Field data were afterwards compiled, analysed and interpreted in the group. Single days could be combined as clusters of up to one week and were bookable for national and international groups of max. 25 students. The courses were taught by active scientists with the assistance of student guides as the larger groups had to be split up. The paper gives an overview over the development history of the school lab and explains the course contents, the teaching methods and several employed escorting measures. Possible impact on the professional career decisions of the students is discussed.

Informing Policy for Reducing Stroke Health Disparities from the Experience of African-American Male Stroke Survivors.

PubMed

Perzynski, Adam; Blixen, Carol; Cage, Jamie; Colón-Zimmermann, Kari; Sajatovic, Martha

2016-09-01

The burden of stroke is severe among African-Americans. Despite overall declines in the rate of stroke since 2000, outcomes are largely unimproved or have worsened for African-American men. Adverse psychosocial challenges may hinder adherence to a regimen of risk factor reduction. Focus group analysis was combined with a review of current published guidelines and epidemiologic evidence on risk factors to better understand stroke health disparities and potential policy solutions. Transcripts from three focus groups with ten African-American male stroke survivors under age 65 and their care partners (N = 7) were analyzed and compared with existing published data on (a) the burden of stroke (b) trends in clinical risk factors, and (c) trends in behavioral risk factors. Participants described myriad psychosocial barriers that impede reduction of risk indicators, including low trust in providers, poor social support, access difficulties, depression, and distress. In order to be effective, policies and programs must target mechanisms consistent with the challenges faced by African-American men. Infrastructure is needed to better identify and share practices effective for improving cardiovascular outcomes within specific racial and ethnic groups.

Training communication partners of people with severe traumatic brain injury improves everyday conversations: a multicenter single blind clinical trial.

PubMed

Togher, Leanne; McDonald, Skye; Tate, Robyn; Power, Emma; Rietdijk, Rachael

2013-07-01

To determine effectiveness of communication training for partners of people with severe traumatic brain injury. Three arm non-randomized controlled trial comparing communication partner training (JOINT) with individual treatment (TBI SOLO) and a waitlist control group with 6 month follow-up. Forty-four outpatients with severe chronic traumatic brain injuries were recruited. Ten-week conversational skills treatment program encompassing weekly group and individual sessions for both treatment groups. The JOINT condition focused on both the partner and the person with traumatic brain injury while the TBI SOLO condition focused on the individual with TBI only. Primary outcomes were blind ratings of the person with traumatic brain injury's level of participation during conversation on the Measure of Participation in Communication Adapted Kagan scales. Communication partner training improved conversational performance relative to training the person with traumatic brain injury alone and a waitlist control group on the primary outcome measures. Results were maintained at six months post-training. Training communication partners of people with chronic severe traumatic brain injury was more efficacious than training the person with traumatic brain injury alone. The Adapted Kagan scales proved to be a robust and sensitive outcome measure for a conversational skills training program.

Improving the organization of palliative care: identification of barriers and facilitators in five European countries.

PubMed

van Riet Paap, Jasper; Vernooij-Dassen, Myrra; Brouwer, Frederike; Meiland, Franka; Iliffe, Steve; Davies, Nathan; Leppert, Wojciech; Jaspers, Birgit; Mariani, Elena; Sommerbakk, Ragni; Vissers, Kris; Engels, Yvonne

2014-10-16

Interventions to improve palliative care encounter challenges beyond the usual implementation problems because of palliative care's complex and changing character. In this study, we explored barriers and facilitators faced by health-care professionals in five European countries (England, Germany, Italy, Norway and the Netherlands) with regard to improving the organization of their palliative care service. Semi-structured individual and focus group interviews were conducted with purposefully selected health-care professionals. The constant comparative method was used to analyse the data. Professionals working in hospitals, hospices, nursing homes and primary care facilities who provide palliative care to adult patients were interviewed (n =40) or participated in ten focus group interviews (n =59). Barriers and facilitators were inductively grouped into 16 categories and arranged into five themes: innovation, individual professional level, group dynamics, organizational context and local political-economic context. Although the barriers and facilitators identified differed in scope, context, strength and provenance, they were shared by professionals from different European countries. This study identified barriers and facilitators to organizational change in palliative care. Some of these barriers and facilitators were experienced by professionals in almost all countries and are therefore prerequisites to change. Understanding the barriers to and facilitators of change will help tailor organizational improvements to the needs of individuals and organizations.

Social and cultural factors influencing health in southern West Virginia: a qualitative study.

PubMed

Coyne, Cathy A; Demian-Popescu, Cristina; Friend, Dana

2006-10-01

Social, cultural, and economic environments are associated with high rates of disease incidence and mortality in poor Appalachian regions of the United States. Although many historical studies suggest that aspects of Appalachian culture (e.g., fatalism, patriarchy) include values and beliefs that may put Appalachians at risk for poor health, other cultural aspects may be protective (e.g., strong social ties). Few recent studies have explored regional cultural issues qualitatively. The purpose of this study was to examine social and cultural factors that may be associated with health and illness in an Appalachian region. Ten focus groups were conducted in southern West Virginia and included five groups of men and five groups of women. Cultural norms associated with residents of rural Appalachia, such as faith, family values, and patriarchy, were examined. Both men and women in the focus groups have a sense of place, strong family ties, and a strong spiritual belief or faith in God. Patriarchy as a cultural value was not a strong factor. There are limits to how qualitative data may be used, but findings from this study help increase understanding of the social and cultural environments of people living in rural Appalachia and how these environments may affect health.

All the World's a School

ERIC Educational Resources Information Center

Young, Jonathan

2017-01-01

This article reports on a research project which focused on the aspirations and identities of students in an international school. Ten boys and ten girls were interviewed using semi-structured and photo-elicitation interviews. This research indicates convincingly that socio-economic background and international capital are crucial factors framing…

Empowering Women

ERIC Educational Resources Information Center

Gomez, Aurelia

2012-01-01

Empowering Women is a traveling exhibition of folk art that focuses on ten cooperatives from four continents and ten countries. The exhibition is a window into the ways that cooperatives empower women to: (1) preserve and reinvigorate their country's traditional arts; (2) generate steady livelihoods for their families; (3) send their children to…

Development of a web-based executive functioning intervention for adolescents with epilepsy: The Epilepsy Journey.

PubMed

Modi, Avani C; Schmidt, Matthew; Smith, Aimee W; Turnier, Luke; Glaser, Noah; Wade, Shari L

2017-07-01

Youth with epilepsy exhibit significant deficits in executive functioning (EF), yet there are few interventions to improve EF for adolescents. The aims of the current study were to develop an individually-tailored intervention, called Epilepsy Journey, to improve aspects of EF through an iterative, patient-centered process including focus groups and usability testing. Five adolescents and caregivers participated in focus groups. This input was used to develop ten learning modules based on subscales of the Behavioral Rating Inventory of Executive Functions and key issues that may impact EF in adolescents. Six adolescents participated in usability testing and a usability expert conducted a heuristic evaluation. Demographic information, chart reviews and measures of EF were also completed. Focus group participants and their parents reported difficulties with memory, attention, organization, monitoring, initiation, impulsivity, emotional control, sleep, awareness in schools and managing stress. They also identified successful strategies to address memory and organizational difficulties. Usability testing of the resultant Epilepsy Journey modules revealed problems with navigation and identified features that promoted usability, including progress bars and interactive modules. Program modifications were made after each usability trial resulting in a relatively brief, interactive and readily navigable program. Perceived utility was high with all but one participant. Participants rated the content as helpful and indicated they would recommend Epilepsy Journey to others. Feedback from the focus group and usability testing yielded a feasible, acceptable, relevant and user-friendly web-based intervention for adolescents with epilepsy. The Epilepsy Journey program will be further tested in an open pilot with adolescents with epilepsy and associated EF deficits. Copyright © 2017 Elsevier Inc. All rights reserved.

The Effect of Changes in Health Beliefs Among African-American and Rural White Church Congregants Enrolled in an Obesity Intervention: A Qualitative Evaluation.

PubMed

Martinez, Diane J; Turner, Monique M; Pratt-Chapman, Mandi; Kashima, Kanako; Hargreaves, Margaret K; Dignan, Mark B; Hébert, James R

2016-06-01

Church interventions can reduce obesity disparities by empowering participants with knowledge and skills within an established community. The purpose of this study was to evaluate the Biomedical/Obesity Reduction Trial (BMORe) and investigate changes in health beliefs among obese adult participants. Ten pre-/post-intervention focus groups applying the Health Belief Model conducted in two African-American churches in Tennessee (n = 20) and South Carolina (n = 20), and one rural Appalachian church in Kentucky (n = 21). Two independent coders using NVivo analyzed transcribed audio data and notes. Participants' health status of being overweight/obese and having comorbidities of diabetes and high blood pressure motivated enrollment in BMORe. Initially participants voiced low self-efficacy in cooking healthy and reading food labels. BMORe made participants feel "empowered" after 12 weeks compared to initially feeling "out of control" with their weight. Participants reported improvements in emotional health, quality of life, and fewer medications. During post-intervention focus groups, participants reported increased self-efficacy through family support, sharing healthy eating strategies, and having accountability partners. Solidarity and common understanding among BMORe participants led focus group attendees to comment how their peers motivated them to stay in the program for 12 weeks. Long-term barriers include keeping the weight off by maintaining habits of exercise and healthy eating. Implementation of pre-/post-intervention focus groups is an innovative approach to evaluate an obesity intervention and track how changes in health beliefs facilitated behavior change. This novel approach shows promise for behavioral interventions that rely on participant engagement for sustained effectiveness.

Development of the PedsQL™ Epilepsy Module: Focus group and cognitive interviews.

PubMed

Follansbee-Junger, Katherine W; Mann, Krista A; Guilfoyle, Shanna M; Morita, Diego A; Varni, James W; Modi, Avani C

2016-09-01

Youth with epilepsy have impaired health-related quality of life (HRQOL). Existing epilepsy-specific HRQOL measures are limited by not having parallel self- and parent-proxy versions, having a restricted age range, not being inclusive of children with developmental disabilities, or being too lengthy for use in a clinical setting. Generic HRQOL measures do not adequately capture the idiosyncrasies of epilepsy. The purpose of the present study was to develop items and content validity for the PedsQL™ Epilepsy Module. An iterative qualitative process of conducting focus group interviews with families of children with epilepsy, obtaining expert input, and conducting cognitive interviews and debriefing was utilized to develop empirically derived content for the instrument. Eleven health providers with expertise in pediatric epilepsy from across the country provided feedback on the conceptual model and content, including epileptologists, nurse practitioners, social workers, and psychologists. Ten pediatric patients (age 4-16years) with a diagnosis of epilepsy and 11 parents participated in focus groups. Thirteen pediatric patients (age 5-17years) and 17 parents participated in cognitive interviews. Focus groups, expert input, and cognitive debriefing resulted in 6 final domains including restrictions, seizure management, cognitive/executive functioning, social, sleep/fatigue, and mood/behavior. Patient self-report versions ranged from 30 to 33 items and parent proxy-report versions ranged from 26 to 33 items, with the toddler and young child versions having fewer items. Standardized qualitative methodology was employed to develop the items and content for the novel PedsQL™ Epilepsy Module. The PedsQL™ Epilepsy Module has the potential to enhance clinical decision-making in pediatric epilepsy by capturing and monitoring important patient-identified contributors to HRQOL. Copyright © 2016 Elsevier Inc. All rights reserved.

Comparative effectiveness of Low Level Laser therapy and Transcutaneous Electric Nerve Stimulation on Temporomandibular Joint Disorders.

PubMed

Seifi, Massoud; Ebadifar, Asghar; Kabiri, Sattar; Badiee, Mohammad Reza; Abdolazimi, Zahra; Amdjadi, Parisa

2017-01-01

Introduction: Temporomandibular joint disorders (TMDs) are the most common source of pain on the face. There are multiple etiologies, and several types of treatment have been reported. The use of non-invasive and reversible therapies in the treatment of such problems is recommended. The present study evaluated the effect of low-level laser (LLL) therapy and transcutaneous electric nerve stimulation (TENS) on TMDs. Methods: In this single-blind study, 40 patients with temporomandibular disorders were randomly divided into four groups: TENS (TENSTem dental), LLL (diode 810 nm CW), shamTENS, and sham-LLL. All subjects were examined and data on pain and tenderness in the temporomandibular joint (TMJ) and masticatory muscles (using the visual analogue scale) and mouth-opening (distance between incisal edges before feeling pain; mm) were collected before baseline (T1), after each session (T2-T5) and one month after the end of the sessions (T6)), and analyzed using repeated measure analysis of variance (ANOVA) and Bonferroni statistical tests. A P value < 0.05 was considered significant. Results: The decrease in pain ( P =0.000), tenderness ( P =0.000) and increase in mouth-opening ability ( P =0.002) was greater in the TENS and LLL groups than in the placebo groups. At the one-month follow-up, significant decrease in pain and tenderness was recorded in the TENS and LLL groups ( P =0.000). There was no significant differences between TENS and LLL and the placebo groups for maximum mouth-opening at the end of the study ( P =0.692). Conclusion: Using TENS or LLL therapy can improve TMD symptoms at least for the short term. Although the effects of the placebo played a role in improving symptoms, their effects were less important.

Comparative effectiveness of Low Level Laser therapy and Transcutaneous Electric Nerve Stimulation on Temporomandibular Joint Disorders

PubMed Central

Seifi, Massoud; Ebadifar, Asghar; Kabiri, Sattar; Badiee, Mohammad Reza; Abdolazimi, Zahra; Amdjadi, Parisa

2017-01-01

Introduction: Temporomandibular joint disorders (TMDs) are the most common source of pain on the face. There are multiple etiologies, and several types of treatment have been reported. The use of non-invasive and reversible therapies in the treatment of such problems is recommended. The present study evaluated the effect of low-level laser (LLL) therapy and transcutaneous electric nerve stimulation (TENS) on TMDs. Methods: In this single-blind study, 40 patients with temporomandibular disorders were randomly divided into four groups: TENS (TENSTem dental), LLL (diode 810 nm CW), shamTENS, and sham-LLL. All subjects were examined and data on pain and tenderness in the temporomandibular joint (TMJ) and masticatory muscles (using the visual analogue scale) and mouth-opening (distance between incisal edges before feeling pain; mm) were collected before baseline (T1), after each session (T2-T5) and one month after the end of the sessions (T6)), and analyzed using repeated measure analysis of variance (ANOVA) and Bonferroni statistical tests. A P value < 0.05 was considered significant. Results: The decrease in pain (P=0.000), tenderness (P=0.000) and increase in mouth-opening ability (P=0.002) was greater in the TENS and LLL groups than in the placebo groups. At the one-month follow-up, significant decrease in pain and tenderness was recorded in the TENS and LLL groups (P=0.000). There was no significant differences between TENS and LLL and the placebo groups for maximum mouth-opening at the end of the study (P=0.692). Conclusion: Using TENS or LLL therapy can improve TMD symptoms at least for the short term. Although the effects of the placebo played a role in improving symptoms, their effects were less important PMID:29071032

Treatment of femur fractures in young children: a multicenter comparison of flexible intramedullary nails to spica casting in young children aged 2 to 6 years.

PubMed

Heffernan, Michael J; Gordon, J Eric; Sabatini, Coleen S; Keeler, Kathryn A; Lehmann, Charles L; O'Donnell, June C; Seehausen, Derek A; Luhmann, Scott J; Arkader, Alexandre

2015-03-01

Spica casting is the standard of care for femur fractures in children up to 6 years of age. The indications for surgery are controversial. We sought to compare immediate spica casting (Spica) and flexible intramedullary nailing [titanium elastic nailing (TEN)] in a group of children ages 2 to 6 years. We hypothesized that young children can be successfully treated with flexible nails, resulting in faster return to ambulation and an equivalent complication rate when compared with spica casting. This was a multicenter retrospective review of 215 patients, 141 treated with immediate spica casting, and 74 treated with elastic nails. Patient demographics, fracture characteristics, mechanism of injury, associated injuries, outcomes, and complications were recorded and compared between the 2 groups. Patients in the elastic nailing group were more likely to be injured as a pedestrian struck by an automobile (Spica 8% vs. TEN 26%, P=0.001), and had increased rates of associated injuries (P<0.001). Time to fracture union was similar between the 2 groups (P=0.652). The TEN group had shorter time to independent ambulation (Spica 51±14 vs. TEN 29±14 d, P<0.001) and return to full activities (Spica 87±19 vs. TEN 74±28 d, P=0.023). TEN is a reasonable option for treatment of femur fractures in young children when compared with spica casting with shorter time to independent ambulation and full activities. Fractures associated with a high-energy mechanism are especially appropriate for consideration of treatment with TEN. Level III, this was a retrospective comparative study.

Effects of Weight-shifting Exercise Combined with Transcutaneous Electrical Nerve Stimulation on Muscle Activity and Trunk Control in Patients with Stroke.

PubMed

Jung, Kyoung-Sim; Jung, Jin-Hwa; In, Tae-Sung; Cho, Hwi-Young

2016-12-01

This study investigated the effects of weight-shifting exercise (WSE) combined with transcutaneous electrical nerve stimulation (TENS), applied to the erector spinae and external oblique (EO) muscles, on muscle activity and trunk control in patients with hemiparetic stroke. Sixty patients with stroke were recruited to this study and randomly distributed into three treatment groups: (1) WSE + TENS, (2) WSE + placebo TENS, and (3) control. All participants underwent 30 sessions of training (30 minutes five times per week for 6 weeks) and received 1 hour of conventional physical therapy five times per week for 6 weeks. Muscle activity, maximum reaching distance and trunk impairment scale scores were assessed in all patients before and after the training. After training, the WSE + TENS group showed significant increase in the EO activity, maximum reaching distance and trunk impairment scale scores compared with the WSE + placebo TENS and control groups. These findings suggest that WSE with TENS applied to the erector spinae and EO muscles increased the trunk muscle activity and improved trunk control. Therefore, WSE with TENS could be a beneficial intervention in clinical settings for individuals with hemiparetic stroke. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Snails in bottles and language cuckoos: an evaluation of patient information resources for South Asians with osteomalacia.

PubMed

Samanta, A; Johnson, M R D; Guo, F; Adebajo, A

2009-03-01

To assess the acceptability for use of information on osteomalacia for South Asian patients. Ten focus groups of South Asian persons speaking Bengali, Gujarati, Hindi, Punjabi and Urdu (one male and one female group for each language) were used to evaluate the written (leaflets) and spoken information (CD) on osteomalacia for South Asian patients produced by the Arthritis Research Campaign (ARC). Focus group discussion was facilitated by community-based workers using the Social Action Research Method. A subsidiary evaluation of the information was conducted by a questionnaire-based survey sent to British Society of Rheumatology/British Health Professionals in Rheumatology (BSR/BHPR) members and others who had requested such materials from ARC in the past. Evaluation by focus groups revealed that there were potential difficulties relating to the understanding of the information leaflets and CDs and problematic issues regarding the quality of translation and pronunciation. Evaluation by BSR/BHPR members and others who had requested such material was that although the information was culturally appropriate, there were some weak areas such as mispronunciation, the quality of translation and specific customs. Healthcare information resources for minority ethnic groups has traditionally been developed depending upon the needs of the community, the language spoken and cultural norms. Such information is regarded as 'culturally sensitive'. However, an additional dimension is required. Information should be evaluated by the community and also specific users in order to determine its acceptability. This test of 'cultural competence' can ensure that such information has real practical value. An iterative evaluation process with feedback and refinement of information resources for minority ethnic groups is essential.

Analyzing components of Community Reinforcement and Family Training (CRAFT): Is treatment entry training sufficient?

PubMed

Kirby, Kimberly C; Benishek, Lois A; Kerwin, MaryLouise E; Dugosh, Karen L; Carpenedo, Carolyn M; Bresani, Elena; Haugh, James A; Washio, Yukiko; Meyers, Robert J

2017-11-01

Community Reinforcement and Family Training (CRAFT) assists family members with a treatment-resistant loved one. The most consistent outcome of CRAFT is increased treatment entry of the identified treatment-resistant person (IP). This led us to question whether all 6 components of CRAFT are necessary. In a randomized clinical trial, 115 concerned significant others (CSOs) of an IP received 12-14 sessions of the full CRAFT intervention, 4-6 sessions focused on Treatment Entry Training (TEnT), or 12-14 sessions of Al-Anon/Nar-Anon Facilitation (ANF). We monitored treatment entry, attendance, and substance use of the IP and the CSO's mood and functioning. Data were collected at baseline and 4, 6, and 9 months after the baseline. We found significant reductions in time to treatment entry (χ(2)2 = 8.89, p = .01) and greater treatment entry rates for CRAFT (62%; odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.1-6.9) and TEnT (63%; OR = 2.9, 95% CI = 1.2-7.5) compared with ANF (37%), but CRAFT and TEnT did not differ significantly from each other (OR = 1.1, 95% CI = 0.4-2.7). No between-group differences in IP drug use were reported by CSOs, but days of drug use decreased over time for all groups (F(3, 277) = 13.47, p < .0001). Similarly, CSO mood and functioning did not differ between the 3 conditions but improved over time (p < .0001 for all significant measures). We replicated the results of previous trials demonstrating that CRAFT produces greater treatment entry rates than ANF and found similar treatment entry rates for CRAFT and TEnT. This suggests that treatment entry training is sufficient for producing the best established outcome of CRAFT. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Dose postural control improve following application of transcutaneous electrical nerve stimulation in diabetic peripheral neuropathic patients? A randomized placebo control trial.

PubMed

Saadat, Z; Rojhani-Shirazi, Z; Abbasi, L

2017-12-01

peripheral neuropathy is the most common problem of diabetes. Neuropathy leads to lower extremity somatosensory deficits and postural instability in these patients. However, there are not sufficient evidences for improving postural control in these patients. To investigate the effects of transcutaneous electrical nerve stimulation (TENS) on postural control in patients with diabetic neuropathy. Twenty eighth patients with diabetic neuropathy (40-55 Y/O) participated in this RCT study. Fourteen patients in case group received TENS and sham TENS was used for control group. Force plate platform was used to extract sway velocity and COP displacement parameters for postural control evaluation. The mean sway velocity and center of pressure displacement along the mediolateral and anteroposterior axes were not significantly different between two groups after TENS application (p>0.05). Application of 5min high frequency TENS on the knee joint could not improve postural control in patients with diabetic neuropathy. Copyright © 2017. Published by Elsevier Ltd.

Blockade of NMDA receptors prevents analgesic tolerance to repeated transcutaneous electrical nerve stimulation (TENS) in rats

PubMed Central

Hingne, Priyanka M.; Sluka, Kathleen A.

2008-01-01

Repeated daily application transcutaneous electrical nerve stimulation (TENS) results in tolerance, at spinal opioid receptors, to the anti-hyperalgesia produced by TENS. Since N-Methyl-D-Aspartate (NMDA) receptor antagonists prevent analgesic tolerance to opioid agonists we hypothesized that blockade of NMDA receptors will prevent tolerance to TENS. In rats with knee joint inflammation, TENS was applied for 20 minute daily at high frequency (100 Hz), low frequency (4 Hz), or sham TENS. Rats were treated with the NMDA antagonist MK-801 (0.01 mg/kg-0.1 mg/kg) or vehicle daily before TENS. Paw withdrawal thresholds were tested before and after inflammation, and before and after TENS treatment for 4 days. On day 1 TENS reversed the decreased mechanical withdrawal threshold induced by joint inflammation. On day 4 TENS had no effect on the decreased withdrawal threshold in the group treated with vehicle demonstrating development of tolerance. However, in the group treated with 0.1 mg/kg MK-801, TENS significantly reversed the mechanical withdrawal thresholds on day 4 demonstrating that tolerance did not develop. Vehicle treated animals developed cross-tolerance at spinal opioid receptors. Treatment with MK-801 reversed this cross-tolerance at spinal opioid receptors. In summary, blockade of NMDA receptors prevents analgesic tolerance to daily TENS by preventing tolerance at spinal opioid receptors. Perspective Tolerance observed to the clinical treatment of TENS could be prevented by administration of pharmaceutical agents with NMDA receptors activity such as ketamine or dextromethorphan. PMID:18061543

Transcutaneous electrical nerve stimulation reduces acute low back pain during emergency transport.

PubMed

Bertalanffy, Alexander; Kober, Alexander; Bertalanffy, Petra; Gustorff, Burkhard; Gore, Odette; Adel, Sharam; Hoerauf, Klaus

2005-07-01

Patients with acute low back pain may require emergency transport because of pain and immobilization. Transcutaneous electrical nerve stimulation (TENS) is a nonpharmaceutical therapy for patients with low back pain. To evaluate the efficacy of paramedic-administered TENS in patients with acute low back pain during emergency transport. This was a prospective, randomized study involving 74 patients transported to hospital. The patients were randomly assigned to two groups: group 1 (n = 36) was treated with true TENS, while group 2 (n = 36) was treated with sham TENS. The authors recorded pain and anxiety as the main outcome variables using a visual analog scale (VAS). The authors recorded a significant (p < 0.01) pain reduction (mean +/- standard deviation) during transport in group 1 (79.2 +/- 6.5 mm VAS to 48.9 +/- 8.2 mm VAS), whereas pain scores remained unchanged in group 2 (75.9 +/- 16.4 mm VAS and 77.1 +/- 11.2 mm VAS). Similarly, the scores for anxiety were significantly reduced (p < 0.01) in group 1 (81.7 +/- 7.9 mm VAS to 69.2 +/- 12.1 mm VAS) after treatment. No significant change was noted (84.5 +/- 5.8 mm VAS and 83.5 +/- 8.9 mm VAS, respectively) in group 2. TENS was found to be effective and rapid in reducing pain during emergency transport of patients with acute low back pain and should be considered due to its ease of use and lack of side effects in the study population.

A comparison study of immune-inflammatory response in electroacupuncture and transcutaneous electrical nerve stimulation for patients undergoing supratentorial craniotomy

PubMed Central

Li, Guoyan; Li, Shuqin; Sun, Lizhi; Lin, Fangcai; Wang, Baoguo

2015-01-01

Objective: The effect of transcutaneous electrical nerve stimulation (TENS) on immuno-inflammatory response was tested and the differences between electroacupuncture (EA) and TENS in immuno-inflammatory response in patients undergoing supratentorial craniotomy were explored. Methods: 51 patients received craniotomy were randomly divided into 3 groups: control (group C, n=18), EA (group A, n=19) and TENS (group T, n=14) groups. Blood samples were collected before anesthesia (T0) and 30 min (T1), 2 h (T2) and 4 h (T3) after induction of anesthesia to measure the levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-8, IL-10, IgM, IgA and IgG. Results: No significant difference existed between group A and group T during craniotomy. IgM and IgA decreased significantly in group C compared with groups A and T at T2 and T3 time points. Compared with group C, there were significant differences in TNF-α, IgM and IgA levels at T0 in groups A and T; no significant difference was found in the levels of IgG, IL-10 and IL-8. Conclusion: EA and TENS could reduce immunosuppression in patients undergoing supratentorial craniotomy and it has significance in choice of treatment in immunosuppressive therapy. PMID:25785107

A comparison study of immune-inflammatory response in electroacupuncture and transcutaneous electrical nerve stimulation for patients undergoing supratentorial craniotomy

PubMed Central

Li, Guoyan; Li, Shuqin; Sun, Lizhi; Lin, Fangcai; Wang, Baoguo

2015-01-01

Objective: The effect of transcutaneous electrical nerve stimulation (TENS) on immuno-inflammatory response was tested and the differences between electroacupuncture (EA) and TENS in immuno-inflammatory response in patients undergoing supratentorial craniotomy were explored. Methods: 51 patients received craniotomy were divided randomly into 3 groups: control (group C, n=18), EA (group A, n=19) and TENS (group T, n=14) groups. Blood samples were collected before anesthesia (T0) and 30 min (T1), 2 h (T2) and 4 h (T3) after induction of anesthesia to measure the levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-8, IL-10, IgM, IgA and IgG.. Results: No significant difference existed between groups A and group T during craniotomy. IgM and IgA decreased significantly in group C compared with groups A and T at T2 and T3 time points. Compared with group C, there were significant difference in TNF-α, IgM and IgA level at T0 in groups A and T; no significant difference was found in the levels of IgG, IL-10 and IL-8. Conclusion: EA and TENS could reduce immunosuppression in patients undergoing supratentorial craniotomy and it has significance in choice of treatment in immunosuppressive therapy. PMID:25932216

Do the Effects of Transcutaneous Electrical Nerve Stimulation on Knee Osteoarthritis Pain and Function Last?

PubMed

Cherian, Jeffrey Jai; Harrison, Paige E; Benjamin, Samantha A; Bhave, Anil; Harwin, Steven F; Mont, Michael A

2016-08-01

Transcutaneous electrical nerve stimulation (TENS) has been shown to decrease pain associated with knee osteoarthritis, which potentially leads to better function, improved quality of life, and postpones the need for surgical intervention. The purpose of this study was to perform a 1-year follow-up of a previous prospective group of patients with knee osteoarthritis, randomized to TENS or standard of care, who were asked to rate their changes in: (1) patient pain perception; (2) subjective medication use; (3) subjective functional abilities; (4) quality of life; (5) device use; and (6) conversion to TKA. A population of 70 patients were randomized to receive either a TENS device or a standard conservative therapy regimen. Patients were evaluated based on various subjective outcomes at minimum 1-year (mean, 19 months) follow-up. The TENS cohort had lower visual analog pain scores compared with the matching cohort. Subjective functional outcomes, as well as functional and activity scores, were also greater in the TENS cohort. Patients in TENS cohort showed significant improvements in their subjective and functional outcomes as compared with their initial status, while the control group did not show significant change. A majority of the TENS patients were able to reduce the amount of pain medications. Additionally, a large portion of the patients assigned to the TENS group continue to use the device, after completion of the trial. This study demonstrated the benefit of TENS for improving subjective outcomes in patients with pain due to knee osteoarthritis, compared with standard conservative treatments. The results of the study suggest that TENS is a safe and effective adjunct as part of the spectrum of current nonoperative treatment methods for knee osteoarthritis. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ten Questions about the Future of Art and Design Education.

ERIC Educational Resources Information Center

Steers, John

1997-01-01

Asks ten questions about the future of art, crafts, and design education. Focuses on why art, crafts, and design education should be included in the curriculum; how the curriculum should be defined; and how art educators should respond to conflicting calls for cultural relativism and for cultural nationalism. (DSK)

Ten Principles of Effective School Design

ERIC Educational Resources Information Center

New Visions for Public Schools, 2006

2006-01-01

This brief document offers ten principles of effective school design. They are: (1) Clear Focus and High Expectations for staff and students are defining features of an effective school; (2) A Rigorous Instructional Program provides equitable opportunities to learn and enables every student to master challenging content, skills, and learning…

[Reasons for losing weight: Why have programed support?].

PubMed

Jiménez-López, José Luis; Maldonado-Guzmán, María Elena; Flores-Pérez Pastén, Leticia; Déciga-García, Eduardo

2012-01-01

Obesity has increased in the entire World in recent decades. The increased incidence has put in doubt the efficacy of weight-control programs; therefore the study of this phenomenon has been focused in psychological reasons that have influence in the response to those programs. The aim of this study was to explore what were the patient's motives in a weight-loss program. the qualitative method to analyze the experience was performed. The focus group included ten patients with one investigator as an active observer, and 12 weekly sessions. We identified motives related with aesthetic that could benefit success, and unrealistic expectations that could lead to failure after the strategy was completed. the encouraging of certain motives could keep success of weight-loss programs. It is needed more qualitative research to support this conclusion and quantitative research to confirm it.

Transcutaneous electrical nerve stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial.

PubMed

Santana, Licia Santos; Gallo, Rubneide Barreto Silva; Ferreira, Cristine Homsi Jorge; Duarte, Geraldo; Quintana, Silvana Maria; Marcolin, Alessandra Cristina

2016-01-01

In the active phase of the first stage of labour, does transcutaneous electrical nerve stimulation (TENS) relieve pain or change its location? Does TENS delay the request for neuraxial analgesia during labour? Does TENS produce any harmful effects in the mother or the foetus? Are women in labour satisfied with the care provided? Randomised trial with concealed allocation, assessor blinding for some outcomes, and intention-to-treat analysis. Forty-six low-risk, primigravida parturients with a gestational age > 37 weeks, cervical dilation of 4cm, and without the use of any medications from hospital admission until randomisation. The principal investigator applied TENS to the experimental group for 30minutes starting at the beginning of the active phase of labour. A second investigator assessed the outcomes in both the control and experimental groups. Both groups received routine perinatal care. The primary outcome was pain severity after the intervention period, which was assessed using the 100-mm visual analogue scale. Secondary outcomes included: pain location, duration of the active phase of labour, time to pharmacological labour analgesia, mode of birth, neonatal outcomes, and the participant's satisfaction with the care provided. After the intervention, a significant mean difference in change in pain of 15mm was observed favouring the experimental group (95% CI 2 to 27). The application of TENS did not alter the location or distribution of the pain. The mean time to pharmacological analgesia after the intervention was 5.0hours (95% CI 4.1 to 5.9) longer in the experimental group. The intervention did not significantly impact the other maternal and neonatal outcomes. Participants in both groups were satisfied with the care provided during labour. TENS produces a significant decrease in pain during labour and postpones the need for pharmacological analgesia for pain relief. NCT01600495. Copyright © 2015. Published by Elsevier B.V.

Comparison of Transcutaneous Electrical Nerve Stimulation and Lidocaine on Episiotomy Complication in Primiparous Women: A Randomized Clinical Trial

PubMed Central

Rezaeyan, Maryam; Geranmayeh, Mehrnaz; Direkvand-Moghadam, Ashraf

2017-01-01

Introduction: Transcutaneous electrical nerve stimulation (TENS) through the skin is a nonpharmacological method of pain relief. The present study aimed to compare TENS and lidocaine on episiotomy complication in primiparous women. Material and Methods: In a randomized, controlled clinical trial, 80 participants were included from March to July 2011 at the antenatal clinic and postdelivery ward in the Social Security Organization Hospital, Khorramabad, Lorestan, Iran. Data were collected using a demographic questionnaire, visual analog scale and redness, edema, ecchymosis, discharge, and approximation scales. The participants were randomized into two groups with equal number of participants. All participants received 5 cc of local infiltration of 1% lidocaine before episiotomy, and TENS electrodes were placed on He Gu and Shenmen points during the crowning of fetal head. The TENS group received TENS with 100; 250 μs, the output range of 15–20 mm amplifier from crowning of first stage of labor to the end of the episiotomy repairing. The lidocaine group received 10 cc of local infiltration of 1% lidocaine before episiotomy repair while did not receive TENS electrodes. The pain intensity during and after episiotomy repair was recorded. Results: TENS and lidocaine have similar effects on pain relief at the episiotomy cutting, the start of the episiotomy repair, and at end of the episiotomy repair; however, the pain relief of both the interventions was different during the episiotomy repair. The effect of TENS in reducing edema was statistically significant (P = 0.001). Conclusions: TENS and lidocaine are effective for the episiotomy complications during and after episiotomy repair. PMID:28382054

Ultrasound combined transcutaneous electrical nerve stimulation (UltraTENS) versus phonophoresis of piroxicam (PhP) in symptomatic knee osteoarthritis: A randomized double-blind, controlled trial.

PubMed

Boonhong, Jariya; Suntornpiyapan, Phitsanu; Piriyajarukul, Apatchanee

2018-02-02

Ultrasound combined with transcutaneous electrical nerve stimulation (UltraTENS) and phonophoresis of piroxicam (PhP) are combined modality therapy that frequently used in musculoskeletal pain including knee osteoarthritis (OA). But it is lack of a good clinical trial to prove and compare their effects. To compare the effects of UltraTENS with PhP on mild to moderate degree of symptomatic knee OA. Sixty-one patients (55 women), mean age of 63.4 ± 8.1 y, 50-90 mm VAS of knee pain and Kellgren-Lawrence score of grade I-III were randomly allocated into UltraTENS and PhP (N = 31 and 30, respectively). The UltraTENS group received a combined ultrasound with TENS program and a non-drug gel, whereas the PhP group got an ultrasound program with piroxicam gel and sham TENS. All patients were treated for a total of 10 sessions, consisting of five times per week and 10 min per session. Before and after treatment, patients were evaluated knee pain by using the 100-mm VAS and functional performance by Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index. The UltraTENS and PhP groups experienced considerable improvement in both VAS and total WOMAC scores post-treatment (P< 0.001). The PhP had better VAS of pain and WOMAC scores but no statistical significance. Results show that UltraTENS and PhP were effective for relieving pain and improve functionality knee OA without significant differences between their effects.

The effect of group music therapy on quality of life for participants living with a severe and enduring mental illness.

PubMed

Grocke, Denise; Bloch, Sidney; Castle, David

2009-01-01

A 10-week group music therapy project was designed to determine whether music therapy influenced quality of life and social anxiety for people with a severe and enduring mental illness living in the community. Ten one-hour weekly sessions including song singing, song writing and improvisation, culminated in each group recording original song/s in a professional studio. The principal outcome measure was the WHOQOLBREF Quality of Life (QoL) Scale; other instruments used were the Social Interaction Anxiety Scale (SIAS) and the Brief Symptom Inventory (BSI). Qualitative data were gathered through focus group interviews and an analysis of lyric themes. Statistically significant improvement was found on five items of the QoL Scale. There were no changes on the BSI indicating that QoL improvement was not mediated by symptomatic change. Themes from the focus groups were: music therapy gave joy and pleasure, working as a team was beneficial, participants were pleasantly surprised at their creativity, and they took pride in their song. An analysis of song lyrics resulted in 6 themes: a concern for the world, peace and the environment; living with mental illness is difficult; coping with mental illness requires strength; religion and spirituality are sources of support; living in the present is healing; and working as a team is enjoyable.

Electrocortical Analysis of Patients with Intercostobrachial Pain Treated with TENS after Breast Cancer Surgery

PubMed Central

Silva, Julio Guilherme; Santana, Camila Gonçalves; Inocêncio, Kelly Rosane; Orsini, Marco; Machado, Sergio; Bergmann, Anke

2014-01-01

[Purpose] Among the physical therapeutic procedures to decrease pain, there is transcutaneous electrical neural stimulation (TENS). There is no consensus about its efficacy for oncological patients, especially for post-mastectomy pain and eletrocortical changes in somatosensory areas. The aim of this study was to analyze acute electrocortical changes after TENS treatment of patients with intercostobrachial post mastectomy pain. [Subjects] Eighteen patients were divided into acupuncture (A) and burst (B) group. [Methods] In this pre and post-intervention study each group was measured for EEG analysis in absulte power in alpha band (8–14 Hz). Outcomes variables were the alpha waveband in the sensorymotor cortex and pain pre-and-post TENS intervention. Data were analyzed using ANOVA to compare times (rest, 10 and 15 min), group and electrodes. Pain was analyzed using percentual pain evaluation (PPE) in both groups. [Results] Outcomes indicate main effects of time and electrodes because of slow (8–10 Hz) and fast alpha (10–12 Hz) wavebands decreased. PPE reduced 88.4% in A and 66.3% in G. [Conclusion] TENS promoted electrical modification in the parietal region and a decrease in pain. Future studies should investigate other wave must be proposed for other bands and use different methods of EEG analysis to elucidate the actual mechanisms behind the efficacy of TENS treatment. PMID:24707082

Electrocortical Analysis of Patients with Intercostobrachial Pain Treated with TENS after Breast Cancer Surgery.

PubMed

Silva, Julio Guilherme; Santana, Camila Gonçalves; Inocêncio, Kelly Rosane; Orsini, Marco; Machado, Sergio; Bergmann, Anke

2014-03-01

[Purpose] Among the physical therapeutic procedures to decrease pain, there is transcutaneous electrical neural stimulation (TENS). There is no consensus about its efficacy for oncological patients, especially for post-mastectomy pain and eletrocortical changes in somatosensory areas. The aim of this study was to analyze acute electrocortical changes after TENS treatment of patients with intercostobrachial post mastectomy pain. [Subjects] Eighteen patients were divided into acupuncture (A) and burst (B) group. [Methods] In this pre and post-intervention study each group was measured for EEG analysis in absulte power in alpha band (8-14 Hz). Outcomes variables were the alpha waveband in the sensorymotor cortex and pain pre-and-post TENS intervention. Data were analyzed using ANOVA to compare times (rest, 10 and 15 min), group and electrodes. Pain was analyzed using percentual pain evaluation (PPE) in both groups. [Results] Outcomes indicate main effects of time and electrodes because of slow (8-10 Hz) and fast alpha (10-12 Hz) wavebands decreased. PPE reduced 88.4% in A and 66.3% in G. [Conclusion] TENS promoted electrical modification in the parietal region and a decrease in pain. Future studies should investigate other wave must be proposed for other bands and use different methods of EEG analysis to elucidate the actual mechanisms behind the efficacy of TENS treatment.

Translating Anxiety-Focused CBT for Youth in a First Nations Context in Northwestern Ontario

PubMed Central

Nowrouzi, Behdin; Manassis, Katharina; Jones, Emily; Bobinski, Tina; Mushquash, Christopher J.

2015-01-01

Objective: We sought to evaluate a translation of anxiety-focused cognitive behavioral therapy (CBT) to a First Nations children’s mental health provider in rural Ontario and to enhance our understanding of CBT challenges and adaptations unique to the First Nations context. Methods: The study was conceptualized as a mixed methods sequential explanatory approach using a quasi-experimental (before and after) design with quantitative and qualitative components. Data were produced in two ways: questionnaires completed by therapists, parents and clients pre- and post-training, and through a focus group with therapists working with First Nations clients. Participants of this study were a subset of a larger knowledge translation study involving ten agencies, and comprised nine therapists (two males and seven females), and seven children (six males and one female) from a single First Nations agency. The mean age of children was 11.8 years (±2.71), comparable to children in other agencies. Results: First Nations therapists’ scores on a child CBT knowledge questionnaire post-training did not differ from those of therapists in other agencies when controlling for initial values, suggesting comparable training benefit. Children did not differ between groups on any key measures, and all key measures showed improvement from pre- to post-training. Four key themes emerged from therapist focus groups: client challenges, value of supervision, practice challenges, and Northern/rural/remote challenges. Conclusions: The study highlights the importance of delivering a culturally appropriate CBT program to First Nations populations in Northern Ontario, and provides preliminary evidence of its effectiveness. PMID:26336378

Prophylactic titanium elastic nailing (TEN) following femoral lengthening (Lengthening then rodding) with one or two nails reduces the risk for secondary interventions after regenerate fractures: a cohort study in monolateral vs. bilateral lengthening procedures

PubMed Central

2013-01-01

Background Femoral fracture rates of up to 30% have been reported following lengthening procedures using fixators. “Lengthening then rodding” uses one or two titanium elastic nails (TENs) for prophylactic intramedullary nailing to reduce this complication. The aim of the study was to decide if usage of only one TEN is safe or has it a higher risk of getting a fracture? And we asked if there is a difference between patients with monolateral or bilateral lengthening procedures according to their fracture rate? Methods One or two TENs were implanted in two groups of patients (monolateral and bilateral) after femoral lengthening procedures. The regenerate quality was classified using the Li system and fractures were categorized using the Simpson and Kenwright classification. The follow-up period was at least 1 year after removal of the frame. Results Sixty-seven patients with 101 femoral lengthening procedures were included in 2007–2011. Group A included 34 patients with bilateral lengthening due to congenital short stature. Group B consisted of 33 patients with congenital disorders with leg length discrepancies. Seven fractures in six patients were seen in group A and five fractures in group B. One patient had residual shortening of 1 cm, and 11 fractures healed without relevant deviation (< 5°) or shortening (< 5 mm). A soft-tissue infection in one patient led to early removal of one TEN. Conclusions Fractures occurred in both groups of patients in total in 12 of the 101 cases (12%). The rate of secondary interventions was markedly reduced. Usage of one or two TENs did not influence the fracture rate. PMID:24156728

Short-duration transcutaneous electrical nerve stimulation in the postoperative period of cardiac surgery.

PubMed

Gregorini, Cristie; Cipriano Junior, Gerson; Aquino, Leticia Moraes de; Branco, João Nelson Rodrigues; Bernardelli, Graziella França

2010-03-01

Respiratory muscle strength has been related to the postoperative outcome of cardiac surgeries. The main documented therapeutic purpose of transcutaneous electrical nerve stimulation (TENS) is the reduction of pain, which could bring secondary benefits to the respiratory muscles and, consequently, to lung capacities and volumes. The objective of the present study was to evaluate the effectiveness of short-duration transcutaneous electrical nerve stimulation (TENS) in the reduction of pain and its possible influence on respiratory muscle strength and lung capacity and volumes of patients in the postoperative period of cardiac surgery. Twenty five patients with mean age of 59.9 +/- 10.3 years, of whom 72% were men, and homogeneous as regards weight and height, were randomly assigned to two groups. One group received therapeutic TENS (n = 13) and the other, placebo TENS (n = 12), for four hours on the third postoperative day of cardiac surgery. Pain was analyzed by means of a visual analogue scale, and of respiratory muscle strength as measured by maximum respiratory pressures and lung capacity and volumes before and after application of TENS. Short-duration TENS significantly reduced pain of patients in the postoperative period (p < 0.001). Respiratory muscle strength (p < 0.001), tidal volume (p < 0.001) and vital capacity (p < 0.05) significantly improved after therapeutic TENS, unlike in the placebo group. Short-duration TENS proved effective for the reduction of pain and improvement of respiratory muscle strength, as well as of lung volumes and capacity.

Work-Related Stressors Among Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Home Visitors: A Qualitative Study.

PubMed

Alitz, Paige J; Geary, Shana; Birriel, Pamela C; Sayi, Takudzwa; Ramakrishnan, Rema; Balogun, Omotola; Salloum, Alison; Marshall, Jennifer T

2018-05-31

Background The Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program delivers evidence-based home visiting services to over 1400 families each year. Home visitors are integral in providing resources for families to promote healthy pregnancy, child development, family wellness, and self-sufficiency. Due to the nature of this work, home visitors experience work-related pressures and stressors that can impact staff well-being and retention. Objectives The purpose of this study was to understand primary sources of work-related stress experienced by home visitors, subsequent effects on their engagement with program participants, and to learn of coping mechanisms used to manage stress. Methods In 2015, Florida MIECHV program evaluators conducted ten focus groups with 49 home visitors during which they ranked and discussed their top sources of work-related stress. Qualitative analysis was conducted to identify emergent themes in work-related stressors and coping/supports. Results Across all sites, the burden of paperwork and data entry were the highest ranked work-related stressors perceived as interfering with home visitors' engagement with participants. The second-highest ranked stressors included caseload management, followed by a lack of resources for families, and dangerous environments. Home visitors reported gratification in their helping relationships families, and relied on coworkers or supervisors as primary sources of workplace support along with self-care (e.g. mini-vacations, recreation, and counseling). Conclusions for practice Florida MIECHV home visitors across all ten focus groups shared similar work-related stressors that they felt diminished engagement with program participants and could impact participant and staff retention. In response, Florida MIECHV increased resources to support home visitor compensation and reduce caseloads, and obtained a competitive award from HRSA to implement a mindfulness-based stress reduction training statewide.

Shared experiences of CRNAs who were on duty in New Orleans during Hurricane Katrina.

PubMed

Geisz-Everson, Marjorie A; Dodd-McCue, Dianne; Bennett, Marsha

2012-06-01

The purpose of this focused ethnography was to describe the shared experiences of certified registered nurse anesthetists (CRNAs) who were on duty in New Orleans, Louisiana, during Hurricane Katrina as well as to elucidate the psychosocial impact the storm had on them. Ten CRNAs participated in 1 of 3 focus groups that were audio recorded. The audio recordings were transcribed and analyzed using qualitative data analysis computer software (NVivo 8, QSR International, Melbourne, Australia). Six major themes emerged from the study: caught off guard; sense of duty; uncertainty/powerlessness/frustration; group identity and cohesiveness; anger; and life-changing event. The themes represented how the CRNAs appraised and coped with the stressful events surrounding Hurricane Katrina. The psychosocial impact of Hurricane Katrina on the CRNAs resulted mainly in short-term sleep disturbances and increased drinking. Only 2 CRNAs expressed long-term psychosocial effects from the storm. The results of this study should be used to guide policies regarding disaster activation of CRNAs, to educate CRNAs on preparing for disaster duty, and to provide a framework for future disaster studies regarding CRNAs.

The Cultural and Social Context of Oral and Pharyngeal Cancer Risk and Control among Hispanics in New York

PubMed Central

Cruz, Gustavo D.; Shulman, Lawrence C.; Kumar, Jayanth V.; Salazar, Christian R.

2007-01-01

New York City (NYC) has one of the highest incidence and mortality rates of oral and pharyngeal cancer (OPC) for Hispanics of any major U.S. city. This qualitative assessment explores OPC awareness, attitudes, and screening practices among at-risk Hispanics, health care providers, and community leaders in a Hispanic neighborhood of NYC. Four focus groups (N=39) were conducted with at-risk Hispanics. Structured interviews were conducted with ten health care providers (four physicians, four dentists, two dental hygienists) and three key community leaders. Results showed major gaps in OPC awareness across all key stakeholders. Focus group participants expressed difficulty in accessing appropriate health care. Health care providers were not familiar with OPC prevention and early detection practices. Community leaders lacked the knowledge and resources necessary for advocating prevention and early detection for their constituencies. All participants reported cultural, social, and structural barriers to prevention. There is a need for developing a comprehensive, culturally competent health communication program that targets all key stakeholders in the at-risk Hispanic community of NYC. PMID:17982210

Antipsychotics side effects' influence on stigma of mental illness: focus group study results.

PubMed

Novak, Lan; Svab, Vesna

2009-03-01

Little research was done on the influence of antipsychotics' side effects on stigma of mental illness. An overview of studies shows that people with mental illness state that because of medication side effects they feel discriminated in the field of employment, observe worsening of family relations and tend to skip or discontinue their regular medication. It is difficult to discriminate between stigmatizing effects of antipsychotics and other stigma related factors such as illness symptoms. A focus group of ten patients with schizophrenia or schizoaffective disorder with severe and remitting mental illness treated with antipsychotic medication was conducted to obtain their personal views on how side effects of antipsychotic drugs affect their everyday lives and contribute to the stigmatization because of mental illness. The patients felt most stigmatized in areas of employment and occupation. They repeatedly skipped or discontinued regular medication due to side effects. Their families supported them throughout treatment and recovery despite problems associated with psychotropic medication. Medication induced stigma affects patients' lives in substantial ways and therefore merits further research, part of which is the patients' personal experience.

African American Perspectives and Experiences of Domestic Violence in a Rural Community.

PubMed

Valandra; Murphy-Erby, Yvette; Higgins, Brandon M; Brown, Lucy M

2016-09-01

Relatively few studies have explored domestic violence from a multiplicity of African American perspectives, experiences, and socio-demographic backgrounds within rural African American communities. Community-based participatory action research methods were used to explore domestic violence perceptions of African Americans with heterogeneous backgrounds and experiences of violence. Ten focus groups were held throughout the community with 52 diverse women ( n = 33) and men ( n = 19) living in the northwest region of Arkansas. Demographic data were collected from 47 women ( n = 28) and men ( n = 19) participating in focus groups regarding their perceptions and experiences of domestic violence, media messages, help-seeking behaviors, and services. Data were analyzed using grounded theory methods. Three major themes emerged, including (a) a heightened awareness of race, gender, and class differences; (b) imbalanced and mixed messages from media; and (c) multi-systemic dynamics influencing abusive behavior and relationships. Results indicate that study participants' perspectives and experiences with domestic violence reflect a complex interrelated gamut of societal, community, familial, and individual dynamics. Participant recommendations related to interpersonal dynamics, media messages, and societal influences are reported with implications for practice, policy, and future research.

Cognitive-behavioral therapy for women with lifelong vaginismus: a randomized waiting-list controlled trial of efficacy.

PubMed

van Lankveld, Jacques J D M; ter Kuile, Moniek M; de Groot, H Ellen; Melles, Reinhilde; Nefs, Janneke; Zandbergen, Maartje

2006-02-01

Women with lifelong vaginismus (N=117) were randomly assigned to cognitive-behavioral group therapy, cognitive-behavioral bibliotherapy, or a waiting list. Manualized treatment comprised sexual education, relaxation exercises, gradual exposure, cognitive therapy, and sensate focus therapy. Group therapy consisted of ten 2-hr sessions with 6 to 9 participants per group. Assistance with minimal-contact bibliotherapy consisted of 6 biweekly, 15-min telephone contacts. Twenty-one percent of the participants left the study before posttreatment assessment. Intent-to-treat analysis revealed that successful intercourse at posttreatment was reported by 14% of the treated participants compared with none of the participants in the control condition. At the 12-month follow-up 21% of the group therapy participants and 15% of the bibliotherapy participants, respectively, reported successful intercourse. Cognitive-behavioral treatment of lifelong vaginismus was thus found to be efficacious, but the small effect size of the treatment warrants future efforts to improve the treatment. Copyright (c) 2006 APA, all rights reserved.

Acute, Five- and Ten-Day Inhalation Study of Hydroprocessed Esters and Fatty Acids-Mixed Fats (HEFA-F) Jet Fuel

DTIC Science & Technology

2012-09-01

Groups ...................18 Table 6. Urine Specific Gravity in the Ten-Day Duration Groups ...............................................19 Table 7...exposed rats were not consistently significant compared to control groups and were considered random due to small group sizes. In urine samples...sources. Alternative fuels may be developed by synthesis from simpler molecules (e.g., natural gas) or by refining from non-petroleum sources (e.g

Linear and Nonlinear Time Reverse Acoustics in Geomaterials

NASA Astrophysics Data System (ADS)

Sutin, A.; Johnson, P. A.; Tencate, J.

2004-12-01

Linear and Nonlinear Time Reverse Acoustics in Geomaterials P. A. Johnson, A.Sutin and J. TenCate Time Reversal Acoustics (TRA) is one of the most interesting topics to have emerged in modern acoustics in the last 40 years. Much of the seminal research in this area has been carried out by the group at the Laboratoire Ondes et Acoustique at the University of Paris 7, who have demonstrated the ability and robustness of TRA (using Time Reversal Mirrors) to provide spatial control and focusing of an ultrasonic beam (e.g. Fink, 1999). The ability to obtain highly focused signals with TRA has numerous applications, including lithotripsy, ultrasonic brain surgery, nondestructive evaluation and underwater acoustic communication. Notably, the study of time reversal in solids and in the earth is still relatively new. The problem is fundamentally different from the purely acoustic one due to the excitation and propagation of both compressional (bulk) and shear waves as well as the scattering and potentially high dissipation of the medium. We conducted series of TRA experiments in different solids using direct-coupled transducers on solids in tandem with a large bandwidth laser vibrometer detector. A typical time reversal experiment was carried out using the following steps (Sutin et al. 2004a). Laboratory experiments were conducted in different geomaterials of different shapes and sizes, including Carrera marble, granite and Berea sandstone. We observed that, in spite of potentially huge numbers of wave conversions (e.g., compressional to shear, shear to compressional, compressional/shear to surface waves, etc.) for each reflection at each free surface, time reversal still provides significant spatial and temporal focusing in these different geophysical materials. The typical size of the focal area is approximately equivalent to the shear wavelength and the focal area, but becomes larger with increasing wave attenuation (Sutin et al. 2004a; Delsanto et al., 2003)). The TR-induced focusing of wave energy at a point in space and time is ideal from the perspective of enhancing elastic wave, nonlinear response (for example, higher harmonic generation or wave modulation effects). We call this technique Nonlinear Time Reverse Acoustics (NLTRA) (Sutin et a. 2004b). We investigated the harmonic generation in TRA signals focused above a small crack (2mm) in a glass cube. Large second harmonic amplitudes were observed above the crack. Scanning of the surface by applying the laser vibrometer simultaneous with TRA focusing of the signal to an array of corresponding scanning points provided nonlinear imaging of the surface, showing all cracks in the scanned region. References: Delsanto, P. P., P. A. Johnson, M. Scalerandi, J. A. TenCate, LISA simulations of time-reversed acoustic and elastic wave experiments, J. of Physics D: Applied Physics 35, 3145-3152, (2003). M. Fink, Time Reversed Acoustics, Scientific American, 91-97 (1999). Sutin, A., J. TenCate and P. A. Johnson, Single-channel time reversal in elastic solids, J. Acoust. Soc. Am., in press (2004a). Sutin, A., P. Johnson, and J. TenCate, Development of nonlinear time reverse acoustics (NLTRA) method for crack detection in solids, Proceedings of the World Congress on Acoustics (Paris) [http://www.sfa.asso.fr/wcu2003/] 121-124 (2003b).

Efficacy of Transcutaneous Electric Nerve Stimulation on Parotid Saliva Flow Rate in Relation to Age and Gender

PubMed Central

Dhillon, Manu; M Raju, Srinivasa; S Mohan, Raviprakash; Tomar, Divya

2016-01-01

Statement of the Problem Treatment with salivary substitutes and stimulation of salivary flow by either mechanical or pharmacologic methods has side effects and only provides symptomatic relief but no long-lasting results. Purpose To assess the effectiveness of extraoral transcutaneous electric nerve stimulation (TENS) as a mean of stimulating salivary function in healthy adult subjects; as well as to determine the gender and age-dependent changes in salivary flow rates of unstimulated and stimulated parotid saliva. Materials and Method Hundred patients were divided into two groups; Group I aged 20-40 and Group II aged ≥ 60 years. The TENS electrode pads were externally placed on the skin overlying the parotid glands. Unstimulated and stimulated parotid saliva was collected for 5 minutes each by using standardized collection techniques. Results Eighty seven of 100 subjects demonstrated increased salivary flow when stimulated via the TENS unit. Ten experienced no increase and 3 experienced a decrease. The mean unstimulated salivary flow rate was 0.01872 ml/min in Group I and 0.0088 ml/min in Group II. The mean stimulated salivary flow rate was 0.03084 ml/min (SD= 0.01248) in Group I, and 0.01556 ml/min (SD 0.0101) in Group II. After stimulation, the amount of salivary flow increased significantly in both groups (p< 0.001). Statistical comparison of the two groups revealed them to be significantly different (p< 0.001), with Group I producing more saliva. Gender-wise, no statistically significant difference was seen among the subjects in Group I (p = 0.148), and those in Group II (p= 0.448). Out of 12 subjects with 0 baseline flows, 7 continued to have no flow. Five subjects observed side effects, although minimal and transient. Conclusion The TENS unit was effective in increasing parotid gland salivary flow in healthy subjects. There was age-related but no gender-related variability in parotid salivary flow rate. PMID:27602390

Efficacy of Transcutaneous Electric Nerve Stimulation on Parotid Saliva Flow Rate in Relation to Age and Gender.

PubMed

Dhillon, Manu; M Raju, Srinivasa; S Mohan, Raviprakash; Tomar, Divya

2016-09-01

Treatment with salivary substitutes and stimulation of salivary flow by either mechanical or pharmacologic methods has side effects and only provides symptomatic relief but no long-lasting results. To assess the effectiveness of extraoral transcutaneous electric nerve stimulation (TENS) as a mean of stimulating salivary function in healthy adult subjects; as well as to determine the gender and age-dependent changes in salivary flow rates of unstimulated and stimulated parotid saliva. Hundred patients were divided into two groups; Group I aged 20-40 and Group II aged ≥ 60 years. The TENS electrode pads were externally placed on the skin overlying the parotid glands. Unstimulated and stimulated parotid saliva was collected for 5 minutes each by using standardized collection techniques. Eighty seven of 100 subjects demonstrated increased salivary flow when stimulated via the TENS unit. Ten experienced no increase and 3 experienced a decrease. The mean unstimulated salivary flow rate was 0.01872 ml/min in Group I and 0.0088 ml/min in Group II. The mean stimulated salivary flow rate was 0.03084 ml/min (SD= 0.01248) in Group I, and 0.01556 ml/min (SD 0.0101) in Group II. After stimulation, the amount of salivary flow increased significantly in both groups (p< 0.001). Statistical comparison of the two groups revealed them to be significantly different (p< 0.001), with Group I producing more saliva. Gender-wise, no statistically significant difference was seen among the subjects in Group I (p = 0.148), and those in Group II (p= 0.448). Out of 12 subjects with 0 baseline flows, 7 continued to have no flow. Five subjects observed side effects, although minimal and transient. The TENS unit was effective in increasing parotid gland salivary flow in healthy subjects. There was age-related but no gender-related variability in parotid salivary flow rate.

Designing an Educational Game with Ten Steps to Complex Learning

ERIC Educational Resources Information Center

Enfield, Jacob

2012-01-01

Few instructional design (ID) models exist which are specific for developing educational games. Moreover, those extant ID models have not been rigorously evaluated. No ID models were found which focus on educational games with complex learning objectives. "Ten Steps to Complex Learning" (TSCL) is based on the four component instructional…

Hemispheric Language Dominance of Language-Disordered, Articulation-Disordered, and Normal Children.

ERIC Educational Resources Information Center

Pettit, John M.; Helms, Suzanne B.

1979-01-01

The hemispheric dominance for language of three groups of six- to nine- year-olds (ten language-disordered, ten articulation-disordered, and ten normal children) was compared, and two dichotic listening tests (digits and animal names) were administered. (Author/CL)

The effect of peculiar complex core balance training on isokinetic muscle functions of the knee and lumbus.

PubMed

Lee, Myungsun; Han, Gunsoo

2016-04-01

[Purpose] This study aimed to investigate the effect of peculiar complex core balance training on the isokinetic muscle function of the knee joint and lumbus to provide fundamental data for establishing a training program that focuses on improving the performance and prevention of injury by developing the core and low extremity muscles. [Subjects and Methods] The participants in this study included a total of ten high school athletes involved in a throwing event for over five years. The subjects were randomly divided into two groups: The experimental group (N=5) and the control group (N=5). The experimental group underwent peculiar complex core balance training. [Results] According to the analysis of covariance, there was a significant effect of peculiar complex core balance training. Therefore, the isokinetic muscle function of the knee joint and lumbus in the experimental group participating in peculiar complex core balance training was significantly increased compared to the control group. [Conclusion] It is concluded that peculiar complex core balance training had a positive effect on the isokinetic muscle function of the knee and lumbus in throwing event athletes.

The transfer of learning process: From an elementary science methods course to classroom instruction

NASA Astrophysics Data System (ADS)

Carter, Nina Leann

The purpose of this qualitative multiple-case study was to explore the transfer of learning process in student teachers. This was carried out by focusing on information learned from an elementary science methods and how it was transferred into classroom instruction during student teaching. Participants were a purposeful sampling of twelve elementary education student teachers attending a public university in north Mississippi. Factors that impacted the transfer of learning during lesson planning and implementation were sought. The process of planning and implementing a ten-day science instructional unit during student teaching was examined through lesson plan documentation, in-depth individual interviews, and two focus group interviews. Narratives were created to describe the participants' experiences as well as how they plan for instruction and consider science pedagogical content knowledge (PCK). Categories and themes were then used to build explanations applying to the research questions. The themes identified were Understanding of Science PCK, Minimalism, Consistency in the Teacher Education Program, and Emphasis on Science Content. The data suggested that the participants lack in their understanding of science PCK, took a minimalistic approach to incorporating science into their ten-day instructional units, experienced inconsistencies in the teacher education program, and encountered a lack of emphasis on science content in their field experience placements. The themes assisted in recognizing areas in the elementary science methods courses, student teaching field placements, and university supervision in need of modification.

Landscapes of promise: An examination of students' journals written during a cross-cultural wilderness experience

NASA Astrophysics Data System (ADS)

Freund, Judith Ann

1997-12-01

This paper is an examination of nature journals written by ten American and ten Russian high school students during a cross-cultural exchange that provided experiences in selected national wilderness areas designated by the respective countries. The students participated in a backpacking excursion in the Lee Metcalf Wilderness Area of Montana in the summer of 1994, and a camping experience in the wilderness areas in the provincial region of Penza, Russia in the summer of 1995. The examination of the journals focuses on the following areas: aesthetic "peak" experiences; spiritual inspiration derived from experiences in nature; attitudes toward the preservation of wildlife; and environmental ethics. The students' attitudes toward the environment is compared using student-identified cultural values of both the Russian and the American students. Also discussed is the viability of the students' reflections as natural history journal-writing, with references to selected natural history authors, including Henry David Thoreau, Aldo Leopold and Anne Dillard. Because the experience focused on wilderness preservation students were invited to speculate about how to develop and reinforce essential attitudes that are respectful of ecology. Conclusions they reached included the necessity to economic security at some level and the notion that direct experience in the environment is essential to developing an attitude that will engender an ethics of caring within their--as well as other--cultural groups.

Promoting healthful family meals to prevent obesity: HOME Plus, a randomized controlled trial.

PubMed

Fulkerson, Jayne A; Friend, Sarah; Flattum, Colleen; Horning, Melissa; Draxten, Michelle; Neumark-Sztainer, Dianne; Gurvich, Olga; Story, Mary; Garwick, Ann; Kubik, Martha Y

2015-12-15

Family meal frequency has been shown to be strongly associated with better dietary intake; however, associations with weight status have been mixed. Family meals-focused randomized controlled trials with weight outcomes have not been previously conducted. Therefore, this study purpose was to describe weight-related outcomes of the HOME Plus study, the first family meals-focused randomized controlled trial to prevent excess weight gain among youth. Families (n = 160 8-12-year-old children and their parents/guardians) were randomized to intervention (n = 81) or control (n = 79) groups. Data were collected at baseline (2011-2012), post-intervention (12-months post-baseline) and follow-up (21-months post-baseline). The intervention included ten monthly group sessions (nutrition education; hands-on meal and snack planning, preparation, and skill development; screen time reductions) and five motivational, goal-setting phone calls. The main outcome was child body mass index (BMI) z-score. General linear models, adjusted for baseline values and demographics, showed no significant treatment group differences in BMI z-scores at post-intervention or follow-up; however, a promising reduction in excess weight gain was observed. Post-hoc stratification by pubertal onset indicated prepubescent children in the intervention group had significantly lower BMI z-scores than their control group counterparts. The study used a strong theoretical framework, rigorous design, quality measurement and a program with high fidelity to test a family meals-focused obesity prevention intervention. It showed a modest decrease in excess weight gain. The significant intervention effect among prepubescent children suggests the intervention may be more efficacious among relatively young children, although more research with appropriately powered samples are needed to replicate this finding. This study is registered at www.clinicaltrials.gov NCT01538615. Registered 01/17/2012.

Effectiveness of complementary pain treatment for women with deep endometriosis through Transcutaneous Electrical Nerve Stimulation (TENS): randomized controlled trial.

PubMed

Mira, Ticiana A A; Giraldo, Paulo C; Yela, Daniela A; Benetti-Pinto, Cristina L

2015-11-01

Evaluate TENS effectiveness as a complementary treatment of chronic pelvic pain and deep dyspareunia in women with deep endometriosis. This randomized controlled trial was performed in a tertiary health care center, including twenty-two women with deep endometriosis undergoing hormone therapy with persistent pelvic pain and/or deep dyspareunia. This study was registered in the Brazilian Record of Clinical Trials (ReBEC), under n RBR-3rndh6. TENS application for 8 weeks followed a randomized allocation into two groups: Group 1 - acupuncture-like TENS (Frequency: 8Hz, pulse duration: 250μs) - VIF (n=11) and Group 2 - self-applied TENS (Frequency: 85Hz, pulse duration: 75μs) (n=11). The intensity applied was "strong, but comfortable". We evaluated patients before and after treatment by the use of the Visual Analogue Scale, Deep Dyspareunia Scale and Endometriosis Quality of Life Questionnaire. We used the Wilcoxon and Mann-Whitney tests to compare before and after treatment conditions. Despite the use of hormone therapy for 1.65±2.08 years, the 22 women with deep endometriosis sustained pelvic pain complaints (VAS=5.95±2.13 and 2.45±2.42, p<.001) and/or deep dyspareunia (DDS=2.29±0.46 and 1.20±1.01, p=.001). We observed significant improvement for chronic pelvic pain, deep dyspareunia and quality of life by the use of TENS. Both application types of TENS were effective for improving the evaluated types of pain. Both resources (acupuncture-like TENS and self-applied TENS) demonstrated effectiveness as a complementary treatment of pelvic pain and deep dyspareunia, improving quality of life in women with deep endometriosis regardless of the device used for treatment. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Binding characteristics of Cu2+ to natural humic acid fractions sequentially extracted from the lake sediments.

PubMed

He, En; Lü, Changwei; He, Jiang; Zhao, Boyi; Wang, Jinghua; Zhang, Ruiqing; Ding, Tao

2016-11-01

Humic acids (HAs) determine the distribution, toxicity, bioavailability, and ultimate fate of heavy metals in the environment. In this work, ten HA fractions (F1-F10) were used as adsorbent, which were sequentially extracted from natural sediments of Lake Wuliangsuhai, to investigate the binding characteristics of Cu 2+ to HA. On the basis of the characterization results, differences were found between the ten extracted HA fractions responding to their elemental compositions and acidic functional groups. The characterization results reveal that the responses of ten extracted HA fractions to their elemental compositions and acidic functional groups were different. The O/C and (O + N)/C ratio of F1-F8 approximately ranged from 0.66 to 0.53 and from 0.72 to 0.61, respectively; the measured results showed that the contents of phenolic groups and carboxyl groups decreased from 4.46 to 2.60 mmol/g and 1.60 to 0.58 mmol/g, respectively. The binding characteristics of Cu 2+ to the ten HA fractions were well modeled by the bi-Langmuir model; the binding behavior of Cu 2+ to all the ten HA fractions were strongly impacted by pH and ionic strength. The FTIR and SEM-EDX image of HA fractions (pre- and post-adsorption) revealed that carboxyl and phenolic groups were responsible for the Cu 2+ sorption on the ten sequentially extracted HA fractions process, which is the same with the analysis of the ligand binding and bi-Langmuir models Accordingly, the adsorption capacity of the former HA fractions on Cu 2+ were higher than the latter ones, which may be attributed to the difference of carboxyl and phenolic group contents between the former and latter extracted HA fractions. Additionally, the functional groups with N and S should not be neglected. This work is hopeful to understand the environmental effect of humic substances, environmental geochemical behavior, and bioavailability of heavy metals in lakes.

Preemptive Analgesic Effects of Transcutaneous Electrical Nerve Stimulation (TENS) on Postoperative Pain: A Randomized, Double-Blind, Placebo-Controlled Trial.

PubMed

Eidy, Mohammad; Fazel, Mohammad Reza; Janzamini, Monir; Haji Rezaei, Mostafa; Moravveji, Ali Reza

2016-04-01

Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological analgesic method used to control different types of pain. The aim of this study was to evaluate the effects of preoperative TENS on post inguinal hernia repair pain. This randomized, double-blind, placebo-controlled clinical trial was performed on 66 male patients with unilateral inguinal hernias who were admitted to the Shahid Beheshti hospital in Kashan, Iran, from April to October 2014. Participants were selected using a convenience sampling method and were assigned to intervention (n = 33) and control (n = 33) groups using permuted-block randomization. Patients in the intervention group were treated with TENS 1 hour before surgery, while the placebo was administered to patients in the control group. All of the patients underwent inguinal hernia repair by the Lichtenstein method, and pain intensity was evaluated at 2, 4, 6, and 12 hours after surgery using a visual analogue scale. Additionally, the amounts of analgesic administered by pump were calculated and compared between the two groups. The mean estimated postoperative pain intensity was 6.21 ± 1.63 in the intervention group and 5.45 ± 1.82 in the control group (P = 0.08). In the intervention group pain intensity at 2 and 4 hours after surgery were 3.54 ± 1.48 and 5.12 ± 1.41 (P < 0.001), respectively. In the control group these values were 4.0±1.5 and 4.76 ± 1.39 (P = 0.04), respectively. No significant differences were observed in mean pain intensities at 6 and 12 hours. TENS can reduce postoperative pain in the early hours after inguinal hernia repair surgery.

Preemptive Analgesic Effects of Transcutaneous Electrical Nerve Stimulation (TENS) on Postoperative Pain: A Randomized, Double-Blind, Placebo-Controlled Trial

PubMed Central

Eidy, Mohammad; Fazel, Mohammad Reza; Janzamini, Monir; Haji Rezaei, Mostafa; Moravveji, Ali Reza

2016-01-01

Background Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological analgesic method used to control different types of pain. Objectives The aim of this study was to evaluate the effects of preoperative TENS on post inguinal hernia repair pain. Patients and Methods This randomized, double-blind, placebo-controlled clinical trial was performed on 66 male patients with unilateral inguinal hernias who were admitted to the Shahid Beheshti hospital in Kashan, Iran, from April to October 2014. Participants were selected using a convenience sampling method and were assigned to intervention (n = 33) and control (n = 33) groups using permuted-block randomization. Patients in the intervention group were treated with TENS 1 hour before surgery, while the placebo was administered to patients in the control group. All of the patients underwent inguinal hernia repair by the Lichtenstein method, and pain intensity was evaluated at 2, 4, 6, and 12 hours after surgery using a visual analogue scale. Additionally, the amounts of analgesic administered by pump were calculated and compared between the two groups. Results The mean estimated postoperative pain intensity was 6.21 ± 1.63 in the intervention group and 5.45 ± 1.82 in the control group (P = 0.08). In the intervention group pain intensity at 2 and 4 hours after surgery were 3.54 ± 1.48 and 5.12 ± 1.41 (P < 0.001), respectively. In the control group these values were 4.0±1.5 and 4.76 ± 1.39 (P = 0.04), respectively. No significant differences were observed in mean pain intensities at 6 and 12 hours. Conclusions TENS can reduce postoperative pain in the early hours after inguinal hernia repair surgery. PMID:27275401

Western tent caterpillar: Contact toxicity of ten insecticides applied to the larvae

Treesearch

Jacqueline L. Robertson; Nancy L. Gillette

1973-01-01

Ten chemicals representative of four insecticide groups (earbamate, organophosphate, chlorinated hydrocarbon, and pyrethroid) were applied topically to mixed groups of 5th- and 6th-stage larvae of Malaeosoma californicum califomicum (Packard). Only 2&emdash;the pyrethroid NIA 24110 ((5-benzyl-3-furyl) methyl trans-( +)-3-(...

Communicable Diseases Prioritized According to Their Public Health Relevance, Sweden, 2013

PubMed Central

Dahl, Viktor; Tegnell, Anders; Wallensten, Anders

2015-01-01

To establish strategic priorities for the Public Health Agency of Sweden we prioritized pathogens according to their public health relevance in Sweden in order to guide resource allocation. We then compared the outcome to ongoing surveillance. We used a modified prioritization method developed at the Robert Koch Institute in Germany. In a Delphi process experts scored pathogens according to ten variables. We ranked the pathogens according to the total score and divided them into four priority groups. We then compared the priority groups to self-reported time spent on surveillance by epidemiologists and ongoing programmes for surveillance through mandatory and/or voluntary notifications and for surveillance of typing results. 106 pathogens were scored. The result of the prioritization process was similar to the outcome of the prioritization in Germany. Common pathogens such as calicivirus and Influenza virus as well as blood-borne pathogens such as human immunodeficiency virus, hepatitis B and C virus, gastro-intestinal infections such as Campylobacter and Salmonella and vector-borne pathogens such as Borrelia were all in the highest priority group. 63% of time spent by epidemiologists on surveillance was spent on pathogens in the highest priority group and all pathogens in the highest priority group, except for Borrelia and varicella-zoster virus, were under surveillance through notifications. Ten pathogens in the highest priority group (Borrelia, calicivirus, Campylobacter, Echinococcus multilocularis, hepatitis C virus, HIV, respiratory syncytial virus, SARS- and MERS coronavirus, tick-borne encephalitis virus and varicella-zoster virus) did not have any surveillance of typing results. We will evaluate the possibilities of surveillance for the pathogens in the highest priority group where we currently do not have any ongoing surveillance and evaluate the need of surveillance for the pathogens from the low priority group where there is ongoing surveillance in order to focus our work on the pathogens with the highest relevance. PMID:26397699

A new electromagnetic shock-wave generator "SLX-F2" with user-selectable dual focus size: ex vivo evaluation of renal injury.

PubMed

Leistner, Rasmus; Wendt-Nordahl, Gunnar; Grobholz, Rainer; Michel, Maurice Stephan; Marlinghaus, Ernst; Köhrmann, Kai Uwe; Alken, Peter; Häcker, Axel

2007-08-01

Storz Medical AG (Kreutzlingen/Switzerland) has developed a new electromagnetic shockwave (SW) generator, the "SLX-F2", which allows the user to choose between a small-focus, high-pressure treatment regime or a wide-focus, low-pressure option. The aim of this study was to investigate, under standardized conditions, the impact of these two different treatment regimes on SW-induced renal injury. SW-induced renal injury was investigated by using the standardized model of the perfused ex vivo kidney. SWs were applied under ultrasound control in the parenchyma of a kidney pole. Different SW numbers (20, 50, 125, 250, 500, 1,000) were applied in three groups: group A was treated with a wider focus (80 MPa), groups B (60 MPa) and C (120 MPa) with a smaller focus (each parameter setting was repeated ten-fold). Disintegration capacity (measured by crater volume in cubes of plaster of Paris) was the same in groups A and C. After SW exposure, barium sulphate suspension was perfused through the renal artery. The maximum diameter (mm) of the extravasation in the cortex, representing the extent of vascular injury, was measured on X-ray mammography films. H&E staining was performed. In all three groups (A, B, C) a higher number of SWs caused the diameter of the extravasate to increase, with statistical significance appearing at 1,000 shots versus 20 shots (p < 0.05). Vascular injury was not influenced by the focal size and positive peak pressure at identical SW numbers applied. Histology of the focal area showed gap-like defects. Our ex vivo data show that renal vascular injury is independent of the focal diameter of the SW generator at the same peak positive pressure and disintegration power. This confirms the in vivo findings that show renal injury caused by SW as being related to the number of SWs administered. Clinical studies are needed to investigate whether there is any advantage to offering both treatment regimes in one SW machine-for example, by using the "wide-focus, low-pressure" option for kidney stones and the "small-focus, high-pressure" regimen for stones in the ureter. The renal injury caused by either regime remains comparable.

Evaluation of effect of transcutaneous electrical nerve stimulation on salivary flow rate in radiation induced xerostomia patients: a pilot study.

PubMed

Lakshman, Anusha Rangare; Babu, G Subhas; Rao, Suresh

2015-01-01

Xerostomia is a common sequel in patients undergoing irradiation of malignant tumors of the head and neck. Palliative treatments of xerostomia like topical agents such as ice-chips, saliva substitutes, systemic sialogogues like pilocarpine and cevimeline work well for some patients. Electrostimulation was studied in the past and showed moderate promise but never became part of the mainstream therapy for better management of xerostomia patients. The aim of the following study is to evaluate the effectiveness of a transcutaneous electrical nerve stimulation (TENS) unit in stimulating the whole salivary flow rate in radiation induced xerostomia patients. A total of 40 subjects were included in the study. The study group consisted of 30 individuals and was divided into Group S1 (n = 20), which was further subdivided into Group S1A (n = 10) subjects complaining of dry mouth who were undergoing head and neck radiotherapy with TENS stimulation during the commencement of radiotherapy, on the 3 rd , 6 th week and after a month of completion of radiotherapy and Group S1B (n = 10) with TENS stimulation daily during the full course of radiotherapy and Group S2 (n = 10) subjects complaining of dry mouth who had undergone head and neck radiotherapy that ended 1 month prior to their entry into the study. The control group (n = 10) consisted of healthy individuals not complaining of dry mouth and who have not undergone head and neck radiotherapy. Whole saliva was collected without stimulation for 10 min and after electrostimulation with TENS unit for additional 10 min in a graduated test tube. The results were statistically analyzed using Mann-Whitney U-test and Kruskal-Wallis's test. The data analysis revealed that control and S1B group showed increased salivary flow rate after stimulation by TENS therapy compared with the unstimulated salivary flow, whereas in S1A and S2 group it was found to be statistically non-significant. The present study gave us an insight about the effectiveness of TENS therapy in stimulating salivary flow in healthy subjects and it is very effective when used in conjunction with radiation therapy by reducing the side-effects of radiation therapy. Hence, TENS therapy can be used as an adjunctive method for the treatment of xerostomia along with other treatment modalities.

Prostate cancer community collaboration and partnership: education, awareness, recruitment, and outreach to southern African-American males.

PubMed

Hughes, Gail D; Sellers, Denethia B; Fraser, Lionel; Teague, Robert; Knight, Bern'Nadette

2007-01-01

Prostate cancer is a significant health problem for African-American men intensified by low participation in screenings, clinical trials, and prospective cohort studies. Ten focus groups were conducted with African-American males and their female partners/spouses. Perceptions and knowledge about prostate cancer, as well as willingness to participate in screening and research studies were measured. Participants had a basic level of knowledge about prostate cancer, and the importance of education was a unified theme. Dialogue with targeted African-American men and their partners/spouses may increase awareness and retention in medical research, while influencing health promotion, education and behavior.

Special Issue ;Sediment cascades in cold climate geosystems;

NASA Astrophysics Data System (ADS)

Morche, David; Krautblatter, Michael; Beylich, Achim A.

2017-06-01

This Editorial introduces the Special Issue on sediment cascades in cold climate geosystems that evolved from the eighth I.A.G./A.I.G. SEDIBUD (Sediment Budgets in Cold Environments; http://www.geomorph.org/sedibud-working-group/) workshop. The workshop was held from 1st to 4th September 2014 at the Environmental Research Station ;Schneefernerhaus; (http://www.schneefernerhaus.de/en/home.html) located at Mt. Zugspitze, the highest peak of Germany, (2962 m asl). Paper and poster presentations focused on observations, measurements and modeling of geomorphological processes in sediment cascades in cold climate geosystems. This resulting Special Issue brings together ten selected contributions from arctic and alpine environments.

Making sense of global warming: Norwegians appropriating knowledge of anthropogenic climate change.

PubMed

Ryghaug, Marianne; Sørensen, Knut Holtan; Naess, Robert

2011-11-01

This paper studies how people reason about and make sense of human-made global warming, based on ten focus group interviews with Norwegian citizens. It shows that the domestication of climate science knowledge was shaped through five sense-making devices: news media coverage of changes in nature, particularly the weather, the coverage of presumed experts' disagreement about global warming, critical attitudes towards media, observations of political inaction, and considerations with respect to everyday life. These sense-making devices allowed for ambiguous outcomes, and the paper argues four main outcomes with respect to the domestication processes: the acceptors, the tempered acceptors, the uncertain and the sceptics.

Cafeteria factors that influence milk-drinking behaviors of elementary school children: grounded theory approach.

PubMed

Connors, P; Bednar, C; Klammer, S

2001-01-01

This study was conducted to identify factors that influenced milk-drinking behaviors of elementary school children in North Texas. Ten focus groups with a total of 41 children aged 6 to 11 years were conducted using a grounded theory approach. Based on the principles of Social Learning Theory, milk preferences and health beliefs were identified as personal factors that influenced drinking. Cafeteria rules, milk flavor, product packaging, modeling by adults, and shared experiences were environmental factors. The data suggest that school cafeterias can capitalize on their unique position to offer milk-drinking opportunities that children can share to combine nutrition education with sensory experience.

Efficacy of the use of two simultaneously TENS devices for fibromyalgia pain.

PubMed

Lauretti, Gabriela Rocha; Chubaci, Eliana Fazuoli; Mattos, Anita Leocadia

2013-08-01

Fibromyalgia is characterized by a range of symptoms that include muscle pain, fatigue and sleep disorders. Transcutaneous electrical nerve stimulation (TENS) is an established method for pain relief. The purpose of the study was to evaluate the effectiveness and safety of the use of two simultaneously new TENS devices for fibromyalgia pain. After Ethics approval and informed consent, 39 patients were prospectively divided into three groups to evaluate TENS device, applied simultaneously in each patient: (1) at the lower back (perpendicular to the vertebrae canal, at the level of the 5th lumbar vertebrae) and (2) centrally above and below the space between the C7 and T1 spinous processes. The devices were applied for 20 min at 12-h interval during 7 consecutive days. For the placebo group (PG), the devices did not transmitted electrical stimulus. The single-TENS group (STG) (n = 13) had one active and one placebo TENS. The DTG applied both active TENS devices at the low back and cervical areas. Diclofenac was used as rescue analgesic. The efficacy measures were pain relief, reduction in use of daily analgesic tablets, quality of sleep and fatigue. The evaluation within groups revealed that patients from DPG refereed no pain relief when compared to their previous VAS pain score (8 cm, p > 0.05), while patients from the STG refereed improvement of 2.5 cm in the pain VAS (previous 8.5 cm compared to 6 cm after treatment) (p < 0.05), and the DPG refereed daily maintained reduction of 4 cm in the VAS pain (previous 8.5-4.3 cm) (p < 0.02). Concurrent daily consumption of analgesic tablets was reduced in both STG (p < 0.05) and DTG (p < 0.02). Comparison among groups revealed that analgesia, as well as quality of sleep and disposition, was DTG > STG > PG (p < 0.05). Participants subjectively found the active device useful. While the application of a single active TENS improved pain relief in fibromyalgia pain, pain and fatigue were further improved when two active devices were simultaneously applied at the low back and cervical area, with no side effects.

Seeing the Implications of Zero Again

ERIC Educational Resources Information Center

Ponce, Gregorio A.

2015-01-01

Composing and decomposing numbers with base-ten blocks depends on children being able to see ten both as ten units and as one group of ten units (a long), cognizant that its value is the same in either case. Being able to see, or deciding when to see, an object or collection of objects as a unit is a key skill that children must develop to solve…

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION AT BOTH HIGH AND LOW FREQUENCIES ACTIVATES VENTROLATERAL PERIAQUEDUCTAL GREY TO DECREASE MECHANICAL HYPERALGESIA IN ARTHRITIC RATS

PubMed Central

Desantana, J. M.; Da Silva, L. F. S.; De Resende, M. A.; Sluka, K. A.

2014-01-01

Transcutaneous electric nerve stimulation (TENS) is widely used for the treatment of pain. TENS produces an opioid-mediated antinociception that utilizes the rostroventromedial medulla (RVM). Similarly, antinociception evoked from the periaqueductal grey (PAG) is opioid-mediated and includes a relay in the RVM. Therefore, we investigated whether the ventrolateral or dorsolateral PAG mediates antinociception produced by TENS in rats. Paw and knee joint mechanical withdrawal thresholds were assessed before and after knee joint inflammation (3% kaolin/carrageenan), and after TENS stimulation (active or sham). Cobalt chloride (CoCl2; 5 mM) or vehicle was microinjected into the ventrolateral periaqueductal grey (vlPAG) or dorsolateral periaqueductal grey (dlPAG) prior to treatment with TENS. Either high (100 Hz) or low (4 Hz) frequency TENS was then applied to the inflamed knee for 20 min. Active TENS significantly increased withdrawal thresholds of the paw and knee joint in the group microinjected with vehicle when compared to thresholds prior to TENS (P<0.001) or to sham TENS (P<0.001). The increases in withdrawal thresholds normally observed after TENS were prevented by microinjection of CoCl2 into the vlPAG, but not the dlPAG prior to TENS and were significantly lower than controls treated with TENS (P<0.001). In a separate group of animals, microinjection of CoCl2 into the vlPAG temporarily reversed the decreased mechanical withdrawal threshold suggesting a role for the vlPAG in the facilitation of joint pain. No significant difference was observed for dlPAG. We hypothesize that the effects of TENS are mediated through the vlPAG that sends projections through the RVM to the spinal cord to produce an opioid-mediated analgesia. PMID:19576962

Adults and children prefer a plate food guide relative to a pyramid.

PubMed

Talati, Zenobia; Pettigrew, Simone; Moore, Sarah; Pratt, Iain S

2017-01-01

This study explored attitudes toward two food guides currently being widely used in Australia: the Healthy Eating Pyramid and the Australian Guide to Healthy Eating Plate. Ten focus groups were conducted with adults (aged 18+ years) and children (aged 10-17 years) across various locations in Perth, Western Australia. The discussions focused on liked and disliked aspects of each food guide and the implications for participants' perceptions of their relative usefulness. When asked to state their preference, a large majority of participants nominated the plate as their preferred nutrition guide. The style of presentation used for the plate was reportedly clearer and more aesthetically pleasing. The plate was also perceived to be more complex while the pyramid was considered by adults to be more child-friendly. This study provides information on consumers' reactions to different food guides and the implications for perceived relevance and utility.

Are intra-articular corticosteroid injections better than conventional TENS in treatment of rotator cuff tendinitis in the short run? A randomized study.

PubMed

Eyigor, C; Eyigor, S; Kivilcim Korkmaz, O

2010-09-01

Rotator cuff problems are common causes of pain and restriction of movement in shoulder. The aim of this study to compare the effect of intra-articular injection of corticosteroid and conventional transcutaneous electrical nerve stimulator (TENS) treatment in treatment of rotator cuff tendinitis. Subjects were randomly allocated into Group 1 (intra-articular injection of corticosteroid) and Group 2 (conventional transcutaneous electrical nerve stimulation-TENS). Outcome measurements were performed using the Visual Analogue Scale (VAS) for pain, range of motion (ROM), the Shoulder Disability Questionnaire (SDQ), the Short Form-36 (SF-36), and Beck Depression Scale (BDS) questionnaires and paracetamol consumption. In both groups, significant improvement was observed in all weeks in VAS, ROM and SDQ scores (P<0.05). Improvement was detected in most of the SF36 scores at the end of the treatment in both groups (P<0.05), while no significant change was observed in BDI score (P>0.05). In both treatment groups, paracetamol consumption decreased in time (P<0.05). When the groups were compared, a significant difference was found between the groups in favor of Group 1 in terms of VAS-at night and VAS-at rest in weeks 1, 4 and 12, and VAS-during movement in week 1 and 12 (P<0.05). The comparison of two groups revealed a significant difference in favor of Group 1 in weeks 1 in the passive abduction and the active and passive IR ROM measurements (P<0.05). There was also a significant difference in favor of Group 1 observed in weeks 1 in SDQ scores (P<0.05). Intra-articular injection of corticosteroid and conventional TENS are efficient in the treatment of rotator cuff tendinitis. When two treatments are compared, it may be concluded that intra-articular steroid injection was more effective especially in the first weeks regarding pain, ROM and disability. Otherwise, use of TENS allow to patients to increase activity level, improve function and quality of life like that in our study. TENS, as it is cheaper, non-invasive, more easily performed and efficient, may be preferable for the treatment of shoulder pain. Further studies are needed to include these results in the prospective treatment guidelines.

Sensory trigeminal ULF-TENS stimulation reduces HRV response to experimentally induced arithmetic stress: A randomized clinical trial.

PubMed

Monaco, Annalisa; Cattaneo, Ruggero; Ortu, Eleonora; Constantinescu, Marian Vladimir; Pietropaoli, Davide

2017-05-01

Ultra Low Frequency Transcutaneous Electric Nervous Stimulation (ULF-TENS) is extensively used for pain relief and for the diagnosis and treatment of temporomandibular disorders (TMD). In addition to its local effects, ULF-TENS acts on the autonomic nervous system (ANS), with particular reference to the periaqueductal gray (PAG), promoting the release of endogenous opioids and modulating descending pain systems. It has been suggested that the PAG participates in the coupling between the emotional stimulus and the appropriate behavioral autonomic response. This function is successfully investigated by HRV. Therefore, our goal is to investigate the effects of trigeminal ULF-TENS stimulation on autonomic behavior in terms of HRV and respiratory parameters during an experimentally-induced arithmetic stress test in healthy subjects. Thirty healthy women between 25 and 35years of age were enrolled and randomly assigned to either the control (TENS stimulation off) or test group (TENS stimulation on). Heart (HR, LF, HF, LF/HF ratio, DET, RMSSD, PNN50, RR) and respiratory (BR) rate were evaluated under basal, T1 (TENS off/on), and stress (mathematical task) conditions. Results showed that HRV parameters and BR significantly changed during the arithmetic stress paradigm (p<0.01). Independently of stress conditions, TENS and control group could be discriminated only by non-linear HRV data, namely RR and DET (p=0.038 and p=0.027, respectively). During the arithmetic task, LF/HF ratio was the most sensitive parameter to discriminate between groups (p=0.019). Our data suggest that trigeminal sensory ULF-TENS reduces the autonomic response in terms of HRV and BR during acute mental stress in healthy subjects. Future directions of our work aim at applying the HRV and BR analysis, with and without TENS stimulation, to individuals with dysfunctional ANS among those with TMD. Copyright © 2017 Elsevier Inc. All rights reserved.

Effectiveness of diadynamic currents and transcutaneous electrical nerve stimulation in disc disease lumbar part of spine.

PubMed

Ratajczak, Barbara; Hawrylak, Arletta; Demidaś, Aneta; Kuciel-Lewandowska, Jadwiga; Boerner, Ewa

2011-01-01

Back pain has multi-factorial etiology and is modified by environmental influences, character of work, and individual predispositions. The aim of this study was to compare the efficiency of analgesic DD current therapy and TENS in low back discopathy. Eighty patients (age, 45-60 years) with diagnosed low back pain syndrome due to discopathy were subjected to therapy. In the first group (DD) of 40 people, DD current therapy was applied. In the second group (TENS) of 40 people, TENS was applied. The third group of 40 people was a control group in which a functional fitness test was performed for comparison purposes. The control group was in this case an equivalent to a norm. Before the beginning and on the completion of therapy in all patients, a pain level measurement and functional fitness test were performed. On the basis of research conducted it was stated that both therapies reduce pain level effectively. Obtained analyzed results conclude that both therapies applied have an analgesic effect. DD current and TENS therapies in low back discopathy have an analgesic impact and improve functional fitness. The applied therapies have a comparable impact on researched parameters.

Effect of rotator cuff strengthening as an adjunct to standard care in subjects with adhesive capsulitis: A randomized controlled trial.

PubMed

Rawat, Pallavi; Eapen, Charu; Seema, Kulathuran Pillai

Randomized controlled trial. To study the effect of adding rotator cuff (RC) muscles strengthening to joint mobilization and transcutaneous electrical nerve stimulation (TENS) in patients with adhesive capsulitis. A prospective, parallel-group, randomised clinical trial was conducted on 42 patients. One group received TENS and joint mobilization and in the other group RC muscles strengthening was added. Treatment was given for 12 sessions within 4 weeks. When compared between the groups statistically significant changes were seen in all the outcome measures in the group that received RC muscle strengthening exercises vs TENS and mobilization. VAS 12.76 ± 1.04 vs 4.05 ± 1.32; SPADI 34.66 ± 6.69 vs 54.29 ± 12.17; PFPS 3.06 ± 0.80 vs 4.70 ± 0.81; and ROM (elevation >125 vs >110 degrees and rotations >70 vs >48 degrees). Addition of a structured RC strengthening program to TENS and joint mobilization in the treatment of adhesive capsulitis resulted in improvement in pain, ROM and function. 1b. Copyright © 2016 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

[How do general practitioners limit their prescriptions? A qualitative study based on a focus group].

PubMed

Duffaud, Sylvain; Liébart, Sandra

2014-01-01

There is no consensus on prescription of medicines in many situations in general medicine. The aim of this study was to identify the strategies used by general practitioners to limit prescriptions in order to make their prescriptions more effective. A mixed sample of general practitioners in terms of age and types of practice were interviewed using the focus group method until a sufficient number of data were obtained. Fourteen women and ten men aged between 32 and 64 years were interviewed by means of three group interviews. Various strategies were identified: the practitioner's attitude (rapid identification of the patient's needs, listening and evaluation of symptoms, support by physical examination) and the use of resources (reference tools and news) during the consultation; the importance of the conclusion of the consultation (written advice or visit report, review of the previous prescription) and explanation (reasons for limitation, reassurance, arguments, proposal of a follow-up visit). Limitation of prescriptions also depends on the practitioner's own reasons (initial and continued training, motivation and personal objectives, part of a peer group) but equally on the health care system (institutional, specialist support). The study highlights numerous approach to facilitate limitation of prescriptions: training and informing practitioners and patients, consultation management, promote communication at the heart of the health care system and policy-makers. Training organizations and health authorities could facilitate these strategies for the benefit of patients.

Factors Influencing Choices for Colorectal Cancer Screening Among Previously Unscreened African and Caucasian Americans: Findings from a Triangulation Mixed Methods Investigation

PubMed Central

Ruffin, Mack T.; Creswell, John W.; Jimbo, Masahito

2014-01-01

We investigated factors that influence choice of colorectal cancer (CRC) screening test and assessed the most- and least-preferred options among fecal occult blood testing (FOBT), flexible sigmoidoscopy, colonoscopy, and double contrast barium enema among adults with varied race, gender, and geographic region demographics. Mixed methods data collection consisted of 10 focus group interviews and a survey of the 93 focus group participants. Participants were ≥50 years of age and reported not having been screened for colorectal cancer in the last ten years. Analyses examined differences by race, gender, and geographic location. Participants had modest knowledge about CRC and there were fewer correct answers to knowledge questions by African Americans. Participants recognized value of early detection, and identified health symptoms and their doctor's recommendation as influential for obtaining CRC screening. They chose colonoscopy and FOBT as the most preferred tests, while barium enema was least preferred. The analysis revealed intra-group variations in preference, though there were no significant differences by race, gender, or location. Openness of discussing this sensitive topic, lack of knowledge about colorectal cancer and screening costs, and diversity of preferences expressed within study groups suggest the importance of patient-physician dialogue about colorectal cancer screening options. New approaches to promoting colorectal cancer screening need to explore methods to facilitate patients establishing and expressing preferences among the screening options. PMID:19082695

Transcutaneous electrical nerve stimulation (TENS) for pain relief in labour.

PubMed

Dowswell, Therese; Bedwell, Carol; Lavender, Tina; Neilson, James P

2009-04-15

Transcutaneous nerve stimulation (TENS) has been proposed as a means of reducing pain in labour. The TENS unit emits low-voltage electrical impulses which vary in frequency and intensity. During labour, TENS electrodes are generally placed on the lower back, although TENS may be used to stimulate acupuncture points or other parts of the body. The physiological mechanisms whereby TENS relieves pain are uncertain. The TENS unit is frequently operated by women, which may increase sense of control in labour. To assess the effects of TENS on pain in labour. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2008). Randomised controlled trials comparing women receiving TENS for pain relief in labour versus routine care, alternative pharmacological methods of pain relief, or placebo devices. We included all types of TENS machines. Two review authors assessed for inclusion all trials identified by the search strategy, carried out data extraction and assessed risk of bias. We have recorded reasons for excluding studies. The search identified 25 studies; we excluded six and included 19 studies including 1671 women. Fifteen examined TENS applied to the back, two to acupuncture points and two to the cranium. Overall, there was little difference in pain ratings between TENS and control groups, although women receiving TENS to acupuncture points were less likely to report severe pain (risk ratio 0.41, 95% confidence interval 0.32 to 0.55). The majority of women using TENS said they would be willing to use it again in a future labour. Where TENS was used as an adjunct to epidural analgesia there was no evidence that it reduced pain. There was no consistent evidence that TENS had any impact on interventions and outcomes in labour. There was little information on outcomes for mothers and babies. No adverse events were reported. There is only limited evidence that TENS reduces pain in labour and it does not seem to have any impact (either positive or negative) on other outcomes for mothers or babies. The use of TENS at home in early labour has not been evaluated. TENS is widely available in hospital settings and women should have the choice of using it in labour.

Efficacy of the transcutaneous electrical nerve stimulation for the treatment of chronic low back pain: a meta-analysis.

PubMed

Brosseau, Lucie; Milne, Sarah; Robinson, Vivian; Marchand, Serge; Shea, Beverley; Wells, George; Tugwell, Peter

2002-03-15

Low back pain affects a large proportion of the population. Transcutaneous electrical nerve stimulation (TENS) was introduced more than 30 years ago as an alternative therapy to pharmacologic treatments for chronic pain. However, despite its widespread use, the efficacy of TENS is still controversial. The aim of this meta-analysis was to determine the efficacy of TENS in the treatment of chronic low back pain. The authors searched MEDLINE, EMBASE, PEDro, and the Cochrane Controlled Trials Register up to June 1, 2000. Only randomized controlled clinical trials of TENS for the treatment of patients with a clinical diagnosis of chronic low back pain were included. Abstracts were excluded unless further data could be obtained from the authors. Two reviewers independently selected trials and extracted data using predetermined forms. Heterogeneity was tested with Cochrane's Q test. A fixed effects model was used throughout for continuous variables, except where heterogeneity existed, in which case, a random effects model was used. Results are presented as weighted mean differences with 95% confidence intervals, where the difference between the treated and control groups was weighted by the inverse of the variance. Standardized mean differences were calculated by dividing the difference between the treated and control by the baseline variance. Standardized mean differences were used when different scales were integrated to measure the same concept. Dichotomous outcomes were analyzed with odds ratios. Five trials were included, with 170 subjects randomized to the placebo group receiving sham TENS and 251 subjects receiving active TENS (153 for conventional mode, 98 for acupuncture-like TENS). The schedule of treatments varied greatly between studies ranging from one treatment/day for 2 consecutive days, to three treatments/day for 4 weeks. There were no statistically significant differences between the active TENS group compared with the placebo TENS group for any outcome measures. Subgroup analysis performed on TENS application and methodologic quality did not demonstrate a significant statistical difference (P > 0.05). Remaining preplanned subgroup analysis was not conducted because of the small number of included trials and the variety of outcome measures reported. The results of the meta-analysis present no evidence to support the use or nonuse of TENS alone in the treatment of chronic low back pain. Considering the small number of studies responding to the criteria to be included in this meta-analysis, it is clear that more appropriately designed studies are needed before a final conclusion. Clinicians and researchers should consistently report the characteristics of the TENS device and the application techniques used. New trials on TENS should make use of standardized outcome measures. This meta-analysis lacked data on how TENS efficacy is affected by four important factors: type of applications, site of application, treatment duration of TENS, and optimal frequencies and intensities.

Tell Me Your Story: A Pilot Narrative Medicine Curriculum During the Medicine Clerkship.

PubMed

Chretien, Katherine C; Swenson, Rebecca; Yoon, Bona; Julian, Ricklie; Keenan, Jonathan; Croffoot, James; Kheirbek, Raya

2015-07-01

Narrative medicine educational interventions may enhance patient-centered care, yet most educational interventions do not involve actual patient-provider interactions, nor do they assess narrative competence, a key skill for its practice. An experiential narrative medicine curriculum for medical students was developed and piloted. The purpose of the study was to develop narrative competence, practice attentive listening, and stimulate reflection. Participants were third-year medicine clerkship students. The curriculum involved 1) an introductory session, 2) a patient storytelling activity, and 3) a group reflection session. For the storytelling activity, students elicited illness narratives in storytelling form from patients, listened attentively, wrote their versions of the story, and then read them back to patients. Five student focus groups were conducted between July 2011 and March 2012 (n = 31; 66%) to explore students' experiences, student-patient dynamics, challenges, and what they learned. Patient interviews (n = 17) on their experience were conducted in January 2013. Thematic analysis of the audiotaped stories of ten patients and corresponding student-written stories helped gauge narrative competence. The curriculum was found to be feasible and acceptable to both patients and students. Some patients and students were profoundly moved. Ongoing focus groups resulted in continual process improvement. Students' stories showed attainment of narrative competence.

Advance Care Planning Meets Group Medical Visits: The Feasibility of Promoting Conversations

PubMed Central

Lum, Hillary D.; Jones, Jacqueline; Matlock, Daniel D.; Glasgow, Russell E.; Lobo, Ingrid; Levy, Cari R.; Schwartz, Robert S.; Sudore, Rebecca L.; Kutner, Jean S.

2016-01-01

PURPOSE Primary care needs new models to facilitate advance care planning conversations. These conversations focus on preferences regarding serious illness and may involve patients, decision makers, and health care providers. We describe the feasibility of the first primary care–based group visit model focused on advance care planning. METHODS We conducted a pilot demonstration of an advance care planning group visit in a geriatrics clinic. Patients were aged at least 65 years. Groups of patients met in 2 sessions of 2 hours each facilitated by a geriatrician and a social worker. Activities included considering personal values, discussing advance care planning, choosing surrogate decision-makers, and completing advance directives. We used the RE-AIM framework to evaluate the project. RESULTS Ten of 11 clinicians referred patients for participation. Of 80 patients approached, 32 participated in 5 group visit cohorts (a 40% participation rate) and 27 participated in both sessions (an 84% retention rate). Mean age was 79 years; 59% of participants were female and 72% white. Most evaluated the group visit as better than usual clinic visits for discussing advance care planning. Patients reported increases in detailed advance care planning conversations after participating (19% to 41%, P = .02). Qualitative analysis found that older adults were willing to share personal values and challenges related to advance care planning and that they initiated discussions about a broad range of relevant topics. CONCLUSION A group visit to facilitate discussions about advance care planning and increase patient engagement is feasible. This model warrants further evaluation for effectiveness in improving advance care planning outcomes for patients, clinicians, and the system. PMID:26951587

The use of optical fiber in endodontic photodynamic therapy. Is it really relevant?

PubMed

Garcez, Aguinaldo S; Fregnani, Eduardo R; Rodriguez, Helena M; Nunez, Silvia C; Sabino, Caetano P; Suzuki, Hideo; Ribeiro, Martha S

2013-01-01

This study analyzed the necessity of use of an optical fiber/diffusor when performing antimicrobial photodynamic therapy (PDT) associated with endodontic therapy. Fifty freshly extracted human single-rooted teeth were used. Conventional endodontic treatment was performed using a sequence of ProTaper (Dentsply Maillefer Instruments), the teeth were sterilized, and the canals were contaminated with Enterococcus faecalis 3 days' biofilm. The samples were divided into five groups: group 1--ten roots irradiated with a laser tip (area of 0.04 cm(2)), group 2--ten roots irradiated with a smaller laser tip (area of 0.028 cm(2)), and group 3--ten teeth with the crown, irradiate with the laser tip with 0.04 cm(2) of area. The forth group (G4) followed the same methodology as group 3, but the irradiation was performed with smaller tip (area of 0.028 cm(2)) and G5 ten teeth with crown were irradiated using a 200-mm-diameter fiber/diffusor coupled to diode laser. Microbiological samples were taken after accessing the canal, after endodontic therapy, and after PDT. Groups 1 and 2 showed a reduction of two logs (99%), groups 3 and 4 of one log (85% and 97%, respectively), and group 5 of four logs (99.99%). Results suggest that the use of PDT added to endodontic treatment in roots canals infected with E. faecalis with the optical fiber/diffusor is better than when the laser light is used directed at the access of cavity.

GIS WORK GROUP: AN OVERVIEW (INCLUDES GIS-QA AND AUDITING GIS DATABASE SYSTEMS)

EPA Science Inventory

In order to promote cooperation in the implementation of GIS in regional offices, a GIS Regional Workgroup was established by the ten Regions in 1989. Since that time the GIS Work Group evolved and now consists of members from each of the ten EPA Regional Offices, the Office of A...

The medium-term effects of diadynamic currents in chronic low back pain; TENS versus diadynamic currents: A randomised, follow-up study.

PubMed

Sayilir, Selcuk; Yildizgoren, Mustafa Turgut

2017-11-01

The aims of the study were to evaluate the medium-term effects of diadynamic (DD) currents on relieving symptoms/improving physical functionality in patients with chronic low back pain (LBP) and to compare the efficacy of DD versus TENS. The patients were divided into two groups as the TENS group (n = 26) and the DD group (n = 29). Additional treatment of hot pack + therapeutic ultrasound was applied to all patients. The therapy programs were administered as a total of 10 sessions over a period of 2 weeks. Roland Morris Disability Questionnaire (RDQ), Oswestry Disability Index and Visual Analog Scale (VAS) values were recorded. Both groups showed significant improvements in VAS and RDQ scores after one month of the therapies (all p < 0.05). Using TENS and DD currents in chronic LBP can lead to reduced pain, and improved physical functions. Hence, DD currents can be used as an adjuvant therapy for rehabilitation of chronic LBP. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Comparative study on effects of manipulation treatment and transcutaneous electrical nerve stimulation on patients with cervicogenic headache].

PubMed

Li, Chen; Zhang, Xiu-ling; Ding, Hong; Tao, Yue-qiang; Zhan, Hong-sheng

2007-07-01

To compare the effects of manipulation treatment and transcutaneous electrical nerve stimulation (TENS) on patients with cervicogenic headache. Seventy patients with cervicogenic headache were randomly allocated to receive manipulation treatment and TENS treatment, which were given every other day respectively for total 40 days. The headache degree (numeric rating scale, NRS), frequency, lasting time and the range of motion (ROM) of the cervical spine 2 weeks before treatment and 4 weeks after treatment, were compared. Before treatment, there were no significant differences in the headache NRS scores , frequency, lasting time and the ROM scores between the two groups (P>0.05). After treatment, the headache NRS score, frequency, lasting time in the manipulation group decreased significantly (P<0.01), while in the TENS group just the headache NRS score decreased significantly (P<0.05). The ROM scores in both groups showed no significant changes (P>0.05). The response rate of manipulation treatment is 94.5%, significantly higher than 64.5% of TENS treatment (P<0.05). The manipulation treatment is an effective method for patients with cervicogenic headache.

Assessing the performance of multiplexed tandem PCR for the diagnosis of pathogenic genotypes of Theileria orientalis using pooled blood samples from cattle.

PubMed

Gebrekidan, Hagos; Gasser, Robin B; Stevenson, Mark A; McGrath, Sean; Jabbar, Abdul

2017-02-01

Oriental theileriosis caused by multiple genotypes of Theileria orientalis is an important tick-borne disease of bovines. Here, we assessed the performance of an established multiplexed tandem PCR (MT-PCR) for the diagnosis of the two recognized, pathogenic genotypes (chitose and ikeda) of T. orientalis in cattle using pooled blood samples. We used a total of 265 cattle blood samples, which were divided into two groups according to previous MT-PCR results for individual samples. Samples in group 1 (n = 155) were from a herd with a relatively high prevalence of T. orientalis infection; and those in group 2 (n = 110) were from four herds with a low prevalence. For group 1, 31 and 15 batches of five- and ten-pooled samples (selected at random), respectively, were formed. For group 2, 22 and 11 batches of five- and ten-pooled samples (selected at random), respectively, were formed. DNAs from individual pooled samples in each batch and group were then tested by MT-PCR. For group 1, the apparent prevalences estimated using the 31 batches of five-pooled samples (97%) and 15 batches of ten-pooled samples (100%) were significantly higher compared with individual samples (75%). For group 2, higher apparent prevalences (9% and 36%) were also recorded for the 22 and 11 batches of pooled samples, respectively, compared with individual samples (7%). Overall, the average infection intensity recorded for the genotypes of chitose and ikeda were considerably lower in pooled compared with individual samples. The diagnostic specificities of MT-PCR were estimated at 95% and 94%, respectively, when batches of five- and ten-pooled samples were tested, and 94% for individual samples. The diagnostic sensitivity of this assay was estimated at 98% same for all individual, five- and ten-pooled samples. This study shows that screening batches of five- and ten-pooled blood samples from cattle herds are similar to those obtained for individual samples, and, importantly, that the reduced cost for the testing of pooled samples represents a considerable saving to herd managers. Copyright © 2016 Elsevier Ltd. All rights reserved.

Health promotion practices in primary care groups.

PubMed

Heidemann, Ivonete Teresinha Schulter Buss; Alonso da Costa, Maria Fernanda Baeta Neves; Hermida, Patrícia Madalena Vieira; Marçal, Cláudia Cossentino Bruck; Antonini, Fabiano Oliveira; Cypriano, Camilla Costa

2018-04-01

This is a descriptive-exploratory study using a qualitative approach, conducted in ten municipalities in southern Brazil. Data were obtained by talking to 21 nurses from February to November 2012, through semi-structured interviews using questions to probe their health promotion practices. Data were analyzed through thematic analysis focused on health promotion concepts. We identified four themes about health promotion practices of family health nurses in Brazil: a) training of nurses for health promotion practice was weak; b) nurses formed health promotion groups around diseases and life stages; c) nurses formed groups to meet community needs; and d) nurses used health promotion techniques in group work. These family health nurses were somewhat aware of the importance of health promotion, and how to assist the population against various ailments using some health promotion strategies. The main weaknesses were the lack of understanding about health promotion concepts, and the difficulty of understanding the relevance of its practice, probably attributable to limitations in training. We conclude that primary care groups in Brazil's unified health system could do better in applying health promotion concepts in their practice.

Exploring participant appreciation of group-based principles for action in community-based physical activity programs for socially vulnerable groups in the Netherlands.

PubMed

Herens, Marion; Wagemakers, Annemarie; Vaandrager, Lenneke; Koelen, Maria

2015-11-25

Physical inactivity is a core risk factor for non-communicable diseases. In the Netherlands, socially vulnerable groups are relatively less active than groups with higher socio-economic status. Community-based health-enhancing physical activity (CBHEPA) programs aim to empower socially vulnerable groups by improving participants' health and wellbeing through physical activity. CBHEPA programs often revolve around group-based principles for action, such as active participation, enjoyment, and fostering group processes. As such principles are rarely made explicit, our study aims to identify which of the group-based principles for action are considered important by participants. Respondents (n = 76) from ten focus groups scored their individual appreciation of group-based principles for action - active participation, enjoyment, and fostering group processes - on a three-point, statement-based scale. Opinions were further discussed in the focus group. Focus group discussions were transcribed and analysed by a team of investigators. The coding procedures, identifying elements appreciated in group-based principles for action, were thematic and data driven. Statements about participatory programming generated much less consensus in appreciation among respondents than statements about enjoyment and fostering group processes. To some extent, group members participated in the development of program content. Participation in group formation or community initiatives was less frequently perceived as something within group members' control. Enjoyment, expressed as physical and emotional experiences, was found to be an individual driver of group exercise. Fostering group processes, expressed as social support, was found to contribute to enjoyment and learning achievements. Responsive leadership, ensuring responsive guidance, by an enthusiastic exercise trainer acting as a role model, were identified as additional necessary principles for action. Group-based principles for action in CBHEPA programs are not clearly demarcated. Fostering group processes is an overarching principle, conditional for the spin-off in terms of enjoyment and active participation. This, in turn, leads to a sense of ownership among participants, who take up responsibility for the exercise group as well as their individual activity behaviour. CBHEPA programs thrive on participants having fun together and exercise trainers' leadership skills. A professional, competent, responsive exercise trainer plays a key role in the organisation and maintenance of CBHEPA programs.

Effective small group teaching strategies for research supervision - A case study

NASA Astrophysics Data System (ADS)

Pathirana, Assela

2010-05-01

UNESCO-IHE's students are unique in several aspects: they are mid-career professionals separated from their last university experience by a number of years in the profession, they are from diverse social and cultural backgrounds, and they often have relatively clear understanding on the diverse problems in the practice of engineering in their respective countries and are focused on solving those. As a result of the diversity in many forms, managing effective groups during the research phase of the UNESCO-IHE master's course pose considerable challenge. In this paper, we present a unique combination of tools and approaches that are employed in managing a small group of students (between five and ten) in one study area, who were working on diverse research topics that had the common denominator of mathematical modelling. We blend a number of traditional (e.g. seminars, group discussions, focused training sessions) and non-traditional (e.g. Using collaboration platforms like WIKI, peer-learning) approaches so that the cohesion of the group in maintained and every member benefits from being a part of the group. Four years of experience with employing this blend of tools on a six-month long master's research programme showed us: The approach motivates the students to perform focusing not only on the end-goal of their research study, but on the process of day to day work that lead to that goal. The students' self-confidence is often enhanced by being a part of close-knit group. Initial workload of the teacher increases significantly by this approach, but later this is more than compensated by the fact that the teacher has to do little maintain the momentum. Both strong and not so-strong students equally benefit from the approach. A significant number of students develop a keen interest in being involved in research further. (e.g. engaging in doctoral studies.)

Pain relief by transcutaneous electric nerve stimulation with bidirectional modulated sine waves in patients with chronic back pain: a randomized, double-blind, sham-controlled study.

PubMed

Shimoji, Koki; Takahashi, Norio; Nishio, Yasuyuki; Koyanagi, Mika; Aida, Sumihisa

2007-01-01

Objectives.  Newly developed bidirectional modulated sine waves (BMW) might provide some derived benefit to patients with low back pain. Pain relief by transcutaneous electric nerve stimulation (TENS) with BMWs was tested. Materials and Methods.  Analgesic effects of BMWs and conventional bidirectional pulsed waves on chronic back pain in 28 patients were compared, and effects of repeated TENS using BMWs on chronic back pain were investigated in 21 patients by means of a randomized double-blind, sham-controlled, parallel-group method. Pain intensity was assessed using numerical rating scale (NRS). Results.  There was significant immediate reduction in NRS in patients receiving BMWs, and 60 min after treatment compared to sham TENS. Weekly repeated treatments using massage and TENS with BMWs for 5 weeks resulted in a decrease of NRS, but there were no significant differences between the TENS plus massage and sham TENS plus massage groups. Conclusions.  This study shows that TENS with BMWs significantly inhibits chronic back pain, and treatment effects are attained within a day. The results also suggest that there were no statistically significant long-term effects of TENS with BMW in the repeated treatment.

Occupational toxic epidermal necrolysis associated with dalbergia cochinchinensis: a retrospective comparative study of eight cases in China.

PubMed

Yang, Yongsheng; Zhang, Zhen; Lu, Xiaonian; Zhu, Xiaohua; Huang, Qiong; Liang, Jun; Xu, Jinhua

2015-12-01

Occupational toxic epidermal necrolysis (TEN) related to Dalbergia cochinchinensis has seldom been reported in the past. Its clinical characteristic needs to be investigated. This study reports eight cases of such disease in China. Eight patients with occupational TEN admitted from 2003 to 2012 were retrospectively analyzed and compared with 15 patients admitted with TEN caused by drugs as controls. Patients all received combination therapy of corticosteroid and intravenous immunoglobulin. The times for bullous ceasing, tapering of corticosteroid, and total hospitalization were compared between the two groups of patients. SCORTEN, a severity-of-illness scoring system for TEN prognosis, was applied to evaluate clinical outcome. The three time measurements in occupational TEN were longer than those in control, and the differences were statistically significant (P = 0.0023, 0.026, 0.0017), which means the total dose of corticosteroid needed in occupational TEN was higher than that in the control. There were no deaths in the two groups, although expected deaths were 0.612 and 0.836, respectively. Occupational TEN has a longer progression than TEN caused by drugs, and there is more difficulty in its treatment. Clinicians should pay attention to this disease. However, its mechanism and target therapy remain unclear. © 2015 The International Society of Dermatology.

Assessing the effects of transcutaneous electrical nerve stimulation (TENS) in post-thoracotomy analgesia.

PubMed

Ferreira, Fabiana Cristina; Issy, Adriana Machado; Sakata, Rioko Kimiko

2011-01-01

Transcutaneous electrical nerve stimulation (TENS) is commonly used to treat musculoskeletal pain, but it may also be indicated for postoperative analgesia. The objective of this study was to evaluate the analgesic effects of TENS on post-thoracotomy. Thirty patients between 18 and 60 years of age undergoing thoracotomy for lung cancer resection on the second postoperative day were included in this study. Patients were divided into two groups (G1 and G2). G1 patients were treated with TENS; and in G2 (without TENS) electrodes were placed but the equipment was not turned on. TENS was maintained for one hour. The visual analogue scale was used to evaluate the analgesic effects on three moments: before TENS (M0), immediately after TENS (M1), and one hour later (M2), with the patient at rest, elevation of the upper limbs, change in decubitus, and coughing. The intensity of pain at rest was higher in G2 immediately after TENS, but not one hour after the procedure. There was no difference between both groups with elevation of the upper limbs, decubitus change, and coughing. With the use of TENS for one hour on the second post-thoracotomy day in patients who received fentanyl (50 μg) associated with bupivacaine (5 mL), a reduction in pain intensity was observed at rest immediately after TENS; with elevation of the upper limbs, change in decubitus, and coughing, a reduction in pain severity was not observed. Copyright © 2011 Elsevier Editora Ltda. All rights reserved.

A pilot study of herbal medicine use in a Midwest Latino population

PubMed Central

Kiefer, David; Bradbury, E. Jane; Tellez-Girón, Patricia

2014-01-01

Background Herbal medicine use is common in the United States, especially in immigrant populations. This plant use is incompletely understood, with significant gaps in the literature for people living in the Midwest, about the plant species used, and about how home herbal medicine use interacts with allopathic medicine. Methods This pilot project used a qualitative research approach (interviews and focus groups, convenience sampling) to explore this topic for Latin America immigrants living in Madison, Wisconsin. Results Eight interviews and focus groups consisting of 42 people yielded 199 minutes of audio recordings and the mention of 57 medicinal plants. These plants were obtained from gardens, relatives and friends (abroad and local), mail order, and ten local retail establishments. Retail sites sold fresh plants, dried plants, spices, foods, and packaged products, ranging from 20 to over 150 plant products per site. A preponderance of plants, especially in Latino-focused stores, was food that also served a medicinal purpose. Participants mentioned 35 distinct health and disease categories for which herbal medicines were used, and sometimes, but not always, discussed plant use with their health care provider. When compared with likely Latin binomial taxonomic names, clinically-relevant confusions with the use of common plant names were also identified. Conclusions Overall, the findings presented illustrate the complexities surrounding herbal medicine use, and create a case for future work to involve other demographics, and focus on botanical identification, the quantification of disclosure rates, and the development of educational interventions for physicians and patients. PMID:24908901

Priority setting: what constitutes success? A conceptual framework for successful priority setting.

PubMed

Sibbald, Shannon L; Singer, Peter A; Upshur, Ross; Martin, Douglas K

2009-03-05

The sustainability of healthcare systems worldwide is threatened by a growing demand for services and expensive innovative technologies. Decision makers struggle in this environment to set priorities appropriately, particularly because they lack consensus about which values should guide their decisions. One way to approach this problem is to determine what all relevant stakeholders understand successful priority setting to mean. The goal of this research was to develop a conceptual framework for successful priority setting. Three separate empirical studies were completed using qualitative data collection methods (one-on-one interviews with healthcare decision makers from across Canada; focus groups with representation of patients, caregivers and policy makers; and Delphi study including scholars and decision makers from five countries). This paper synthesizes the findings from three studies into a framework of ten separate but interconnected elements germane to successful priority setting: stakeholder understanding, shifted priorities/reallocation of resources, decision making quality, stakeholder acceptance and satisfaction, positive externalities, stakeholder engagement, use of explicit process, information management, consideration of values and context, and revision or appeals mechanism. The ten elements specify both quantitative and qualitative dimensions of priority setting and relate to both process and outcome components. To our knowledge, this is the first framework that describes successful priority setting. The ten elements identified in this research provide guidance for decision makers and a common language to discuss priority setting success and work toward improving priority setting efforts.

Endothelial function and its relationship to leptin, homocysteine, and insulin resistance in lean and overweight eumenorrheic women and PCOS patients: a pilot study.

PubMed

Mancini, Fulvia; Cianciosi, Arianna; Reggiani, Giulio Marchesini; Facchinetti, Fabio; Battaglia, Cesare; de Aloysio, Domenico

2009-06-01

To verify if patients with polycystic ovarian syndrome (PCOS), have an increased cardiovascular risk compared with healthy controls. Prospective case-control study. University-based practice. Twenty eumenorrheic controls (ten lean [group A] and ten overweight [group B]) and 24 PCOS women (14 lean [group C] and ten overweight [group D]). Cardiovascular risk markers and hormonal parameters were assessed. Androgens, fasting glucose, insulin, leptin, fibrinogen, homocysteine, endothelin-1 and flow-mediated dilatation of the brachial artery were measured to investigate their relationship to weight and to PCOS. The brachial artery diameter and the pulsatility index, after the reactive hyperemia, showed in group A the most intense vasodilatation compared with the other groups. Homocysteine levels did not differ among the groups. Endothelin-1 was significantly higher in group A compared with groups B and D. Leptin was significantly lower in groups A and C compared with groups B and D. Insulin resistance was higher in groups B and D. Group A had significantly higher glucose-insulin ratio compared with all of the other groups; group C had significantly higher glucose-insulin ratio only compared with group D. Weight and PCOS are two independent variables affecting the endothelial function.

The New Portable Transcutaneous Electrical Nerve Stimulation Device Was Efficacious in the Control of Primary Dysmenorrhea Cramp Pain.

PubMed

Lauretti, Gabriela R; Oliveira, Raquel; Parada, Flavia; Mattos, Anita L

2015-08-01

Transcutaneous electrical nerve stimulation (TENS) is an established method for pain relief in dysmenorrhea. A feasible advantage would be the study of a portable device. The purpose of the study was to evaluate the effectiveness and safety of a new portable TENS device (TANYX®) for menstruation cramps. Forty women were evaluated in a double-blind, prospective, randomized fashion, divided into sham and active groups. TENS was applied medially at the suprapubic region, for 30-min duration at eight-hour intervals, up to seven days. The placebo group (PG) received sham device. The TENS group (TG) applied an active 85 Hz frequency TENS. Efficacy measures were pain relief evaluated on a visual analog scale (VAS) and diclofenac intake, and quality of life represented by: 1) capacity to get out of the bed, 2) food or drink intake, 3) missing routine daily activities such as work or school, and 4) quality of sleep. The active TENS device induced a prompt onset of pain relief in a strictly segmental manner nearby the dermatomes where the TENS was applied at the skin, and there was a drop in mean pain score from 8 to 2 cm (p < 0.001). Diclofenac consumption was also significantly reduced (p < 0.01), compared with the PG. Quality of life improved significantly in TG when compared with PG (p < 0.05). Three months after the beginning of the study, 14/20 of the women were still using the active device regularly. No adverse effects were observed. The portable, disposable, active TENS device induced a prompt onset of pain relief and improved the quality of life, without adverse effects, in patients with painful cramps associated with dysmenorrhea. © 2015 International Neuromodulation Society.

Effects of laryngeal manual therapy (LMT) and transcutaneous electrical nerve stimulation (TENS) in vocal folds diadochokinesis of dysphonic women: a randomized clinical trial.

PubMed

Siqueira, Larissa Thaís Donalonso; Silverio, Kelly Cristina Alves; Brasolotto, Alcione Ghedini; Guirro, Rinaldo Roberto de Jesus; Carneiro, Christiano Giácomo; Behlau, Mara

2017-05-15

To verify and compare the effect of transcutaneous electrical nerve stimulation (TENS) and laryngeal manual therapy (LMT) on laryngeal diadochokinesis (DDK) of dysphonic women. Twenty women with bilateral vocal nodules participated and were equally divided into: LMT Group - LMT application; TENS Group - TENS application; both groups received 12 sessions of treatment, twice a week, with a duration of 20 minutes each, applied by the same therapist. The women were evaluated as to laryngeal DDK at three moments: diagnostic, pre-treatment, and post-treatment, which produced three groups of measurements. The DDK recording was performed with intersected repetition of vowels /a/ and / i/. The analysis of vowels was performed by the program Motor Speech Profile Advanced (MSP)-KayPentax. The DDK parameters of the three evaluations were compared by means of the paired t-test (p≤0.05). The measurements of laryngeal DDK parameters were similar in the phase without treatment, indicating no individual variability over time. There was no change with respect to the speed of DDK after intervention, but after LMT, DDK of the vowel /i/ was more stable in terms of the duration of the emissions and intensity of emissions repeated. These results show improved coordination of vocal folds movement during phonation. There were no changes in the DDK parameters following TENS. LMT provides greater regularity of movement during laryngeal diadochokinesis in dysphonic women, which extends knowledge on the effect of rebalancing the larynx muscles during phonation, although TENS does not impact laryngeal diadochokinesis.

The effect of survivalism--self-expressionism culture on black male suicide acceptability: a cross-national analysis.

PubMed

Stack, Steven; Kposowa, Augustine J

2011-04-01

Cultural explanations of black suicide have focused on the US and stressed religiosity as a protective factor. This paper adds to this literature by (1) expanding the analysis of the impact of religiosity on black suicide to 10 nations, and (2) assessing the extent to which a broader cultural construct (self expressionism) affects black suicide acceptability. Data are from Wave 4 of the World Values Surveys 1991-2001 and refer to 3580 black males nested in ten countries. A hierarchical linear regression model determined that religiosity predicted black suicide acceptability across ten nations. Self expressionism was positively associated with individual level suicide acceptability. Further, a cross-level interaction was found wherein individual level and societal level self expressionism combined to affect suicide acceptability. The variability in suicide acceptability among black males is predicted, in part, by both individual and group levels of adherence to values contained in a major cultural axis of nations: self expressionism. These new found associations compliment the impact of a standard predictor, religiosity, on suicide acceptability. Copyright © 2011 Elsevier Ltd. All rights reserved.

Community structure of aquatic insects in the karstic Jadro River in Croatia.

PubMed

Rađa, Biljana; Santić, Mate

2014-04-19

This study focused on the aquatic insect community in the longitudinal gradient and temporal scales of the Jadro River. The river was sampled for a period of ten years (2000- 2010), four times per year through the various seasons, along the river course. Sampling stations were selected in the upper, middle, and downstream parts of the river. A total of 21,852 specimens of aquatic insects belonging to six orders were obtained. The species determination confirmed 27 different species in the river. The data were analyzed by the multivariate methodologies of correspondence analysis and cluster analysis (unweighted pair group method with arithmetic mean) using the similarity index of Morosita for all ten years. Canonical correspondence analysis was applied to the data to check which of the mesured physicochemical variables significantly explained community variation. According to those data, significant variables for the upper station were water temperature and dissolved oxygen, and chlorides was the significant variable for the lower stations. This is an open access paper. We use the Creative Commons Attribution 3.0 license that permits unrestricted use, provided that the paper is properly attributed.

The Subchronic Oral Toxicity of 2,4-Dinitroanisole (DNAN) in Rats

DTIC Science & Technology

2012-06-01

Harlan, Teklad; ALPHA-dri® is a registered trademark with Shepard Specialty Papers.) A total of four male and four female rats not placed on study...registered trademark with Shepard Specialty Papers.) Ten males and ten females were distributed into four treatment groups and a vehicle control group...If significant differences were observed, then a Mann~Whitney test was conducted to compare pairs of treatment groups. SPSS® 16.0 ( Chicago

Grassland Bird Conservation Efforts in Missouri and Iowa: How Will We Measure Success?

Treesearch

Brad Jacobs; Rolf R. Koford; Frank R. Thompson III; Hope Woodward; Mike Hubbard; Jane A. Fitzgerald; James R. Herkert

2005-01-01

Missouri and Iowa have adopted the Bird Conservation Area (BCA) model of Partners in Flight and applied the BCA model to ten areas managed to benefit grassland birds. These ten BCAs have large core areas of continuous grassland centered on active lek sites of Greater Prairie-Chickens (Tympanuchus cupido). Management is focused on expanding the number...

Great Expectations: Creative Achievements of the Sociometric Stars in a 30-Year Study

ERIC Educational Resources Information Center

Torrance, E. Paul

2004-01-01

The creative achievements and characteristics of a group of ten high school students identified as the most creative by their high school peers were compared to those of ten participants from the same group who had the greatest number of publicly recognized creative achievements approximately 30 years later (Sociometric Stars vs. Beyonders).…

The long-term impact of employment on mental health service use and costs for persons with severe mental illness.

PubMed

Bush, Philip W; Drake, Robert E; Xie, Haiyi; McHugo, Gregory J; Haslett, William R

2009-08-01

Stable employment promotes recovery for persons with severe mental illness by enhancing income and quality of life, but its impact on mental health costs has been unclear. This study examined service cost over ten years among participants in a co-occurring disorders study. Latent-class growth analysis of competitive employment identified trajectory groups. The authors calculated annual costs of outpatient services and institutional stays for 187 participants and examined group differences in ten-year utilization and cost. A steady-work group (N=51) included individuals whose work hours increased rapidly and then stabilized to average 5,060 hours per person over ten years. A late-work group (N=57) and a no-work group (N=79) did not differ significantly in utilization or cost outcomes, so they were combined into a minimum-work group (N=136). More education, a bipolar disorder diagnosis (versus schizophrenia or schizoaffective disorder), work in the past year, and lower scores on the expanded Brief Psychiatric Rating Scale predicted membership in the steady-work group. These variables were controlled for in the outcomes analysis. Use of outpatient services for the steady-work group declined at a significantly greater rate than it did for the minimum-work group, while institutional (hospital, jail, or prison) stays declined for both groups without a significant difference. The average cost per participant for outpatient services and institutional stays for the minimum-work group exceeded that of the steady-work group by $166,350 over ten years. Highly significant reductions in service use were associated with steady employment. Given supported employment's well-established contributions to recovery, evidence of long-term reductions in the cost of mental health services should lead policy makers and insurers to promote wider implementation.

First Year After Stroke: An Integrated Approach Focusing on Participation Goals Aiming to Reduce Depressive Symptoms.

PubMed

Graven, Christine; Brock, Kim; Hill, Keith D; Cotton, Sue; Joubert, Lynette

2016-11-01

Depression is a common issue after stroke. A focus on assisting people to achieve their personal participation goals may reduce levels of depression. The aim of this study was to investigate the effectiveness of a person-centered, integrated approach on facilitating goal achievement in the first year poststroke on depressive symptoms. This study was a randomized controlled trial that addressed ways to enhance participation in patient-valued activities and intermittently screen for adverse sequelae postdischarge from rehabilitation. Collaborative goal setting was undertaken in both groups at discharge from inpatient rehabilitation. The control group received standard management as determined by the treating team. In addition, the intervention group received a multimodal approach, including telephone contacts, screening for adverse sequelae, written information, home visits, review of goal achievement, and further referral to relevant health services. The main outcome measure was depressed mood, measured by the 15-item Geriatric Depression Scale. One hundred ten participants were recruited. No group differences were identified at baseline on any demographic and clinical variables. Using multiple linear regression analysis, there was a significant difference between the 2 groups with respect to the severity of depressive symptoms at 12 months poststroke (R 2 =0.366; F (6, 89)=8.57; P<0.005), with the intervention group recording lower depressive scores. This model of community-based rehabilitation proved effective in reducing poststroke depressive symptoms. An integrated approach using pursuit of patient-identified activities should form part of routine poststroke management. URL: http://www.anzctr.org.au. Unique identifier: ACTRN12608000042347. © 2016 American Heart Association, Inc.

Inquiry Teaching in High School Chemistry Classrooms: The Role of Knowledge and Beliefs

NASA Astrophysics Data System (ADS)

Roehrig, Gillian H.; Luft, Julie A.

2004-10-01

"Science as inquiry" is a key content standard in the National Science Education Standards, yet implementation of inquiry-based teaching is rare in secondary chemistry classrooms. This paper is the result of a study conducted to understand factors that effect the inquiry-based instruction of ten novice secondary chemistry teachers. The study focused on the influence of teaching beliefs and content knowledge on the instructional practices of these ten teachers. Case and cross-case comparisons revealed that chemistry teachers' intentions to implement inquiry teaching were strongly influenced by their teaching beliefs rather than their knowledge of chemistry. The quality of inquiry lessons, however, was found to depend on the teachers' knowledge of chemistry content. This study reinforces the need for chemistry-focused inservice training for beginning chemistry teachers that focuses on both inquiry teaching strategies and teaching beliefs.

Using virtual worlds for role play simulation in child and adolescent psychiatry: an evaluation study

PubMed Central

Vallance, Aaron K.; Hemani, Ashish; Fernandez, Victoria; Livingstone, Daniel; McCusker, Kerri; Toro-Troconis, Maria

2014-01-01

Aims and method To develop and evaluate a novel teaching session on clinical assessment using role play simulation. Teaching and research sessions occurred sequentially in computer laboratories. Ten medical students were divided into two online small-group teaching sessions. Students role-played as clinician avatars and the teacher played a suicidal adolescent avatar. Questionnaire and focus-group methodology evaluated participants’ attitudes to the learning experience. Quantitative data were analysed using SPSS, qualitative data through nominal-group and thematic analyses. Results Participants reported improvements in psychiatric skills/knowledge, expressing less anxiety and more enjoyment than role-playing face to face. Data demonstrated a positive relationship between simulator fidelity and perceived utility. Some participants expressed concern about added value over other learning methods and non-verbal communication. Clinical implications The study shows that virtual worlds can successfully host role play simulation, valued by students as a useful learning method. The potential for distance learning would allow delivery irrespective of geographical distance and boundaries. PMID:25285217

Overdose Education and Naloxone for Patients Prescribed Opioids in Primary Care: A Qualitative Study of Primary Care Staff.

PubMed

Binswanger, Ingrid A; Koester, Stephen; Mueller, Shane R; Gardner, Edward M; Goddard, Kristin; Glanz, Jason M

2015-12-01

The rate of fatal unintentional pharmaceutical opioid poisonings has increased substantially since the late 1990s. Naloxone is an effective opioid antidote that can be prescribed to patients for bystander use in the event of an overdose. Primary care clinics represent settings in which large populations of patients prescribed opioids could be reached for overdose education and naloxone prescription. Our aim was to investigate the knowledge, attitudes and beliefs about overdose education and naloxone prescription among clinical staff in primary care. This was a qualitative study using focus groups to elucidate both clinic-level and provider-level barriers and facilitators. Ten primary care internal medicine, family medicine and infectious disease/HIV practices in three large Colorado health systems. A focus group guide was developed based on behavioral theory. Focus group transcripts were coded for manifest and latent meaning, and analyzed for themes using a recursive approach that included inductive and deductive analysis. Themes emerged in four content areas related to overdose education and naloxone prescription: knowledge, barriers, benefits and facilitators. Clinical staff (N = 56) demonstrated substantial knowledge gaps about naloxone and its use in outpatient settings. They expressed uncertainty about who to prescribe naloxone to, and identified a range of logistical barriers to its use in practice. Staff also described fears about offending patients and concerns about increased risk behaviors in patients prescribed naloxone. When considering naloxone, some providers reflected critically and with discomfort on their own opioid prescribing. These barriers were balanced by beliefs that prescribing naloxone could prevent death and result in safer opioid use behaviors. Findings from these qualitative focus groups may not be generalizable to other settings. In addition to evidence gaps, logistical and attitudinal barriers will need to be addressed to enhance uptake of overdose education and naloxone prescription for patients prescribed opioids for pain.

What does it mean to be a family physician?

PubMed Central

Beaulieu, Marie-Dominique; Dory, Valérie; Pestiaux, Dominique; Pouchain, Denis; Rioux, Marc; Rocher, Guy; Gay, Bernard; Boucher, Laurier

2009-01-01

Abstract OBJECTIVE To explore the conceptions that family medicine residents from 3 countries have of the roles and responsibilities of family physicians in order to gain a better understanding of challenges that might transcend the specific contexts of different health care systems. DESIGN Qualitative study using focus groups. SETTING Resident training programs in France, Belgium, and Canada. PARTICIPANTS A total of 57 residents in the last year of training. METHOD Ten focus groups were conducted in 3 countries: 2 in France, 3 in Belgium, and 5 in Canada. All focus groups were held in different cities, with residents registered in different universities in France and Canada and with residents from the same university in Belgium. The study was informed by Abbott’s conceptual framework on the system of professions. Each 90-minute focus group was moderated by the same researchers. The transcripts were analyzed according to the immersion-crystallization method. MAIN FINDINGS Respondents shared common conceptions of the family physician’s role: continuity of care and patient advocacy were seen as the foundations of the discipline. Respondents also shared a sense of discomfort about how accessible they were expected to be for patients and about the scope of family practice. They saw family medicine as flexible and reported that they strove for balance between their professional and personal life goals. All respondents strongly believed that their profession was undervalued by the medical schools where they trained. CONCLUSION This exploratory study suggests that there are more similarities than differences in the understanding that future family physicians from different countries have of their discipline and of their careers. We observed a tension between a desire to develop a “new general practice” and the more traditional vision of the discipline. The culture in academic settings appears to contribute to the persistent low appeal of being a primary care physician. PMID:19675252

The noxious effects of electroimmobilization in adult Holstein cows: a pilot study.

PubMed Central

Pascoe, P J; McDonell, W N

1986-01-01

Ten adult Holstein cows were used in an experiment to determine whether the induction of electroimmobilization was a noxious event. The cows were halter trained and accustomed to being led into a set of stocks. The time taken for the cattle to walk the last ten metres into the stocks was recorded. The heart rate of the cow was recorded for a three minute period prior to a ten second exposure to a high pitched sound (the conditioning stimulus). Measurements were collected for three repetitions and then the cows were assigned to two groups of five. One group was immobilized for 30 seconds using a commercial electroimmobilizer, the other group was not treated. This procedure was repeated ten times over a period of eight days. The cows were then exposed to the conditioning stimulus and their response observed. The treated group took significantly (P less than 0.05) longer to get into the stocks and the regression slopes for heart rate were significantly different from the control group. The treated cows responded to the conditioning stimulus at five and nine months after the end of the conditioning period. Adult Holstein cows regarded electroimmobilization as a noxious event and were very strongly conditioned to this stimulus. PMID:3756681

The efficacy of transcutaneous electrical nerve stimulation on the improvement of walking distance in patients with peripheral arterial disease with intermittent claudication: study protocol for a randomised controlled trial: the TENS-PAD study.

PubMed

Besnier, Florent; Sénard, Jean-Michel; Grémeaux, Vincent; Riédel, Mélanie; Garrigues, Damien; Guiraud, Thibaut; Labrunée, Marc

2017-08-10

In patients with peripheral arterial disease (PAD), walking improvements are often limited by early pain onset due to vascular claudication. It would thus appear interesting to develop noninvasive therapeutic strategies, such as transcutaneous electrical nerve stimulation (TENS), to improve the participation of PAD patients in rehabilitation programmes, and thus improve their quality of life. Our team recently tested the efficacy of a single 45-min session of 10-Hz TENS prior to walking. TENS significantly delayed pain onset and increased the pain-free walking distance in patients with class-II PAD. We now seek to assess the efficacy of a chronic intervention that includes the daily use of TENS for 3 weeks (5 days a week) on walking distance in Leriche-Fontaine stage-II PAD patients. This is a prospective, double-blind, multicentre, randomised, placebo-controlled trial. One hundred subjects with unilateral PAD (Leriche-Fontaine stage II) will be randomised into two groups (1:1). For the experimental group (TENS group): the treatment will consist of stimulation of the affected leg (at a biphasic frequency of 10 Hz, with a pulse width of 200 μs, maximal intensity below the motor threshold) for 45 min per day, in the morning before the exercise rehabilitation programme, for 3 weeks, 5 days per week. For the control group (SHAM group): the placebo stimulation will be delivered according to the same modalities as for the TENS group but with a voltage level automatically falling to zero after 10 s of stimulation. First outcome: walking distance without pain. transcutaneous oxygen pressure (TcPO 2 ) measured during a Strandness exercise test, peak oxygen uptake (VO 2 peak), endothelial function (EndoPAT®), Ankle-brachial Pressure Index, Body Mass Index, lipid profile (LDL-C, HDL-C, triglycerides), fasting glycaemia, HbA1c level, and the WELCH questionnaire. TENS-PAD is the first randomised controlled trial that uses transcutaneous electrical therapy as an adjuvant technique to improve vascular function in the treatment of PAD. If the results are confirmed, this technique could be incorporated into the routine care in cardiovascular rehabilitation centers and used in the long term by patients to improve their walking capacity. ClinicalTrials.gov, ID: NCT02678403 . Registered on 9 February 2016. Toulouse University Hospital.

An evaluation of a pain education programme for physiotherapists in clinical practice.

PubMed

Monaghan, Jenni; Adams, Nicola; Fothergill, Melissa

2018-03-01

The present study evaluated the implementation and acceptability of a pain education programme delivered to physiotherapists in clinical practice. A pre-test/post-test design with 10 physiotherapists was employed. Descriptive and inferential statistics were used for outcome measure data. Focus groups were carried out with seven physiotherapists within 1 month post-intervention. These data were analysed using the framework approach. Ten musculoskeletal physiotherapists were recruited. It was possible to develop and deliver the intervention and this was found to be acceptable to physiotherapists within clinical practice. The study explored trends within outcome measures, and one was considered appropriate. The focus groups yielded three interlinked themes, which related to the impact of the programme: "providing a context for pain education", "influence on aspects of the patient-therapist encounter" and "logistics of the education programme in clinical practice". A pain education programme delivered to physiotherapists in clinical practice was both possible to deliver and acceptable to participants. A key strength of the programme was the applicability to real-life practice, which was valued by physiotherapists. While physiotherapists felt that pain neurophysiology education was important, they reported lacking confidence in implementing their pain neurophysiology knowledge with patients. Thus, more time is needed to focus on pain neurophysiology education, with the aim of increasing confidence with the application of this approach in clinical practice. Copyright © 2017 John Wiley & Sons, Ltd.

Underlying neurological dysfunction in children with language, speech or learning difficulties and a verbal IQ--performance IQ discrepancy.

PubMed

Meulemans, J; Goeleven, A; Zink, I; Loyez, L; Lagae, L; Debruyne, F

2012-01-01

We investigated the relationship between possible underlying neurological dysfunction and a significant discrepancy between verbal IQ/performance IQ (VIQ-PIQ) in children with language, speech or learning difficulties. In a retrospective study, we analysed data obtained from intelligence testing and neurological evaluation in 49 children with a significant VIQ-PIQ discrepancy (> or = 25 points) who were referred because of language, speech or learning difficulties to the Multidisciplinary University Centre for Logopedics and Audiology (MUCLA) of the University Hospitals of Leuven, Belgium. The group of children broke down into a group of 35 children with PIQ > VIQ and a group of 14 children with VIQ > PIQ. In the first group, neurological data were present for 24 children. The neurological history and clinical neurological examination were normal in all cases. Brain MRI was performed in 15 cases and proved to be normal in all children. Brain activity was assessed with long-term video EEG monitoring in ten children. In two children, the EEG results were abnormal: there was an epileptic focus in one child and a manifest alteration in the EEG typical of Landau-Kleffner syndrome in the other. In the second group of 14 children whose VIQ was higher than the PIQ, neurological data were available for ten children. Neurological history and clinical neurological examination were normal in all cases. Brain MRI was performed in five cases and was normal in all children. EEG monitoring was performed in one child. This revealed benign childhood epilepsy with centrotemporal spikes. In a small number of children (9%) with speech, language and learning difficulties and a discrepancy between VIQ and PIQ, an underlying neurological abnormality is present. We recommend referring children with a significant VIQ-PIQ mismatch to a paediatric neurologist. As an epileptic disorder seems to be the most common underlying neurological pathology in this specific group of children, EEG monitoring should be recommended in these children. Neuro-imaging should only be used in selected patients.

Been There, Done That: The Experience of Acting as a Young Adult Mentor to Adolescents Living With Chronic Illness.

PubMed

Ahola Kohut, Sara; Stinson, Jennifer; Forgeron, Paula; Luca, Stephanie; Harris, Lauren

2017-10-01

To explore the perceived benefits and challenges of acting as a young adult peer mentor to adolescents with chronic illness. A qualitative descriptive study, using interviews and a focus group, explored the perceptions of young adult peer mentors following participation in the iPeer2Peer program, a Skype-based peer-mentorship program for adolescents with chronic illness. Interviews and focus group data were transcribed and analyzed using inductive content analysis. Ten peer mentors (20.00 ± 1.49 years old, range 17-22 years; diagnosed with chronic pain [n = 4] or juvenile idiopathic arthritis [n = 6]) who mentored four mentees (±2.55 mentees, range = 1-10 mentees) participated. Four main categories were identified: social connection, personal growth, mentor role in mentee growth, and logistics of mentorship. Acting as a peer mentor online is a feasible and rewarding experience that supports the mentor's own illness self-management, social connection, and personal growth. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

The Surgeons' Leadership Inventory (SLI): a taxonomy and rating system for surgeons' intraoperative leadership skills.

PubMed

Henrickson Parker, Sarah; Flin, Rhona; McKinley, Aileen; Yule, Steven

2013-06-01

Surgeons must demonstrate leadership to optimize performance and maximize patient safety in the operating room, but no behavior rating tool is available to measure leadership. Ten focus groups with members of the operating room team discussed surgeons' intraoperative leadership. Surgeons' leadership behaviors were extracted and used to finalize the Surgeons' Leadership Inventory (SLI), which was checked by surgeons (n = 6) for accuracy and face validity. The SLI was used to code video recordings (n = 5) of operations to test reliability. Eight elements of surgeons' leadership were included in the SLI: (1) maintaining standards, (2) managing resources, (3) making decisions, (4) directing, (5) training, (6) supporting others, (7) communicating, and (8) coping with pressure. Interrater reliability to code videos of surgeons' behaviors while operating using this tool was acceptable (κ = .70). The SLI is empirically grounded in focus group data and both the leadership and surgical literature. The interrater reliability of the system was acceptable. The inventory could be used for rating surgeons' leadership in the operating room for research or as a basis for postoperative feedback on performance. Copyright © 2013 Elsevier Inc. All rights reserved.

Preschoolers’ Dietary Behaviours: Parents’ Perspectives

PubMed Central

TUCKER, PATRICIA; IRWIN, JENNIFER D.; HE, MEIZI; BOUCK, L. MICHELLE SANGSTER; POLLETT, GRAHAM

2016-01-01

Purpose Preschoolers’ dietary intake behaviours are described from the perspective of their parents. Methods A maximum variation sample of 71 parents of preschoolers participated in this qualitative study. Ten semi-structured focus group interviews were conducted. Two experienced moderators facilitated all focus groups, which were audio-recorded and transcribed verbatim. Strategies to ensure trustworthiness of the data were employed throughout the study. Two team members independently performed inductive content analysis. NVivo software was used to code the emerging themes. Results Parents identified food and food issues as key health-related behaviours among preschoolers. Parents discussed challenges to healthy eating, including time limitations and societal pressures, as well as methods for facilitating healthy food choices, including bribery, education, and being creative with food. Conclusions Dietary intake is on the minds of preschoolers’ parents. Unfortunately, some methods that parents currently use to promote healthy food choices may be more detrimental than beneficial for children in the long term. Parents’ keen interest in their preschoolers’ eating habits may make them particularly receptive to learning about and facilitating healthy choices in more behaviourally appropriate ways. Widespread educational messages about the benefits and detriments of various strategies to facilitate healthy eating among preschoolers therefore seem warranted. PMID:16759432

Research priorities for nursing and midwifery in Southern Ireland.

PubMed

McCarthy, G; Savage, E; Lehane, E

2006-06-01

To identify research priorities for nursing and midwifery in the Southern Health Board area in Ireland for the immediate and long term. Ten focus groups were conducted over a 2-month period with 70 nurses and midwives working in clinical, managerial and educational roles participating. Based on focus group findings and a literature review a multi-item Likert type questionnaire was constructed and administered to 520 nurses and midwives (response rate 95%n=494). Research priorities were identified as: (1) impact of staff shortages on retention of RNs/RM's (80%); (2) quality of life of chronically ill patients (76%); (3) stress and bullying in the workplace (76%); (4) assessment and management of pain (75%); (5) skill mix and staff burnout (73%); (6) cardio-pulmonary resuscitation decision making (72%); (7) coordination of care between hospital and primary care settings (69%); (8) medication errors (67%); and (9) promoting healthy lifestyles (64%). Respondents also indicated that these priorities warranted immediate attention. Implications for practice include the need for: (1) emphasis on quality pain control; (2) recognition and exploration of the ethical issues relating to resuscitation; and (3) management of the context within which clinical care is given.

Preschoolers' dietary behaviours: parents' perspectives.

PubMed

Tucker, Patricia; Irwin, Jennifer D; He, Meizi; Bouck, L Michelle Sangster; Pollett, Graham

2006-01-01

Preschoolers' dietary intake behaviours are described from the perspective of their parents. A maximum variation sample of 71 parents of preschoolers participated in this qualitative study. Ten semi-structured focus group interviews were conducted. Two experienced moderators facilitated all focus groups, which were audio-recorded and transcribed verbatim. Strategies to ensure trustworthiness of the data were employed throughout the study. Two team members independently performed inductive content analysis. NVivo software was used to code the emerging themes. Parents identified food and food issues as key health-related behaviours among preschoolers. Parents discussed challenges to healthy eating, including time limitations and societal pressures, as well as methods for facilitating healthy food choices, including bribery, education, and being creative with food. Dietary intake is on the minds of preschoolers' parents. Unfortunately, some methods that parents currently use to promote healthy food choices may be more detrimental than beneficial for children in the long term. Parents' keen interest in their preschoolers' eating habits may make them particularly receptive to learning about and facilitating healthy choices in more behaviourally appropriate ways. Widespread educational messages about the benefits and detriments of various strategies to facilitate healthy eating among preschoolers therefore seem warranted.

Sequentially allocated clinical trial of rhythmic stabilization exercises and TENS in women with chronic low back pain.

PubMed

Kofotolis, Nikolaos D; Vlachopoulos, Symeon P; Kellis, Eleftherios

2008-02-01

To examine the effectiveness of rhythmic stabilization exercises and transcutaneous electrical nerve stimulation (TENS) and their combination in treating women with chronic low back pain. Sequentially allocated, single-blinded and controlled study, with a two-month follow-up. The data were collected in a patient rehabilitation setting. A total of 92 women (34-46 years old) with chronic low back pain were studied. Sequential allocation was undertaken into four groups: ;rhythmic stabilization' (n=23), ;rhythmic stabilization - TENS' (n=23), TENS (n=23), and a placebo group (n = 23). Each programme lasted for four weeks. All outcome measures were assessed prior to, immediately after, four weeks and eight weeks post intervention. Data were obtained on functional disability, pain intensity, trunk extension range of motion, dynamic endurance of trunk flexion and static endurance of trunk extension. A total of 88 patients provided two-month follow-up data. The ;rhythmic stabilization' and the ;rhythmic stabilization - TENS' groups displayed statistically significant (P<0.05) improvements in functional disability and pain intensity (ranging from 21.2 to 42.8%), trunk extension range of motion (ranging from 6.5 to 25.5%), dynamic endurance of trunk flexion and static endurance of trunk extension (ranging from 13.5 to 74.3%) compared with the remaining groups. The rhythmic stabilization programmes resulted in more gains in women with chronic low back pain regarding the present outcome variables compared with the other groups; therefore, its application in female chronic low back pain patients aged 34-46 years is recommended.

String universality in ten dimensions.

PubMed

Adams, Allan; Taylor, Washington; Dewolfe, Oliver

2010-08-13

We show that the N=1 supergravity theories in ten dimensions with gauge groups U(1){496} and E{8}×U(1){248} are not consistent quantum theories. Cancellation of anomalies cannot be made compatible with supersymmetry and Abelian gauge invariance. Thus, in ten dimensions all supersymmetric theories of gravity without known inconsistencies are realized in string theory.

Randomized Trial of Treatment for Children with Sexual Behavior Problems: Ten-Year Follow-Up

ERIC Educational Resources Information Center

Carpentier, Melissa Y.; Silovsky, Jane F.; Chaffin, Mark

2006-01-01

This study prospectively follows 135 children 5-12 years of age with sexual behavior problems from a randomized trial comparing a 12-session group cognitive-behavioral therapy (CBT) with group play therapy and follows 156 general clinic children with nonsexual behavior problems. Ten-year follow-up data on future juvenile and adult arrests and…

Learning from the Experts: Gaining Insights into Best Practice during the Acquisition of Three Novel Motor Skills

ERIC Educational Resources Information Center

Hodges, Nicola J.; Edwards, Christopher; Luttin, Shaun; Bowcock, Alison

2011-01-01

The amount and quality of practice predicts expertise, yet optimal conditions of practice have primarily been explored with novice learners. Ten expert musicians and ten novices practiced disc-throwing skills under self-regulated conditions. A third novice group practiced with the same schedule as the music experts (yoked). The groups did not…

Building organizational supports for knowledge sharing in county human service organizations: a cross-case analysis of works-in-progress.

PubMed

Lee, Chris; Austin, Michael J

2012-01-01

Building on the literature related to evidence-based practice, knowledge management, and learning organizations, this cross-case analysis presents twelve works-in-progress in ten local public human service organizations seeking to develop their own knowledge sharing systems. The data for this cross-case analysis can be found in the various contributions to this Special Issue. The findings feature the developmental aspects of building a learning organization that include knowledge sharing systems featuring transparency, self-assessment, and dissemination and utilization. Implications for practice focus on the structure and processes involved in building knowledge sharing teams inside public human service organizations. Copyright © Taylor & Francis Group, LLC

Strong terahertz field generation, detection, and application

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kim, Ki-Yong

2016-05-22

This report describes the generation and detection of high-power, broadband terahertz (THz) radiation with using femtosecond terawatt (TW) laser systems. In particular, this focuses on two-color laser mixing in gases as a scalable THz source, addressing both microscopic and macroscopic effects governing its output THz yield and radiation profile. This also includes the characterization of extremely broad THz spectra extending from microwaves to infrared frequencies. Experimentally, my group has generated high-energy (tens of microjoule), intense (>8 MV/cm), and broadband (0.01~60 THz) THz radiation in two-color laser mixing in air. Such an intense THz field can be utilized to study THz-drivenmore » extremely nonlinear phenomena in a university laboratory.« less

Strong terahertz field generation, detection, and application

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kim, Ki-Yong

2016-05-15

This report describes the generation and detection of high-power, broadband terahertz (THz) radiation with using femtosecond terawatt (TW) laser systems. In particular, this focuses on two-color laser mixing in gases as a scalable THz source, addressing both microscopic and macroscopic effects governing its output THz yield and radiation profile. This also includes the characterization of extremely broad THz spectra extending from microwaves to infrared frequencies. Experimentally, my group has generated high-energy (tens of microjoule), intense (>8 MV/cm), and broadband (0.01~60 THz) THz radiation in two-color laser mixing in air. Such an intense THz field can be utilized to study THz-drivenmore » extremely nonlinear phenomena in a university laboratory.« less

Four Generations of Maintenance Resource Management Programs in the United States: An Analysis of the Past, Present, and Future

NASA Technical Reports Server (NTRS)

Taylor, James C.; Patankar, Manoj S.

2001-01-01

This paper analyzes four generations of Maintenance Resource Management (MRM) programs implemented by aviation maintenance organizations in the United States. Data collected from over ten years of survey research and field observations are used for this analysis; they are presented in a case-study format. The first three generations of MRM programs were episodic efforts to increase safety through teamwork, focus group discussions, and awareness courses, respectively. Now, the fourth generation programs, characterized by a commitment to long-term communication and behavioral changes in maintenance, are set to build on those earlier generations, toward a culture of mutual trust between mechanics, their managers, and regulators.

The effect of peculiar complex core balance training on isokinetic muscle functions of the knee and lumbus

PubMed Central

Lee, Myungsun; Han, Gunsoo

2016-01-01

[Purpose] This study aimed to investigate the effect of peculiar complex core balance training on the isokinetic muscle function of the knee joint and lumbus to provide fundamental data for establishing a training program that focuses on improving the performance and prevention of injury by developing the core and low extremity muscles. [Subjects and Methods] The participants in this study included a total of ten high school athletes involved in a throwing event for over five years. The subjects were randomly divided into two groups: The experimental group (N=5) and the control group (N=5). The experimental group underwent peculiar complex core balance training. [Results] According to the analysis of covariance, there was a significant effect of peculiar complex core balance training. Therefore, the isokinetic muscle function of the knee joint and lumbus in the experimental group participating in peculiar complex core balance training was significantly increased compared to the control group. [Conclusion] It is concluded that peculiar complex core balance training had a positive effect on the isokinetic muscle function of the knee and lumbus in throwing event athletes. PMID:27190470

Effects of visual illusion and transcutaneous electrical nerve stimulation on neuropathic pain in patients with spinal cord injury: A randomised controlled cross-over trial.

PubMed

Özkul, Çağla; Kılınç, Muhammed; Yıldırım, Sibel Aksu; Topçuoğlu, Elif Yalçın; Akyüz, Müfit

2015-01-01

Chronic pain is a common consequence of spinal cord injury (SCI). No therapeutic drugs or drug groups are proven to be superior for neuropathic pain and treatments only aim to convert pain from dull to tolerable levels and not to remove it. This study was planned to compare the effect of visual illusion (VI) and transcutaneous electrical nerve stimulation (TENS) on pain intensity, pain quality and functional capacity in SCI patients with neuropathic pain. Twenty-four patients were included and randomly categorized into two groups. In the first group (n= 12), visual illusion was applied for first two weeks, 1 week wash out period and then TENS was applied for 2 weeks. In second group (n= 12), TENS was applied firstly, 1 week wash out and then %visual illusion VI were applied. Pain severity, pain quality, and functional capacity were assessed with the visual analog scale (VAS), the neuropathic pain scale (NPS), and the brief pain inventory (BPI), respectively. A pre-post-treatment and cross over design was used. Wilcoxon signed-rank tests were used for within group analyses. Mann-Whitney U tests were used for analyses that compared different groups. It was observed that pain intensity decrease immediately after both applications (VI: p= 0.07, TENS: p= 0.08). After TENS application for 2 weeks, it was observed that significant decrease in most (p= 0.04) and less (p= 0.02) pain intensity; while there was no significant decrease in pain intensity after 2 weeks for VI (p> 0.05). When findings of NPS were analyzed, hot (p= 0.047), sharp (p= 0.02), unpleasant (p= 0.03) and deep items (p= 0.047) decreased after VI application. When the results of BPI were detected, they were observed that the negative effect of pain on moving ability (p= 0.04) after visual illusion application and the negative effect of pain on mood (p= 0.03), relationships with others (p= 0.04) and sleep (p= 0.04) after TENS application decreased significantly. TENS and VI therapies can be successfully used in clinical practice as an alternative treatment or as a supportive method separetely or together.

Effects of transcutaneous electrical nerve stimulation on pain, walking function, respiratory muscle strength and vital capacity in kidney donors: a protocol of a randomized controlled trial

PubMed Central

2013-01-01

Background Pain is a negative factor in the recovery process of postoperative patients, causing pulmonary alterations and complications and affecting functional capacity. Thus, it is plausible to introduce transcutaneous electrical nerve stimulation (TENS) for pain relief to subsequently reduce complications caused by this pain in the postoperative period. The objective of this paper is to assess the effects of TENS on pain, walking function, respiratory muscle strength and vital capacity in kidney donors. Methods/design Seventy-four patients will be randomly allocated into 2 groups: active TENS or placebo TENS. All patients will be assessed for pain intensity, walk function (Iowa Gait Test), respiratory muscle strength (maximal inspiratory pressure and maximal expiratory pressure) and vital capacity before and after the TENS application. The data will be collected by an assessor who is blinded to the group allocation. Discussion This study is the first to examine the effects of TENS in this population. TENS during the postoperative period may result in pain relief and improvements in pulmonary tests and mobility, thus leading to an improved quality of life and further promoting organ donation. Trial registration Registro Brasileiro de Ensaios Clinicos (ReBEC), number RBR-8xtkjp. PMID:23311705

Adjunct High Frequency Transcutaneous Electric Stimulation (TENS) for Postoperative Pain Management during Weaning from Epidural Analgesia Following Colon Surgery: Results from a Controlled Pilot Study.

PubMed

Bjerså, Kristofer; Jildenstaal, Pether; Jakobsson, Jan; Egardt, Madelene; Fagevik Olsén, Monika

2015-12-01

The potential benefit of nonpharmacological adjunctive therapy is not well-studied following major abdominal surgery. The aim of the present study was to investigate transcutaneous electrical nerve stimulation (TENS) as a complementary nonpharmacological analgesia intervention during weaning from epidural analgesia (EDA) after open lower abdominal surgery. Patients were randomized to TENS and sham TENS during weaning from EDA. The effects on pain at rest, following short walk, and after deep breath were assessed by visual analog scale (VAS) grading. Number of patients assessed was lower than calculated because of change in clinical routine. Pain scores overall were low. A trend of lower pain scores was observed in the active TENS group of patients; a statistical significance between the groups was found for the pain lying prone in bed (p < .05). This controlled pilot study indicates benefits of TENS use in postoperative pain management during weaning from EDA after open colon surgery. Further studies are warranted in order to verify the potential beneficial effects from TENS during weaning from EDA after open, lower abdominal surgery. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Non-functional genes repaired at the RNA level.

PubMed

Burger, Gertraud

2016-01-01

Genomes and genes continuously evolve. Gene sequences undergo substitutions, deletions or nucleotide insertions; mobile genetic elements invade genomes and interleave in genes; chromosomes break, even within genes, and pieces reseal in reshuffled order. To maintain functional gene products and assure an organism's survival, two principal strategies are used - either repair of the gene itself or of its product. I will introduce common types of gene aberrations and how gene function is restored secondarily, and then focus on systematically fragmented genes found in a poorly studied protist group, the diplonemids. Expression of their broken genes involves restitching of pieces at the RNA-level, and substantial RNA editing, to compensate for point mutations. I will conclude with thoughts on how such a grotesquely unorthodox system may have evolved, and why this group of organisms persists and thrives since tens of millions of years. Copyright © 2016 Académie des sciences. Published by Elsevier SAS. All rights reserved.

Working together: critical care nurses experiences of temporary staffing within Swedish health care: A qualitative study.

PubMed

Berg Jansson, Anna; Engström, Åsa

2017-08-01

The aim of this study is to describe critical care nurses (CCN's) experiences of working with or as temporary agency staff. This explorative qualitative study is based on interviews with five agency CCNs and five regular CCNs, a total of ten interviews, focusing on the interviewees' experiences of daily work and temporary agency staffing. The interviews were analysed manually and thematically following an inductive approach. Four themes that illustrate both similarities and differences between regular and temporary agency CCNs emerged: "working close to patients versus being responsible for everything", "teamwork versus independence", "both groups needed" and "opportunities and challenges". The study findings illustrate the complexity of the working situation for agency and regular staff in terms of the organisation and management of the temporary agency nurses and the opportunities and challenges faced by both groups. Copyright © 2016 Elsevier Ltd. All rights reserved.

Piloting a stress management and mindfulness program for undergraduate nursing students: student feedback and lessons learned.

PubMed

van der Riet, Pamela; Rossiter, Rachel; Kirby, Dianne; Dluzewska, Teresa; Harmon, Charles

2015-01-01

Widespread reports of high stress levels and mental health problems among university student populations indicate the use of interventions to facilitate stress reduction and support student resilience and wellbeing. There is growing evidence that regular mindfulness practice may confer positive health benefits and reduced stress levels. The aim of this pilot project was to explore the impact of a seven-week stress management and mindfulness program as a learning support and stress reduction method for nursing and midwifery students. The program was conducted at a large regional university in Australia. Fourteen first-year undergraduate nursing and midwifery students agreed to attend the program and to participate in a follow-up focus group. A descriptive qualitative design was utilised to examine the impact of the program. A semi-structured focus group interview was conducted with a thematic analysis undertaken of the transcript and process notes. Ten students completed the research component of this project by participating in the focus group interview. Three main themes capture the participants' experience: attending to self, attending to others and attending to program related challenges. Data indicate a positive impact on sleep, concentration, clarity of thought and a reduction in negative cognitions. Participants also identified challenges related to timetabling, program structure and venue. Overall, this pilot program enhanced the participants' sense of well-being. Despite the challenges, benefits were identified on a personal and professional level. Valuable feedback was provided that will be used to further develop and expand stress management and mindfulness programs offered to students attending this university. Copyright © 2014. Published by Elsevier Ltd.

It's more than just luck: A qualitative exploration of breastfeeding in rural Australia.

PubMed

McKellar, Lois; Fleet, Julie; Dove, Shona

2017-09-21

It's more than just luck: A qualitative exploration of breastfeeding in rural Australia PROBLEM: Despite significant public health benefits, breastfeeding for six months continues to be challenging for women. In the Mid North of South Australia, healthcare professionals were concerned that breastfeeding rates were lower than the national average and that a collaborative approach was needed to promote breastfeeding. To explore the experiences of women and health professional in the Mid North, to inform interventions to improve breastfeeding longevity. Two focus groups were conducted to examine breastfeeding experience in the region. Focus group one included nine mothers who had breastfed more than six months and focus group two consisted of ten health professionals from the Mid North. Thematic analysis was used to analyse the data. Two overarching themes were identified; 'breastfeeding: It's more than just luck' represented the voices of the mothers and 'breastfeeding: It's everybody's business' captured the discussion between the health professionals. Women described themselves as lucky while acknowledging that their own persistence, as well as positive support was vital. Health professionals identified education and support as key foci, and a need for a holistic approach to improve breastfeeding rates. Breastfeeding should be understood as a relationship, in which broadly applied solutions do not necessarily influence longevity, particularly in rural communities. Strategies should also reflect a realistic picture of breastfeeding and safeguard against idealistic expectation of the experience. A holistic approach to improve breastfeeding rates is imperative. One of the most promising antidotes to the breastfeeding dilemma is the provision of midwifery continuity of care. Copyright © 2017. Published by Elsevier Ltd.

Effect of transcutaneous electrical nerve stimulation on peripheral to central blood pressure ratio in healthy subjects.

PubMed

da Silva, Marianne L; Chiappa, Gaspar R; da Silva, Vinicius M; Neves, Laura M T; de Lima, Alexandra C G B; Tomasi, Fernanda P; Junior, Luiz T G; Vilela-Martin, José F; Bottaro, Martim; Junior, Gerson C

2016-07-01

To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on the arterial stiffness in healthy young adult and middle-aged men using the augmentation index (AI-x) and hemodynamic measures. Twenty-four men (12 aged 27·25 ± 5·53 years and 12 aged 54·83 ± 5·10 years) were randomly allocated to two subgroups: TENS or placebo in ganglion region for 45 min. The AI-x and hemodynamic measures [late systolic blood pressure (SBP), central blood pressure (CBP), difference between P1 and P2 (ΔP) and tension time index (TTI)] were determined before and after protocols. TENS resulted in reduction of SBP in younger adults (TENSpre: 111 ± 2; post: 105 ± 2·2 mm Hg; PLACEBOpre: 113 ± 1·8; post: 114 ± 2·5 mm Hg; GEE, P<0·01), whereas no difference was found in middle-aged group. TENS also resulted in reduction of AI-x younger adults group (TENSpre: 56 ± 2·8; post: 53 ± 2%; PLACEBOpre: 55 ± 3; post: 58 ± 2·5%; GEE, P<0·01). ΔP and TTI were significantly decreased after the application of TENS in both groups, but significantly greater reductions in TTI and the SBP/CBP ratio were found in the group of younger adults. The acute application of ganglion TENS attenuated arterial stiffness in younger adults as well as hemodynamic measures in the middle-aged group. This method could emerge as effective therapy for the management of arterial blood pressure. © 2015 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

Successful early dietary intervention avoids obesity in patients with Prader-Willi syndrome: a ten-year follow-up.

PubMed

Schmidt, H; Pozza, S Bechtold-Dalla; Bonfig, W; Schwarz, H P; Dokoupil, K

2008-07-01

Hyperphagia is a frequent symptom in patients with Prader-Willi syndrome (PWS) and results in marked obesity with the risk of metabolic and cardiovascular complications. To investigate whether early diagnosis of PWS and strict dietary intervention prevents excessive weight gain in patients with PWS. A strict fat reduced and modified carbohydrate diet consisting of 10 kcal/ cm height was provided to nine patients (seven female, two male) diagnosed early with PWS (group A). Patients were prospectively followed at our center with follow-up visits every three months. Eight patients with late diagnosis of PWS served as controls (group B). Body mass index (BMI) SDS and height SDS were compared between these two groups over a ten-year period. At the age of two years height SDS and BMI SDS were significantly lower in group A (-2.9 vs -1.2, p <0.05, and BMI SDS -0.1 vs +1.8, p < 0.05). After ten years BMI SDS increased significantly to +1.2 SDS in group A, but was still significantly lower than in group B (BMI SDS +2.4), p <0.005. Patients without restrictive diet were significantly taller than patients on the diet (height SDS group A -2.8 vs group B -1.3, p < 0.05). Early dietary treatment starting at the second year of life and continued until the age of ten years is effective in avoiding excessive weight gain in patients with PWS, but results in shorter stature. Therefore growth hormone may be a useful additional treatment in these patients.

Ten Ways to Infuse Positive Psychology in the Schools

ERIC Educational Resources Information Center

Huebner, Scott

2012-01-01

School professionals, including school psychologists, have often operated from a problem- or deficit-based perspective with a focus on identifying and remediating psychoeducational disorders in children and adolescents. However, positive psychologists have argued that an exclusive focus on deficits does not offer a comprehensive perspective of…

A pilot investigation of the hypoalgesic effects of transcutaneous electrical nerve stimulation upon low back pain in people with multiple sclerosis.

PubMed

Al-Smadi, J; Warke, K; Wilson, I; Cramp, A F L; Noble, G; Walsh, D M; Lowe-Strong, A S

2003-11-01

To investigate the hypoalgesic effects of transcutaneous electrical nerve stimulation (TENS) upon low back pain (LBP) in people with multiple sclerosis (MS). A randomized double-blind placebo controlled clinical pilot study. Fifteen people with MS were recruited and randomly allocated to one of the following groups under double blind conditions (n = 5 per group): TENS 1 (4 Hz, 200 micros), TENS 2 (110 Hz, 200 micros), placebo TENS. Treatment was applied for 45 minutes three times a week for six weeks with a four-week follow-up. The following outcome measures were taken at weeks 1, 6, and 10: visual analogue scale (VAS) (for current LBP, right leg pain, left leg pain); Leeds Multiple Sclerosis Quality of Life Questionnaire; Roland Morris Disability Questionnaire; Short Form-36 (SF-36) Version 1; and the McGill Pain Questionnaire (MPQ). VAS for current LBP, right and left leg pain were also taken before and after treatment, and once a week during the follow-up period. Analysis showed no statistically significant effects for any of the data. However, both active treatment groups showed a trend of improvement in the majority of the outcome measures. Active TENS was more effective than placebo TENS in decreasing VAS scores following each treatment although results were not statistically significant. Further work in this area is warranted and should include a larger number of participants in the form of a randomized controlled clinical trial to determine the efficacy of this modality.

40 CFR 35.4180 - Must my group keep financial records after we finish our TAG?

Code of Federal Regulations, 2010 CFR

2010-07-01

... TAG financial records for ten years from the date of the final Financial Status Report, or until any audit, litigation, cost recovery, and/or disputes initiated before the end of the ten-year retention period are settled, whichever, is longer. (b) At the ten-year mark, you may dispose of your TAG financial...

The Effects of a Grouping by Tens Manipulative on Children's Strategy Use, Base Ten Understanding and Mathematical Knowledge

ERIC Educational Resources Information Center

Pagar, Dana

2013-01-01

Manipulatives have the potential to be powerful tools in helping children improve their number sense, develop advanced mathematical strategies, and build an understanding of the base ten number system. Physical manipulatives used in classrooms, however, are often not designed to promote efficient strategy use, such as counting on, and typically do…

The use of transcutaneous electrical nerve stimulation (TENS) for pain relief in labour: a review of the evidence.

PubMed

Bedwell, Carol; Dowswell, Therese; Neilson, James P; Lavender, Tina

2011-10-01

to assess the effects of transcutaneous electrical nerve stimulation (TENS) for pain relief in labour. studies were identified from a search of the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2008). randomised controlled trials comparing women receiving TENS for pain relief in labour vs routine care or placebo devices. All types of TENS machines were included. two review authors assessed all trials identified by the search strategy, carried out data extraction and assessed risk of bias. 14 studies including 1256 women were included: 11 examined TENS applied to the back, two to acupuncture points and one to the cranium. Overall, there was little difference in satisfaction with pain relief or in pain ratings between TENS and control groups, although women receiving TENS to acupuncture points were less likely to report severe pain (risk ratio 0.41, 95% confidence interval 0.32-0.55). The majority of women using TENS would use it again in a future labour. There was no evidence that TENS had any impact on interventions and outcomes in labour. There was little information on outcomes for mothers and infants. No adverse events were reported. there is only limited evidence that TENS reduces pain in labour and it does not seem to have any impact on other outcomes for mothers or infants. The use of TENS at home in early labour has not been evaluated. Although the guidelines of the National Institute for Health and Clinical Excellence recommend that TENS should not be offered to women in labour, women appear to be choosing it and midwives are supporting them in their choice. Given the absence of adverse effects and the limited evidence base, it seems unreasonable to deny women that choice. More robust studies of effectiveness are needed. Copyright © 2009 Elsevier Ltd. All rights reserved.

Deep tissue afferents, but not cutaneous afferents, mediate transcutaneous electrical nerve stimulation-Induced antihyperalgesia.

PubMed

Radhakrishnan, Rajan; Sluka, Kathleen A

2005-10-01

In this study we investigated the involvement of cutaneous versus knee joint afferents in the antihyperalgesia produced by transcutaneous electrical nerve stimulation (TENS) by differentially blocking primary afferents with local anesthetics. Hyperalgesia was induced in rats by inflaming one knee joint with 3% kaolin-carrageenan and assessed by measuring paw withdrawal latency to heat before and 4 hours after injection. Skin surrounding the inflamed knee joint was anesthetized using an anesthetic cream (EMLA). Low (4 Hz) or high (100 Hz) frequency TENS was then applied to the anesthetized skin. In another group, 2% lidocaine gel was injected into the inflamed knee joint, and low or high frequency TENS was applied. Control experiments were done using vehicles. In control and EMLA groups, both low and high frequency TENS completely reversed hyperalgesia. However, injection of lidocaine into the knee joint prevented antihyperalgesia produced by both low and high frequency TENS. Recordings of cord dorsum potentials showed that both low and high frequency TENS at sensory intensity activates only large diameter afferent fibers. Increasing intensity to twice the motor threshold recruits Adelta afferent fibers. Furthermore, application of EMLA cream to the skin reduces the amplitude of the cord dorsum potential by 40% to 70% for both high and low frequency TENS, confirming a loss of large diameter primary afferent input after EMLA is applied to the skin. Thus, inactivation of joint afferents, but not cutaneous afferents, prevents the antihyperalgesia effects of TENS. We conclude that large diameter primary afferent fibers from deep tissue are required and that activation of cutaneous afferents is not sufficient for TENS-induced antihyperalgesia. Transcutaneous electrical nerve stimulation (TENS) is an accepted clinical modality used for pain relief. It is generally believed that TENS analgesia is caused mainly by cutaneous afferent activation. In this study by differentially blocking cutaneous and deep tissue primary afferents, we show that the activation of large diameter primary afferents from deep somatic tissues, and not cutaneous afferents, are pivotal in causing TENS analgesia.

Stevens-Johnson syndrome and toxic epidermal necrolysis due to anticonvulsants share certain clinical and laboratory features with drug-induced hypersensitivity syndrome, despite differences in cutaneous presentations.

PubMed

Teraki, Y; Shibuya, M; Izaki, S

2010-10-01

Drug-induced hypersensitivity syndrome (DIHS)/drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is characterized by late disease onset, fever, rash, hepatic dysfunction, haematological abnormalities, lymphadenopathy and often, human herpesvirus (HHV) reactivation. The diagnosis of DIHS is based on the combined presence of these findings. Anticonvulsants are a major cause of DIHS and may also cause Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). We examined whether SJS/TEN due to anticonvulsants display similar clinical and laboratory features seen in DIHS. Patients diagnosed with SJS or TEN due to anticonvulsants (n = 8) were examined and their clinical features and laboratory findings were compared with patients with anticonvulsant-related DIHS (n = 6). Seven of the eight patients with SJS/TEN developed symptoms > 3 weeks after starting anticonvulsants. Hepatic dysfunction was present in six patients with SJS/TEN and five patients with DIHS. Leucocytosis and/or eosinophilia was noted in seven patients with SJS/TEN and four patients with DIHS. Only one patient in the SJS/TEN group had atypical lymphocytosis; this was present in four patients with DIHS. Reactivation of HHV-6 was detected in one of the four patients tested in the SJS/TEN group, although it was seen in five of the six patients with DIHS. TSJS/TEN due to anticonvulsants may exhibit some clinical and laboratory features of DIHS. The nature of the cutaneous involvement should be emphasized in the diagnosis of DIHS. © 2009 The Author(s). Journal compilation © 2009 British Association of Dermatologists.

Ten Leading Causes of Death and Injury

MedlinePlus

... Brain Injury Violence Prevention Ten Leading Causes of Death and Injury Recommend on Facebook Tweet Share Compartir ... Emergency Departments, United States – 2014 Leading Causes of Death Charts Causes of Death by Age Group 2016 [ ...

Flame Spread and Group-Combustion Excitation in Randomly Distributed Droplet Clouds with Low-Volatility Fuel near the Excitation Limit: a Percolation Approach Based on Flame-Spread Characteristics in Microgravity

NASA Astrophysics Data System (ADS)

Mikami, Masato; Saputro, Herman; Seo, Takehiko; Oyagi, Hiroshi

2018-03-01

Stable operation of liquid-fueled combustors requires the group combustion of fuel spray. Our study employs a percolation approach to describe unsteady group-combustion excitation based on findings obtained from microgravity experiments on the flame spread of fuel droplets. We focus on droplet clouds distributed randomly in three-dimensional square lattices with a low-volatility fuel, such as n-decane in room-temperature air, where the pre-vaporization effect is negligible. We also focus on the flame spread in dilute droplet clouds near the group-combustion-excitation limit, where the droplet interactive effect is assumed negligible. The results show that the occurrence probability of group combustion sharply decreases with the increase in mean droplet spacing around a specific value, which is termed the critical mean droplet spacing. If the lattice size is at smallest about ten times as large as the flame-spread limit distance, the flame-spread characteristics are similar to those over an infinitely large cluster. The number density of unburned droplets remaining after completion of burning attained maximum around the critical mean droplet spacing. Therefore, the critical mean droplet spacing is a good index for stable combustion and unburned hydrocarbon. In the critical condition, the flame spreads through complicated paths, and thus the characteristic time scale of flame spread over droplet clouds has a very large value. The overall flame-spread rate of randomly distributed droplet clouds is almost the same as the flame-spread rate of a linear droplet array except over the flame-spread limit.

The Representation of Pragmatic Knowledge in Recent ELT Textbooks

ERIC Educational Resources Information Center

Ren, Wei; Han, Zhengrui

2016-01-01

Pragmatic competence has become an increasingly crucial component of language pedagogy. This article reports on a quantitative and qualitative study of ten English language textbooks used in Chinese universities with a particular focus on their coverage of pragmatic knowledge. Detailed analysis focused specifically on the mention of pragmatic…

[Lack of protection against gentamicin ototoxicity by auditory conditioning with noise].

PubMed

Strose, Alex; Hyppolito, Miguel Ângelo; Colombari, Gleice Cristina; Rossato, Maria; Oliveira, Jose Antônio Aparecido de

2014-01-01

Auditory conditioning consists of the pre-exposure to low levels of a potential harmful agent to protect against a subsequent harmful exposure. To confirm if conditioning with an agent different from that used to cause the trauma can also be effective. This was an experimental study with 17 guinea pigs, divided into three groups: an ototoxic control group (Cont) that received intramuscular administration of gentamicin 160 mg/kg/day for ten consecutive days, but no sound exposure; a sound control group (Sound) that was exposed to 85 dB broadband noise centered at 4 kHz, 30 min each day for ten consecutive days, but received no ototoxic medications; and an experimental group (Expt) that received sound exposure identical to the Sound group and after each noise presentation, received gentamicin similarly to Cont group. The animals were evaluated by distortion product otoacoustic emissions (DPOAEs), brainstem auditory evoked potentials (BAEPs), and scanning electron microscopy. The animals that were conditioned with noise did not show any protective effect compared with the ones that received only the ototoxic gentamicin administration. This lack of protection was observed functionally and morphologically. Conditioning with 85 dB broadband noises, 30 min a day for ten consecutive days does not protect against an ototoxic gentamicin administration of 160 mg/kg/day for ten consecutive days in the guinea pig. Copyright © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Factors contributing to the low participation rate of Turkish women to a breast cancer screening program in Antwerp, Belgium.

PubMed

Topal, F; Van Roosbroeck, S; Van Hal, G; Jacquemyn, Y

2015-01-01

To explore possible factors explaining a low participation rate to breast cancer screening for Turkish women living in Antwerp, Belgium, and to develop ways to increase participation rate. The authors used focus group discussions with Turkish women to explore their reasons to participate or not to participate in breast cancer screening. Groups consisted of four to six women. Inclusion criteria were: being female, having a Turkish origin, and age between 50 and 69 years. For each focus group, one Turkish women was invited and asked to invite five other women meeting the inclusion criteria. Three focus group discussions with in total 17 women have taken place. Six women had participated to all consecutive invitations for breast cancer screening. One woman had participated once, but not the next time she was invited. Ten women had never participated to screening mammography, although some of them had undergone diagnostic mammography. In all three focus groups, insufficient knowledge of the Dutch language, the unavailability of a professional interpreter, being careless about healthcare, and a negative influence of the husband, were the main reasons not to participate in breast cancer screening. Invitation letters are not read because they are in a language the woman does not understand. Less frequently mentioned obstacles were being on a holiday or being sick on the day of the scheduled mammography, fear of pain, considering an examination useless when not having any symptoms, being anxious for a positive result, and the physical distance to the screening center. Receiving an invitation in Turkish and knowing that a person speaking Turkish will be available at the screening center were proposed as possible measures to improve participation. The single most important reason why Turkish women living in Antwerp, Belgium, do not participate in breast cancer screening was a language problem; other reasons were a lack of knowledge concerning breast cancer screening and not worrying about breast cancer. The language barrier in this population of older women can possible be overcome by Turkish speaking personnel at the screening centers.

A novel platelet activating factor receptor antagonist reduces cell infiltration and expression of inflammatory mediators in mice exposed to desiccating conditions after PRK.

PubMed

Esquenazi, Salomon; He, Jiucheng; Li, Na; Bazan, Nicolas G; Esquenazi, Isi; Bazan, Haydee E P

2009-01-01

To study the contribution of a novel PAF receptor antagonist LAU-0901 in the modulation of the increased inflammatory response in mice exposed to dessicating conditions (DE) after PRK. Eighty 13-14 week old female Balb/C mice were used. They were divided into two groups: One group was treated with LAU-0901 topical drops. The other group was treated with vehicle. In each group ten mice served as controls and ten were placed in DE. The other twenty mice underwent bilateral PRK and were divided in two additional groups: ten mice remained under normal conditions (NC) and the other ten were exposed to DE. After 1 week all animals underwent in vivo confocal microscopy, immunostaining and western blotting analysis. Confocal microscopy showed an increased number of reflective structures in the corneal epithelium after PRK and exposure to DE in eyes treated with vehicle as compared to eyes treated with LAU-090). Significant decrease of COX-2 and Arginase I expression and reduced alpha SMA cells was observed after PRK and exposure to DE in eyes treated with LAU-0901. Exposure of mice to a DE after PRK increases the epithelial turnover rate. PAF is involved in the inflammatory cell infiltration and expression of inflammatory cytokines that follow PRK under DE.

Clinical and economic impact of TENS in patients with chronic low back pain: analysis of a nationwide database.

PubMed

Pivec, Robert; Stokes, Michael; Chitnis, Abhishek S; Paulino, Carl B; Harwin, Steven F; Mont, Michael A

2013-12-01

This study evaluated patients who were given transcutaneous electrical nerve stimulation (TENS) compared with a matched group without TENS prior to intervention and at 1-year follow-up. Patients who were treated with TENS had significantly fewer hospital and clinic visits, used less diagnostic imaging (31 vs 46 events per 100 patients), had fewer physical therapy visits (94 vs 107), and required less back surgery (7.5 vs 9.2 surgeries) than patients receiving other treatment modalities. Total annual costs for chronic low back pain patients without neurological involvement were lower in TENS patients ($17,957 vs $17,986 for non-TENS), even when the cost of the device was taken into account.

Dual agency in critical care nursing: Balancing responsibilities towards colleagues and patients.

PubMed

Trapani, Josef; Scholes, Julie; Cassar, Maria

2016-10-01

To explore critical care nurses' decisions to seek help from doctors. Despite their well-documented role in improving critically ill patients' outcomes, research indicates that nurses rarely take decisions about patients' treatment modalities on their own and constantly need to seek advice or authorization for their clinical decisions, even for protocol-guided actions. However, research around the factors related to, and the actual process of, such referrals is limited. A grounded theory study, underpinned by a symbolic interactionist perspective. Data collection took place in a general intensive care unit between 2010 - 2012 and involved: 20 hours of non-participant and 50 hours of participant observation; ten informal and ten formal interviews; and two focus groups with ten nurses, selected by purposive and theoretical sampling. Data analysis was guided by the dimensional analysis approach to generating grounded theory. Nurses' decisions to seek help from doctors involve weighing up several occasionally conflicting motivators. A central consideration is that of balancing their moral obligation to safeguard patients' interests with their duty to respect doctors' authority. Subsequently, nurses end up in a position of dual agency as they need to concurrently act as an agent to medical practitioners and patients. Nurses' dual agency relationship with patients and doctors may deter their moral obligation of keeping patients' interest as their utmost concern. Nurse leaders and educators should, therefore, enhance nurses' assertiveness, courage and skills to place patients' interest at the forefront of all their actions and interactions. © 2016 John Wiley & Sons Ltd.

Priority setting: what constitutes success? A conceptual framework for successful priority setting

PubMed Central

Sibbald, Shannon L; Singer, Peter A; Upshur, Ross; Martin, Douglas K

2009-01-01

Background The sustainability of healthcare systems worldwide is threatened by a growing demand for services and expensive innovative technologies. Decision makers struggle in this environment to set priorities appropriately, particularly because they lack consensus about which values should guide their decisions. One way to approach this problem is to determine what all relevant stakeholders understand successful priority setting to mean. The goal of this research was to develop a conceptual framework for successful priority setting. Methods Three separate empirical studies were completed using qualitative data collection methods (one-on-one interviews with healthcare decision makers from across Canada; focus groups with representation of patients, caregivers and policy makers; and Delphi study including scholars and decision makers from five countries). Results This paper synthesizes the findings from three studies into a framework of ten separate but interconnected elements germane to successful priority setting: stakeholder understanding, shifted priorities/reallocation of resources, decision making quality, stakeholder acceptance and satisfaction, positive externalities, stakeholder engagement, use of explicit process, information management, consideration of values and context, and revision or appeals mechanism. Conclusion The ten elements specify both quantitative and qualitative dimensions of priority setting and relate to both process and outcome components. To our knowledge, this is the first framework that describes successful priority setting. The ten elements identified in this research provide guidance for decision makers and a common language to discuss priority setting success and work toward improving priority setting efforts. PMID:19265518

Potential Audiological and MRI Markers of Tinnitus.

PubMed

Gopal, Kamakshi V; Thomas, Binu P; Nandy, Rajesh; Mao, Deng; Lu, Hanzhang

2017-09-01

Subjective tinnitus, or ringing sensation in the ear, is a common disorder with no accepted objective diagnostic markers. The purpose of this study was to identify possible objective markers of tinnitus by combining audiological and imaging-based techniques. Case-control studies. Twenty adults drawn from our audiology clinic served as participants. The tinnitus group consisted of ten participants with chronic bilateral constant tinnitus, and the control group consisted of ten participants with no history of tinnitus. Each participant with tinnitus was closely matched with a control participant on the basis of age, gender, and hearing thresholds. Data acquisition focused on systematic administration and evaluation of various audiological tests, including auditory-evoked potentials (AEP) and otoacoustic emissions, and magnetic resonance imaging (MRI) tests. A total of 14 objective test measures (predictors) obtained from audiological and MRI tests were subjected to statistical analyses to identify the best predictors of tinnitus group membership. The least absolute shrinkage and selection operator technique for feature extraction, supplemented by the leave-one-out cross-validation technique, were used to extract the best predictors. This approach provided a conservative model that was highly regularized with its error within 1 standard error of the minimum. The model selected increased frontal cortex (FC) functional MRI activity to pure tones matching their respective tinnitus pitch, and augmented AEP wave N₁ amplitude growth in the tinnitus group as the top two predictors of tinnitus group membership. These findings suggest that the amplified responses to acoustic signals and hyperactivity in attention regions of the brain may be a result of overattention among individuals that experience chronic tinnitus. These results suggest that increased functional MRI activity in the FC to sounds and augmented N₁ amplitude growth may potentially be the objective diagnostic indicators of tinnitus. However, due to the small sample size and lack of subgroups within the tinnitus population in this study, more research is needed before generalizing these findings. American Academy of Audiology

Fast photorefractive self focusing in InP:Fe semiconductor at near infrared wavelengths

NASA Astrophysics Data System (ADS)

Wolfersberger, Delphine; Dan, Cristian; Khelfaoui, Naïma; Fressengeas, Nicolas; Hervé, Leblond

2008-04-01

Self-trapping of optical beams in photorefractive (PR) materials at telecommunications wavelengths has been studied at steady state in insulators such as SBN [1] and in semiconductor InP:Fe [2], CdTe [3]. PR self-focusing and soliton interactions in semiconductors find interesting applications in optical communications such as optical routing and interconnections because of several advantages over insulators: their sensitivity to near-infrared wavelengths and shorter response time. Photorefractive self focusing in InP:Fe is characterized as a function of beam intensity and temperature. Transient self focusing is found to occur on two time scales for input intensities of tens of W/cm2 (one on the order of tens of μs, one on the order of milliseconds). A theory developed describes the photorefractive self focusing in InP:Fe and confirmed by steady state and transient regime measurements. PR associated phenomena (bending and self focusing) are taking place in InP:Fe as fast as a μs for intensities on the order of 10W/cm2 at 1.06 μm. Currently we are conducting more experiments in order to estimate the self focusing response time at 1.55μm, to clarify the temporal dynamic of the self focusing and to build up a demonstrator of fast optical routing by photorefractive spatial solitons interactions.

Set a Structure of Objects with a Help of Grouping to Ten Strategy to Understand the Idea of Unitizing

ERIC Educational Resources Information Center

Assiti, Saliza Safta; Zulkardi; Darmawijoyo

2013-01-01

The intention of the present study is to know how the pupils can learn to make a group of ten to understand the idea of unitizing. The pupils were given a contextual problem "Counting the Beads" in order to promote their understanding about the idea of unitizing. The process of designing the problem was based on the 5 tenets of…

Phenotypic characterization of ten methanol oxidation (Mox) mutant classes in methylobacterium AM1

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nunn, D.N.; Lidstrom, M.E.

Twenty-five methanol oxidation mutants of the facultative methylotroph Methylobacterium strain AM1 have been characterized by complementation analysis and assigned to ten complementation groups, Mox A1,A2,A3 and B-H. We have characterized each of the mutants belonging to the ten Mox complementation groups by PMS-DCPIP dye linked methanol dehydrogenase activity, by methanol-dependent whole cell oxygen consumption, by the presence or absence of methanol dehydrogenase protein by SDS-polyacrylamide gels and Western blotting, by the absorption spectra of purified mutant methanol dehydrogenase proteins and by the presence or absence of the soluble cytochrome c proteins of Methylobacterium AM1. We propose functions for each ofmore » the genes deficient in the mutants of the ten Mox complementation groups. These functions include two linked genes that encode the methanol dehydrogenase structural protein and the soluble cytochrome c/sub L/, a gene encoding a secretion function essential for the synthesis and export of methanol dehydrogenase and cytochrome c/sub L/, three gene functions responsible for the proper association of the PQQ prosthetic group with the methanol dehydrogenase apoprotein and four positive regulatory gene functions controlling the expression of the ability to oxidize methanol. 24 refs., 5 figs., 2 tabs.« less

Perceptions about Iranian-Kurds' ethnic-inequality in health.

PubMed

Yari, Arezoo; Nedjat, Saharnaz; Asadi-Lari, Mohsen; Majdzadeh, Reza

2017-09-12

Evidence shows ethnic-inequality is a very effective variable in the Community and individual health associated outcomes. This study focused on gaining a deeper understanding of people's perception on inequality of health in Iranian-Kurds and its determinants. The study was conducted in the three cities of Marivan, Sanandaj (capital of Kurdistan province in Iran) and Tehran (capital of the country). The study was conducted through 34 in-depth interviews and ten focus group discussions with health services users, academic graduates and health delivery service personnel. Consensus on social, mental and physical health inequality did not exist within the study participants. However, there were concerns about differences in healthcare access and utilization. Several participants believed that access to health services and socio-cultural differences of Kurds affected the healthcare utilization. Since, people perceived ethnic-inequality in healthcare access and utilization, ethnicity must be considered as a mandatory stratifier in monitoring health status and a concern during planning health interventions. People's awareness, resources management and allocation are factors requiring more consideration when choosing policy options.

Qualitative Analysis of Collaborative Learning Groups in Large Enrollment Introductory Astronomy

NASA Astrophysics Data System (ADS)

Skala, Chija; Slater, Timothy F.; Adams, Jeffrey P.

2000-08-01

Large-lecture introductory astronomy courses for undergraduate, non-science majors present numerous problems for faculty. As part of a systematic effort to improve the course learning environment, a series of small-group, collaborative learning activities were implemented in an otherwise conventional lecture astronomy survey course. These activities were used once each week during the regularly scheduled lecture period. After eight weeks, ten focus group interviews were conducted to qualitatively assess the impact and dynamics of these small group learning activities. Overall, the data strongly suggest that students enjoy participating in the in-class learning activities in learning teams of three to four students. These students firmly believe that they are learning more than they would from lectures alone. Inductive analysis of the transcripts revealed five major themes prevalent among the students' perspectives: (1) self-formed, cooperative group composition and formation should be more regulated by the instructor; (2) team members' assigned rolls should be less formally structured by the instructors; (3) cooperative groups helped in learning the course content; (4) time constraints on lectures and activities need to be more carefully aligned; and (5) gender issues can exist within the groups. These themes serve as a guide for instructors who are developing instructional interventions for large lecture courses.

Population genetic study in ten endogamous groups of West Bengal, India.

PubMed

Mukherjee, B N; Walter, H; Malhotra, K C; Chakraborty, R; Sauber, P; Banerjee, S; Roy, M

1987-09-01

Ten endogamous population groups of West Bengal (India)--Rabhas, Garos, Mechs, Rajbanshis, Jalia Kaibartas, Bagdis, Lodhas, Mundas, Brahmins, Vaidyas--have been typed for twelve polymorphic systems: ABO, Gm, Km, Hp, Cp, Tf, Alb, Hb, aP, EsD, AK and PGM1. The results are compared with those obtained on other Indian populations. Serological and anthropometric data, which have been included into population comparisons, reveal a considerable genetic variability of the groups under study. This variability is obviously connected with the population history of West Bengal.

Transcutaneous Electrical Nerve Stimulation Improves Walking Performance in Patients With Intermittent Claudication.

PubMed

Seenan, Chris; McSwiggan, Steve; Roche, Patricia A; Tan, Chee-Wee; Mercer, Tom; Belch, Jill J F

2016-01-01

The purpose of this study was to investigate the effects of 2 types of transcutaneous electrical nerve stimulation (TENS) on walking distance and measures of pain in patients with peripheral arterial disease (PAD) and intermittent claudication (IC). In a phase 2a study, 40 participants with PAD and IC completed a graded treadmill test on 2 separate testing occasions. Active TENS was applied to the lower limb on the first occasion; and placebo TENS, on the second. The participants were divided into 2 experimental groups. One group received high-frequency TENS; and the other, low-frequency TENS. Measures taken were initial claudication distance, functional claudication distance, and absolute claudication distance. The McGill Pain Questionnaire (MPQ) vocabulary was completed at the end of the intervention, and the MPQ-Pain Rating Index score was calculated. Four participants were excluded from the final analysis because of noncompletion of the experimental procedure. Median walking distance increased with high-frequency TENS for all measures (P < .05, Wilcoxon signed rank test, all measures). Only absolute claudication distance increased significantly with low-frequency TENS compared with placebo (median, 179-228; Ws = 39; z = 2.025; P = .043; r = 0.48). No difference was observed between reported median MPQ-Pain Rating Index scores: 21.5 with placebo TENS and 21.5 with active TENS (P = .41). Transcutaneous electrical nerve stimulation applied to the lower limb of the patients with PAD and IC was associated with increased walking distance on a treadmill but not with any reduction in pain. Transcutaneous electrical nerve stimulation may be a useful adjunctive intervention to help increase walking performance in patients with IC.

Group attributional training as an effective approach to human resource development under team work systems.

PubMed

Wang, Z M

1994-07-01

An experimental programme of group attributional training under team work system was conducted as part of human resource development in Chinese industrial enterprises. One hundred and ten shopfloor employees participated in the study. Among them, 58 employees took part in the factorial-designed experiment to find out the effects of attributions on performance, and 52 employees of ten work groups participated in the group attributional training programme twice a week for two months. The results showed that the group attributional training was effective in modifying employees' attributional patterns and enhancing group performance and satisfaction. On the basis of the results, an attributional model of work motivation is proposed, and its theoretical and practical implications for human resource management discussed.

Transcutaneous electrical nerve stimulation: nonparallel antinociceptive effects on chronic clinical pain and acute experimental pain.

PubMed

Cheing, G L; Hui-Chan, C W

1999-03-01

To investigate to what extent a single 60-minute session of transcutaneous electrical nerve stimulation (TENS) would modify chronic clinical pain, acute experimental pain, and the flexion reflex evoked in chronic low back pain patients. Thirty young subjects with chronic low back pain were randomly allocated to two groups, receiving either TENS or placebo stimulation to the lumbosacral region for 60 minutes. The flexion reflex was elicited by an electrical stimulation applied to the subject's right sole and recorded electromyographically from the biceps femoris and the tibialis anterior muscles. Subjective sensation of low back pain and the electrically induced pain were measured by two separate visual analog scales, termed VAS(LBP) and VAS(FR), respectively. Data obtained before, during, and 60 minutes after TENS and placebo stimulations were analyzed using repeated measures ANOVA. The VAS(LBP) score was significantly reduced to 63.1% of the prestimulation value after TENS (p<.001), but the reduction was negligible after placebo stimulation (to 96.7%, p = .786). In contrast, no significant change was found in the VASFR score (p = .666) and the flexion reflex area (p = .062) during and after stimulation within each group and between the two groups (p = .133 for VASFR and p = .215 for flexion reflex area). The same TENS protocol had different degrees of antinociceptive influence on chronic and acute pain in chronic low back pain patients.

Helper-Dependent Properties of Friend Spleen Focus-Forming Virus: Effect of the Fv-1 Gene on the Late Stages in Virus Synthesis

PubMed Central

Eckner, Robert J.

1973-01-01

Co-infection of neonatal BALB/c mice with Friend virus (FV) complex (containing defective spleen focus-forming virus [SFFV] and endogenous N-tropic leukemia-inducing helper virus [LLV-F]) and B-tropic Tennant leukemia virus (TenLV) resulted in the inhibition of LLV-F by the Fv-1b gene and recovery of a TenLV pseudotype of SFFV, abbreviated SFFV(TenLV). The host range of this pseudotype was B-tropic, since SFFV(TenLV) was 10 to 100 times more infectious for B-type (Fv-1bb) than for N-type (Fv-1nn) mice. The similar patterns of neutralization of N-tropic and B-tropic SFFV by type-specific murine antisera suggested that the difference in infectivity between these two SFFV preparations did not reside in envelope determinants. Rather, helper control of SFFV's host range was only apparent and dependent upon the ability of associated virus to provide a helper function for late stages in SFFV synthesis. Early stages in SFFV's infectious cycle were shown to be helper independent. The Fv-1 gene did not act at the level of the cell membrane to effectively restrict SFFV infection, since SFFV-induced transformed cells could be detected in the absence of spleen focus formation and SFFV synthesis. Further, the generation of these transformed cells by SFFV followed a one-hit, dose-response pattern, suggesting that SFFV-induced cell transformation is helper independent. Finally, restriction of helper function by Fv-1 may be an intracellular event, because both SFFV and its associated LLV-F helper share common envelope determinants and presumably adsorb onto and penetrate target cells with equal efficiency. PMID:4127030

Monitoring socioeconomic inequity in maternal health indicators in Egypt: 1995-2005

PubMed Central

2009-01-01

Background Egypt's longstanding commitment to safe motherhood and maternal health has paid off in substantial declines in maternal mortality ratio and significant improvement in the levels of many maternal health indicators. The current study aims to monitor trends of maternal health indicators and their socioeconomic inequities among Egyptian women over ten-year period (1995-2005). It poses the question "to what extent have the recent maternal health improvements been shared among the various socioeconomic categories of women?" Methods The current paper uses data on maternal health available in three consecutive Demographic and Health Surveys (1995-2000-2005). Concentration index is used to assess the levels of health inequity over the ten year period. Results Although previous efforts in maternal health have contributed to substantial improvements in the general levels of maternal health indicators, these improvements were not enjoyed equally by women in various social groups. Indicators that have long been the focus of health policy such as fertility and contraceptive use showed some declines in disparities but they are far behind from achieving equity. Other indicators which relate to unmet need, prenatal care, delivery, postnatal care still loaded with high levels of inequity and call for more comprehensive policy interventions. PMID:19895706

Task-Based Neurofeedback Training: A Novel Approach Toward Training Executive Functions

PubMed Central

Hosseini, SM Hadi; Pritchard-Berman, Mika; Sosa, Natasha; Ceja, Angelica; Kesler, Shelli R.

2016-01-01

Cognitive training is an emergent approach to improve cognitive functions in various neurodevelopmental and neurodegenerative diseases. However, current training programs can be relatively lengthy, making adherence potentially difficult for patients with cognitive difficulties. Previous studies suggest that providing individuals with real-time feedback about the level of brain activity (neurofeedback) can potentially help them learn to control the activation of specific brain regions. In the present study, we developed a novel task-based neurofeedback training paradigm that benefits from the effects of neurofeedback in parallel with computerized training. We focused on executive function training given its core involvement in various developmental and neurodegenerative diseases. Near-infrared spectroscopy (NIRS) was employed for providing neurofeedback by measuring changes in oxygenated hemoglobin in the prefrontal cortex. Of the twenty healthy adult participants, ten received real neurofeedback (NFB) on prefrontal activity during cognitive training, and ten were presented with sham feedback (SHAM). Compared with SHAM, the NFB group showed significantly improved executive function performance including measures of working memory after four sessions of training (100 minutes total). The NFB group also showed significantly reduced training-related brain activity in the executive function network including right middle frontal and inferior frontal regions compared with SHAM. Our data suggest that providing neurofeedback along with cognitive training can enhance executive function after a relatively short period of training. Similar designs could potentially be used for patient populations with known neuropathology, potentially helping them to boost/recover the activity in the affected brain regions. PMID:27015711

Social Studies. Grade Ten. Interim Guide.

ERIC Educational Resources Information Center

Manitoba Dept. of Education, Winnipeg. Curriculum Development Branch.

This social studies curriculum guide for grade 10 in Manitoba, Canada, examines the characteristics of the physical and social environments of North America and analyzes the interrelationships among them. The primary focus is on Canada and the United States with a secondary focus on Central America. The study has been divided into the following…

Team Building for School Change: Equipping Teachers for New Roles.

ERIC Educational Resources Information Center

Maeroff, Gene I.

Focusing on teacher teams and their use as a lever for change, the author examines the importance of teachers becoming knowledgeable, skilled, and increasingly articulate about their leadership and participation so that they may take their rightful place in the school reform movement. Ten chapters focus on teams sponsored by the Rockefeller…

Explaining Autism: Ten Reasons to Focus on the Developing Self

ERIC Educational Resources Information Center

Hobson, R. Peter

2010-01-01

My aim in this paper is to present reasons for adopting a focus on the development of self/other-awareness when characterizing the developmental psychopathology of autism. The strengths of such a position include an emphasis on children's emotional relations with embodied persons as foundational for their growing understanding of minds. I give…

AgNORs in hyperplasia, papilloma and oral squamous cell carcinoma.

PubMed

Fonseca, L M; do Carmo, M A

2000-01-01

Ten inflammatory fibrous hyperplasias, ten papillomas, and nineteen oral squamous cell carcinomas were analyzed by the AgNOR technique to determine if different disturbances of oral epithelia presented different AgNOR counts. The papilloma group showed higher mean AgNOR counts (3.15 +/- 0.58) than the hyperplasia group (1.98 +/- 0.24) and smaller than the well-differentiated oral squamous cell carcinoma group (6.56 +/- 1.25) and poorly differentiated oral squamous cell carcinoma group (7.07 +/- 1.60). The differences among the groups of lesions were statistically significant (P < 0.05) except between the well differentiated oral squamous cell carcinoma group and the poorly differentiated oral squamous cell carcinoma group. Our findings suggest that the cellular proliferation ratio in papillomas is greater than hyperplasias and smaller than carcinomas.

The effect of transcutaneous electrical nerve stimulation on postural sway on fatigued dorsi-plantar flexor.

PubMed

Yu, JaeHo; Lee, SoYeon; Kim, HyongJo; Seo, DongKwon; Hong, JiHeon; Lee, DongYeop

2014-01-01

The application of transcutaneous electrical nerve stimulation (TENS) enhances muscle weakness and static balance by muscle fatigue. It was said that TENS affects decrease of the postural sway. On the other hand, the applications of TENS to separate dorsi-plantar flexor and the comparison with and without visual input have not been studied. Thus, the aim of this study was to compare the effects of TENS on fatigued dorsi-plantar flexor with and without visual input. 13 healthy adult males and 12 females were recruited and agreed to participate as the subject (mean age 20.5 ± 1.4, total 25) in this study after a preliminary research. This experiment was a single group repeated measurements design in three days. The first day, after exercise-induced fatigue, the standing position was maintained for 30 minutes and then the postural sway was measured on eyes open(EO) and eyes closed(EC). The second, TENS was applied to dorsi flexor in standing position for 30 minutes after conducting exercise-induced fatigue. On the last day, plantar flexor applied by TENS was measured to the postural sway on EO and EC after same exercise-induced fatigue. The visual input was not statistically difference between the groups. However, when compared of dorsi-plantar flexor after applied to TENS without visual input, the postural sway of plantar flexor was lower than the dorsi flexor (p< 0.05). As the result, the application of TENS in GCM clinically decreases the postural sway with visual input it helps to stable posture control and prevent to falling down.

Specific or nonspecific? Evaluation of band, baseline, and cognitive specificity of sensorimotor rhythm- and gamma-based neurofeedback.

PubMed

Kober, Silvia Erika; Witte, Matthias; Neuper, Christa; Wood, Guilherme

2017-10-01

Neurofeedback (NF) is often criticized because of the lack of empirical evidence of its specificity. Our present study thus focused on the specificity of NF on three levels: band specificity, cognitive specificity, and baseline specificity. Ten healthy middle-aged individuals performed ten sessions of SMR (sensorimotor rhythm, 12-15Hz) NF training. A second group (N=10) received feedback of a narrow gamma band (40-43Hz). Effects of NF on EEG resting measurements (tonic EEG) and cognitive functions (memory, intelligence) were evaluated using a pre-post design. Both training groups were able to linearly increase the target training frequencies (either SMR or gamma), indicating the trainability of these EEG frequencies. Both NF training protocols led to nonspecific changes in other frequency bands during NF training. While SMR NF only led to concomitant changes in slower frequencies, gamma training affected nearly the whole power spectrum. SMR NF specifically improved memory functions. Gamma training showed only marginal effects on cognitive functions. SMR power assessed during resting measurements significantly increased after SMR NF training compared to a pre-assessment, indicating specific effects of SMR NF on baseline/tonic EEG. The gamma group did not show any pre-post changes in their EEG resting activity. In conclusion, SMR NF specifically affects cognitive functions (cognitive specificity) and tonic EEG (baseline specificity), while increasing SMR during NF training nonspecifically affects slower EEG frequencies as well (band non-specificity). Gamma NF was associated with nonspecific effects on the EEG power spectrum during training, which did not lead to considerable changes in cognitive functions or baseline EEG activity. Copyright © 2017 Elsevier B.V. All rights reserved.

Factors that affect implementation of web-based faculty evaluation forms: residents' perspectives from a developing country.

PubMed

Ibrahim, S H; Ali, S K; Sadaf, S

2010-08-01

A web-based evaluation system for residents to provide feedback on faculty was piloted in four training programs at the Aga Khan University prior to institution-wide implementation. Of the four programs, less than 50% of forms were submitted by residents of three programs while more than 70% of forms were submitted by the residents of one program. This study was conducted to identify reasons for the varying participation rates of the four programs with a view to improving the system. A qualitative approach was employed using focus group discussions (FGDs). Volunteers were invited and three groups of eight to ten residents each were formed. Participants for FGDs were selected from all residency years. FGDs were used to identify residents' perceptions regarding the web-based faculty evaluation system and to identify residents' problems and concerns with completing the web-based faculty evaluating forms. Technical issues in completing and submitting the forms online were identified to be the main deterrents to completing the evaluation forms. Non-accessibility of a resource person for resolving technical problems with the software and the burden of taking time out to complete the forms were considered as limiting factors by many residents. Residents recommended a focused orientation session to the new system within the departments. Residents' confidence and support are key to promoting adequate participation in web-based evaluations. Focused orientation sessions, reinforcement, reminders, assurances of confidentiality, and removal of technical glitches should help to improve resident participation.

Patient and Family Advisory Councils (PFACs): Identifying Challenges and Solutions to Support Engagement in Research.

PubMed

Harrison, James D; Anderson, Wendy G; Fagan, Maureen; Robinson, Edmondo; Schnipper, Jeffrey; Symczak, Gina; Hanson, Catherine; Carnie, Martha B; Banta, Jim; Chen, Sherry; Duong, Jonathan; Wong, Celene; Auerbach, Andrew D

2018-02-01

The aim was to describe barriers to patient and family advisory council (PFAC) member engagement in research and strategies to support engagement in this context. We formed a study team comprising patient advisors, researchers, physicians, and nurses. We then undertook a qualitative study using focus groups and interviews. We invited PFAC members, PFAC leaders, hospital leaders, and researchers from nine academic medical centers that are part of a hospital medicine research network to participate. All participants were asked a standard set of questions exploring the study question. We used content analysis to analyze data. Eighty PFAC members and other stakeholders (45 patient/caregiver members of PFACs, 12 PFAC leaders, 12 hospital leaders, 11 researchers) participated in eight focus and 19 individual interviews. We identified ten barriers to PFAC member engagement in research. Codes were organized into three categories: (1) individual PFAC member reluctance; (2) lack of skills and training; and (3) problems connecting with the right person at the right time. We identified ten strategies to support engagement. These were organized into four categories: (1) creating an environment where the PFAC members are making a genuine and unique contribution; (2) building community between PFAC members and researchers; (3) best practice activities for researchers to facilitate engagement; and (4) tools and training. Barriers to engaging PFAC members in research include patients' negative perceptions of research and researchers' lack of training. Building community between PFAC members and researchers is a foundation for partnerships. There are shared training opportunities for PFAC members and researchers to build skills about research and research engagement.

Building Chronic Kidney Disease Clinical Practice Guidelines Using the openEHR Guideline Definition Language.

PubMed

Lin, Ching-Heng; Lo, Ying-Chih; Hung, Pei-Yuan; Liou, Der-Ming

2016-12-07

As a result of the disease's high prevalence, chronic kidney disease (CKD) has become a global public health problem. A clinical decision support system that integrates with computer-interpretable guidelines (CIGs) should improve clinical outcomes and help to ensure patient safety. The openEHR guideline definition language (GDL) is a formal language used to represent CIGs. This study explores the feasibility of using a GDL approach for CKD; it also attempts to identify any potential gaps between the ideal concept and reality. Using the Kidney Disease Improving Global Outcomes (KDIGO) anemia guideline as material, we designed a development workflow in order to establish a series of GDL guidelines. Focus group discussions were conducted in order to identify important issues related to GDL implementation. Ten GDL guidelines and 37 archetypes were established using the KDIGO guideline document. For the focus group discussions, 16 clinicians and 22 IT experts were recruited and their perceptions, opinions and attitudes towards the GDL approach were explored. Both groups provided positive feedback regarding the GDL approach, but raised various concerns about GDL implementation. Based on the findings of this study, we identified some potential gaps that might exist during implementation between the GDL concept and reality. Three directions remain to be investigated in the future. Two of them are related to the openEHR GDL approach. Firstly, there is a need for the editing tool to be made more sophisticated. Secondly, there needs to be integration of the present approach into non openEHR-based hospital information systems. The last direction focuses on the applicability of guidelines and involves developing a method to resolve any conflicts that occur with insurance payment regulations.

Retrospective Analysis of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in 88 Chinese Patients

PubMed Central

Wang, Li; Mei, Xue-Ling

2017-01-01

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening diseases with high mortality rates. This study was designed to analyze the pathogenic factors, clinical manifestations, complications, treatment, and prognosis of SJS/TEN and to explore the differences between surviving and deceased patients. Methods: SJS/TEN patients admitted to Beijing Friendship Hospital from January 2006 to December 2015 were included in the study. Patients’ data were retrospectively analyzed. Comparative studies were performed on the survival group and the deceased group, and Fisher's exact probability test was used for statistical analysis. Results: Among the 88 patients included, 40 (45.5%) were male with a mean age of 45 ± 18 years. Forty-eight (54.5%) had SJS, 34 (38.6%) had SJS/TEN, and 6 (6.8%) had TEN. Fifty-three (60.2%) cases were caused by medications, mainly antibiotics (n = 24) followed by traditional Chinese medicines (n = 7). Forty-two cases (47.7%) developed visceral damage. Eighty-two patients improved or recovered and were discharged from hospital, and six patients died. Comparative studies on the survival group and the deceased group showed that the presence of malignant tumor (χ2 = 27.969, P < 0.001), connective tissue diseases (χ2 = 9.187, P = 0.002), previous abnormal liver/kidney functions (χ2 = 6.006, P = 0.014), heart rate >100 times/min (χ2 = 6.347, P = 0.012), detached skin area >20% (χ2 = 5.594, P = 0.018), concurrent mucosal involvement at the mouth, eyes, and external genitals (χ2 = 4.945, P = 0.026), subsequent accompanying liver/kidney damage (χ2 = 11.839, P = 0.001, and χ2 = 36.302, P < 0.001, respectively), and SCORTEN score >2 (χ2 = 37.148, P < 0.001) increased the risk of death. Conclusions: SJS/TEN is mainly caused by medications, and nearly half of patients develop visceral damage. Multiple factors increase the mortality risk. PMID:28469101

Development and application of a newly designed massage instrument for deep cross-friction massage in chronic non-specific low back pain.

PubMed

Yoon, Yong-Soon; Yu, Ki-Pi; Lee, Kwang Jae; Kwak, Soo-Hyun; Kim, Jong Yun

2012-02-01

To introduce a newly designed massage instrument, the Hand Grip T-bar (HT-bar) and use it to relieve chronic non-specific low back pain (nLBP) through deep cross-friction massage (roptrotherapy). 22 subjects (9 males and 13 females, aged 51.6±6.7) with chronic nLBP were allocated randomly to a Roptrotherapy group (n=12) and a Transcutaneous Electrical Nerve Stimulation (TENS) group (n=10). The Roptrotherapy group received deep cross-friction massage with the HT-bar, which was made of metal and had a cylinder for increasing weight and grooves for an easy grip. It was applied across the middle and lower back for 20 minutes a day, 3 days a week for 2 weeks. The TENS group received TENS for 20 minutes a day, 5 days a week for 2 weeks. The outcome was measured on the pain numeric rating scale (PNRS), by the Oswestry disability index (ODI), and by the Roland & Morris Disability Questionnaire (RMDQ) at pre-treatment, at immediate post-treatment and 2 weeks later. The application of the HT-bar was assessed by a questionnaire to 19 therapists. At post-treatment, immediately and 2 weeks later, both groups showed significant improvement in PNRS, ODI and RMDQ. During the two weeks after post-treatment, however, the Roptrotherapy group improved in PNRS, ODI and RMDQ, but the TENS group did not. Over 80% of the therapists responded that the HT-bar was useful and comfortable. This study suggests that deep cross-friction massage can be a beneficial therapeutic technique and that the HT-bar can be a useful instrument in deep cross-friction massage for chronic nLBP patients.

Family medicine residency training and burnout: a qualitative study

PubMed Central

Rutherford, Kimberly; Oda, Joanna

2014-01-01

Background Almost three-quarters of family practice residents in British Columbia (BC) meet criteria for burnout. We sought to understand how burnout is perceived and experienced by family medicine residents, and to identify both contributory and protective factors for resident burnout. Method Two semi-structured focus groups were conducted with ten family practice residents from five distinct University of British Columbia training sites. Participants completed the Maslach Burnout Inventory (MBI). The data were analyzed using a thematic analysis approach. Results Seventy percent of the focus group participants met criteria for burnout using the MBI. The experience of burnout was described as physical and emotional exhaustion, loss of motivation, isolation from loved ones, and disillusionment with the medical profession. Contributory factors included high workload, burned-out colleagues, perceived undervaluing of family medicine, lack of autonomy, and inability to achieve work-life balance. Protective factors included strong role models in medicine, feeling that one’s work is valued and rotations in family medicine. Conclusions The high level of burnout in family medicine residents in BC is a multifactorial and complex phenomenon. Training programs and faculty should be aware of burnout risk factors and strive to implement changes to reduce burnout, including allowing residents increased control over scheduling, access to counseling services and training for resident mentors. PMID:26451218

Environmental and Individual Factors Affecting Menu Labeling Utilization: A Qualitative Research Study

PubMed Central

Schindler, Jennifer; Kiszko, Kamila; Abrams, Courtney; Islam, Nadia; Elbel, Brian

2013-01-01

Obesity is a significant public health concern that disproportionally affects low-income and minority populations. Recent policies mandating the posting of calories on menus in fast food chain restaurants have not proven to uniformly influence food choice. This qualitative research study uses focus groups to study individual and environmental factors affecting the usage of these menu labels among low-income, minority populations. Ten focus groups targeting low-income residents (n=105) were conducted at various community organizations throughout NYC in Spanish, English, or a combination of both languages, over a nine-month period in 2011. In late 2011 and early 2012, transcripts were coded through the process of thematic analysis using Atlas.ti for naturally emerging themes, influences, and determinants of food choice. Few used menu labels, despite awareness. Among the themes pertaining to menu label usage, price and time constraints, confusion and lack of understanding of caloric values, as well as the priority of preference, hunger, and habitual ordering habits were most frequently cited as barriers to menu label usage. Based on the individual and external influences on food choice that often take priority over calorie consideration, a modified approach may be necessary to make menu labels more effective and user-friendly. PMID:23402695

Patient perspectives on racial and ethnic implicit bias in clinical encounters: Implications for curriculum development.

PubMed

Gonzalez, Cristina M; Deno, Maria L; Kintzer, Emily; Marantz, Paul R; Lypson, Monica L; McKee, M Diane

2018-05-20

Patients describe feelings of bias and prejudice in clinical encounters; however, their perspectives on restoring the encounter once bias is perceived are not known. Implicit bias has emerged as a target for curricular interventions. In order to inform the design of novel patient-centered curricular interventions, this study explores patients' perceptions of bias, and suggestions for restoring relationships if bias is perceived. The authors conducted bilingual focus groups with purposive sampling of self-identified Black and Latino community members in the US. Data were analyzed using grounded theory. Ten focus groups (in English (6) and Spanish (4)) with N = 74 participants occurred. Data analysis revealed multiple influences patients' perception of bias in their physician encounters. The theory emerging from the analysis suggests if bias is perceived, the outcome of the encounter can still be positive. A positive or negative outcome depends on whether the physician acknowledges this perceived bias or not, and his or her subsequent actions. Participant lived experience and physician behaviors influence perceptions of bias, however clinical relationships can be restored following perceived bias. Providers might benefit from skill development in the recognition and acknowledgement of perceived bias in order to restore patient-provider relationships. Copyright © 2018 Elsevier B.V. All rights reserved.

The Aftermath of Suicide: A Qualitative Study With Guyanese Families.

PubMed

Groh, Carla J; Anthony, Maureen; Gash, Jean

2018-06-01

The suicide rate in Guyana was five times higher than the world average in 2014 (WHO) which puts Guyana at the top of the list with 44.2 per 100,000 people, the highest suicide rate in the world. For every completed suicide, there are survivors who experience high levels of psychological, physical, and social distress, and report feelings of guilt, shame, social stigma, and search for meaning. The aim of this qualitative study was to explore how family members coped and understand the suicide of their loved one, and to determine what resources were available to help them during this transition. Ten family members were recruited to participate in a focus group. The focus group lasted approximately 90 min and was recorded. The audio recordings were later transcribed. Four overarching themes emerged from the data: (1) perceived causes of suicide, (2) perceived solutions, (3) barriers to helping persons who are suicidal, and (4) personal and community reactions to suicide. Nurses in Guyana are uniquely positioned to take a leadership role in creating and implementing postvention programs for suicide survivors that are culturally and ethnically relevant. Opportunities to partner with schools of nursing in higher income countries are explored. Copyright © 2018 Elsevier Inc. All rights reserved.

Factors influencing adherence with therapeutic sunlight exposure in older people in intermediate care facilities.

PubMed

Durvasula, Seeta; Sambrook, Philip N; Cameron, Ian D

2012-01-01

The purpose of this study was to investigate the factors influencing low adherence with therapeutic sunlight exposure in a randomized controlled trial conducted with older people living in intermediate care facilities. The study involved participants in the FREEDOM (Falls Risk Epidemiology: Effect of vitamin D on skeletal Outcomes and other Measures) study, a randomized controlled trial of therapeutic sun exposure to reduce falls in older people in intermediate care facilities. Semi-structured interviews were conducted with thirty participants in the FREEDOM trial, and with ten sunlight officers who were employed to facilitate the sun exposure. Two focus groups involving 10 participants in the FREEDOM trial were also held at the end of the intervention period. Common themes were derived from the interview and focus group transcripts. The study showed that the perceived health benefits did not influence adherence with the sun exposure. Factors such as socializing with others and being outdoors were more important in encouraging attendance. The main barriers to adherence included the perceived inflexibility and regimentation of daily attendance, clash with other activities, unsuitable timing and heat discomfort. This study showed that providing greater flexibility and autonomy to older people in how and when they receive sun exposure is likely to improve adherence. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Local election: does bureaucracy become one of main political power?

NASA Astrophysics Data System (ADS)

Amin, Muryanto; Musthafa Sembiring, Walid

2018-03-01

This writing aims to analyze the emergence of bureaucracy as one of political power in local level after the local election is held in Indonesia. Due to information authorization, media network, and stable structure, the bureaucracy soon transforms into political power which can compete with the other political power at the local level. In Medan local election in 2010 and 2015 has evidently proven the power of bureaucracy network in winning the bureaucrat-background candidates. As methods of the research, the researcher held a Focus-Group Discussion (FGD) and had an in-depth interview with ten bureaucracy elites in Medan and local political elites. The observation and Focus-Group Discussion (FGD) are analyzed using qualitative analysis technique typology. The result states that the bureaucracy network in Medan has been used in a massive way as the political power of winning. The structure of bureaucracy – from the top to the low – is involved in the winning. The most governmental programs were applied to attract the mass’ sympathy toward the candidates. The bureaucratic proximity to media network is also used to do a campaign in a massive way. The conclusion of the research is that bureaucracy emerges as a new, massive, effective local political power in the local election.

Family medicine residency training and burnout: a qualitative study.

PubMed

Rutherford, Kimberly; Oda, Joanna

2014-01-01

Almost three-quarters of family practice residents in British Columbia (BC) meet criteria for burnout. We sought to understand how burnout is perceived and experienced by family medicine residents, and to identify both contributory and protective factors for resident burnout. Two semi-structured focus groups were conducted with ten family practice residents from five distinct University of British Columbia training sites. Participants completed the Maslach Burnout Inventory (MBI). The data were analyzed using a thematic analysis approach. Seventy percent of the focus group participants met criteria for burnout using the MBI. The experience of burnout was described as physical and emotional exhaustion, loss of motivation, isolation from loved ones, and disillusionment with the medical profession. Contributory factors included high workload, burned-out colleagues, perceived undervaluing of family medicine, lack of autonomy, and inability to achieve work-life balance. Protective factors included strong role models in medicine, feeling that one's work is valued and rotations in family medicine. The high level of burnout in family medicine residents in BC is a multifactorial and complex phenomenon. Training programs and faculty should be aware of burnout risk factors and strive to implement changes to reduce burnout, including allowing residents increased control over scheduling, access to counseling services and training for resident mentors.

"Ebola kills generations": Qualitative discussions with Liberian healthcare providers.

PubMed

Bell, Sue Anne; Munro-Kramer, Michelle L; Eisenberg, Marisa C; Williams, Garfee; Amarah, Patricia; Lori, Jody R

2017-02-01

the purpose of this study was to explore healthcare providers' perceptions and reactions to the Ebola Virus Disease (EVD) epidemic. a descriptive, qualitative study design was employed. Focus groups were conducted with Liberian healthcare providers who participated in care of patients with EVD. the study was conducted in Bong County, Liberia (population: 333,000), which was severely affected, with over 650 reported cases and close to 200 deaths by the end of 2015. the total sample of 58 participants, included 11 nurses, ten traditional birth attendants (TBAs), four midwives, 28 general community health volunteers, three physician assistants, one community member and one pharmacy dispenser. five core themes related to changes in healthcare practices and interactions since the EVD outbreak were identified based on the results of the focus groups; fear, stigma, resource constraints, lack of knowledge and training, and shifting cultural practices. this work represents a preliminary understanding of Liberian healthcare workers reactions to the EVD epidemic, and highlights the significant issues they faced as they attempted to care for patients and protect themselves. while the EVD epidemic has been declared over, preparedness activities for future disease outbreaks must continue. This study can inform future healthcare policy initiatives as well as preparedness activities targeted towards healthcare workers in low resource settings. Copyright © 2016 Elsevier Ltd. All rights reserved.

If you come from a well-known organisation, I will trust you: Exploring and understanding the community's attitudes towards healthcare research in Cambodia.

PubMed

Pol, Sreymom; Fox-Lewis, Shivani; Neou, Leakhena; Parker, Michael; Kingori, Patricia; Turner, Claudia

2018-01-01

To explore Cambodian community members' understanding of and attitudes towards healthcare research. This qualitative study generated data from semi-structured interviews and focus group discussions. This study was conducted at a non-governmental paediatric hospital and in nearby villages in Siem Reap province, Cambodia. A total of ten semi-structured interviews and four focus group discussions were conducted, involving 27 participants. Iterative data collection and analysis were performed concurrently. Data were analysed by thematic content analysis and the coding structure was developed using relevant literature. Participants did not have a clear understanding of what activities related to research compared with those for routine healthcare. Key attitudes towards research were responsibility and trust: personal (trust of the researcher directly) and institutional (trust of the institution as a whole). Villagers believe the village headman holds responsibility for community activities, while the village headman believes that this responsibility should be shared across all levels of the government system. It is essential for researchers to understand the structure and relationship within the community they wish to work with in order to develop trust among community participants. This aids effective communication and understanding among all parties, enabling high quality ethical research to be conducted.

Resilience in eating disorders: A qualitative study.

PubMed

Las Hayas, Carlota; Padierna, Jesús A; Muñoz, Pedro; Aguirre, Maialen; Gómez Del Barrio, Andrés; Beato-Fernández, Luís; Calvete, Esther

2016-07-01

The objectives of the authors in this study were two-fold: (1) to explore the role of resilience in recovery from eating disorders (EDs), and (2) to develop a model of resilience in women with EDs. Semi-structured interviews with ten women were conducted in April 2011, along with two focus groups with women who had recovered from EDs (n  = 5 women each; conducted in April 2012 at the University of Deusto, Spain), one focus group with clinical experts (n = 8; conducted in April 2012 at the Foundation Against EDs of Biskay, Spain), and six narratives from primary caregivers of ED patients living in Biskay, Spain (conducted in November 2012). All data were analyzed using a grounded theory approach. All female participants acknowledged experiencing resilience in their recovery. The analysis resulted in a conceptual model of resilience composed of the following categories: deep dissatisfaction with life, turning point, acceptance, hope, determination to change, accountability for the ED, active coping, getting social support, gaining self-knowledge, getting information about EDs, increase well-being, trait resilience, initiating new projects and living in the here and now. According to the model presented, resilience preceded the experience of recovery in women with EDs in this sample and could be a useful asset for future interventions.

A content analysis of kindergarten-12th grade school-based nutrition interventions: taking advantage of past learning.

PubMed

Roseman, Mary G; Riddell, Martha C; Haynes, Jessica N

2011-01-01

To review the literature, identifying proposed recommendations for school-based nutrition interventions, and evaluate kindergarten through 12th grade school-based nutrition interventions conducted from 2000-2008. Proposed recommendations from school-based intervention reviews were developed and used in conducting a content analysis of 26 interventions. Twenty-six school-based nutrition interventions in the United States first published in peer-reviewed journals from 2000-2008. VARIABLE MEASURED: Ten proposed recommendations based on prior analyses of school-based nutrition interventions: (1) behaviorally focused, (2) multicomponents, (3) healthful food/school environment, (4) family involvement, (5) self-assessments, (6) quantitative evaluation, (7) community involvement, (8) ethnic/heterogeneous groups, (9) multimedia technology, and (10) sequential and sufficient duration. Descriptive statistics. The most frequent recommendations used were: (1) behaviorally focused components (100%) and (2) quantitative evaluation of food behaviors (96%). Only 15% of the interventions included community involvement or ethnic/heterogeneous groups, whereas 31% included anthropometric measures. Five of the 10 proposed recommendations were included in over 50% of the interventions. Rising trend of overweight children warrants the need to synthesize findings from previous studies to inform research and program development and assist in identification of high-impact strategies and tactics. Copyright © 2011 Society for Nutrition Education. Published by Elsevier Inc. All rights reserved.

Screen-Viewing Behaviors Among Preschoolers

PubMed Central

He, Meizi; Irwin, Jennifer D.; Bouck, L. Michelle Sangster; Tucker, Patricia; Pollett, Graham L.

2016-01-01

Background Childhood obesity has emerged as a public health concern in Canada. It has been suggested that excessive screen viewing (i.e., television, computer, video) is a major factor contributing to the increased risk of obesity in children. Exploring young children’s experiences with this modifiable behavior may be beneficial to the creation of a multifaceted program aimed at the primary prevention of obesity. Objectives To seek parents’ perceptions and insights pertaining to their preschoolers’ screen-viewing behaviors. Methods This qualitative study targeted a heterogeneous sample of parents with children aged 2.5 to 5 years. Two experienced moderators using a semistructured interview guide conducted the ten focus groups between September and November 2003. All focus groups were audio-recorded and transcribed verbatim. In fall 2003 to spring 2004, inductive content analysis was conducted independently by a minimum of two qualitative researchers. Results Many parents were not concerned with the amount of screen viewing their children engaged in, although the content of what was on the screen was of particular interest to them. Very few parents seemed to appreciate the linkage between preschoolers’ screen-viewing habits and their potential risk for obesity. Conclusions Public health interventions are needed to increase parents’ awareness with respect to the harmful effects of excessive screen viewing in preschoolers. PMID:16005808

[Efficacy of decoding training for children with difficulty reading hiragana].

PubMed

Uchiyama, Hitoshi; Tanaka, Daisuke; Seki, Ayumi; Wakamiya, Eiji; Hirasawa, Noriko; Iketani, Naotake; Kato, Ken; Koeda, Tatsuya

2013-05-01

The present study aimed to clarify the efficacy of decoding training focusing on the correspondence between written symbols and their readings for children with difficulty reading hiragana (Japanese syllabary). Thirty-five children with difficulty reading hiragana were selected from among 367 first-grade elementary school students using a reading aloud test and were then divided into intervention (n=15) and control (n=20) groups. The intervention comprised 5 minutes of decoding training each day for a period of 3 weeks using an original program on a personal computer. Reading time and number of reading errors in the reading aloud test were compared between the groups. The intervention group showed a significant shortening of reading time (F(1,33)=5.40, p<0.05, two-way ANOVA) compared to the control group. However, no significant difference in the number of errors was observed between the two groups. Ten children in the control group who wished to participate in the decoding training were included in an additional study;as a result, improvement of the number of reading errors was observed (t= 2.863, p< 0.05, paired t test), but there was no improvement in reading time. Decoding training was found to be effective for improving both reading time and reading errors in children with difficulty reading hiragana.

The Effect of Transcutaneous Electrical Nerve Stimulation of Sympathetic Ganglions and Acupuncture Points on Distal Blood Flow.

PubMed

Kamali, Fahimeh; Mirkhani, Hossein; Nematollahi, Ahmadreza; Heidari, Saeed; Moosavi, Elahesadat; Mohamadi, Marzieh

2017-04-01

Transcutaneous electrical nerve stimulation (TENS) is a widely-practiced method to increase blood flow in clinical practice. The best location for stimulation to achieve optimal blood flow has not yet been determined. We compared the effect of TENS application at sympathetic ganglions and acupuncture points on blood flow in the foot of healthy individuals. Seventy-five healthy individuals were randomly assigned to three groups. The first group received cutaneous electrical stimulation at the thoracolumbar sympathetic ganglions. The second group received stimulation at acupuncture points. The third group received stimulation in the mid-calf area as a control group. Blood flow was recorded at time zero as baseline and every 3 minutes after baseline during stimulation, with a laser Doppler flow-meter. Individuals who received sympathetic ganglion stimulation showed significantly greater blood flow than those receiving acupuncture point stimulation or those in the control group (p<0.001). Data analysis revealed that blood flow at different times during stimulation increased significantly from time zero in each group. Therefore, the application of low-frequency TENS at the thoracolumbar sympathetic ganglions was more effective in increasing peripheral blood circulation than stimulation at acupuncture points. Copyright © 2017 Medical Association of Pharmacopuncture Institute. Published by Elsevier B.V. All rights reserved.

[Top ten progression of neuro-ophthalmology research in China in the latest five years].

PubMed

2014-12-01

Ten researches that represent the most advanced neuro-ophthalmology related studies in china were voted by specialists from Chinese Neuro-ophthalmology Society. These researches were concentrated in the following fields: clinical and basic researches of optic neuritis, studies of ischemic optic neuropathy, and clinical present of Leber's hereditary optic neuropathy. These researches represented the level of neuro-ophthalmology in China and also showed the focus of our Chinese neuro-ophthalmologists in recent years.

[Beliefs and knowledge of a group of doctors about the nutritional management of the child with acute diarrhea].

PubMed

Corral-Terrazas, Martha; Martínez, Homero; Flores-Huerta, Samuel; Duque-L, Ma Ximena; Turnbull, Bernardo; Levario-Carrillo, Margarita

2002-01-01

To identify the beliefs and knowledge of a group of rural physicians on the dietary management of children under five years of age, with acute diarrhea. Physicians' dietary management was compared with that recommended by the World Health Organization. A cognitive anthropology study was carried out from July to December 1998, on ten physicians that care for the infant population ascribed to Hospital Rural IMSS-Solidaridad of San Juanito Bocoyna, Chihuahua, Mexico. Data were collected through focus groups, case vignettes, free listing, pile sorting, and a semi-structured questionnaire, and then cross-referred. The physicians recognized the negative impact of diarrhea on the nutritional state of the child, but not all of them evaluated this state. Prevailing interventions were antibiotic therapy, fluid management, and feeding recommendations. Among the latter, the most consistent were breastfeeding, delayed feeding, and gradual feeding. The obtained information is in conflict with WHO's recommendations, specially with that of sustained feeding. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Short-term transcutaneous electrical nerve stimulation reduces pain and improves the masticatory muscle activity in temporomandibular disorder patients: a randomized controlled trial.

PubMed

Ferreira, Ana Paula de Lima; Costa, Dayse Regina Alves da; Oliveira, Ana Izabela Sobral de; Carvalho, Elyson Adam Nunes; Conti, Paulo César Rodrigues; Costa, Yuri Martins; Bonjardim, Leonardo Rigoldi

2017-01-01

To investigate the short-term effect of transcutaneous electrical nerve stimulation (TENS) by examining pain intensity, pressure pain threshold (PPT) and electromyography (EMG) activity in patients with temporomandibular disorder (TMD). Forty patients with myofascial TMD were enrolled in this randomized placebo-controlled trial and were divided into two groups: active (n=20) and placebo (n=20) TENS. Outcome variables assessed at baseline (T0), immediately after (T2) and 48 hours after treatment (T1) were: pain intensity with the aid of a visual analogue scale (VAS); PPT of masticatory and cervical structures; EMG activity during mandibular rest position (MR), maximal voluntary contraction (MVC) and habitual chewing (HC). Two-way ANOVA for repeated measures was applied to the data and the significance level was set at 5%. There was a decrease in the VAS values at T1 and T2 when compared with T0 values in the active TENS group (p<0.050). The PPT between-group differences were significant at T1 assessment of the anterior temporalis and sternocleidomastoid (SCM) and T2 for the masseter and the SCM (p<0.050). A significant EMG activity reduction of the masseter and anterior temporalis was presented in the active TENS during MR at T1 assessment when compared with T0 (p<0.050). The EMG activity of the anterior temporalis was significantly higher in the active TENS during MVC at T1 and T2 when compared with placebo (p<0.050). The EMG activity of the masseter and anterior temporalis muscle was significantly higher in the active TENS during HC at T1 when compared with placebo (p<0.050). The short-term therapeutic effects of TENS are superior to those of the placebo, because of reported facial pain, deep pain sensitivity and masticatory muscle EMG activity improvement.

Focus on function: a cluster, randomized controlled trial comparing child- versus context-focused intervention for young children with cerebral palsy

PubMed Central

LAW, MARY C; DARRAH, JOHANNA; POLLOCK, NANCY; WILSON, BRENDA; RUSSELL, DIANNE J; WALTER, STEPHEN D; ROSENBAUM, PETER; GALUPPI, BARB

2011-01-01

AIM This study evaluated the efficacy of a child-focused versus context-focused intervention in improving performance of functional tasks and mobility in young children with cerebral palsy. METHOD A randomized controlled trial cluster research design enrolled 128 children (49 females, 79 males; age range 12mo to 5y 11mo; mean age 3y 6mo, SD −1y 5mo) who were diagnosed with cerebral palsy. Children across levels I to V on the Gross Motor Classification System (GMFCS) were included in the study. Children were excluded if there were planned surgical or medication changes during the intervention period. Therapists from 19 children's rehabilitation centers were block randomized (by occupational therapist or physical therapist) to a treatment arm. Children from consenting families followed their therapists into their assigned group. Children received child-focused (n=71) or context-focused intervention (n=57) over 6 months, returning to their regular therapy schedule and approach between 6 and 9 months. The primary outcome measure was the Pediatric Evaluation of Disability Inventory (PEDI). Secondary outcome measures included the Gross Motor Function Measure (GMFM-66), range of motion of hip abduction, popliteal angle and ankle dorsiflexion, the Assessment of Preschool Children's Participation (APCP), and the Family Empowerment Scale (FES). Outcome evaluators were masked to group assignment and completed assessments at baseline, 6 months, and 9 months. RESULTS Ten children did not complete the full intervention, six in the child group and four in context group. GMFCS levels for children in the study were level I (n=37), level II (n=23), level III (n=21), level IV (n=21), and level V (n=26). There were no significant differences at baseline between the treatment groups for GMFCS level, parental education, or parental income. For the PEDI, there was no significant difference between the treatment groups, except for a small effect (p<0.03) on the Caregiver Assistance Mobility subscale between baseline and 9 months. The mean scores of both groups changed significantly on the Functional Skills Scales (p<0.001) and Caregiver Assistance Scales (p<0.02) of the PEDI after the 6-month intervention. There was no additional statistically significant change on the PEDI during the follow-up period from 6 to 9 months. A subgroup effect was found for age (p<0.001), with children younger than 3 years changing significantly more than older children. GMFCS level at baseline did not influence the amount of change on the PEDI scales. There were no significant differences between the treatment groups on the GMFM, range of motion measures, APCP or FES assessments. For the GMFM, there was a significant change over time from baseline to 6 months (p<0.001) and no significant change between 6 and 9 months. There was no adverse side effect as range of motion did not decrease in either group. Hip abduction increased significantly (p<0.01) at the 9-month assessment for both groups. For the APCP, significant changes for both treatment groups were found between baseline and 6 months for play intensity (p<0.04), physical activity intensity and diversity (p<0.001), and total score intensity (p<0.01). INTERPRETATION This study shows that child- or context-focused therapy approaches are equally effective and that frequency of intervention may be a critical component of successful intervention. Further evaluation is required to identify the various `dose-response' relations of amount of treatment and changes in functional abilities. PMID:21569012

DNA barcoding of wild edible mushrooms consumed by the ethnic tribes of India.

PubMed

Khaund, Polashree; Joshi, S R

2014-10-15

Wild edible mushrooms are consumed by the tribes of Meghalaya in the North-Eastern region of India, as part of their ethnic cuisine because of their favored organoleptic characteristics and traditionally known health benefits. Majority of these mushrooms have not yet been characterized in detail and are slowly shrinking in their natural habitats owing to anthropogenic factors and climate change. In the present study, representative specimens of ten morphologically distinct groups of wild edible mushrooms available in the traditional markets and their respective forest habitats, were subjected to multi-loci molecular characterization using SSU, ITS, RPB1 and RPB2 markers. The species identities inferred for the ten mushroom types using the SSU marker matched their morphological description in the case of four morphological groups only whereas the ITS marker successfully resolved the species identity for nine out of the ten mushroom groups under study. Both the protein coding gene markers RPB1 and RPB2 successfully resolved the species identity for three out of the ten morphologically distinct groups. Finally the most likely identity of the wild edible mushrooms under study has been suggested by matching their unique morphological characteristics with the generated DNA barcoding data. The present molecular characterization reveals the ten widely consumed wild mushroom types of Meghalaya, India to be Gomphus floccosus, Lactarius deliciosus, Lactarius volemus, Cantharellus cibarius, Tricholoma viridiolivaceum, Inocybe aff. sphaerospora, Laccaria vinaceoavellanea, Albatrellus ellisii, Ramaria maculatipes and Clavulina cristata. The final species identity generated by the ITS marker matched more accurately with the morphological characteristics/appearance of the specimens indicating the ITS region as a reliable barcode for identifying wild edible mushrooms. Copyright © 2014 Elsevier B.V. All rights reserved.

The floating shoulder—-clinical and radiological results after intramedullary stabilization of the clavicle in cases with minor displacement of the scapular neck fracture.

PubMed

Izadpanah, Kaywan; Jaeger, Martin; Maier, Dirk; Kubosch, David; Hammer, Thorsten Oliver; Südkamp, Norbert P

2012-02-01

The aim of this study was to compare the clinical and radiologic results of titanium elastic nail (TEN) and plate osteosynthesis for treatment of clavicle fractures in patients with a floating shoulder injury. From 2000 to 2008, 16 patients with a floating shoulder injury (ipsilateral clavicle and minor displaced scapular neck fracture) were treated by isolated stabilization of the clavicle. The patients were treated with open reduction and plate osteosynthesis (group 1[G1]) or TEN osteosynthesis (group 2 [G2]). Both procedures were compared with regard to functional and radiologic outcome. Nine patients were treated with a plate osteosynthesis (G1) and seven with a TEN osteosynthesis (G2). The follow-up time was 35.7 months ± 16 months. There was no difference in functional outcome with regard to the intraindividual Constant score 83.9(G1) versus 86.7 (G2) or the American Shoulder and Elbow Surgeons score 79.1 (G1) versus 85.7 (G2). No significant postoperative dislocation of the glenopolar angle appeared. In the TEN-treated group, a clavicle shortening of 2.4 mm was observed. Subgroup analysis revealed significant greater shortening in type B and C compared with type A (OTA) clavicle fractures(4.7 mm vs. 0.8 mm). No clavicle shortening in the plate-treated group appeared. The treatment of floating shoulder injuries with TEN and plate osteosynthesis of the clavicle and nonoperative treatment of a minimally displaced glenoid neck fracture provide equal functional results. However, in type B and C (but not in type A) fractures of the clavicle, a shortening of 5 mm can be expected after titanium elastic nailing. Copyright ©2012 by Lippincott Williams & Wilkins

Efficacy of Droncit Spot-on (praziquantel) 4% w/v against immature and mature Echinococcus multilocularis in cats.

PubMed

Jenkins, D J; Romig, T

2000-07-01

The causative agent of alveolar hydatidosis in humans, the fox tapeworm Echinococcus multilocularis, is extending its geographical range in Europe and has been found in domestic cats in some areas. A dermally applied cestocidal treatment for domestic cats has been developed and the efficacy of this treatment is reported. Thirty purpose-bred cats were experimentally infected each with 10000 protoscoleces of Echinococcus multilocularis. Ten days later one group of ten cats was treated with Droncit(R) Spot-on (Praziquantel) 4% w/v dermally in one place on the dorsal aspect of the neck at a dose of 8 mg/kg. Eleven days later (21 days p.i.) a second group of ten cats was also treated with Droncit(R) Spot-on the same way. One group of ten cats was left untreated as controls. Twenty three days after infection the cats were examined for the presence of E. multilocularis tapeworms. No E. multilocularis were recovered from any of the cats in either of the treated groups. Echinococcus multilocularis were recovered from eight of the ten cats left untreated as controls. The worm burdens in the untreated cats were 0, 0, 5, 15, 75, 110, 220, 815, 2635, and 3045 worms per cat. The worms ranged in development from the three to four segment stage. Many of the E. multilocularis with four segments contained unshelled eggs in the terminal segment. This study indicates that Droncit(R) Spot-on (Praziquantel) 4% w/v applied dermally at 8 mg/kg is highly effective in removing E. multilocularis from the small intestine of cats infected with immature and mature (prepatent) infections of E. multilocularis. In the cats with the mature infections all tapeworms were absent from the small intestine within 2 days of treatment.

[Study on the quality of digested piggery wastewater in large-scale farms in Jiaxing].

PubMed

Wei, Dan; Wan, Mei; Liu, Rui; Wang, Gen-Rong; Zhang, Xun-Da; Wen, Xiao-Gang; Zhao, Yuan; Chen, Lü-Jun

2014-07-01

Pollution characteristics of digested piggery wastewater (DPW), including not only the chemical oxygen demand (COD), nitrogen and phosphorus but also the veterinary antibiotics and heavy metals, were investigated in ten large-scale pig farms in Jiaxing City. Results showed that the water quality of DPW greatly varied with farms and seasons. DPW in the spring group showed the highest pollutant concentration, with seven of the ten pig farms demonstrating COD of over 2 000 mg x L(-1), total nitrogen and ammonia nitrogen of over 1 000 mg x L(-1) and total phosphorus of over 60 mg x L(-1). Pollutant concentrations of DPW were lower in the autumn and winter groups, while the lowest was observed in the summer group. Unbalanced nutrient was observed in DPW, the carbon nitrogen ratio showed the lowest value of 0.8-4.3 in the autumn group. Four classes (tetracyclines, quinolones, macrolides and sulfonamides) of ten antibiotics and six heavy metals (Cu, Zn, Pb, Cd, Ni and Cr) were detectable in DPW from all the ten farms. Cu and Zn were the top two dominant heavy metals, with an average concentration of 1.88 mg x L(-1) and 7.63 mg L(-1), respectively. Tetracyclines (including Tetracycline, Oxytetracycline and Chlortetracycline) were always the dominant antibiotics. The total concentration of the ten antibiotics was in the range of 10.1 microg x L(-1) to 1090 microg x L(-1), far exceeding the antibiotics limit of 10 ng x L(-1) in the water environment specified by EU. Efficient but low cost treatment technologies are in urgent need in order to deal with the pollution by DPW, a wastewater that is not only difficult to remove nitrogen and phosphorus, but also seriously polluted by heavy metals and antibiotics.

Current status, future opportunities, and remaining challenges in landscape genetics [Chapter 14

Treesearch

Niko Balkenhol; Samuel A. Cushman; Lisette P. Waits; Andrew Storfer

2016-01-01

Landscape genetics has advanced the field of evolutionary ecology by providing a direct focus on relationships between landscape patterns and population processes, such as gene flow, selection, and genetic drift. This chapter discusses the current and emerging challenges and opportunities, which focus and facilitate future progress in the field. It presents ten...

Effect of Unmodulated 5-kHz Alternating Currents Versus Transcutaneous Electrical Nerve Stimulation on Mechanical and Thermal Pain, Tactile Threshold, and Peripheral Nerve Conduction: A Double-Blind, Placebo-Controlled Crossover Trial.

PubMed

Avendaño-Coy, Juan; Gómez-Soriano, Julio; Goicoechea-García, Carlos; Basco-López, Julian Angel; Taylor, Julian

2017-05-01

To investigate the effect of unmodulated 5-kHz alternating current on mechanical pain threshold (MPT), heat pain threshold (HPT), tactile threshold (TT), and peripheral nerve conduction (PNC) compared with transcutaneous electrical nerve stimulation (TENS) and sham stimulation. National referral center. Randomized, double-blind, placebo-controlled crossover trial. Healthy volunteers (N=38). No dropouts or adverse events were reported. TENS, unmodulated 5-kHz currents, and sham stimulation were applied on the radial nerve for 20 minutes with a 24-hour washout period between them and concealed intervention allocation. Four measures were taken: before, during, and 2 after the interventions. Algometry was used to assess MPT, a Peltier thermode for HPT using the method of limits, Von Frey filaments for TT, and radial nerve compound action potential. No differences were observed on MPT, HPT, and PNC when 5-kHz current and TENS were compared. However, TT increased 56.2mN (95% confidence interval [CI], 28.8-83.6) in the TENS group compared with the 5-kHz current group during intervention. Compared with sham stimulation during intervention, MPT increased 4.7N (95% CI, 0.3-9.2) using 5-kHz current and 10.4N (95% CI, 3.5-17.3) with TENS. TT increased 17.2mN (95% CI, 4.7-29.7) with 5-kHz current and 73.4mN (95% CI, 47.5-99.2) with TENS. However, HPT increased 1.0°C (95% CI, 0.2-2.0) only with TENS. For the PNC, no differences were found among the 3 groups. Unmodulated 5-kHz current produced an increase in somatosensory thresholds that was greater than placebo but not when compared with TENS; however, participants perceived 5-kHz currents to be more comfortable and showed more habituation to them. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Enhancing hazard avoidance in teen-novice riders.

PubMed

Vidotto, Giulio; Bastianelli, Alessia; Spoto, Andrea; Sergeys, Filip

2011-01-01

Research suggests that novice drivers' safety performance is inferior to that of experienced drivers in different ways. One of the most critical skills related to accident avoidance by a novice driver is the detection, recognition and reaction to traffic hazards; it is called hazard perception and is defined as the ability to identify potentially dangerous traffic situations. The focus of this research is to assess how far a motorcycle simulator could improve hazard avoidance skills in teenagers. Four hundred and ten participants (207 in the experimental group and 203 in the control group) took part in this research. Results demonstrated that the mean proportion of avoided hazards increases as a function of the number of tracks performed in the virtual training. Participants of the experimental group after the training had a better proportion of avoided hazards than participants of the control group with a passive training based on a road safety lesson. Results provide good evidence that training with the simulator increases the number of avoided accidents in the virtual environment. It would be reasonable to explain this improvement by a higher level of hazard perception skills. Copyright © 2010 Elsevier Ltd. All rights reserved.

Exploring Ecosystems and Health by Shifting to a Regional Focus: Perspectives from the Oceania EcoHealth Chapter

PubMed Central

Kingsley, Jonathan; Patrick, Rebecca; Horwitz, Pierre; Parkes, Margot; Jenkins, Aaron; Massy, Charles; Henderson-Wilson, Claire; Arabena, Kerry

2015-01-01

This article highlights contributions that can be made to the public health field by incorporating “ecosystem approaches to health” to tackle future environmental and health challenges at a regional level. This qualitative research reviews attitudes and understandings of the relationship between public health and the environment and the priorities, aspirations and challenges of a newly established group (the Oceania EcoHealth Chapter) who are attempting to promote these principles. Ten semi-structured interviews with Oceania EcoHealth Chapter members highlighted the important role such groups can play in informing organisations working in the Oceania region to improve both public health and environmental outcomes simultaneously. Participants of this study emphasise the need to elevate Indigenous knowledge in Oceania and the role regional groups play in this regard. They also emphasis that regional advocacy and ecosystem approaches to health could bypass silos in knowledge and disciplinary divides, with groups like the Oceania EcoHealth Chapter acting as a mechanism for knowledge exchange, engagement, and action at a regional level with its ability to bridge the gap between environmental stewardship and public health. PMID:26473903

Bayesian assessment of moving group membership: importance of models and prior knowledge

NASA Astrophysics Data System (ADS)

Lee, Jinhee; Song, Inseok

2018-04-01

Young nearby moving groups are important and useful in many fields of astronomy such as studying exoplanets, low-mass stars, and the stellar evolution of the early planetary systems over tens of millions of years, which has led to intensive searches for their members. Identification of members depends on the used models sensitively; therefore, careful examination of the models is required. In this study, we investigate the effects of the models used in moving group membership calculations based on a Bayesian framework (e.g. BANYAN II) focusing on the beta-Pictoris moving group (BPMG). Three improvements for building models are suggested: (1) updating a list of accepted members by re-assessing memberships in terms of position, motion, and age, (2) investigating member distribution functions in XYZ, and (3) exploring field star distribution functions in XYZ and UVW. The effect of each change is investigated, and we suggest using all of these improvements simultaneously in future membership probability calculations. Using this improved MG membership calculation and the careful examination of the age, 57 bona fide members of BPMG are confirmed including 12 new members. We additionally suggest 17 highly probable members.

Someone to talk to: young mothers' experiences of participating in a young parents support programme.

PubMed

Mills, Annie; Schmied, Virginia; Taylor, Christine; Dahlen, Hannah; Shuiringa, Wies; Hudson, Margaret E

2013-09-01

To identify young parents' perceptions and experiences of a parenting support programme, run by a non-government organisation, which provided both community group-based, and one-on-one home visiting, support. A qualitative descriptive study was conducted in one of the most socio-economically disadvantaged areas of Sydney, NSW; this is also an area with one of the highest percentage of births among young parents. Young parents were eligible to participate whether they attended one of the parenting groups and/or received professional home visiting through the young parents programme. Eighteen young women were interviewed, and a further ten participated in a focus group. Thematic analysis of the focus groups and interviews was undertaken. Four themes were identified in the analysis: 'someone I know and trust', 'we just talk about anything and everything', 'doing the personal' and 'getting out and relaxing'. These themes were linked through the common thread of relationships; the relationships between themselves and other young mothers, and with the workers on the programme. The characteristics of the person with whom they had a relationship, the type of relationship, the content of their interactions and the benefits of these relationships were all important. This study is limited by the small sample size and the 'low risk' status of the young parents who engaged in the programme. This study demonstrated not only the importance for young parents of all forms of interaction, whether it is one-on-one, in a group or social networking; but most importantly, the benefits of having someone to talk to. © 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

Theoretical Astrophysics at Fermilab

NASA Technical Reports Server (NTRS)

2004-01-01

The Theoretical Astrophysics Group works on a broad range of topics ranging from string theory to data analysis in the Sloan Digital Sky Survey. The group is motivated by the belief that a deep understanding of fundamental physics is necessary to explain a wide variety of phenomena in the universe. During the three years 2001-2003 of our previous NASA grant, over 120 papers were written; ten of our postdocs went on to faculty positions; and we hosted or organized many workshops and conferences. Kolb and collaborators focused on the early universe, in particular and models and ramifications of the theory of inflation. They also studied models with extra dimensions, new types of dark matter, and the second order effects of super-horizon perturbations. S tebbins, Frieman, Hui, and Dodelson worked on phenomenological cosmology, extracting cosmological constraints from surveys such as the Sloan Digital Sky Survey. They also worked on theoretical topics such as weak lensing, reionization, and dark energy. This work has proved important to a number of experimental groups [including those at Fermilab] planning future observations. In general, the work of the Theoretical Astrophysics Group has served as a catalyst for experimental projects at Fennilab. An example of this is the Joint Dark Energy Mission. Fennilab is now a member of SNAP, and much of the work done here is by people formerly working on the accelerator. We have created an environment where many of these people made transition from physics to astronomy. We also worked on many other topics related to NASA s focus: cosmic rays, dark matter, the Sunyaev-Zel dovich effect, the galaxy distribution in the universe, and the Lyman alpha forest. The group organized and hosted a number of conferences and workshop over the years covered by the grant. Among them were:

Patients' experiences of coping with Idiopathic Pulmonary Fibrosis and their recommendations for its clinical management.

PubMed

Senanayake, Sameera; Harrison, Kim; Lewis, Michael; McNarry, Melitta; Hudson, Joanne

2018-01-01

Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive and life-limiting condition. From a healthcare perspective it is vital to establish effective methods of improving the quality of remaining life in these patients. This requires a detailed understanding of the multiple impacts of an IPF diagnosis on the individual. We sought to understand how patients coped with their initial diagnosis, how they live with the disease day-to-day, and their experiences and opinions of the professional support they receive. A patient-centred approach was used to explore the social, psychological and physical impacts of IPF. Semi-structured interviews were conducted by an experienced academic. Interview questions were written by the researchers but guided by informal conversations with patients and clinicians. An inductive thematic approach was used to analyse the data, allowing us to identify common themes in the patients' experiences. Of fifty invited participants, ten took part in the study (aged 53-81 years; 9 male). Inductive analysis of interviews identified seven second-order themes and eleven first-order themes, represented by two General Dimensions: 'Patient experience with the condition' and 'Patient-led recommendations for practice'. The key message on 'coping' in these patients was that acceptance of their condition led to a sense of optimism. Participants reported using appraisal-focused coping strategies to change their perspectives (thinking positively) and emotion-focused strategies to overcome depression (the main opportunity for emotional expression being an IPF support group). The support group also facilitated problem-focused coping: individuals exchanged knowledge and experience and gave one another tips on how to live with their condition. Health professionals should provide patients with information that focuses on living with IPF, encouraging them to make lifestyle changes and adaptations to improve quality of life. Family members should receive education about IPF so that they can support such changes. Patients should be encouraged to join a support group and to participate in physical activity (again preferably group-based). This study offers novel findings that will help inform much-needed changes in the practice of supporting IPF patients to cope with their diagnosis and disease progression.

'We are all scared for the baby': promoting access to dental services for refugee background women during pregnancy.

PubMed

Riggs, Elisha; Yelland, Jane; Shankumar, Ramini; Kilpatrick, Nicky

2016-01-21

Vulnerable populations such as people with refugee backgrounds are at increased risk of poor oral health. Given that maternal characteristics play a significant role in the development of dental caries in children, antenatal care offers an opportunity to both provide information to women about the importance of maternal oral health and accessing dental care. Although pregnant women are recognised for 'priority' care under Victorian state-government policy, rarely do they attend. This study aims to describe Afghan and Sri Lankan women's knowledge and beliefs surrounding maternal oral health, barriers to accessing dental care during pregnancy, and to present the perspectives of maternity and dental service providers in relation to dental care for pregnant women. One agency comprising both dental and maternity services formed the setting for the study. Using participatory methods that included working with bicultural community workers, focus groups were conducted with Afghan and Sri Lankan refugee background participants. Focus groups were also completed with midwives and dental service staff. Thematic analysis was applied to analyse the qualitative data. Four community focus groups were conducted with a total of 14 Afghan women, eight Sri Lankan women, and three Sri Lankan men. Focus groups were also conducted with 19 dental staff including clinicians and administrative staff, and with ten midwives. Four main themes were identified: perceptions of dental care during pregnancy, navigating dental services, maternal oral health literacy and potential solutions. Key findings included women and men's perception that dental treatment is unsafe during pregnancy, the lack of awareness amongst both the midwives and community members of the potential impact of poor maternal oral health and the overall lack of awareness and understanding of the 'priority of access' policy that entitles pregnant women to receive dental care cost-free. This study highlights a significant policy-to-practice gap which if not addressed has the potential to widen oral health inequalities across the life-course. Stakeholders were keen to collaborate and support action to improve the oral health of mothers and their infants with the over-riding priority being to develop inter-service relationships to promote seamless access to oral health care.

Efficacy of the device combining high-frequency transcutaneous electrical nerve stimulation and thermotherapy for relieving primary dysmenorrhea: a randomized, single-blind, placebo-controlled trial.

PubMed

Lee, Banghyun; Hong, Seung Hwa; Kim, Kidong; Kang, Wee Chang; No, Jae Hong; Lee, Jung Ryeol; Jee, Byung Chul; Yang, Eun Joo; Cha, Eun-Jong; Kim, Yong Beom

2015-11-01

To investigate the efficacy and safety of the combined therapy with high-frequency transcutaneous electrical nerve stimulation (hf-TENS) and thermotherapy in relieving primary dysmenorrheal pain. In this randomized, single-blind, placebo-controlled study, 115 women with moderate or severe primary dysmenorrhea were assigned to the study or control group at a ratio of 1:1. Subjects in the study group used an integrated hf-TENS/thermotherapy device, whereas control subjects used a sham device. A visual analog scale was used to measure pain intensity. Variables related to pain relief, including reduction rate of dysmenorrheal score, were compared between the groups. The dysmenorrheal score was significantly reduced in the study group compared to the control group following the use of the devices. The duration of pain relief was significantly increased in the study group compared to the control group. There were no differences between the groups in the brief pain inventory scores, numbers of ibuprofen tablets taken orally, and World Health Organization quality of life-BREF scores. No adverse events were observed related to the use of the study device. The combination of hf-TENS and thermotherapy was effective in relieving acute pain in women with moderate or severe primary dysmenorrhea. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Optimal duration of ultra low frequency-transcutaneous electrical nerve stimulation (ULF-TENS) therapy for muscular relaxation in neuromuscular occlusion: A preliminary clinical study.

PubMed

Esclassan, Rémi; Rumerio, Anaïs; Monsarrat, Paul; Combadazou, Jean Claude; Champion, Jean; Destruhaut, Florent; Ghrenassia, Christophe

2017-05-01

The primary aim of this work was to determine the duration of ultra-low-frequency transcutaneous electrical nerve stimulation (ULF-TENS) application necessary to achieve sufficient relaxation of the masticatory muscles. A secondary aim was to analyze the influence of stimulation on muscle relaxation in pathological subjects and determine whether ULF-TENS has a noteworthy impact on muscle relaxation. Sixteen adult subjects with temporomandibular disorders (TMD) and muscle pain and a group of four control subjects were included in this study. ULF-TENS was applied, and muscular activities of the masseter, temporal, and sternocleidomastoid muscles (SCM) were recorded for 60 min. Significant relaxation was achieved in the TMD group from 20, 40, and 60 min for the temporal, masseter, and SCM muscles (p < 0.05), respectively. Maximum relaxation was achieved in 12.5% of the subjects after 20 min, in a further 12.5% after 40 min, and in the remaining 75% after 60 min. Significant relaxation was achieved in the control group from 20 to 40 min for the masseter and temporal muscles, respectively (p < 0.05). Taken together, the results suggest that an ideal ULF-TENS application would last 40 min to obtain sufficient muscle relaxation both in patients with masticatory system disorders and healthy subjects, a time constraint that is consistent with everyday clinical practice.

Transcutaneous Electrical Nerve Stimulation and Conditioned Pain Modulation Influence the Perception of Pain in Humans

PubMed Central

Liebano, Richard E.; Vance, Carol G.T.; Rakel, Barbara; Lee, Jennifer E.; Cooper, Nicholas A.; Marchand, Serge; Walsh, Deirdre M.; Sluka, Kathleen A.

2013-01-01

Background Research in animal models suggest that transcutaneous electrical nerve stimulation (TENS) and conditioned pain modulation (CPM) produce analgesia via two different supraspinal pathways. No known studies have examined whether TENS and CPM applied simultaneously in human subjects will enhance the analgesic effect of either treatment alone. The purpose of the current study was to investigate whether the simultaneous application of TENS and CPM will enhance the analgesic effect of that produced by either treatment alone. Methods Sixty healthy adults were randomly allocated into 2 groups: 1) CPM plus Active TENS; 2) CPM plus Placebo TENS. Pain threshold for heat (HPT) and pressure (PPT) was recorded from subject’s left forearm at baseline, during CPM, during Active or Placebo TENS, and during CPM plus Active or Placebo TENS. CPM was induced by placing the subjects’ contralateral arm in a hot water bath (46.5°C) for two minutes. TENS (100µs, 100Hz) was applied to the forearm for 20 minutes at a strong but comfortable intensity. Results Active TENS alone increased PPT (but not HPT) more than Placebo TENS alone (p=0.011). Combining CPM and Active TENS did not significantly increase PPT (p=0.232) or HPT (p=0.423) beyond CPM plus Placebo TENS. There was a significant positive association between PPT during CPM and during Active TENS (r2=0.46, p=0.003). Conclusions TENS application increases PPT, however combining CPM and TENS does not increase the CPM’s hypoalgesic response. CPM effect on PPT is associated with effects of TENS on PPT. PMID:23650092

Association of HLA-B*5801 allele and allopurinol-induced stevens johnson syndrome and toxic epidermal necrolysis: a systematic review and meta-analysis

PubMed Central

2011-01-01

Background Despite some studies suggesting a possible association between human leukocyte antigen, HLA-B*5801 and allopurinol induced Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), the evidence of association and its magnitude remain inconclusive. This study aims to systematically review and meta-analyze the association between HLA-B*5801 allele and allopurinol-induced SJS/TEN. Methods A comprehensive search was performed in databases including MEDLINE, Pre-MEDLINE, Cochrane Library, EMBASE, International Pharmaceutical Abstracts (IPA), CINAHL, PsychInfo, the WHO International, Clinical Trial Registry, and ClinicalTrial.gov from their inceptions to June 2011. Only studies investigating association between HLA-B*5801 with allopurinol-induced SJS/TEN were included. All studies were extracted by two independent authors. The primary analysis was the carrier frequency of HLA-B*5801 comparison between allopurinol-induced SJS/TEN cases and each comparative group. The pooled odds ratios were calculated using a random effect model. Results A total of 4 studies with 55 SJS/TEN cases and 678 matched-controls (allopurinol-tolerant control) was identified, while 5 studies with 69 SJS/TEN cases and 3378 population-controls (general population) were found. SJS/TEN cases were found to be significantly associated with HLA-B*5801 allele in both groups of studies with matched-control (OR 96.60, 95%CI 24.49-381.00, p < 0.001) and population-control (OR 79.28, 95%CI 41.51-151.35, p < 0.001). Subgroup analysis for Asian and Non-Asian population yielded similar findings. Conclusion We found a strong and significant association between HLA-B*5801 and allopurinol-induced SJS/TEN. Therefore, HLA-B*5801 allele screening may be considered in patients who will be treated with allopurinol. PMID:21906289

Low Intensity Laser Therapy (LILT) Versus Transcutaneous Electrical Nerve Stimulation On Microcirculation In Diabetic Neuropathy

NASA Astrophysics Data System (ADS)

Battecha, Kadria H.; Atya, Azza M.

2011-09-01

Reduced microcirculation is a morbid element of neuropathy and one of the most common complications of uncontrolled diabetes. Many physical modalities have gained a considerable attention for enhancing cutaneous microcirculation in diabetic patients and prevent its serious complications. Accordingly, the present study was conducted to compare between the effect of low intensity laser therapy (LILT) and transcutaneous electrical nerve stimulation (TENS) on microcirculation in diabetic neuropathy. Thirty diabetic polyneuropathic patients ranged in age from 45-60 years participated in this study. They were randomly divided into two groups of equal number; patients in group (A) received LILT on plantar surface of foot with a dose of 3 J/cm2 and wavelength (904 nm), while those in group (B) received TENS on lower leg for 30 minutes with frequency (2 HZ). Treatment was conducted 3 times/week for 6 weeks. The cutaneous microcirculation was evaluated by Laser Doppler flowmetry at the baseline and at the end of treatment. Results revealed that group (A) showed statistically significant increase in the cutaneous microcirculation compared with group (B). So, it was concluded that LILT has to be more efficient than TENS in increasing cutaneous microcirculation in patients with diabetic neuropathy.

Understanding motivations for dietary supplementation during pregnancy: A focus group study.

PubMed

Malek PhD, Lenka; Umberger PhD, Wendy J; Makrides PhD, Maria; Collins PhD, Carmel T; Zhou PhD, Shao Jia

2018-02-01

to increase understanding of psychosocial factors (behavioural, normative and control beliefs) motivating vitamin and mineral supplement use during pregnancy. ten focus group discussions and two in-depth interviews were conducted using a script comprising questions based on study objectives. All discussions were recorded, transcribed verbatim and analysed using a framework approach. South Australia, Australia. 40 women aged 21-45 years who were either pregnant or<12 months postpartum. Groups were stratified by education level (secondary education only vs. post-secondary) and gravidity (first vs. subsequent pregnancy). all women, except one, used dietary supplements during pregnancy. Most women took supplements to achieve peace of mind knowing that nutrient requirements were 'definitely' being met. Other common factors motivating supplement use were the beliefs that supplementation: benefits maternal and fetal health; corrects known nutritional deficiencies; and is a more efficient method of obtaining required nutrients relative to food. Advice received from healthcare providers and marketing of supplements also motivated supplementation, while forgetting to take supplements was the most common barrier to use. Cost was only a barrier when considering whether or not to continue supplementation post-birth. women believe that supplements are an easier and more reliable source of nutrients than food intake alone, and rely on dietary supplementation as an insurance policy during pregnancy. Further studies are needed in larger and more representative samples to validate these findings and to test the effectiveness of information and intervention strategies targeting appropriate supplement use during pregnancy. Copyright © 2017 Elsevier Ltd. All rights reserved.

Effects of Transcutaneous Electrical Nerve Stimulation on Pain, Pain Sensitivity, and Function in People With Knee Osteoarthritis: A Randomized Controlled Trial

PubMed Central

Vance, Carol Grace T.; Rakel, Barbara A.; Blodgett, Nicole P.; DeSantana, Josimari Melo; Amendola, Annunziato; Zimmerman, Miriam Bridget; Walsh, Deirdre M.

2012-01-01

Background Transcutaneous electrical nerve stimulation (TENS) is commonly used for the management of pain; however, its effects on several pain and function measures are unclear. Objective The purpose of this study was to determine the effects of high-frequency TENS (HF-TENS) and low-frequency TENS (LF-TENS) on several outcome measures (pain at rest, movement-evoked pain, and pain sensitivity) in people with knee osteoarthritis. Design The study was a double-blind, randomized clinical trial. Setting The setting was a tertiary care center. Participants Seventy-five participants with knee osteoarthritis (29 men and 46 women; 31–94 years of age) were assessed. Intervention Participants were randomly assigned to receive HF-TENS (100 Hz) (n=25), LF-TENS (4 Hz) (n=25), or placebo TENS (n=25) (pulse duration=100 microseconds; intensity=10% below motor threshold). Measurements The following measures were assessed before and after a single TENS treatment: cutaneous mechanical pain threshold, pressure pain threshold (PPT), heat pain threshold, heat temporal summation, Timed “Up & Go” Test (TUG), and pain intensity at rest and during the TUG. A linear mixed-model analysis of variance was used to compare differences before and after TENS and among groups (HF-TENS, LF-TENS, and placebo TENS). Results Compared with placebo TENS, HF-TENS and LF-TENS increased PPT at the knee; HF-TENS also increased PPT over the tibialis anterior muscle. There was no effect on the cutaneous mechanical pain threshold, heat pain threshold, or heat temporal summation. Pain at rest and during the TUG was significantly reduced by HF-TENS, LF-TENS, and placebo TENS. Limitations This study tested only a single TENS treatment. Conclusions Both HF-TENS and LF-TENS increased PPT in people with knee osteoarthritis; placebo TENS had no significant effect on PPT. Cutaneous pain measures were unaffected by TENS. Subjective pain ratings at rest and during movement were similarly reduced by active TENS and placebo TENS, suggesting a strong placebo component of the effect of TENS. PMID:22466027

Does transcutaneous electrical nerve stimulation reduce pain and improve quality of life in patients with idiopathic chronic orchialgia? A randomized controlled trial

PubMed Central

Tantawy, Sayed A; Kamel, Dalia M; Abdelbasset, Walid Kamal

2018-01-01

Background Chronic orchialgia is defined as testicular pain, which may be either unilateral or bilateral, lasting for more than 3 months. It disturbs a patient’s daily activities and quality of life (QoL), inciting the patient to search for treatments to alleviate the pain. It is estimated that 25% of chronic orchialgia cases are idiopathic. Purpose The purpose of this study was to investigate how effective transcutaneous electrical nerve stimulation (TENS) is in pain reduction and how it consequently affects the QoL in patients with idiopathic chronic orchialgia (ICO). Patients and methods Seventy-one patients were randomly assigned to group A (study group), which included 36 patients who received TENS and analgesia, and group B (control group), which included 35 patients who received analgesia only. The outcome measures were the participants’ demographic data and results of the visual analog scale (VAS) and QoL questionnaire. These outcomes were measured before and after 4 weeks of treatment and at 2-month follow-up. Results The results showed that compared to pretreatment, there was a significant reduction in pain postintervention and at 2-month follow-up in group A (P<0.0001 and <0.001, respectively; F=7.1) as well as a significant improvement in QoL at these time points (P<0.0001 and <0.0001, respectively). There were no significant differences in the VAS score and QoL in group B at different time points of evaluation. Conclusion The findings indicate that TENS is effective in reducing pain and improving patients’ QoL in cases of ICO. TENS is an easy-to-use, effective, noninvasive, and simple method for ICO-associated pain control and QoL improvement. PMID:29343983

Mid-career faculty development in academic medicine: How does it impact faculty and institutional vitality?

PubMed Central

Campion, MaryAnn W.; Bhasin, Robina M.; Beaudette, Donald J.; Shann, Mary H.; Benjamin, Emelia J.

2016-01-01

Purpose Faculty vitality is integral to the advancement of higher education. Strengthening vitality is particularly important for mid-career faculty, who represent the largest and most dissatisfied segment. The demands of academic medicine appear to be another factor that may put faculty at risk of attrition. To address these issues, we initiated a ten-month mid-career faculty development program. Methods A mixed-methods quasi-experimental design was used to evaluate the program's impact on faculty and institutional vitality. Pre/post surveys compared participants with a matched reference group. Quantitative data were augmented by interviews and focus groups with multiple stakeholders. Results At the program's conclusion, participants showed statistically significant gains in knowledge, skills, attitudes, and connectivity when compared to the referents. Conclusion Given that mid-career faculty development in academic medicine has not been extensively studied, our evaluation provides a useful perspective to guide future initiatives aimed at enhancing the vitality and leadership capacity of mid-career faculty. PMID:27942418

Mid-career faculty development in academic medicine: How does it impact faculty and institutional vitality?

PubMed

Campion, MaryAnn W; Bhasin, Robina M; Beaudette, Donald J; Shann, Mary H; Benjamin, Emelia J

2016-09-01

Faculty vitality is integral to the advancement of higher education. Strengthening vitality is particularly important for mid-career faculty, who represent the largest and most dissatisfied segment. The demands of academic medicine appear to be another factor that may put faculty at risk of attrition. To address these issues, we initiated a ten-month mid-career faculty development program. A mixed-methods quasi-experimental design was used to evaluate the program's impact on faculty and institutional vitality. Pre/post surveys compared participants with a matched reference group. Quantitative data were augmented by interviews and focus groups with multiple stakeholders. At the program's conclusion, participants showed statistically significant gains in knowledge, skills, attitudes, and connectivity when compared to the referents. Given that mid-career faculty development in academic medicine has not been extensively studied, our evaluation provides a useful perspective to guide future initiatives aimed at enhancing the vitality and leadership capacity of mid-career faculty.

Neotropical Copestylum Macquart (Diptera: Syrphidae) Breeding in Fruits and Flowers, Including 7 New Species

PubMed Central

Ricarte, Antonio; Marcos-García, M. Ángeles; Hancock, E. Geoffrey; Rotheray, Graham E.

2015-01-01

Ten species of Copestylum (Diptera: Syrphidae) were reared from fruits and flowers in Costa Rica, Ecuador and Trinidad. Seven were new and in this paper, we describe them, their development sites and the third stage larva and/or the puparium of all ten species. One new synonym is proposed, Copestylum pinkusi (Curran) [= Copestylum cinctiventre (Curran)]. Similarities and differences between these new and other Copestylum species, suggest they separate into two groups, referred to as the Vagum and Cinctiventre species groups. Features characterising these groups for both adult and early stages are assessed. Each species was also distinguished using adult and early stage characters. Within the Vagum group, adults were more disparate morphologically than the larval stage; this was reversed in the Cinctiventre group. Adult colour patterns are probably cryptic in function and for disguise. Vagum species have disruptive marks, while the Cinctiventre species have reflective colours. Biologically, the groups are almost distinguished by larval development sites. Vagum species use predominantly fruits and have a larval stage that is relatively generalised in form and habit. Cinctiventre species are confined to developing in flowers and the larva is more specialised. A key to both adult and early stages of all ten species is provided. PMID:26580811

Does metformin affect ovarian morphology in patients with polycystic ovary syndrome? A retrospective cross-sectional preliminary analysis

PubMed Central

Falbo, Angela; Orio, Francesco; Venturella, Roberta; Rania, Erika; Materazzo, Caterina; Tolino, Achille; Zullo, Fulvio; Palomba, Stefano

2009-01-01

Background The significance of polycystic ovarian morphology and its relation to polycystic ovary syndrome (PCOS) is unclear, but probably it is associated with higher androgen and insulin levels and lower sex hormone binding globulin (SHBG) in absence of identifiable differences in gonadotropin dynamics. The aim of this study was to evaluate ovarian morphology in patients affected by PCOS with different ovulatory responses to metformin. Methods In this cross-sectional analysis, we studied 20 young normal-weight PCOS patients who had received a six-month course of metformin treatment. Ten of these patients remained anovulatory (anovulatory group), whereas other ten became ovulatory, but failed to conceive (ovulatory group). Other ten age- and body mass index (BMI)-matched PCOS subjects were also enrolled as controls and observed without any treatment (control group). Results After six months of metformin, in both PCOS treated groups, a similar improvement in testosterone (T) and insulin resistance indexes was observed. Moreover, in one (10.0%) and nine (90.0%) subjects from anovulatory and ovulatory PCOS groups, respectively, ovarian morphology changed, whereas a significant reduction in ovarian dimension was observed in the PCOS ovulatory group only. Conclusion PCOS patients under metformin administration demonstrate a change in ovarian morphology closely related to ovulatory response. PMID:19480717

Does metformin affect ovarian morphology in patients with polycystic ovary syndrome? A retrospective cross-sectional preliminary analysis.

PubMed

Falbo, Angela; Orio, Francesco; Venturella, Roberta; Rania, Erika; Materazzo, Caterina; Tolino, Achille; Zullo, Fulvio; Palomba, Stefano

2009-05-31

The significance of polycystic ovarian morphology and its relation to polycystic ovary syndrome (PCOS) is unclear, but probably it is associated with higher androgen and insulin levels and lower sex hormone binding globulin (SHBG) in absence of identifiable differences in gonadotropin dynamics. The aim of this study was to evaluate ovarian morphology in patients affected by PCOS with different ovulatory responses to metformin. In this cross-sectional analysis, we studied 20 young normal-weight PCOS patients who had received a six-month course of metformin treatment. Ten of these patients remained anovulatory (anovulatory group), whereas other ten became ovulatory, but failed to conceive (ovulatory group). Other ten age- and body mass index (BMI)-matched PCOS subjects were also enrolled as controls and observed without any treatment (control group). After six months of metformin, in both PCOS treated groups, a similar improvement in testosterone (T) and insulin resistance indexes was observed. Moreover, in one (10.0%) and nine (90.0%) subjects from anovulatory and ovulatory PCOS groups, respectively, ovarian morphology changed, whereas a significant reduction in ovarian dimension was observed in the PCOS ovulatory group only. PCOS patients under metformin administration demonstrate a change in ovarian morphology closely related to ovulatory response.

Ten steps or climbing a mountain: a study of Australian health professionals' perceptions of implementing the baby friendly health initiative to protect, promote and support breastfeeding.

PubMed

Schmied, Virginia; Gribble, Karleen; Sheehan, Athena; Taylor, Christine; Dykes, Fiona C

2011-08-31

The Baby Friendly Hospital (Health) Initiative (BFHI) is a global initiative aimed at protecting, promoting and supporting breastfeeding and is based on the ten steps to successful breastfeeding. Worldwide, over 20,000 health facilities have attained BFHI accreditation but only 77 Australian hospitals (approximately 23%) have received accreditation. Few studies have investigated the factors that facilitate or hinder implementation of BFHI but it is acknowledged this is a major undertaking requiring strategic planning and change management throughout an institution. This paper examines the perceptions of BFHI held by midwives and nurses working in one Area Health Service in NSW, Australia. The study used an interpretive, qualitative approach. A total of 132 health professionals, working across four maternity units, two neonatal intensive care units and related community services, participated in 10 focus groups. Data were analysed using thematic analysis. Three main themes were identified: 'Belief and Commitment'; 'Interpreting BFHI' and 'Climbing a Mountain'. Participants considered the BFHI implementation a high priority; an essential set of practices that would have positive benefits for babies and mothers both locally and globally as well as for health professionals. It was considered achievable but would take commitment and hard work to overcome the numerous challenges including a number of organisational constraints. There were, however, differing interpretations of what was required to attain BFHI accreditation with the potential that misinterpretation could hinder implementation. A model described by Greenhalgh and colleagues on adoption of innovation is drawn on to interpret the findings. Despite strong support for BFHI, the principles of this global strategy are interpreted differently by health professionals and further education and accurate information is required. It may be that the current processes used to disseminate and implement BFHI need to be reviewed. The findings suggest that there is a contradiction between the broad philosophical stance and best practice approach of this global strategy and the tendency for health professionals to focus on the ten steps as a set of tasks or a checklist to be accomplished. The perceived procedural approach to implementation may be contributing to lower rates of breastfeeding continuation.

Exercise enhance the ectopic bone formation of calcium phosphate biomaterials in muscles of mice.

PubMed

Cheng, Lijia; Yan, Shuo; Zhu, Jiang; Cai, Peiling; Wang, Ting; Shi, Zheng

2017-08-01

To investigate whether exercise can enhance ectopic bone formation of calcium phosphate (Ca-P) biomaterials in muscles of mice. Firstly, ten transient receptor potential vanilloid subfamily member 1 (TRPV1) knockout mice (group KO) and ten C57BL/6 mice (group WT) were randomly chosen, 10μg Ca-P biomaterials were implanted into the thigh muscle pouch of each mouse which was far away from femur; after that, all animals were kept in open field for free exploration 5min, and the movement time and distance were automatically analyzed. Ten weeks later, the Ca-P samples were harvested for histological staining and immunochemistry. Secondly, the Ca-P biomaterials were implanted into the thigh muscle pouch of C57BL/6 mice the same as previous operation, and then randomly divided into two groups: running group and non-running group (n=10); in running group, all mice run 1h as a speed of 6m/h in a treadmill for 10weeks. Ten weeks later, the blood was collected to detect the interleukin-4 (IL-4) and IL-12 levels by enzyme linked immunosorbent assay (ELISA), and the samples were harvested for histological staining. In groups KO and WT, both the movement time and distance were significant higher in group KO than that in group WT (P<0.05); furthermore, the histology staining results showed that lots of new bone and bone marrow tissues were observed in group KO, but only bone matrix-like substances were observed in group WT. In running group and non-running group, the ELISA results indicated that the immunological genes, both IL-4 and IL-12 levels were significant higher in running group than that in non-running group (P<0.05); besides that, more new bone tissues were observed in running group than that in non-running group. Knockout of TRPV1 in mice could reduce algesia and induce the stronger athletic ability of mice, causing better osteoinductivity of Ca-P biomaterials both in TRPV1 -/- mice and running mice; according to this, we want to offer a proposal to patients who suffer from bone defects and artificial bone transplantation: do moderate exercise, don't convalesce all the time. Copyright © 2017 Elsevier B.V. All rights reserved.

An Empirical Derivation of Hierarchies of Propositions Related to Ten of Piaget's Sixteen Binary Operations

ERIC Educational Resources Information Center

Benefield, K. Elaine; Capie, William

1976-01-01

A group of students from grades four through twelve were tested on ten binary operations in four truth conditions. It was found that propositional operations which had greater inclusiveness or breadth of concepts were more difficult to comprehend. (MLH)

What makes transcutaneous electrical nerve stimulation work? Making sense of the mixed results in the clinical literature.

PubMed

Sluka, Kathleen A; Bjordal, Jan M; Marchand, Serge; Rakel, Barbara A

2013-10-01

Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacological treatment for control of pain. It has come under much scrutiny lately with the Center for Medicare Services rendering a recent decision stating that "TENS is not reasonable and necessary for the treatment of CLBP [chronic low back pain]." When reading and analyzing the existing literature for which systematic reviews show that TENS is inconclusive or ineffective, it is clear that a number of variables related to TENS application have not been considered. Although many of the trials were designed with the highest of standards, recent evidence suggests that factors related to TENS application need to be considered in an assessment of efficacy. These factors include dosing of TENS, negative interactions with long-term opioid use, the population and outcome assessed, timing of outcome measurement, and comparison groups. The purpose of this perspective is to highlight and interpret recent evidence to help improve the design of clinical trials and the efficacy of TENS in the clinical setting.

Muscle changes can account for bone loss after botulinum toxin injection.

PubMed

Manske, Sarah L; Boyd, Steven K; Zernicke, Ronald F

2010-12-01

Studies to date have assumed that botulinum toxin type A (BTX) affects bone indirectly, through its action on muscle. We hypothesized that BTX has no discernable effect on bone morphometry, independent of its effect on muscle. Therefore, we investigated whether BTX had an additional effect on bone when combined with tenotomy compared to tenotomy in isolation. Female BALB/c mice (n = 73) underwent one of the following procedures in the left leg: BTX injection and Achilles tenotomy (BTX-TEN), BTX injection and sham surgery (BTX-sham), Achilles tenotomy (TEN), or sham surgery (sham). BTX groups were injected with 20 μL of BTX (1 U/100 g) in the posterior lower hindlimb. At 4 weeks, muscle cross-sectional area (MCSA) and tibial bone morphometry were assessed using micro-CT. Each treatment, other than sham, resulted in significant muscle and bone loss (P < 0.05). BTX-TEN experienced the greatest muscle loss (23-45% lower than other groups) and bone loss (20-30% lower bone volume fraction than other groups). BTX-sham had significantly lower MCSA and bone volume fraction than TEN and sham. After adjusting for differences in MCSA, there were no significant between-group differences in bone properties. We found that BTX injection resulted in more adverse muscle and bone effects than tenotomy and that effects were amplified when the procedures were combined. However, between-group differences in bone could be accounted for by MCSA. We conclude that any independent effect of BTX on bone morphometry is likely small or negligible compared with the effect on muscle.

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis--A Comprehensive Review and Guide to Therapy. I. Systemic Disease.

PubMed

Kohanim, Sahar; Palioura, Sotiria; Saeed, Hajirah N; Akpek, Esen K; Amescua, Guillermo; Basu, Sayan; Blomquist, Preston H; Bouchard, Charles S; Dart, John K; Gai, Xiaowu; Gomes, José A P; Gregory, Darren G; Iyer, Geetha; Jacobs, Deborah S; Johnson, Anthony J; Kinoshita, Shigeru; Mantagos, Iason S; Mehta, Jodhbir S; Perez, Victor L; Pflugfelder, Stephen C; Sangwan, Virender S; Sippel, Kimberly C; Sotozono, Chie; Srinivasan, Bhaskar; Tan, Donald T H; Tandon, Radhika; Tseng, Scheffer C G; Ueta, Mayumi; Chodosh, James

2016-01-01

The intent of this review is to comprehensively appraise the state of the art with regard to Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), with particular attention to the ocular surface complications and their management. SJS and TEN represent two ends of a spectrum of immune-mediated, dermatobullous disease, characterized in the acute phase by a febrile illness followed by skin and mucous membrane necrosis and detachment. The widespread keratinocyte death seen in SJS/TEN is rapid and irreversible, and even with early and aggressive intervention, morbidity is severe and mortality not uncommon. We have divided this review into two parts. Part I summarizes the epidemiology and immunopathogenesis of SJS/TEN and discusses systemic therapy and its possible benefits. We hope this review will help the ophthalmologist better understand the mechanisms of disease in SJS/TEN and enhance their care of patients with this complex and often debilitating disease. Part II (April 2016 issue) will focus on ophthalmic manifestations. Copyright © 2016 Elsevier Inc. All rights reserved.

Effects of transcutaneous electrical nerve stimulation (TENS) on arterial stiffness and blood pressure in resistant hypertensive individuals: study protocol for a randomized controlled trial.

PubMed

Vilela-Martin, José Fernando; Giollo-Junior, Luiz Tadeu; Chiappa, Gaspar Rogério; Cipriano-Junior, Gerson; Vieira, Paulo José Cardoso; dos Santos Ricardi, Fábio; Paz-Landim, Manoel Ildefonso; de Andrade, Days Oliveira; Cestário, Elizabeth do Espírito Santo; Cosenso-Martin, Luciana Neves; Yugar-Toledo, Juan Carlos; Cipullo, José Paulo

2016-03-29

Resistant hypertension (RH) treatment requires an adequate and intense therapeutic approach. However, the results are not always satisfactory despite intensive treatment. Of the different pathophysiological mechanisms involved in the pathogenesis of RH, sympathetic overstimulation and therapies that block the sympathetic system have been widely studied. These approaches, however, are invasive and expensive. Another possible approach is by transcutaneous electrical nerve stimulation (TENS), a noninvasive method that modulates activity by using low-frequency transcutaneous electrical stimulation to inhibit primary afferent pathways. Thus, the current study will evaluate the effect of applying TENS in the cervicothoracic region of subjects with RH and will seek to develop a new low-cost and readily available therapy to treat this group of hypertensive individuals. This is a randomized, single blind (subject), parallel-assignment study controlled with a sham group and including participants aged 40 to 70 years with resistant hypertension. The trial has two arms: the treatment and control (sham group). The treatment group will be submitted to the stimulation procedure (TENS). The sham group will not be submitted to stimulation. The primary outcomes will be a reduction in the peripheral blood pressure and adverse events. The secondary outcomes will be a reduction the central blood pressure. The study will last 30 days. The sample size was calculated assuming an alpha error of 5 % to reject the null hypothesis with a statistical power of 80 %, thereby resulting in 28 participants per group (intervention versus sham). In recent decades, RH has become very common and costly. Adequate control requires several drugs, and in many cases, treatment is not successful. Sympathetic nervous system inhibition by renal denervation and central inhibition have significant effects in reducing BP; however, these treatments are costly and invasive. Another type of sympathetic nervous system inhibition can also be noninvasively achieved by electric current. Therefore, the application of TENS may be a new therapeutic option for treating resistant hypertensive individuals. Clinical Trials NCT02365974.

SUSTAINED ISOMETRIC SHOULDER CONTRACTION ON MUSCULAR STRENGTH AND ENDURANCE: A RANDOMIZED CLINICAL TRIAL.

PubMed

Myers, Natalie L; Toonstra, Jenny L; Smith, Jacob S; Padgett, Cooper A; Uhl, Tim L

2015-12-01

The Advanced Throwers Ten Exercise Program incorporates sustained isometric contractions in conjunction with dynamic shoulder movements. It has been suggested that incorporating isometric holds may facilitate greater increases in muscular strength and endurance. However, no objective evidence currently exists to support this claim. The purpose of this research was to compare the effects of a sustained muscle contraction resistive training program (Advanced Throwers Ten Program) to a more traditional exercise training protocol to determine if increases in shoulder muscular strength and endurance occur in an otherwise healthy population. It was hypothesized that utilizing a sustained isometric hold during a shoulder scaption exercise from the Advanced Throwers Ten would produce greater increases in shoulder strength and endurance as compared to a traditional training program incorporating a isotonic scapular plane abduction (scaption) exercise. Randomized Clinical Trial. Fifty healthy participants were enrolled in this study, of which 25 were randomized into the traditional training group (age: 26 ± 8, height:172 ± 10 cm, weight: 73 ± 13 kg, Marx Activity Scale: 11 ± 4) and 25 were randomized to the Advanced Throwers Ten group (age: 28 ± 9, height: 169 ± 23 cm, weight: 74 ± 16 kg, Marx Activity Scale: 11 ± 5). No pre-intervention differences existed between the groups (P>0.05). Arm endurance and strength data were collected pre and post intervention using a portable load cell (BTE Evaluator, Hanover, MD). Both within and between group analyses were done in order to investigate average torque (strength) and angular impulse (endurance) changes. The traditional and Advanced Throwers Ten groups both significantly improved torque and angular impulse on both the dominant and non-dominant arms by 10-14%. There were no differences in strength or endurance following the interventions between the two training groups (p>0.75). Both training approaches increased strength and endurance as the muscle loads were consistent between protocols indicating that either approach will have positive effects. Level 2.

Effectiveness of an Attachment-Focused Manualized Intervention for Parents of Teens at Risk for Aggressive Behaviour: The Connect Program

ERIC Educational Resources Information Center

Moretti, Marlene M.; Obsuth, Ingrid

2009-01-01

Aggressive, violent and antisocial behaviour in children and adolescents is a growing concern across the globe. Targeting parent-teen relationships is critical in reducing problem behaviour. "Connect" is a manualized ten-week program for parents or alternative caregivers of at-risk teens that focuses on the building blocks of secure attachment:…

[Chemotherapy in metastasing breast cancer--is it beneficial?].

PubMed

Høgsberg, I M; Nielsen, M M; Cold, S; Rose, C

1994-10-31

Carcinoma of the breast is the most common type of cancer among women in Denmark (3,000 new cases a year). About half of the patients will at some time develop metastases. Treatment of extended disease is controversial. Public discussion has focused on whether it is desirable to treat these patients with chemotherapy or not. This case story describes four cases with long term survival (nine, ten, 14, 19 years after début of metastases). This underlines that it is possible within the existing types of treatment to achieve both extended survival and acceptable life quality. The doctor's dilemma is that he does not know whom treatment helps. We conclude that treatment should be offered to all patients. This will be of benefit to the whole group.

Freshman year computer engineering students' experiences for flipped physics lab class: An action research

NASA Astrophysics Data System (ADS)

Akı, Fatma Nur; Gürel, Zeynep

2017-02-01

The purpose of this research is to determine the university students' learning experiences about flipped-physics laboratory class. The research has been completed during the fall semester of 2015 at Computer Engineering Department of Istanbul Commerce University. In this research, also known as a teacher qualitative research design, action research method is preferred to use. The participants are ten people, including seven freshman and three junior year students of Computer Engineering Department. The research data was collected at the end of the semester with the focus group interview which includes structured and open-ended questions. And data was evaluated with categorical content analysis. According to the results, students have some similar and different learning experiences to flipped education method for physics laboratory class.

Alternating frequencies of transcutaneous electric nerve stimulation: does it produce greater analgesic effects on mechanical and thermal pain thresholds?

PubMed

Tong, K C; Lo, Sing Kai; Cheing, Gladys L

2007-10-01

To determine whether alternating frequency transcutaneous electric nerve stimulation (TENS) at 2 and 100Hz (2/100Hz) has a more potent hypoalgesic effect than a fixed frequency at 2 or 100Hz in healthy participants. A single-blind randomized controlled trial with a convenience sample. University physiotherapy department. Sixty-four healthy volunteers (32 men [mean age, 28.1+/-5.9y], 32 women [mean age, 27.7+/-5.6y]) were recruited and randomly divided into 4 groups. The 4 groups received TENS delivered at (1) 2Hz; (2) 100Hz; (3) 2/100Hz alternating frequency; and (4) no treatment (control group), respectively. Electric stimulation was applied over the anterior aspect of the dominant forearm for 30 minutes. Mechanical pain thresholds (MPTs) and heat pain thresholds (HPTs) were recorded before, during, and after TENS stimulation. The data were analyzed using linear mixed models, with group treated as a between-subject factor and time a within-subject factor. During and shortly after electric stimulation, HPT increased significantly in the alternating frequency stimulation group (P=.024). MPT increased significantly in both the 100Hz (P=.008) and the alternating frequency groups (P=.012), but the increase was substantially larger in the 100Hz group. Alternating frequency stimulation produced a greater elevation in the HPT, but a greater increase in the MPT was achieved using 100Hz stimulation.

A Phenomenological Study of an Indonesian Cohort Group's Transformative Learning

ERIC Educational Resources Information Center

Budiraharjo, Markus

2013-01-01

This study was set to investigate how a cohort of ten Indonesian teachers experienced transformations in their teaching professionalism upon receiving an assignment of instructional leadership training to other school leaders. These ten teachers, who came from three different Indonesian Jesuit high schools and one archdiocese-based educational…

Confined ion energy >200 keV and increased fusion yield in a DPF with monolithic tungsten electrodes and pre-ionization

NASA Astrophysics Data System (ADS)

Lerner, Eric J.; Hassan, Syed M.; Karamitsos, Ivana; Von Roessel, Fred

2017-10-01

To reduce impurities in the dense plasma focus FF-1 device, we used monolithic tungsten electrodes with pre-ionization. With this new set-up, we demonstrated a three-fold reduction of impurities by mass and a ten-fold reduction by ion number. FF-1 produced a 50% increase in fusion yield over our previous copper electrodes, both for a single shot and for a mean of ten consecutive shots with the same conditions. These results represent a doubling of fusion yield as compared with any other plasma focus device with the same 60 kJ energy input. In addition, FF-1 produced a new single-shot record of 240 ± 20 keV for mean ion energy, a record for any confined fusion plasma, using any device, and a 50% improvement in ten-shot mean ion energy. With a deuterium-nitrogen mix and corona-discharge pre-ionization, we were also able to reduce the standard deviation in the fusion yield to about 15%, a four-fold reduction over the copper-electrode results. We intend to further reduce impurities with new experiments using microwave treatment of tungsten electrodes, followed by the use of beryllium electrodes.

Predictability of the 1997 and 1998 South Asian Summer Monsoons on the Intraseasonal Time Scale Based on 10 AMIP2 Model Runs

NASA Technical Reports Server (NTRS)

Wu, Man Li C.; Schubert, Siegfried; Einaudi, Franco (Technical Monitor)

2000-01-01

Predictability of the 1997 and 1998 South Asian summer monsoons is examined using National Centers for Environmental Prediction/National Center for Atmospheric Research (NCEP/NCAR) reanalyses, and 100 two-year simulations with ten different Atmospheric General Circulation Models (AGCMs) with prescribed sea surface temperature (SST). We focus on the intraseasonal variations of the south Asian summer monsoon associated with the Madden-Julian Oscillation (MJO). The NCEP/NCAR reanalysis shows a clear coupling between SST anomalies and upper level velocity potential anomalies associated with the MJO. We analyze several MJO events that developed during the 1997 and 1998 focusing of the coupling with the SST. The same analysis is carried out for the model simulations. Remarkably, the ensemble mean of the two-year AGCM simulations show a signature of the observed MJO events. The ensemble mean simulated MJO events are approximately in phase with the observed events, although they are weaker, the period of oscillation is somewhat longer, and their onset is delayed by about ten days compared with the observations. Details of the analysis and comparisons among the ten AMIP2 (Atmospheric Model Intercomparison Project) models will be presented in the conference.

Evaluation of a novel information resource for patients with bronchiectasis: study protocol for a randomised controlled trial.

PubMed

Hester, Katy L M; Newton, Julia; Rapley, Tim; De Soyza, Anthony

2016-04-23

There is currently little patient information on bronchiectasis, a chronic lung disease with rising prevalence. Previous work shows that patients and their families want more information, which could potentially improve their understanding and self-management. Using interviews and focus groups, we have co-developed a novel patient and carer information resource, aiming to meet their identified needs. The aims and objectives are: 1. To assess the potential impact of the information resource 2. To evaluate and refine the intervention 3. To establish the feasibility of carrying out a multi-centre randomised controlled trial to determine its effect on understanding, self-management and health outcomes This is a feasibility study, with a single-centre, randomised controlled trial design, comparing use of a novel patient information resource to usual care in bronchiectasis. Additionally, patients and carers will be invited to focus groups to discuss their views on both the intervention itself and the trial process. The study duration for each participant will be 3 months from the study entry date. A total of 70 patients will be recruited to the study, and a minimum of 30 will be randomised to each arm. Ten participants (and their carers if applicable) will be invited to attend focus groups on completion of the study visits. Participants will be adults with bronchiectasis diagnosed as per national bronchiectasis guidelines. Once consented, participants will be randomised to the intervention or control arm using random permuted blocks to ensure treatment group numbers are evenly balanced. Randomisation will be web-based. Those randomised to the intervention will receive the information resource (website and booklet) and instructions on its use. Outcome measures (resource satisfaction, resource use and alternative information seeking, quality of life questionnaires, unscheduled healthcare visits, exacerbation frequency, bronchiectasis knowledge questionnaire and lung function tests) will be recorded at baseline, 2 weeks and 3 months. All outcome measures will be used in assessing feasibility and acceptability of a future definitive trial. Feasibility outcomes include recruitment, retention and study scale form completion rates. Focus groups will strengthen qualitative data for resource refinement and to identify participant views on the trial process, which will also inform feasibility assessments. Questionnaires will also be used to evaluate and refine the resource. ISRCTN84229105.

Clinical evaluation comparing the efficacy of aquacel Ag with vaseline gauze versus 1% silver sulfadiazine cream in toxic epidermal necrolysis.

PubMed

Huang, Shu-Hung; Lin, Cen-Hung; Chang, Kao-Ping; Wu, Sheng-Hua; Lin, Sin-Daw; Lai, Chung-Sheng; Ou, Su-Fei; Lee, Su-Shin

2014-05-01

The purpose of this study was to determine whether using Aquacel Ag (ConvaTec, Skillman, New Jersey) with Vaseline (Unilever, London, England) gauze instead of silver sulfadiazine cream (SSD) as the wound care protocol to treat toxic epidermal necrolysis (TEN) can improve wound healing, pain control, and reduction of labor costs. A retrospective chart review. A burn center with 2 plastic surgeons and 11 nursing staff. A pathologist diagnosed TEN in 35 patients admitted to the burn center from 1995 to 2009. Parameters included the patient's profile, dressing choice, severity-of-illness score for TEN, time to 95% re-epithelialization, visual analog scale pain scores before second dressing change, and labor cost. The exclusion criterion was wound care with neither Aquacel Ag with Vaseline nor SSD exclusively. Twenty patients were enrolled in this study. In the group using Aquacel Ag with Vaseline gauze, the visual analog scale score was significantly less than that of the SSD group (P = .02). Labor costs were significantly lower in the Aquacel Ag with Vaseline gauze group (P < .01). Commencement of specific dressing to 95% re-epithelialization (P = .09) and time spent in the second dressing change (P = .05) had no statistical significance between the 2 groups. This study showed that Aquacel Ag with Vaseline gauze decreased pain and labor costs but did not shorten wound healing time. Thus, Aquacel Ag with Vaseline gauze can be an efficient method for treating TEN wounds.

Microbiological evaluation of groups of beef carcasses: heifers and steers.

PubMed Central

Jericho, K W; Bradley, J A; Kozub, G C

1994-01-01

Numbers of mesophilic bacteria were estimated on carcasses of 25 heifers and 25 steers of beef breeds in a modern, high-line-speed abattoir. One side of each carcass from each sex was sampled at the end of the kill-floor, before the carcass wash, on each of 25 visits. Two adjacent excision samples (5 x 5 x 0.5 cm) were taken from each of ten sites and processed for automatic enumeration of aerobic bacteria on hydrophobic grid membrane filters. The effects of sex and carcass weight on bacterial counts were examined. Groups of carcasses were examined to determine the sample size required for future assessments of kill-floor hygiene. The log10 of the most probable number of growth units (MPNGU)/cm2 did not differ significantly between heifers and steers (average over the ten sites of 2.2) and there was no effect of carcass weight on bacterial counts for nine of the ten sites. There were, however, highly significant (p < 0.001) differences in the counts between sites and the counts from the ten sites clustered into five homogenous groups. The between-carcass component of variation at a site was generally larger than the within-carcass component. We conclude that, to estimate the mean log10 MPNGU/cm2 at a site to within +/- 0.5 units, future group-carcass evaluations require about 200 samples from 10 (two adjacent samples/site) or 20 carcasses (one sample/site). PMID:7954120

Task-based neurofeedback training: A novel approach toward training executive functions.

PubMed

Hosseini, S M Hadi; Pritchard-Berman, Mika; Sosa, Natasha; Ceja, Angelica; Kesler, Shelli R

2016-07-01

Cognitive training is an emergent approach to improve cognitive functions in various neurodevelopmental and neurodegenerative diseases. However, current training programs can be relatively lengthy, making adherence potentially difficult for patients with cognitive difficulties. Previous studies suggest that providing individuals with real-time feedback about the level of brain activity (neurofeedback) can potentially help them learn to control the activation of specific brain regions. In the present study, we developed a novel task-based neurofeedback training paradigm that benefits from the effects of neurofeedback in parallel with computerized training. We focused on executive function training given its core involvement in various developmental and neurodegenerative diseases. Near-infrared spectroscopy (NIRS) was employed for providing neurofeedback by measuring changes in oxygenated hemoglobin in the prefrontal cortex. Of the twenty healthy adult participants, ten received real neurofeedback (NFB) on prefrontal activity during cognitive training, and ten were presented with sham feedback (SHAM). Compared with SHAM, the NFB group showed significantly improved executive function performance including measures of working memory after four sessions of training (100min total). The NFB group also showed significantly reduced training-related brain activity in the executive function network including right middle frontal and inferior frontal regions compared with SHAM. Our data suggest that providing neurofeedback along with cognitive training can enhance executive function after a relatively short period of training. Similar designs could potentially be used for patient populations with known neuropathology, potentially helping them to boost/recover the activity in the affected brain regions. Copyright © 2016 Elsevier Inc. All rights reserved.

Perceived barriers and facilitators to participation in physical activity for children with disability: a qualitative study.

PubMed

Shields, Nora; Synnot, Anneliese

2016-01-19

Children with disability engage in less physical activity compared to their typically developing peers. Our aim was to explore the barriers and facilitators to participation in physical activity for this group. Ten focus groups, involving 63 participants (23 children with disability, 20 parents of children with disability and 20 sport and recreation staff), were held to explore factors perceived as barriers and facilitators to participation in physical activity by children with disability. Data were analysed thematically by two researchers. Four themes were identified: (1) similarities and differences, (2) people make the difference, (3) one size does not fit all, and (4) communication and connections. Key facilitators identified were the need for inclusive pathways that encourage ongoing participation as children grow or as their skills develop, and for better partnerships between key stakeholders from the disability, sport, education and government sectors. Children with disabilities' need for the early attainment of motor and social skills and the integral role of their families in supporting them were considered to influence their participation in physical activity. Children with disability were thought to face additional barriers to participation compared to children with typical development including a lack of instructor skills and unwillingness to be inclusive, negative societal attitudes towards disability, and a lack of local opportunities. The perspectives gathered in this study are relevant to the many stakeholders involved in the design and implementation of effective interventions, strategies and policies to promote participation in physical activity for children with disability. We outline ten strategies for facilitating participation.

Study of the malaria situation in forested foothill and nearby plain areas of Myanmar.

PubMed

Myint, L; Ye, H

1991-12-01

A longitudinal demographic-parasitological survey on malaria was conducted at 10 weekly intervals starting from September in one foothill village with the population of 1,095 and one epidemiologically comparable plain village with the population of 962 in Kyauktaga township, Bago division, 120 miles north of Yangon. The objective was to describe and analyse the current malaria situation in a forested foothill area and an adjacent plain area. Ten weekly blood film collections for malaria parasite examination, six monthly sera collections on filter paper for serological examination from the whole study population and ten weekly splenic measurements from 2-9 year children were done. The malaria parasite rate in the foothill area was invariably higher than that in the plain area in all age groups throughout the study period. Moreover, the parasite rate decreased with the increase in distance from the forested foothill area indicating that the deep forest malaria may have some influence on the foothill villages. The total age specific parasite rate in foothill villages was found to be highest in the 5-8 year age group and decreased as the age advanced which may be due to the increasing immunity. The study revealed the presence of local transmission in the foothill village. From these data it is evident that new village sites should be chosen at least 5 miles away from the forest fringe and the malaria control measures in the plain area should utilize chemoprophylaxis and effective chemotherapy focusing on the people who travel into the forest.

Role of argon laser as an adjunctive therapy for treatment of resistant infected corneal ulcers

PubMed Central

Khater, Mohammad M; Selima, Adel A; El-Shorbagy, Mohammad S

2014-01-01

Purpose To evaluate the role of argon laser as an adjunctive therapy in ten patients with resistant infected corneal ulcers with or without hypopyon. Methods The study included 20 patients, split into two groups of ten, with resistant infected corneal ulcers with or without hypopyon. One group was considered as the control group and treated with local and systemic specific antimicrobial drugs guided with culture and sensitivity tests. The other group started with the same specific therapy as the control group for 1 week with no obvious improvement and then was further treated with argon laser. The ten patients in the control group included five cases of fungal ulcers, three mixed (fungal and bacterial) ulcers, and two viral ulcers. The ten patients in the other group included three cases of fungal ulcers, three mixed (fungal and viral) ulcers, three viral ulcers, and one bacterial ulcer as proven with microbial culture and sensitivity tests. Eight cases of the control group and seven cases of the other group were associated with hypopyon. Before laser treatment, a drop of benoxinate hydrochloride 0.4% and a single drop of fluorescein sodium 0.25% were instilled. Argon laser irradiation of the affected cornea was performed using an argon 532 nm wavelength (Carl Zeiss LSL 532s AG; Carl Zeiss Meditec AG, Jena, Germany). A spot size of 500 μm, pulse duration of 0.2 seconds, and power of 900 mW were used. All cases were followed up for 3 months after healing was achieved. Results During the first 4 weeks after laser treatment, all patients showed complete healing of the epithelial defect and resolution of stromal infiltration with no adverse effects. In the control group, four cases needed an amniotic membrane graft due to thinning and the other six cases were healed in a duration that ranged from 3 to 7 weeks. Conclusion Argon laser phototherapy is useful as an adjunctive treatment for resistant infected corneal ulcers. More cases are needed to get more reliable results and to confirm our findings. PMID:24920878

Role of argon laser as an adjunctive therapy for treatment of resistant infected corneal ulcers.

PubMed

Khater, Mohammad M; Selima, Adel A; El-Shorbagy, Mohammad S

2014-01-01

To evaluate the role of argon laser as an adjunctive therapy in ten patients with resistant infected corneal ulcers with or without hypopyon. The study included 20 patients, split into two groups of ten, with resistant infected corneal ulcers with or without hypopyon. One group was considered as the control group and treated with local and systemic specific antimicrobial drugs guided with culture and sensitivity tests. The other group started with the same specific therapy as the control group for 1 week with no obvious improvement and then was further treated with argon laser. The ten patients in the control group included five cases of fungal ulcers, three mixed (fungal and bacterial) ulcers, and two viral ulcers. The ten patients in the other group included three cases of fungal ulcers, three mixed (fungal and viral) ulcers, three viral ulcers, and one bacterial ulcer as proven with microbial culture and sensitivity tests. Eight cases of the control group and seven cases of the other group were associated with hypopyon. Before laser treatment, a drop of benoxinate hydrochloride 0.4% and a single drop of fluorescein sodium 0.25% were instilled. Argon laser irradiation of the affected cornea was performed using an argon 532 nm wavelength (Carl Zeiss LSL 532s AG; Carl Zeiss Meditec AG, Jena, Germany). A spot size of 500 μm, pulse duration of 0.2 seconds, and power of 900 mW were used. All cases were followed up for 3 months after healing was achieved. During the first 4 weeks after laser treatment, all patients showed complete healing of the epithelial defect and resolution of stromal infiltration with no adverse effects. In the control group, four cases needed an amniotic membrane graft due to thinning and the other six cases were healed in a duration that ranged from 3 to 7 weeks. Argon laser phototherapy is useful as an adjunctive treatment for resistant infected corneal ulcers. More cases are needed to get more reliable results and to confirm our findings.

Stigma Related to HIV among Community Health Workers in Chile

PubMed Central

Cianelli, Rosina; Ferrer, Lilian; Norr, Kathleen F.; McCreary, Linda; Irarrázabal, Lisette; Bernales, Margarita; Miner, Sarah

2011-01-01

Purpose When healthcare workers have stigmatizing attitudes toward people living with HIV it may lead to discriminatory behavior that interferes with prevention, treatment, and care. This research examined the HIV-related stigmatizing attitudes reported by health workers in Santiago, Chile. Methods The study used focus group data from the first phase of a larger study to develop and test a HIV prevention intervention for Chilean health workers. Ten focus groups were conducted with Health workers in two communities in Santiago, Chile. Content analysis was used to analyze the data. Results Two central themes emerged: Societal stigma and discrimination towards people living with HIV and healthcare system’s policies related to HIV. Both inaccurate fears of transmission among the general public and Chilean Health workers and societal prejudices against homosexuals contributed to stigmatization and discrimination. Conclusions Health workers did not recognize their own stigmatizing attitudes or discriminatory behaviors, but their discussion indicated that these behaviors and attitudes did exist. Healthcare system issues identified included problems with confidentiality due to the desire to inform other health workers about client HIV status. Health workers must be sensitized to the current stigmatization and misinformation associated with HIV and its negative impacts on persons living with HIV and the general community. Implications All clinical and non-clinical workers at community clinics need mandatory education for HIV prevention that focuses on changing attitudes as well as sharing knowledge. Also, the Chilean law protecting people living with HIV and the confidentiality of their medical care needs to be publicized, along with guidelines for its enactment in clinics and other health facilities. PMID:21687824

Clean Hands for Life: results of a large, multicentre, multifaceted, social marketing hand-hygiene campaign.

PubMed

Forrester, L A; Bryce, E A; Mediaa, A K

2010-03-01

A year-long multifaceted hand-hygiene campaign entitled Clean Hands for Life targeting individual, environmental and organisational factors that influence healthcare worker (HCW) hand-hygiene behaviour was implemented in 36 acute and long-term care facilities in Vancouver Coastal Health region. The campaign involved rotation of ten novel posters, two poster contests, and distribution of multiple promotional items. A social marketing approach was used to implement and monitor the effectiveness of the campaign. Evaluation included quality assurance surveys, staff surveys (baseline, mid- and post-campaign), and focus groups. A total of 141 poster contest submissions was received, 5452 staff surveys completed and 14 focus groups conducted. Overall knowledge of the importance of hand-hygiene and intention to clean hands was high at baseline. No significant differences were observed when mid- and post-campaign scores were compared to baseline. The majority (89.5%) of HCWs reported that they preferred soap and water over alcohol hand gel. A significant increase in the self-reported use of hand-hygiene products was observed particularly among HCWs not providing direct patient care. Barriers to hand-hygiene included inappropriate placement of sinks, traffic flow issues, inadequately stocked washrooms, workload and time constraints. Organisational support was visible throughout the campaign. The results showed that social marketing is an effective approach in engaging HCWs. Hand-hygiene campaigns that focus almost exclusively on increasing awareness among HCWs may not be as successful as multifaceted campaigns or campaigns that target identified barriers to hand-hygiene. Copyright 2009 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Older People’s Perspectives on Health, Physical Activity and Nutritional Behaviors

PubMed Central

Alizadeh, Leila; Salehi, Leili

2015-01-01

Background: Approaches for investigating health-promoting lifestyle generally focus on physical activity and regular diet. To explore the perspectives of Iranian elders regarding health, healthy eating and physical activity (PA) this study was conducted in 2012. Methods: Participants in this qualitative study were selected through purposeful sampling. Ten focus groups were conducted with 60 older adults in 3 elderly centers in Tehran. A moderator’s guideline that consisted of general and specific questions was used. Focus groups were audio recorded, transcribed verbatim and analysis was performed using conventional content analysis. Results: Participants explained their perspectives regarding health, healthy eating and PA in the following 5 categories: meaning of health was represented based on issues such as absence of pain and disorder, complete body wellbeing, staying away from hazards, complete individual satisfaction, experiencing positive events, effective communication, faithfulness and trust in God. The healthy eating category was featured by adequate eating, age balanced diet, refraining from under or over nutrition and sensible consumption of fruits and vegetables. The PA was described - according to the level of performing outdoor activities or household tasks. Expressions about the perceived benefits and barriers of healthy eating and PA were aligned the two remaining categories. Conclusions: Participants have referred to the association between both PA and dietary practices and health. Understanding how older people define physical activity and nutritional behavior and recognition of the most important perceived benefits and barriers that might contribute to have a healthy eating or adequate PA profile could procure insight into the type of interventions that are required to promote healthy lifestyle among Iranian older adults. PMID:26933648

Healthcare students' experiences when integrating e-learning and flipped classroom instructional approaches.

PubMed

Telford, Mark; Senior, Emma

2017-06-08

This article describes the experiences of undergraduate healthcare students taking a module adopting a 'flipped classroom' approach. Evidence suggests that flipped classroom as a pedagogical tool has the potential to enhance student learning and to improve healthcare practice. This innovative approach was implemented within a healthcare curriculum and in a module looking at public health delivered at the beginning of year two of a 3-year programme. The focus of the evaluation study was on the e-learning resources used in the module and the student experiences of these; with a specific aim to evaluate this element of the flipped classroom approach. A mixed-methods approach was adopted and data collected using questionnaires, which were distributed across a whole cohort, and a focus group involving ten participants. Statistical analysis of the data showed the positive student experience of engaging with e-learning. The thematic analysis identified two key themes; factors influencing a positive learning experience and the challenges when developing e-learning within a flipped classroom approach. The study provides guidance for further developments and improvements when developing e-learning as part of the flipped classroom approach.

Real-life setting in data collection. The role of nutrition knowledge whilst selecting food products for weight management purposes in a supermarket environment.

PubMed

Saarela, Anna-Maria; Lapveteläinen, Anja T; Mykkänen, Hannu M; Kantanen, Teuvo T; Rissanen, Riitta L

2013-12-01

The aim was to explore the role of consumers' nutrition knowledge while selecting foods for weight management and the predominating food selection factors by combining quantitative and qualitative methodology in a real-life setting during two consecutive shopping tasks given in a supermarket. Thirty-six consumers were given a list of 11 products and asked to think-aloud while selecting (i) a product they usually buy and (ii) a product they use for weight management. After the consecutive shopping tasks, the subjects were interviewed and asked to answer a nutrition knowledge questionnaire. The subjects were categorized by the difference in the energy contents of their selections and the food selection criteria. The energy contents of the selections for weight management were reduced by 10-46%. Ten subjects with the greatest difference between the energy contents of their selections had higher level in nutrition knowledge and mentioned less nutritional issues during the selections than ten subjects with the smallest such differences. Taste was an important product selection criterion by the former group, while the latter focused primarily on price. Nutrition knowledge is interrelated with personal factors and selection goals. It is not necessarily utilized consistently when selecting food products. Copyright © 2013 Elsevier Ltd. All rights reserved.

Mental health network governance: comparative analysis across Canadian regions.

PubMed

Wiktorowicz, Mary E; Fleury, Marie-Josée; Adair, Carol E; Lesage, Alain; Goldner, Elliot; Peters, Suzanne

2010-10-26

Modes of governance were compared in ten local mental health networks in diverse contexts (rural/urban and regionalized/non-regionalized) to clarify the governance processes that foster inter-organizational collaboration and the conditions that support them. Case studies of ten local mental health networks were developed using qualitative methods of document review, semi-structured interviews and focus groups that incorporated provincial policy, network and organizational levels of analysis. Mental health networks adopted either a corporate structure, mutual adjustment or an alliance governance model. A corporate structure supported by regionalization offered the most direct means for local governance to attain inter-organizational collaboration. The likelihood that networks with an alliance model developed coordination processes depended on the presence of the following conditions: a moderate number of organizations, goal consensus and trust among the organizations, and network-level competencies. In the small and mid-sized urban networks where these conditions were met their alliance realized the inter-organizational collaboration sought. In the large urban and rural networks where these conditions were not met, externally brokered forms of network governance were required to support alliance based models. In metropolitan and rural networks with such shared forms of network governance as an alliance or voluntary mutual adjustment, external mediation by a regional or provincial authority was an important lever to foster inter-organizational collaboration.

Smokers' and E-Cigarette Users' Perceptions about E-Cigarette Warning Statements.

PubMed

Wackowski, Olivia A; Hammond, David; O'Connor, Richard J; Strasser, Andrew A; Delnevo, Cristine D

2016-06-30

Cigarette warning labels are important sources of risk information, but warning research for other tobacco products is limited. This study aimed to gauge perceptions about warnings that may be used for e-cigarettes. We conducted six small focus groups in late 2014/early 2015 with adult current e-cigarette users and cigarette-only smokers. Participants rated and discussed their perceptions of six e-cigarette warning statements, and warnings in two existing Vuse and MarkTen e-cigarette ads. Participants were open to e-cigarette warnings and provided the strongest reactions to statements warning that e-liquid/e-vapor or e-cigarettes can be poisonous, contain toxins, or are "not a safe alternative to smoking". However, many also noted that these statements were exaggerated, potentially misleading, and could scare smokers away from reducing their harm by switching to e-cigarettes. Opinions on the Food and Drug Administration's proposed nicotine addiction warning and warnings that e-cigarettes had not been approved for smoking cessation or had unknown health effects were mixed. Participants perceived MarkTen's advertisement warning to be stronger and more noticeable than Vuse's. Care should be taken in developing e-cigarette warnings given their relative recentness and potential for harm reduction compared to other tobacco products. Additional research, including with varied audiences, would be instructive.

The effectiveness of transcutaneous electrical nerve stimulation in the management of patients with complex regional pain syndrome: A randomized, double-blinded, placebo-controlled prospective study.

PubMed

Bilgili, Adem; Çakır, Tuncay; Doğan, Şebnem Koldaş; Erçalık, Tülay; Filiz, Meral Bilgilisoy; Toraman, Füsun

2016-11-21

To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on clinical recovery in the management of patients with complex regional pain syndrome Type I (CRPS Type I). The study included 30 patients with stage 1 and 2 CRPS Type I in the upper extremities. The patients were randomly assigned into 2 groups, group 1 (n= 15) received conventional TENS therapy for 20 minutes, and group 2 (n= 15) received sham TENS therapy. The standard physical therapy program, which included contrast bath for 20 minutes; whirlpool bath for 15 minutes; assisted active and passive range of motion, and static stretching exercises up to the pain threshold, was also conducted in both groups. Therapy was scheduled for 15 sessions. A visual analogue scale (VAS) was used to assess spontaneous pain. The Leeds Assessment of Neuropathic Signs and Symptoms (LANSS) scale and the Douleur Neuropathique en 4 Questions (DN-4) were used to assess neuropathic pain. In addition, range of motion (ROM) was measured using a goniometer and volumetric measurements were taken to assess edema. Functional capacity was assessed using a hand dynamometer and the Duruöz Hand Index (DHI). All measurements were performed at baseline and after therapy. Significant improvements were achieved in spontaneous and neuropathic pain scores, edema, ROM, and functional capacity in both groups (p< 0.05). However, improvement was found to be significantly greater in group 1 regarding pain intensity, neuropathic pain assessed using LANNS, edema, and in the 2nd-3rd finger ROM measurements (p< 0.05). No significant difference was detected between groups regarding improvements in 4th-5th finger and wrist ROM measurements, grip strength, and DN4 and DHI scores (p> 0.05). The addition of TENS to the physical therapy program was seen to make a significant contribution to clinical recovery in CRPS Type 1.

Mirror Therapy and Transcutaneous Electrical Nerve Stimulation for Management of Phantom Limb Pain in Amputees - A Single Blinded Randomized Controlled Trial.

PubMed

Tilak, Merlyn; Isaac, Serin Anna; Fletcher, Jebaraj; Vasanthan, Lenny Thinagaran; Subbaiah, Rajalakshmi Sankaran; Babu, Andrew; Bhide, Rohit; Tharion, George

2016-06-01

Phantom limb pain (PLP) can be disabling for nearly two thirds of amputees. Hence, there is a need to find an effective and inexpensive treatment that can be self administered. Among the non-pharmacological treatment for PLP, transcutaneous electrical nerve stimulation (TENS) applied to the contralateral extremity and mirror therapy are two promising options. However, there are no studies to compare the two treatments. The purpose of this study is to evaluate and compare mirror therapy and TENS in the management of PLP in subjects with amputation. The study was an assessor blinded randomized controlled trial conducted at Physiotherapy Gymnasium of Physical Medicine and Rehabilitation Department, Christian Medical College, Vellore. Twenty-six subjects with PLP consented to participate. An initial assessment of pain using visual analogue scale (VAS) and universal pain score (UPS) was performed by a therapist blinded to the treatment given. Random allocation into Group I-mirror therapy and Group II-TENS was carried out. After 4 days of treatment, pain was re-assessed by the same therapist. The mean difference in Pre and Post values were compared among the groups. The change in pre-post score was analyzed using the paired t test. Participants of Group I had significant decrease in pain [VAS ( p = 0.003) and UPS ( p = 0.001)]. Group II also showed a significant reduction in pain [VAS ( p = 0.003) and UPS ( p = 0.002)]. However, no difference was observed between the two groups [VAS ( p = 0.223 and UPS ( p = 0.956)]. Both Mirror Therapy and TENS were found to be effective in pain reduction on a short-term basis. However, no difference between the two groups was found. Substantiation with long-term follow-up is essential to find its long-term effectiveness. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Gene differentiation among ten endogamous groups of West Bengal, India.

PubMed

Chakraborty, R; Walter, H; Mukherjee, B N; Malhotra, K C; Sauber, P; Banerjee, S; Roy, M

1986-11-01

Ten endogamous populations of West Bengal, India have been surveyed for genetic variation in 12 systems. These populations encompass all social ranks in the caste hierarchy and cover almost the entire geographic area of the state. Gene diversity analysis suggests that these groups exhibit significant allele frequency variation at all but three loci. The overall genetic difference is not, however, in accord with the classification based on caste. Two low-ranking scheduled caste groups are, in fact, in close proximity with the high-caste ones, suggesting evidence of past generations of gene flow among them. Three different clusters of groups emerge from the present data, providing support for the anthropologic assertion that in Bengal Proto-Australoid, Caucasoid, and Mongoloid racial elements generally coexist. However, these three components are not uniformly present in all groups. Geographic separation of the groups is a strong determinant of the gene differentiation that exists among these populations.

Trends in motor vehicle traffic collision statistics, 1988-1997

DOT National Transportation Integrated Search

2001-02-01

This report presents descriptive statistics about Canadian traffic collisions during the ten-year period : from 1988 to 1997, focusing specifically on casualty collisions. Casualty collisions are defined as all : reportable motor vehicle crashes resu...

The impact of an online Facebook support group for people with multiple sclerosis on non-active users.

PubMed

Steadman, Jacqui; Pretorius, Chrisma

2014-01-01

Multiple sclerosis (MS) is a debilitating disease and there is little research on support networks for people with MS (PwMS). More specifically, most studies on online support groups focus on those who actively participate in the group, whereas the majority of those who utilise online support groups do so in a passive way. This study therefore aimed to explore the experiences of non-active users of an online Facebook support group for PwMS. Emphasis was placed on the facilitators and the barriers that were associated with membership to this group. An exploratory qualitative research design was implemented, whereby thematic analysis was utilised to examine the ten semi-structured interviews that were conducted. Several facilitators were acquired through the online support group; namely emotional support (constant source of support, exposure to negative aspects of the disease), informational support (group as a source of knowledge, quality of information) and social companionship (place of belonging). Some barriers were also identified; namely emotional support (emotions lost online, response to messages, exposure to negative aspects of the disease), informational support (information posted on the group, misuse of group) and social companionship (non-active status). These findings demonstrate that the non-active members of the online support group for PwMS have valid reasons for their non-active membership status. More important, the findings suggest that the online Facebook support group provided the group members with an important support network in the form of emotional support, informational support and social companionship, despite their non-active membership status or the barriers that have been identified.

Australia. Transition from School to Work or Further Study. Reviews of National Policies for Education.

ERIC Educational Resources Information Center

Organisation for Economic Cooperation and Development, Paris (France).

This book reports on an examination of educational policy in Australia and focuses on the educational and training needs of and provision for young people entering working life. The content is in two parts. Part 1, which comprises two-thirds of the report, has ten chapters. Chapter 1 identifies nine topics on which the report is focused. Chapters…

Enhancement of Entrepreneurial Leadership: A Case Focusing on a Model of Successful Conflict Management Skills

ERIC Educational Resources Information Center

Leffel, Anita; Hallam, Cory; Darling, John

2012-01-01

The purpose of this paper is to present a case study focusing on a new technology start-up firm, founded by two graduate students, an engineer and a business major, who met during their university studies. The case is timely, in that only ten percent of new product introductions result in a profitable business. The causes of failure are numerous…

Ten Strengths of How Teachers Do Cooperative Learning

ERIC Educational Resources Information Center

Jaocbs, George M.

2016-01-01

Cooperative learning involves students in working together with peers to learn, to develop learning skills and to enjoy the learning process. This paper examines ten areas in which the author believes he and other teachers do cooperative learning well. These areas are: (1) keeping group size small, usually four or fewer; (2) encouraging students…

Comparison of Floseal(r) and electrocautery in hemostasis after total knee arthroplasty

PubMed Central

Helito, Camilo Partezani; Gobbi, Riccardo Gomes; Castrillon, Lucas Machado; Hinkel, Betina Bremer; Pécora, José Ricardo; Camanho, Gilberto Luis

2013-01-01

Objective To evaluate whether hemostasis with eletrocauterization in comparison with Floseal(r) leads to different bleeding rates during total knee arthroplasty. Methods A comparative study was performed between two groups: group with ten consecutive total knee arthroplasties with Floseal(r) used as hemostatic method and control group with ten consecutive total knee arthroplasties with eletrocauterization as hemostatic method. Bleeding parameters such as debit of the drain, liquid infusion and blood transfusion rate were recorded. Results Floseal(r) group received less blood transfusion, less liquid infusion and lower drainage in absolute numbers compared to the control group. However, no parameter was statistically significant. Conclusion Hemostasis with Floseal(r) is as effective as hemostasis with eletrocauterization, what makes it a viable alternative to patients with contraindication to electric scalpel use. Level of Evidence II, Prospective Comparative Study. PMID:24453689

Comparison of titanium elastic intramedullary nailing versus injection of bone marrow in treatment of simple bone cysts in children: a retrospective study.

PubMed

Li, Wenchao; Xu, Ruijiang; Du, Minghua; Chen, Hui

2016-08-15

Simple bone cysts are common benign lytic bone lesions in children. The main goals of treatment for bone cysts are to prevent pathological fractures, support the healing process, and prevent recurrence. This retrospective study compared fixation with titanium elastic intramedullary nailing (TEN) versus aspiration and injection of autogenous bone marrow (ABM) for the treatment of simple bone cysts in children. Forty-six patients (mean follow-up, 62 months; range, 34-71 months) who presented with bone cysts (30 in the humerus, 16 in the femur) from January 2006 to December 2012 were retrospectively evaluated. Patients were treated with either TEN or ABM injection. Radiographs were evaluated according to previously established criteria. Clinical evaluations of pain, infection, additional fractures, and range of motion were performed. After treatment, all patients were pain-free and had normal range of motion in adjacent joints. In the ABM group, 14 (60.9 %) bone cysts completely healed, six (26.1 %) healed with small residuals after two injections, and three (13.0 %) recurred. In the TEN group, 16 (69.6 %) bone cysts completely healed, four (17.4 %) healed with small residuals, and three (13.0 %) recurred. There were no significant differences in radiographic outcomes between groups at the final follow-up (P > 0.05). Three patients developed skin irritation as a result of the nail ends. Additional fractures occurred in four patients who underwent ABM injection and in two patients who underwent TEN. No significant associations were found between pathological fractures and cyst activity, location, or treatment outcomes in the patients studied. Both TEN and ABM injection are safe and effective treatment for bone cysts. ABM injection promotes osteogenic differentiation of bone marrow stromal cells; multiple injections can reduce the likelihood of recurrence. TEN stabilizes the affected bone and thus allows early limb mobilization. It also reduces pressure in the capsule wall by continuous decompression to promote cyst healing. ABM injections can be used to treat cyst recurrence after previous TEN, with favorable results.

Short-term transcutaneous electrical nerve stimulation reduces pain and improves the masticatory muscle activity in temporomandibular disorder patients: a randomized controlled trial

PubMed Central

FERREIRA, Ana Paula de Lima; da COSTA, Dayse Regina Alves; de OLIVEIRA, Ana Izabela Sobral; CARVALHO, Elyson Adam Nunes; CONTI, Paulo César Rodrigues; COSTA, Yuri Martins; BONJARDIM, Leonardo Rigoldi

2017-01-01

Abstract Studies to assess the effects of therapies on pain and masticatory muscle function are scarce. Objective To investigate the short-term effect of transcutaneous electrical nerve stimulation (TENS) by examining pain intensity, pressure pain threshold (PPT) and electromyography (EMG) activity in patients with temporomandibular disorder (TMD). Material and Methods Forty patients with myofascial TMD were enrolled in this randomized placebo-controlled trial and were divided into two groups: active (n=20) and placebo (n=20) TENS. Outcome variables assessed at baseline (T0), immediately after (T2) and 48 hours after treatment (T1) were: pain intensity with the aid of a visual analogue scale (VAS); PPT of masticatory and cervical structures; EMG activity during mandibular rest position (MR), maximal voluntary contraction (MVC) and habitual chewing (HC). Two-way ANOVA for repeated measures was applied to the data and the significance level was set at 5%. Results There was a decrease in the VAS values at T1 and T2 when compared with T0 values in the active TENS group (p<0.050). The PPT between-group differences were significant at T1 assessment of the anterior temporalis and sternocleidomastoid (SCM) and T2 for the masseter and the SCM (p<0.050). A significant EMG activity reduction of the masseter and anterior temporalis was presented in the active TENS during MR at T1 assessment when compared with T0 (p<0.050). The EMG activity of the anterior temporalis was significantly higher in the active TENS during MVC at T1 and T2 when compared with placebo (p<0.050). The EMG activity of the masseter and anterior temporalis muscle was significantly higher in the active TENS during HC at T1 when compared with placebo (p<0.050). Conclusions The short-term therapeutic effects of TENS are superior to those of the placebo, because of reported facial pain, deep pain sensitivity and masticatory muscle EMG activity improvement. PMID:28403351

Cesarean Section Rate Analysis in University Hospital Tuzla - According to Robson's Classification.

PubMed

Fatusic, Jasenko; Hudic, Igor; Fatusic, Zlatan; Zildzic-Moralic, Aida; Zivkovic, Milorad

2016-06-01

For last decades, there has public concern about increasing Cesarean Section (CS) rates, and it is an issue of international public health concern. According to World Health Organisation (WHO) there is no justification to have more than 10-15% CS births. WHO proposes the Robson ten-group classification, as a global standard for assessing, monitoring and comparing cesarean section rates. The aim of this study was to investigate Cesarean section rate at University Hospital Tuzla, Bosnia and Herzegovina. Cross sectional study was conducted for one-year period, 2015. Statistical analysis and graph-table presentation was performed using Excel 2010 and Microsoft Office programs. Out of 3,672 births, a total of 936 births were performed by CS. Percentage of the total number of CS to the total birth number was 25,47%. According to Robson classification, the largest was group 5 with relative contribution of 29,80%. On second and third place were group 1 and 2 with relative contribution of 26,06% and 15,78% respectively. Groups 1, 2, 5 made account of realtive contribution of 71,65%. All other groups had entirely relative contribution of 28,35%. Robson 10-group classification provides easy way in collecting information about CS rate. It is important that efforts to reduce the overall CS rate should focus on reducing the primary CS. Data from our study confirm this attitude.

Division G Commission 35: Stellar Constitution

NASA Astrophysics Data System (ADS)

Limongi, Marco; Lattanzio, John C.; Charbonnel, Corinne; Dominguez, Inma; Isern, Jordi; Karakas, Amanda; Leitherer, Claus; Marconi, Marcella; Shaviv, Giora; van Loon, Jacco

2016-04-01

Commission 35 (C35), ``Stellar Constitution'', consists of members of the International Astronomical Union whose research spans many aspects of theoretical and observational stellar physics and it is mainly focused on the comprehension of the properties of stars, stellar populations and galaxies. The number of members of C35 increased progressively over the last ten years and currently C35 comprises about 400 members. C35 was part of Division IV (Stars) until 2014 and then became part of Division G (Stars and Stellar Physics), after the main IAU reorganisation in 2015. Four Working Groups have been created over the years under Division IV, initially, and Division G later: WG on Active B Stars, WG on Massive Stars, WG on Abundances in Red Giant and WG on Chemically Peculiar and Related Stars. In the last decade the Commission had 4 presidents, Wojciech Dziembowski (2003-2006), Francesca D'Antona (2006-2009), Corinne Charbonnel (2009-2012) and Marco Limongi (2012-2015), who were assisted by an Organizing Committee (OC), usually composed of about 10 members, all of them elected by the C35 members and holding their positions for three years. The C35 webpage (http://iau-c35.stsci.edu) has been designed and continuously maintained by Claus Leitherer from the Space Telescope Institute, who deserves our special thanks. In addition to the various general information on the Commission structure and activities, it contains links to various resources, of interest for the members, such as stellar models, evolutionary tracks and isochrones, synthetic stellar populations, stellar yields and input physics (equation of state, nuclear cross sections, opacity tables), provided by various groups. The main activity of the C35 OC is that of evaluating, ranking and eventually supporting the proposals for IAU sponsored meetings. In the last decade the Commission has supported several meetings focused on topics more or less relevant to C35. Since the primary aim of this document is to present the main activity of C35 over the last ten years, in the following we present some scientific highlights that emerged from the most relevant IAU Symposia and meetings supported and organized by C35 in the last decade.

Emerging Good Practices for Transforming Value Assessment: Patients' Voices, Patients' Values.

PubMed

Perfetto, Eleanor M; Harris, Jason; Mullins, C Daniel; dosReis, Susan

2018-04-01

Patient engagement is a transformative strategy for improving value assessment. US value framework developers have increased engagement activities, but more needs to be learned about how to best achieve meaningful patient engagement in value assessment. The objective was to glean good practices in patient engagement emerging from patient community experiences, to be used in value assessment. The National Health Council Value Workgroup conducted a survey and held a focus group with its member advocacy organizations to gather experiences with value framework developers and views on emerging good practices. Ten of 13 organizations completed the survey; reporting 13 interactions with four framework developers. Most rated experiences as "good" to "very good." Emerging good practices included (1) engage early; (2) engage a range of patients; (3) leverage patient-provided information, data resources, and outreach mechanisms; (4) be transparent; and (5) appreciate and accommodate resource constraints. Twelve of 13 organizations participated in the focus group, and this produced 30 emerging good practices in four areas: (1) timing; (2) methodology and data; (3) partnering; and (4) characterizing engagement. Patient engagement was limited in early development of value frameworks but has increased in the past few years. Patient groups report positive experiences that can serve as emerging good practices. These groups also reported experienced challenges in their interactions and recommended good practices to mitigate those challenges. The growing pool of patient engagement experiences can be translated into good practices to advance a patient-centered, value-driven health care ecosystem. Lessons learned from these early experiences can help establish recommend emerging good practices that can eventually result in best practices and standards in the field. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Reorienting risk to resilience: street-involved youth perspectives on preventing the transition to injection drug use.

PubMed

Tozer, Kira; Tzemis, Despina; Amlani, Ashraf; Coser, Larissa; Taylor, Darlene; Van Borek, Natasha; Saewyc, Elizabeth; Buxton, Jane A

2015-08-19

The Youth Injection Prevention (YIP) project aimed to identify factors associated with the prevention of transitioning to injection drug use (IDU) among street-involved youth (youth who had spent at least 3 consecutive nights without a fixed address or without their parents/caregivers in the previous six months) aged 16-24 years in Metro Vancouver, British Columbia. Ten focus groups were conducted by youth collaborators (peer-researchers) with street-involved youth (n = 47) from November 2009-April 2010. Audio recordings and focus group observational notes were transcribed verbatim and emergent themes identified by open coding and categorizing. Through ongoing data analysis we identified that youth produced risk and deficiency rather than resiliency-based answers. This enabled the questioning guide to be reframed into a strengths-based guide in a timely manner. Factors youth identified that prevented them from IDU initiation were grouped into three domains loosely derived from the risk environment framework: Individual (fear and self-worth), Social Environment (stigma and group norms - including street-entrenched adults who actively discouraged youth from IDU, support/inclusion, family/friend drug use and responsibilities), and Physical/Economic Environment (safe/engaging spaces). Engaging youth collaborators in the research ensured relevance and validity of the study. Participants emphasized having personal goals and ties to social networks, supportive family and role models, and the need for safe and stable housing as key to resiliency. Gaining the perspectives of street-involved youth on factors that prevent IDU provides a complementary perspective to risk-based studies and encourages strength-based approaches for coaching and care of at-risk youth and upon which prevention programs should be built.

China's approach to control of HIV. Modern use of tradition in a public security system.

PubMed

Anderson, A F

1995-01-01

HIV/AIDS control policy in China focuses on high risk populations. The public security system is intricately intertwined with the Chinese government's HIV control activities. The government can justify its control of high risk activities because prostitution, related trafficking in females, drug abuse, and drug trafficking are elements of the Six Evils: social problems considered to be pre-revolutionary, influenced by decadent western morality, and incompatible with modernization. Public security campaigns involve arresting tens of thousands of people annually in the combined efforts against HIV and the social evils. Instigators of crime are given punitive prison sentences. For their victims, however, incarceration leans toward treatment. The moral-rehabilitative philosophy is the normative foundation of the Chinese criminal justice process. Confucian thought holds that teaching the disobedient person proper social conduct, not punishment, will effect endless change. So correction officials use patient persuasion and re-education with most criminals. The public security system coercively collects drug abusers for as much as three months of counseling and detoxification (methadone or clonidine). The police detain prostitutes for 6 months to 2 years for re-education, including legal indoctrination, labor, and prevention of sexually transmitted diseases. Family members and community groups participate in treatment and aftercare. All drug abusers and prostitutes undergo HIV testing. HIV-positive offenders are separated from HIV-negative offenders. Pimps, panderers, or traffickers in females or drugs are either executed or put in prison for at least 10 years. A weakness of China's approach is its exclusive focus on high-risk groups rather than on high-risk practices. This approach assumes HIV will be restricted to these groups. Police will likely increase its punitive and regressive responses to group members as its approach fails to prevent HIV transmission.

Gait characteristics after gait-oriented rehabilitation in chronic stroke.

PubMed

Peurala, Sinikka H; Titianova, Ekaterina B; Mateev, Plamen; Pitkänen, Kauko; Sivenius, Juhani; Tarkka, Ina M

2005-01-01

To assess the effects of rehabilitation in thirty-seven ambulatory patients with chronic stroke during three weeks in-patient rehabilitation period. In the intervention group, each patient received 75 min physiotherapy daily every workday including 20 minutes in the electromechanical gait trainer with body-weight support (BWS). In the control group, each patient participated in 45 min conventional physiotherapy daily. Motor ability was assessed with the first five items of the Modified Motor Assessment Scale (MMAS1-5) and ten meters walking speed. Spatio-temporal gait characteristics were recorded with an electrical walkway. The MMAS1-5 (p<0.0005 and p=0.005) and ten meters walking time (p<0.0005 and p=0.006) improved in both groups. The improvements in MMAS1-5 and ten meters walking time did not differ between the groups (p=0.217 and p=0.195). Specific gait characteristics improved only in the intervention group, as seen in increased Functional Ambulation Profile score (p=0.023), velocity (p=0.023), the step lengths (affected side, p=0.011, non-affected side p=0.040), the stride lengths (p=0.018, p=0.006) and decreased step-time differential (p=0.043). Furthermore, all gait characteristics and other motor abilities remained in the discharge level at the six months in the intervention group. It appears that BWS training gives a long-lasting benefit in gait qualities even in chronic stroke patients.

Studies with lucid dreaming as add-on therapy to Gestalt therapy.

PubMed

Holzinger, B; Klösch, G; Saletu, B

2015-06-01

The aim of the present exploratory clinical study was to evaluate LD as an add-on therapy for treating nightmares. Thirty-two subjects having nightmares (ICD-10: F51.5) at least twice a week participated. Subjects were randomly assigned to group: A) Gestalt therapy group (= GTG), or B) Gestalt and lucid dreaming group therapy (= LDG). Each group lasted ten weeks. Participants kept a sleep/dream diary over the treatment. Examinations with respect to nightmare frequency and sleep quality (Pittsburgh Sleep Quality Index) were carried out at the beginning, after five and ten weeks and at a follow-up three months later. Concerning nightmare frequency, a significant reduction was found in both groups after the ten-week-study and at the follow-up (Wilcoxon test: P ≤ 0.05). Significant reduction in dream recall frequency could only be observed in the GTG (Wilcoxon test: P ≤ 0.05). For subjects having succeeded in learning lucid dreaming, reduction was sooner and higher. Sleep quality improved for both groups at the follow-up (P ≤ 0.05, Wilcoxon test). Only the LDG showed significant improvement at the end of therapy (P ≤ 0.05). Lucid dreaming, in combination with Gestalt therapy, is a potent technique to reduce nightmare frequency and improve the subjective quality of sleep. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Study of the potential involvement of pseudorabies virus in swine respiratory disease.

PubMed

Iglesias, G J; Trujano, M; Lokensgard, J; Molitor, T

1992-01-01

In order to investigate the potential involvement of pseudorabies virus (PRV) in swine respiratory disease, nine week old pigs were intranasally inoculated with the PRV strain 4892. Two doses of infection were used: 10(4.5) median tissue culture infectious doses (TCID50)/pig and 10(3.5) TCID50/pig, with ten pigs per group. In the group of pigs inoculated with 10(4.5) TCID50, seven out of ten pigs died within six days after inoculation. The mortality rate in the group of pigs inoculated with the lower dose was only two out of ten and, there were several pigs in this group that showed signs of respiratory distress besides some mild nervous signs. Pseudorabies virus was isolated from various tissues collected postmortem, including alveolar macrophages. Virus localization in tissues was also detected by in situ hybridization. The histopathological examination of the respiratory tract tissues revealed a pathological process that was progressing from mild pneumonia to severe suppurative bronchopneumonia. The isolation of virus from alveolar macrophages provides support to the hypothesis that replication of PRV during the course of infection produces an impairment of the defense mechanisms in the respiratory tract.

What Makes Transcutaneous Electrical Nerve Stimulation Work? Making Sense of the Mixed Results in the Clinical Literature

PubMed Central

Bjordal, Jan M.; Marchand, Serge; Rakel, Barbara A.

2013-01-01

Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacological treatment for control of pain. It has come under much scrutiny lately with the Center for Medicare Services rendering a recent decision stating that “TENS is not reasonable and necessary for the treatment of CLBP [chronic low back pain].” When reading and analyzing the existing literature for which systematic reviews show that TENS is inconclusive or ineffective, it is clear that a number of variables related to TENS application have not been considered. Although many of the trials were designed with the highest of standards, recent evidence suggests that factors related to TENS application need to be considered in an assessment of efficacy. These factors include dosing of TENS, negative interactions with long-term opioid use, the population and outcome assessed, timing of outcome measurement, and comparison groups. The purpose of this perspective is to highlight and interpret recent evidence to help improve the design of clinical trials and the efficacy of TENS in the clinical setting. PMID:23641031

Comparison of marginal and internal adaptation of copings fabricated from three different fabrication techniques: An in vitro study.

PubMed

Arora, Aman; Yadav, Avneet; Upadhyaya, Viram; Jain, Prachi; Verma, Mrinalini

2018-01-01

The purpose of this study was to compare the marginal and internal adaptation of cobalt-chromium (Co-Cr) copings fabricated from conventional wax pattern, three-dimensional (3D)-printed resin pattern, and laser sintering technique. A total of thirty copings were made, out of which ten copings were made from 3D-printed resin pattern (Group A), ten from inlay wax pattern (Group B), and ten copings were obtained from direct metal laser sintering (DMLS) technique (Group C). All the thirty samples were seated on their respective dies and sectioned carefully using a laser jet cutter and were evaluated for marginal and internal gaps at the predetermined areas using a stereomicroscope. The values were then analyzed using one-way ANOVA test and post hoc Bonferroni test. One-way ANOVA showed lowest mean marginal discrepancy for DMLS and highest value for copings fabricated from inlay wax. The values for internal discrepancy were highest for DMLS (169.38) and lowest for 3D-printed resin pattern fabricated copings (133.87). Post hoc Bonferroni test for both marginal and internal discrepancies showed nonsignificant difference when Group A was compared to Group B ( P > 0.05) and significant when Group A was compared with Group C ( P < 0.05). Group B showed significant difference ( P < 0.05) when compared with Group C. Marginal and internal discrepancies of all the three casting techniques were within clinically acceptable values. Marginal fit of DMLS was superior as compared to other two techniques, whereas when internal fit was evaluated, conventional technique showed the best internal fit.

Smoking increases salivary arginase activity in patients with dental implants.

PubMed

Queiroz, D A; Cortelli, J R; Holzhausen, M; Rodrigues, E; Aquino, D R; Saad, W A

2009-09-01

It is believed that an increased arginase activity may lead to less nitric oxide production, which consequently increases the susceptibility to bacterial infection. Considering the hypothesis that smoking may alter the arginase activity and that smoking is considered a risk factor to dental implant survival, the present study aimed at evaluating the effect of smoking on the salivary arginase activity of patients with dental implants. Salivary samples of 41 subjects were collected: ten non-smoking and with no dental implants (group A), ten non-smoking subjects with dental implants (group B), ten smoking subjects with implants (group C), and 11 smoking subjects with no dental implants (group D). The levels of salivary arginase activity were determined by the measurement of L-ornithine and expressed as mIU/mg of protein. A significant increase in the salivary arginase activity was verified in groups C (64.26 +/- 16.95) and D (49.55 +/- 10.01) compared to groups A (10.04 +/- 1.95, p = 0.00001 and p = 0.0110, groups C and D, respectively) and B (11.77 +/- 1.45, p = 0.00001 and p = 0.0147, groups C and D, respectively). No significant difference was found between groups C and D (p = 0.32). Within the limits of the present study, it can be concluded that salivary arginase activity is increased in smoking subjects with dental implants in contrast to non-smoking subjects with dental implants, therefore suggesting a possible mechanism by which cigarette smoking may lead to implant failure. The analysis of salivary arginase activity may represent an important tool to prevent implant failure in the near future.

Management of advanced colon cancer in a community hospital--impact of age on clinical management and survival.

PubMed

Mogili, Sujatha; Yousaf, Mobeen; Nadaraja, Nagendra; Woodlock, Timothy

2012-09-01

Colon cancer is more common in the elderly than in younger and middle-aged people. Cancer clinical trials focus more on younger patients and the management of elderly patients with advanced disease is still unclear. We studied all patients presenting with colon adenocarcinoma metastasis to liver at a community teaching hospital from Dec 2000 through Dec 2007 by a retrospective review of Tumor Registry data and patient chart review with focus on age, clinical management, decision making, and survival. Sixty-seven patients with a median age of 69 and a male to female ratio of 31:36 were identified. The patients with obstructive symptoms and Eastern Cooperative Oncology Group performance status on presentation though varied little by age, smaller proportion of elderly patients underwent resection of the primary bowel tumor in the presence of liver metastases with ten of 16 (63%) aged 80 or greater being managed without surgery. The percentage of patient's preference to physician's preference for patients not undergoing the primary bowel resection increased for older age group. Median survival decreased significantly with age (p < 0.05). Age-related clinical management, decision-making autonomy, and survival are apparent in this study, and there was an increasing trend of patient's involvement in decision making as the age increases and, thus, affecting the age-related clinical management.

Conceptualizing psychological processes in response to globalization: Components, antecedents, and consequences of global orientations.

PubMed

Chen, Sylvia Xiaohua; Lam, Ben C P; Hui, Bryant P H; Ng, Jacky C K; Mak, Winnie W S; Guan, Yanjun; Buchtel, Emma E; Tang, Willie C S; Lau, Victor C Y

2016-02-01

The influences of globalization have permeated various aspects of life in contemporary society, from technical innovations, economic development, and lifestyles, to communication patterns. The present research proposed a construct termed global orientation to denote individual differences in the psychological processes of acculturating to the globalizing world. It encompasses multicultural acquisition as a proactive response and ethnic protection as a defensive response to globalization. Ten studies examined the applicability of global orientations among majority and minority groups, including immigrants and sojourners, in multicultural and relatively monocultural contexts, and across Eastern and Western cultures. Multicultural acquisition is positively correlated with both independent and interdependent self-construals, bilingual proficiency and usage, and dual cultural identifications. Multicultural acquisition is promotion-focused, while ethnic protection is prevention-focused and related to acculturative stress. Global orientations affect individuating and modest behavior over and above multicultural ideology, predict overlap with outgroups over and above political orientation, and predict psychological adaptation, sociocultural competence, tolerance, and attitudes toward ethnocultural groups over and above acculturation expectations/strategies. Global orientations also predict English and Chinese oral presentation performance in multilevel analyses and the frequency and pleasantness of intercultural contact in cross-lagged panel models. We discuss how the psychological study of global orientations contributes to theory and research on acculturation, cultural identity, and intergroup relations. (c) 2016 APA, all rights reserved).

On E-discretization of tori of compact simple Lie groups. II

NASA Astrophysics Data System (ADS)

Hrivnák, Jiří; Juránek, Michal

2017-10-01

Ten types of discrete Fourier transforms of Weyl orbit functions are developed. Generalizing one-dimensional cosine, sine, and exponential, each type of the Weyl orbit function represents an exponential symmetrized with respect to a subgroup of the Weyl group. Fundamental domains of even affine and dual even affine Weyl groups, governing the argument and label symmetries of the even orbit functions, are determined. The discrete orthogonality relations are formulated on finite sets of points from the refinements of the dual weight lattices. Explicit counting formulas for the number of points of the discrete transforms are deduced. Real-valued Hartley orbit functions are introduced, and all ten types of the corresponding discrete Hartley transforms are detailed.

A training study of theory of mind and executive function in children with autistic spectrum disorders.

PubMed

Fisher, Naomi; Happé, Francesca

2005-12-01

This study investigated the relationship between theory of mind and executive functioning in children with autistic spectrum disorders through a training study. Ten children were trained on theory of mind, whilst ten were trained in executive function. Seven children were assigned to a control group, receiving no intervention. Training programmes were administered individually, lasting for 25 minutes per day for 5-10 days. Children were tested before training, after training and at a two-month follow-up. Significant improvements were seen in performance on theory of mind tasks in both trained groups, whilst the control group showed no improvement. No improvement on the executive function tasks was seen in any of the groups. The implications of these findings are discussed.

Transcutaneous electrical nerve stimulation for postoperative pain relief after arthroscopic rotator cuff repair: a prospective double-blinded randomized trial.

PubMed

Mahure, Siddharth A; Rokito, Andrew S; Kwon, Young W

2017-09-01

Arthroscopic rotator cuff repair (ARCR) can be associated with significant postoperative pain. Concern for opioid abuse has led surgeons to identify alternative, efficacious methods of postoperative analgesia. To determine whether transcutaneous electrical nerve stimulation (TENS) can have a similarly beneficial effect after shoulder procedures, we conducted a prospective double-blinded randomized trial in patients undergoing outpatient ARCR. All patients undergoing ARCR of a full-thickness rotator cuff tear by the senior authors were identified. Patients with a history of recent narcotic use or prior narcotic abuse and those under management of a pain control specialist were excluded. Patients were randomized into 2 groups, active or placebo TENS, and used the device for 4 sessions/day for 45 minutes/session for the first postoperative week. All patients received Percocet 5/325 mg (oxycodone/acetaminophen) for use as rescue pain pills. One-week narcotic consumption and visual analog scale pain scores were compared between groups. The final analysis included 37 patients (21 active,16 placebo). Baseline and procedural differences were not different between groups. At 1 week postoperatively, patients in the active group had significantly lower pain scores (3.6 ± 2.1 vs. 5.8 ± 1.2; P= .008). Postoperative Percocet consumption during the initial 48 hours (12.8 ± 4.7 vs. 17.2 ± 6.3; P = .020) and during the first week (25.2 ± 9.9 vs. 33.8 ± 14.3; P = .037) was also significantly lower in the active group. Results from this prospective double-blinded randomized trial demonstrate that compared with placebo TENS, active TENS can result in significantly less pain and reduced opioid use in the immediate postoperative period after ARCR, suggesting that TENS may be potentially useful in a multimodal approach to managing postoperative pain. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Practitioners' experiences of adolescent suicidal behaviour in peer groups.

PubMed

Briggs, S; Slater, T; Bowley, J

2017-06-01

WHAT IS KNOWN ON THE SUBJECT?: Group suicidal behaviour can be devastating for all concerned. There is an absence of research on adolescent suicidal group behaviour. The perspectives of practitioners' experiences of these groups are largely lacking from research literature. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Practitioners work regularly with suicidal behaviour in adolescent peer groups. Practitioners identify peer relationships in groups as complex, including elements that are both suicide encouraging and preventing. Practitioners identify a range of ways in which young people become involved in suicidal behaviour in groups, including indirectly through risk taking and care-seeking as well as directly suicidal or self-harming. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Assessments of young people should routinely include a focus on the qualities of peer relations, including those in the online/digital realm. Assessments and interventions need to consider the complexity of group relationships and roles, and the multiplicity of factors that can contribute to suicidal behaviour in groups. Interventions that sustain therapeutic connectedness are helpful for taking dynamic/fluctuating risks into account. Introduction Group suicidal behaviour by young people can have harmful effects; it may be increasing, influenced by online media and reported increasing self-harm rates; new knowledge and understanding to inform interventions is required. Aim To explore how practitioners experience group suicidal behaviour amongst adolescents, how they assess risks/needs, and how these insights inform understanding about these groups. Method Ten practitioners, including Mental Health Nurses, were interviewed in one multidisciplinary CAMHS, in England. Data analysis was by Thematic Analysis (Braun & Clarke 2006). Results Participants described frequently working with suicidal groups. Roles in groups include suicide encouraging and preventing. Practitioners identify risky and protective connections between young people, online and offline. Clinical tensions include living with suicidal risks, emotional and positional challenges, and getting to grips with digital media. Discussion Peer groups appear to have a larger role in adolescent suicide than recognized to date. Practitioners need to assess young people's roles in groups, their diverse motivations and to understand constantly changing digital media. Implications for practice Assessments of suicide risk for young people should routinely include focus on peer relations including the online/digital realm. Maintaining relationships with vulnerable young people facilitates managing fluctuating risks and understanding different group dynamics. © 2017 John Wiley & Sons Ltd.

Using soccer to build confidence and increase HCT uptake among adolescent girls: A mixed-methods study of an HIV prevention programme in South Africa

PubMed Central

Gannett, Katherine; Merrill, Jamison; Kaufman, Braunschweig Elise; Barkley, Chris; DeCelles, Jeff; Harrison, Abigail

2015-01-01

HIV prevalence is eight times higher in young South African women compared to men. Grassroot Soccer (GRS) developed SKILLZ Street (SS), a single-sex intervention using soccer to improve self-efficacy, HIV-related knowledge, and HIV counselling and testing (HCT) uptake among girls ages 12–16. Female community leaders—“coaches”—deliver ten 2-hour sessions bi-weekly. Attendance and HCT data were collected at 38 programmes across 5 GRS sites during 24 months in 2011–2012. 514 participants completed a 16-item pre/post questionnaire. Focus group discussions (FGDs) were conducted with participants (n=11 groups) and coaches (n=5 groups), and coded for analysis using NVivo. Of 1,953 participants offered HCT, 68.5% tested. Overall, significant pre/post improvement was observed (p<0.001). FGDs suggest participants: valued coach-participant relationship; improved self-efficacy, HIV-related knowledge, communication, and changed perception of soccer as a male-only sport; and increased awareness of testing’s importance. Results suggest SS helps at-risk girls access HCT and HIV-related knowledge while promoting self-confidence. PMID:26997967

The defence technique in Tai Chi Push Hands: a case study.

PubMed

Chen, Hui-Chuan; Cheng, Kuang-You B; Liu, Yu-Jen; Chiu, Hung-Ta; Cheng, Kuang-Yu

2010-12-01

Developed from traditional Chinese martial arts, Tai Chi exercise includes different forms and interactive Push Hands but biomechanical analyses have focused on the former only. To analyse the techniques of Push Hands, an experienced master was asked to defend pushing by four opponents. Movements were videotaped and digitized using a motion analysis system. Surface electrodes were used to record the electromyographic activity of ten muscle groups. Two force plates were used to measure the ground reaction force on each foot. Inexperienced individuals performed the same procedure to serve as the control group. The results indicate that the master adopted a postural adjustment to maintain balance. A clear shift of body weight from the front to the rear foot and mediolateral displacement of the centre of gravity was observed. Low electromyographic activity was observed in the upper body muscle groups, while high electromyographic activity was observed in the right rectus femoris and very high activity in the left rectus femoris during the defence. All inexperienced participants lost their balance in resisting pushing. It is concluded that the Tai Chi defensive technique includes a subtle postural adjustment that slightly changes the pushing force direction, and allows the rear leg to resist the incoming force.

Tonic Investigation Concept of Cervico-vestibular Muscle Afferents

PubMed Central

Dorn, Linda Josephine; Lappat, Annabelle; Neuhuber, Winfried; Scherer, Hans; Olze, Heidi; Hölzl, Matthias

2016-01-01

Introduction Interdisciplinary research has contributed greatly to an improved understanding of the vestibular system. To date, however, very little research has focused on the vestibular system's somatosensory afferents. To ensure the diagnostic quality of vestibular somatosensory afferent data, especially the extra cranial afferents, stimulation of the vestibular balance system has to be precluded. Objective Sophisticated movements require intra- and extra cranial vestibular receptors. The study's objective is to evaluate an investigation concept for cervico-vestibular afferents with respect to clinical feasibility. Methods A dedicated chair was constructed, permitting three-dimensional trunk excursions, during which the volunteer's head remains fixed. Whether or not a cervicotonic provocation nystagmus (c-PN) can be induced with static trunk excursion is to be evaluated and if this can be influenced by cervical monophasic transcutaneous electrical nerve stimulation (c-TENS) with a randomized test group. 3D-video-oculography (VOG) was used to record any change in cervico-ocular examination parameters. The occurring nystagmuses were evaluated visually due to the small caliber of nystagmus amplitudes in healthy volunteers. Results The results demonstrate: no influence of placebo-controlled c-TENS on the spontaneous nystagmus; a significant increase of the vertical nystagmus on the 3D-trunk-excursion chair in static trunk flexion with cervical provocation in all young healthy volunteers (n = 49); and a significant difference between vertical and horizontal nystagmuses during static trunk excursion after placebo-controlled c-TENS, except for the horizontal nystagmus during trunk torsion. Conclusion We hope this cervicotonic investigation concept on the 3D trunk-excursion chair will contribute to new diagnostic and therapeutic perspectives on cervical pathologies in vestibular head-to-trunk alignment. PMID:28050208

Efficacy of Selected Electrical Therapies on Chronic Low Back Pain: A Comparative Clinical Pilot Study.

PubMed

Rajfur, Joanna; Pasternok, Małgorzata; Rajfur, Katarzyna; Walewicz, Karolina; Fras, Beata; Bolach, Bartosz; Dymarek, Robert; Rosinczuk, Joanna; Halski, Tomasz; Taradaj, Jakub

2017-01-07

BACKGROUND In the currently available research publications on electrical therapy of low back pain, generally no control groups or detailed randomization were used, and such studies were often conducted with relatively small groups of patients, based solely on subjective questionnaires and pain assessment scales (lacking measurement methods to objectify the therapeutic progress). The available literature also lacks a comprehensive and large-scale clinical study. The purpose of this study was to assess the effects of treating low back pain using selected electrotherapy methods. The study assesses the influence of individual electrotherapeutic treatments on reduction of pain, improvement of the range of movement in lower section of the spine, and improvement of motor functions and mobility. MATERIAL AND METHODS The 127 patients qualified for the therapy (ultimately, 123 patients completed the study) and assigned to 6 comparison groups: A - conventional TENS, B - acupuncture-like TENS, C - high-voltage electrical stimulation, D - interferential current stimulation, E - diadynamic current, and F - control group. RESULTS The research showed that using electrical stimulation with interferential current penetrating deeper into the tissues results in a significant and more efficient elimination of pain, and an improvement of functional ability of patients suffering from low back pain on the basis of an analysis of both subjective and objective parameters. The TENS currents and high voltage were helpful, but not as effective. The use of diadynamic currents appears to be useless. CONCLUSIONS Selected electrical therapies (interferential current, TENS, and high voltage) appear to be effective in treating chronic low back pain.

Efficacy of Selected Electrical Therapies on Chronic Low Back Pain: A Comparative Clinical Pilot Study

PubMed Central

Rajfur, Joanna; Pasternok, Małgorzata; Rajfur, Katarzyna; Walewicz, Karolina; Fras, Beata; Bolach, Bartosz; Dymarek, Robert; Rosinczuk, Joanna; Halski, Tomasz; Taradaj, Jakub

2017-01-01

Background In the currently available research publications on electrical therapy of low back pain, generally no control groups or detailed randomization were used, and such studies were often conducted with relatively small groups of patients, based solely on subjective questionnaires and pain assessment scales (lacking measurement methods to objectify the therapeutic progress). The available literature also lacks a comprehensive and large-scale clinical study. The purpose of this study was to assess the effects of treating low back pain using selected electrotherapy methods. The study assesses the influence of individual electrotherapeutic treatments on reduction of pain, improvement of the range of movement in lower section of the spine, and improvement of motor functions and mobility. Material/Methods The 127 patients qualified for the therapy (ultimately, 123 patients completed the study) and assigned to 6 comparison groups: A – conventional TENS, B – acupuncture-like TENS, C – high-voltage electrical stimulation, D – interferential current stimulation, E – diadynamic current, and F – control group. Results The research showed that using electrical stimulation with interferential current penetrating deeper into the tissues results in a significant and more efficient elimination of pain, and an improvement of functional ability of patients suffering from low back pain on the basis of an analysis of both subjective and objective parameters. The TENS currents and high voltage were helpful, but not as effective. The use of diadynamic currents appears to be useless. Conclusions Selected electrical therapies (interferential current, TENS, and high voltage) appear to be effective in treating chronic low back pain. PMID:28062862

Emergency Manuals Improved Novice Physician Performance During Simulated ICU Emergencies

PubMed Central

Wang, Jacob; Stiegler, Marjorie P.; Nguyen, Dung; Rebel, Annette; Isaak, Robert S.

2017-01-01

Background Emergency manuals, which are safety essentials in non-medical high-reliability organizations (e.g., aviation), have recently gained acceptance in critical medical environments. Of the existing emergency manuals in anesthesiology, most are geared towards intraoperative settings. Additionally, most evidence supporting their efficacy focuses on the study of physicians with at least some meaningful experience as a physician. Our aim was to evaluate whether an emergency manual would improve the performance of novice physicians (post-graduate year [PGY] 1 or first year resident) in managing a critical event in the intensive care unit (ICU). Methods PGY1 interns (n=41) were assessed on the management of a simulated critical event (unstable bradycardia) in the ICU. Participants underwent a group allocation process to either a control group (n=18) or an intervention group (emergency manual provided, n=23). The number of successfully executed treatment and diagnostic interventions completed was evaluated over a ten minute (600 seconds) simulation for each participant. Results The participants using the emergency manual averaged 9.9/12 (83%) interventions, compared to an average of 7.1/12 (59%) interventions (p < 0.01) in the control group. Conclusions The use of an emergency manual was associated with a significant improvement in critical event management by individual novice physicians in a simulated ICU patient (23% average increase). PMID:29600255

Emergency Manuals Improved Novice Physician Performance During Simulated ICU Emergencies.

PubMed

Kazior, Michael R; Wang, Jacob; Stiegler, Marjorie P; Nguyen, Dung; Rebel, Annette; Isaak, Robert S

2017-01-01

Emergency manuals, which are safety essentials in non-medical high-reliability organizations (e.g., aviation), have recently gained acceptance in critical medical environments. Of the existing emergency manuals in anesthesiology, most are geared towards intraoperative settings. Additionally, most evidence supporting their efficacy focuses on the study of physicians with at least some meaningful experience as a physician. Our aim was to evaluate whether an emergency manual would improve the performance of novice physicians (post-graduate year [PGY] 1 or first year resident) in managing a critical event in the intensive care unit (ICU). PGY1 interns (n=41) were assessed on the management of a simulated critical event (unstable bradycardia) in the ICU. Participants underwent a group allocation process to either a control group (n=18) or an intervention group (emergency manual provided, n=23). The number of successfully executed treatment and diagnostic interventions completed was evaluated over a ten minute (600 seconds) simulation for each participant. The participants using the emergency manual averaged 9.9/12 (83%) interventions, compared to an average of 7.1/12 (59%) interventions (p < 0.01) in the control group. The use of an emergency manual was associated with a significant improvement in critical event management by individual novice physicians in a simulated ICU patient (23% average increase).

Tire traces - discrimination and classification of pyrolysis-GC/MS profiles.

PubMed

Gueissaz, Line; Massonnet, Geneviève

2013-07-10

Tire traces can be observed on several crime scenes as vehicles are often used by criminals. The tread abrasion on the road, while braking or skidding, leads to the production of small rubber particles which can be collected for comparison purposes. This research focused on the statistical comparison of Py-GC/MS profiles of tire traces and tire treads. The optimisation of the analytical method was carried out using experimental designs. The aim was to determine the best pyrolysis parameters regarding the repeatability of the results. Thus, the pyrolysis factor effect could also be calculated. The pyrolysis temperature was found to be five time more important than time. Finally, a pyrolysis at 650°C during 15s was selected. Ten tires of different manufacturers and models were used for this study. Several samples were collected on each tire, and several replicates were carried out to study the variability within each tire (intravariability). More than eighty compounds were integrated for each analysis and the variability study showed that more than 75% presented a relative standard deviation (RSD) below 5% for the ten tires, thus supporting a low intravariability. The variability between the ten tires (intervariability) presented higher values and the ten most variant compounds had a RSD value above 13%, supporting their high potential of discrimination between the tires tested. Principal Component Analysis (PCA) was able to fully discriminate the ten tires with the help of the first three principal components. The ten tires were finally used to perform braking tests on a racetrack with a vehicle equipped with an anti-lock braking system. The resulting tire traces were adequately collected using sheets of white gelatine. As for tires, the intravariability for the traces was found to be lower than the intervariability. Clustering methods were carried out and the Ward's method based on the squared Euclidean distance was able to correctly group all of the tire traces replicates in the same cluster than the replicates of their corresponding tire. Blind tests on traces were performed and were correctly assigned to their tire source. These results support the hypothesis that the tested tires, of different manufacturers and models, can be discriminated by a statistical comparison of their chemical profiles. The traces were found to be not differentiable from their source but differentiable from all the other tires present in the subset. The results are promising and will be extended on a larger sample set. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

A strengths based method for homeless youth: Effectiveness and fidelity of Houvast

PubMed Central

2013-01-01

Background While homelessness among youth is a serious problem, there is little information about evidence-based interventions for homeless youth. In cooperation with professionals and youths, Wolf (2012) developed Houvast (Dutch for ‘grip’): a strengths based method grounded in scientific and practice evidence. The main aim of Houvast is to improve the quality of life of homeless youths by focusing on their strengths, thus stimulating their capacity for autonomy and self-reliance. Method/Design The effectiveness and fidelity of Houvast will be tested in ten Dutch services for homeless youth which are randomly allocated to an intervention group (n = 5), or a control group which provides care as usual (n = 5). Measurements of both objective and subjective quality of life and secondary outcomes (mental and physical health, substance use, coping, resilience, psychological needs, care needs, working relationship with the professional and attainment of personal goals) will be conducted among homeless youths (n = 251). Youths in both groups will be interviewed by means of a structured interview at baseline, at time of ending care or after having received care for six months (T1) and at nine months after baseline (T2). Model fidelity will be tested around T1. Discussion This study is unique as it includes a large number of homeless youths who are followed for a period of nine months, and because it focuses on a strengths based approach. If the Houvast method proves to be effective in improving quality of life it will be the first evidence-based intervention for homeless youth. Trail registration Netherlands Trail Register (NTR):NTR3254 PMID:23594410

Mixed messages: residents' experiences learning cross-cultural care.

PubMed

Park, Elyse R; Betancourt, Joseph R; Kim, Minah K; Maina, Angela W; Blumenthal, David; Weissman, Joel S

2005-09-01

An Institute of Medicine report issued in 2002 cited cross-cultural training as a mechanism to address racial and ethnic disparities in health care, but little is known about residents' training and capabilities to provide quality care to diverse populations. This article explores a select group of residents' perceptions of their preparedness to deliver quality care to diverse populations. Seven focus groups and ten individual interviews were conducted with 68 residents in locations nationwide. Qualitative analysis of focus-group and individual interview transcripts was performed to assess residents' perceptions of (1) preparedness to deliver care to diverse patients; (2) educational climate; and (3) training experiences. Most residents in this study noted the importance of cross-cultural care yet reported little formal training in this area. Residents wanted more formal training yet expressed concern that culture-specific training could lead to stereotyping. Most residents had developed ad hoc, informal skills to care for diverse patients. Although residents perceived institutional endorsement, they sensed it was a low priority due to lack of time and resources. Residents in this study reported receiving mixed messages about cross-cultural care. They were told it is important, yet they received little formal training and did not have time to treat diverse patients in a culturally sensitive manner. As a result, many developed coping behaviors rather than skills based on formally taught best practices. Training environments need to increase training to enhance residents' preparedness to deliver high-quality cross-cultural care if the medical profession is to achieve the goals set by the Institute of Medicine.

Development of a video-based education and process change intervention to improve advance cardiopulmonary resuscitation decision-making.

PubMed

Waldron, Nicholas; Johnson, Claire E; Saul, Peter; Waldron, Heidi; Chong, Jeffrey C; Hill, Anne-Marie; Hayes, Barbara

2016-10-06

Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions. Two focus groups, which involved eight consultants and ten junior doctors, were conducted following a review of the current literature. A subsequent iterative consensus process developed two intervention elements: (i) an updated 'Goals of Patient Care' (GOPC) form and process; (ii) an education video and resources for teaching advance CPR decision-making and communication. A multidisciplinary group of health professionals and policy-makers with experience in systems development, education and research provided critical feedback. Three key themes emerged from the focus groups and the literature, which identified a structure for the intervention: (i) knowing what to say; (ii) knowing how to say it; (iii) wanting to say it. The themes informed the development of a video to provide education about advance CPR decision-making framework, improving communication and contextualising relevant clinical issues. Critical feedback assisted in refining the video and further guided development and evolution of a medical GOPC approach to discussing and recording medical treatment and advance care plans. Through an iterative process of consultation and review, video-based education and an expanded GOPC form and approach were developed to address physician and systemic barriers to advance CPR decision-making and documentation. Implementation and evaluation across hospital settings is required to examine utility and determine effect on quality of care.

World War II Memorial Learning Activities.

ERIC Educational Resources Information Center

Tennessee State Dept. of Education, Nashville.

These learning activities can help students get the most out of a visit to the Tennessee World War II Memorial, a group of ten pylons located in Nashville (Tennessee). Each pylon contains informational text about the events of World War II. The ten pylons are listed as: (1) "Pylon E-1--Terror: America Enters the War against Fascism, June…

Differential Memory of Picture and Word Stimuli in a Paired-Associate Learning Task.

ERIC Educational Resources Information Center

Bartels, Laura Grand; Feinbloom, Jessica

Ten concrete nouns represented in either a pictorial or a linguistic mode and accompanied by ten nonsense syllables were shown to 77 college students in a study of how pictorial stimuli varied in recall and recognition tasks. The group receiving pictorial stimuli recalled and recognized significantly more nonsense syllables than did the group…

Transcutaneous electrical nerve stimulation attenuates CFA-induced hyperalgesia and inhibits spinal ERK1/2-COX-2 pathway activation in rats

PubMed Central

2013-01-01

Background Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacologic treatment for pain relief. In previous animal studies, TENS effectively alleviated Complete Freund’s Adjuvant (CFA)- or carrageenan-induced inflammatory pain. Although TENS is known to produce analgesia via opioid activation in the brain and at the spinal level, few reports have investigated the signal transduction pathways mediated by TENS. Prior studies have verified the importance of the activation of extracellular signal-regulated kinase (ERK) signal transduction pathway in the spinal cord dorsal horn (SCDH) in acute and persistent inflammatory pains. Here, by using CFA rat model, we tested the efficacy of TENS on inhibiting the expressions of p-ERK1/2 and of its downstream cyclooxygenase-2 (COX-2) and the level of prostaglandin E2 (PGE2) at spinal level. Methods Rats were randomly divided into control, model and TENS groups, and injected subcutaneously with 100 μl CFA or saline in the plantar surface of right hind paw. Rats in the TENS group were treated with TENS (constant aquare wave, 2 Hz and 100 Hz alternating frequencies, intensities ranging from 1 to 2 mA, lasting for 30 min each time) at 5 h and 24 h after injection. Paw withdrawal thresholds (PWTs) were measured with dynamic plantar aesthesiometer at 3d before modeling and 5 h, 6 h, and 25 h after CFA injection. The ipsilateral sides of the lumbar spinal cord dosral horns were harvested for detecting the expressions of p-ERK1/2 and COX-2 by western blot analysis and qPCR, and PGE2 by ELISA. Results CFA-induced periphery inflammation decreased PWTs and increased paw volume of rats. TENS treatment significantly alleviated mechanical hyperalgesia caused by CFA. However, no anti-inflammatory effect of TENS was observed. Expression of p-ERK1/2 protein and COX-2 mRNA was significantly up-regualted at 5 h and 6 h after CFA injection, while COX-2 and PGE2 protein level only increased at 6 h after modeling. Furthermore, the high expression of p-ERK1/2 and COX-2, and over-production of PGE2 induced by CFA, were suppressed by TENS administration. Conclusions TENS may be an effective therapy in controlling inflammatory pain induced by CFA. Its analgesic effect may be associated with the inhibition of activation of the spinal ERK1/2-COX-2 pathway. PMID:23768044

Transcutaneous electrical nerve stimulation attenuates CFA-induced hyperalgesia and inhibits spinal ERK1/2-COX-2 pathway activation in rats.

PubMed

Fang, Jun-Fan; Liang, Yi; Du, Jun-Ying; Fang, Jian-Qiao

2013-06-15

Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacologic treatment for pain relief. In previous animal studies, TENS effectively alleviated Complete Freund's Adjuvant (CFA)- or carrageenan-induced inflammatory pain. Although TENS is known to produce analgesia via opioid activation in the brain and at the spinal level, few reports have investigated the signal transduction pathways mediated by TENS. Prior studies have verified the importance of the activation of extracellular signal-regulated kinase (ERK) signal transduction pathway in the spinal cord dorsal horn (SCDH) in acute and persistent inflammatory pains. Here, by using CFA rat model, we tested the efficacy of TENS on inhibiting the expressions of p-ERK1/2 and of its downstream cyclooxygenase-2 (COX-2) and the level of prostaglandin E2 (PGE2) at spinal level. Rats were randomly divided into control, model and TENS groups, and injected subcutaneously with 100 μl CFA or saline in the plantar surface of right hind paw. Rats in the TENS group were treated with TENS (constant aquare wave, 2 Hz and 100 Hz alternating frequencies, intensities ranging from 1 to 2 mA, lasting for 30 min each time) at 5 h and 24 h after injection. Paw withdrawal thresholds (PWTs) were measured with dynamic plantar aesthesiometer at 3d before modeling and 5 h, 6 h, and 25 h after CFA injection. The ipsilateral sides of the lumbar spinal cord dosral horns were harvested for detecting the expressions of p-ERK1/2 and COX-2 by western blot analysis and qPCR, and PGE2 by ELISA. CFA-induced periphery inflammation decreased PWTs and increased paw volume of rats. TENS treatment significantly alleviated mechanical hyperalgesia caused by CFA. However, no anti-inflammatory effect of TENS was observed. Expression of p-ERK1/2 protein and COX-2 mRNA was significantly up-regualted at 5 h and 6 h after CFA injection, while COX-2 and PGE2 protein level only increased at 6 h after modeling. Furthermore, the high expression of p-ERK1/2 and COX-2, and over-production of PGE2 induced by CFA, were suppressed by TENS administration. TENS may be an effective therapy in controlling inflammatory pain induced by CFA. Its analgesic effect may be associated with the inhibition of activation of the spinal ERK1/2-COX-2 pathway.

What Do They Use? Where Do They Get It? An Interdisciplinary Citation Analysis of Latin American Studies Faculty Monographs, 2004-2013

ERIC Educational Resources Information Center

Ostos, Manuel

2017-01-01

This citation analysis examines the ability of the local collection at the Pennsylvania State University to meet the needs of global and area studies researchers focusing on monographs published by faculty members on Latin American studies in a ten-year period. The study focuses on book use to address the tempting notion that packages and online…

40 CFR 798.6560 - Subchronic delayed neuro-toxicity of organophosphorus substances.

Code of Federal Regulations, 2010 CFR

2010-07-01

... employed. (2) Number of animals. Ten hens should be used for each treatment and control group. (3) Control group—(i) General. A concurrent control group should be used. This group should be treated in a manner... control group(s). The highest dose level should result in toxic effects, preferably delayed neurotoxicity...

40 CFR 798.6560 - Subchronic delayed neuro-toxicity of organophosphorus substances.

Code of Federal Regulations, 2013 CFR

2013-07-01

... employed. (2) Number of animals. Ten hens should be used for each treatment and control group. (3) Control group—(i) General. A concurrent control group should be used. This group should be treated in a manner... control group(s). The highest dose level should result in toxic effects, preferably delayed neurotoxicity...

40 CFR 798.6560 - Subchronic delayed neuro-toxicity of organophosphorus substances.

Code of Federal Regulations, 2014 CFR

2014-07-01

... employed. (2) Number of animals. Ten hens should be used for each treatment and control group. (3) Control group—(i) General. A concurrent control group should be used. This group should be treated in a manner... control group(s). The highest dose level should result in toxic effects, preferably delayed neurotoxicity...

40 CFR 798.6560 - Subchronic delayed neuro-toxicity of organophosphorus substances.

Code of Federal Regulations, 2012 CFR

2012-07-01

... employed. (2) Number of animals. Ten hens should be used for each treatment and control group. (3) Control group—(i) General. A concurrent control group should be used. This group should be treated in a manner... control group(s). The highest dose level should result in toxic effects, preferably delayed neurotoxicity...

40 CFR 798.6560 - Subchronic delayed neuro-toxicity of organophosphorus substances.

Code of Federal Regulations, 2011 CFR

2011-07-01

... employed. (2) Number of animals. Ten hens should be used for each treatment and control group. (3) Control group—(i) General. A concurrent control group should be used. This group should be treated in a manner... control group(s). The highest dose level should result in toxic effects, preferably delayed neurotoxicity...

Stand-off explosive detection utilizing low power stimulated emission nuclear quadrupole resonance detection and subwavelength focusing wideband super lens

NASA Astrophysics Data System (ADS)

Apostolos, John; Mouyos, William; Feng, Judy; Chase, Walter

2015-05-01

The need for advanced techniques to detect improvised explosive devices (IED) at stand-off distances greater than ten (10) meters has driven AMI Research and Development (AMI) to develop a solution to detect and identify the threat utilizing a forward looking Synthetic Aperture Radar (SAR) combined with our CW radar technology Nuclear Quadrupole Resonance (NQR) detection system. The novel features include a near-field sub-wavelength focusing antenna, a wide band 300 KHz to 300 MHz rapidly scanning CW radar facilitated by a high Q antenna/tuner, and an advanced processor utilizing Rabi transitions where the nucleus oscillates between states under the time dependent incident electromagnetic field and alternately absorbs energy from the incident field while emitting coherent energy via stimulated emission. AMI's Sub-wavelength Focusing Wide Band Super Lens uses a Near-Field SAR, making detection possible at distances greater than ten (10) meters. This super lens is capable of operating on the near-field and focusing electromagnetic waves to resolutions beyond the diffraction limit. When applied to the case of a vehicle approaching an explosive hazard the methodologies of synthetic aperture radar is fused with the array based super resolution and the NQR data processing detecting the explosive hazard.

Low dose intravenous immunoglobulins and steroids in toxic epidermal necrolysis: a prospective comparative open-labelled study of 36 cases.

PubMed

Jagadeesan, Soumya; Sobhanakumari, K; Sadanandan, Sadeep Melethil; Ravindran, Sheeba; Divakaran, Manjula Velikkakathu; Skaria, Lissy; Kurien, George

2013-01-01

Toxic epidermal necrolysis (TEN) is a severe adverse drug reaction associated with high mortality. Though different modalities of treatment are advocated, there is no consensus regarding specific therapy. Corticosteroids have shown conflicting results and for high dose intravenous immunoglobulins (IVIG), cost is a limiting factor. To find out the effectiveness of combination therapy with low-dose IVIG and steroids versus steroids alone in our TEN patients. After obtaining Ethical Committee approval, 36 consecutive TEN patients (2008-2012) were alternately allocated to 2 groups - Group A was given combination of low-dose IVIG (0.2-0.5 g/kg) and rapidly tapering course of steroids (intravenous dexamethasone 0.1- 0.3 mg/kg/day tapered in 1-2 weeks) while Group B was given same dose of steroids alone. Outcome parameters assessed were time taken for arrest of disease progression, time taken for re-epithelization, duration of hospital stay and mortality rates. Both groups had 18 patients. Baseline characteristics like age, sex ratio, SCORTEN, body surface area involvement and treatment interval were comparable. Time for arrest of disease progression and for re-epithelization was significantly lowered in Group A (P = 0.0001, P = 0.0009 respectively). Though duration of hospital stay and deaths were less in Group A, difference was not statistically significant. SCORTEN based standardized mortality ratio (SMR) analysis revealed that combination therapy reduced the probability of dying by 82% (SMR = 0.18 ± 0.36) and steroids by 37% (SMR = 0.63 ± 0.71). Difference in SMR was statistically significant (P = 0.00001). No significant side effects due to either modality were found in any of the patients. Combination therapy with low-dose IVIG and steroids is more effective in terms of reduced mortality and faster disease resolution when compared to steroids alone in TEN.

[Upbringing and Sexuality in Children from Marginal Prostitute Women Downtown in Bogotá].

PubMed

Amaya, Javier Guillermo Díaz; Acosta, Miguel Barrios; Rojas, Rafael Vásquez

2012-09-01

Child upbringing of women engaged in prostitution has been little explored. Child upbringing beliefs, attitudes and practices regarding sexuality in prostitutes' children and adolescents were explored downtown in Bogota. Analytical-interpretive research included in-depth interviews and a focus group. There were ten women between 28 and 56 years of age. Core issues were their subjectivity as mothers, sexual development challenges, upbringing social and cultural conditions. Structural, symbolic and economic violence are the main determinants of parenting. Sexual abuse and the possibility of pregnancy in their adolescent daughters are the most important concerns. In general, the participants share the same values and reproduce traditional ideals in gender and sexuality, which are transmitted and modeled from upbringing. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Pectus excavatum in children: pulmonary scintigraphy before and after corrective surgery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Blickman, J.G.; Rosen, P.R.; Welch, K.J.

1985-09-01

Regional distribution of pulmonary function was evaluated preoperatively and postoperatively with xenon-133 perfusion and ventilation scintigraphy in 17 patients with pectus excavatum. Ventilatory preoperative studies were abnormal in 12 of 17 patients, resolving in seven of 12 postoperatively. Perfusion scans were abnormal in ten of 17 patients preoperatively; six of ten showed improvement postoperatively. Ventilation-perfusion ratios were abnormal in ten of 17 patients, normalizing postoperatively in six of ten. Symmetry of ventilation-perfusion ratio images improved in six out of nine in the latter group. The distribution of regional lung function in pectus excavatum can be evaluated preoperatively to support indicationsmore » for surgery. Postoperative improvement can be documented by physiological changes produced by the surgical correction.« less

Low and high-frequency TENS in post-episiotomy pain relief: a randomized, double-blind clinical trial.

PubMed

Pitangui, Ana C R; Araújo, Rodrigo C; Bezerra, Michelle J S; Ribeiro, Camila O; Nakano, Ana M S

2014-01-01

To evaluate the effectiveness of low-frequency TENS (LFT) and high-frequency TENS (HFT) in post-episiotomy pain relief. A randomized, controlled, double-blind clinical trial with placebo composed of 33 puerperae with post-episiotomy pain. TENS was applied for 30 minutes to groups: HFT(100 Hz; 100 µs), LFT (5 Hz; 100 µs), and placebo (PT). Four electrodes were placed in parallel near the episiotomy and four pain evaluations were performed with the numeric rating scale. The first and the second evaluation took place before TENS application and immediately after its removal and were done in the resting position and in the activities of sitting and ambulating. The third and fourth evaluation took place 30 and 60 minutes after TENS removal, only in the resting position. Intragroup differences were verified using the Friedman and Wilcoxon tests, and the intergroup analysis employed the Kruskal-Wallis test. In the intragroup analysis, there was no significant difference in the PT during rest, sitting, and ambulation (P>0.05). In the HFT and LFT, a significant difference was observed in all activities (P<0.001). In the intergroup analysis, there was a significant difference in the resting position in the HFT and LFT (P<0.001). In the sitting activity, a significant difference was verified in the second evaluation in the HFT and LFT (P<0.008). No significant difference was verified among the groups in ambulation (P<0.20). LFT and HFT are an effective resource that may be included in the routine of maternity wards.

The Top Ten Trends.

ERIC Educational Resources Information Center

Bassi, Laurie J.; And Others

1996-01-01

Trends shaping the workplace are increased skill requirements; more educated, diverse work force; continued corporate restructuring; change in size and composition of training departments; instructional technology advances; new training delivery methods; focus on performance improvement; integrated high-performance work systems; companies becoming…

How good are the internal controls in your group practice? Ten questions to contemplate.

PubMed

Grant, Barbara J; Foley, Lori A

2002-01-01

Internal controls are the methods and procedures used by any business to prevent or detect errors, safeguard assets (especially cash) from being misappropriated, and encourage staff adherence to prescribed managerial policies. Internal controls in a medical practice differ depending on the size and complexity of the practice. The key, however, is that they prevent or detect errors and efforts to circumvent the established policies and procedures of the organization. How good are the internal controls in your group practice? This article identifies ten questions you should use to evaluate your risk of asset misappropriation.

Effectiveness of focused structural massage and relaxation massage for chronic low back pain: protocol for a randomized controlled trial.

PubMed

Cherkin, Daniel C; Sherman, Karen J; Kahn, Janet; Erro, Janet H; Deyo, Richard A; Haneuse, Sebastien J; Cook, Andrea J

2009-10-20

Chronic back pain is a major public health problem and the primary reason patients seek massage treatment. Despite the growing use of massage for chronic low back pain, there have been few studies of its effectiveness. This trial will be the first evaluation of the effectiveness of relaxation massage for chronic back pain and the first large trial of a focused structural form of massage for this condition. A total of 399 participants (133 in each of three arms) between the ages of 20 and 65 years of age who have low back pain lasting at least 3 months will be recruited from an integrated health care delivery system. They will be randomized to one of two types of massage ("focused structural massage" or "relaxation massage"), or continued usual medical care. Ten massage treatments will be provided over 10 weeks. The primary outcomes, standard measures of dysfunction and bothersomeness of low back pain, will be assessed at baseline and after 10, 26, and 52 weeks by telephone interviewers masked to treatment assignment. General health status, satisfaction with back care, days of back-related disability, perceived stress, and use and costs of healthcare services for back pain will also be measured. Outcomes across assigned treatment groups will be compared using generalized estimating equations, accounting for participant correlation and adjusted for baseline value, age, and sex. For both primary outcome measures, this trial will have at least 85% power to detect the presence of a minimal clinically significant difference among the three treatment groups and 91% power for pairwise comparisons. Secondary analyses will compare the proportions of participants in each group that improve by a clinically meaningful amount. Results of this trial will help clarify the value of two types of massage therapy for chronic low back pain.

Conversations Around Practice: Mediating Opportunities to Learn about Teaching Science

NASA Astrophysics Data System (ADS)

Ricketts, Amy Rene

This study contributes to the knowledge base regarding the ways in which school-based, ongoing, professional learning communities mediate teacher learning. Specifically, it investigates an organic learning group as they met in various contexts over a full school year, engaging in conversations around their teaching practices that focused on supporting students' explanations of scientific phenomena. The group consisted of ten middle school science teachers from three schools in the same public school district, their district science coordinator and a professor of science education. Drawing on traditions of ethnography and discourse analysis, this case study: 1) characterizes each episode of the group's conversations around practice in terms of its potential for generating transformative learning opportunities, 2) identifies which spontaneous and designed features of those conversations accounted for differences in the generative nature of the talk, and 3) explains how those features mediated the generative nature of the talk. In this group, the differences between more- and less- generative talk could be attributed to five features: the context of the conversation; the tools participants used to represent their practice; the stance with which they represented and took up one another's practices in the talk; the resources they drew on (in terms of expertise); the conversational routines in which they engaged. These five features interacted in complex, patterned ways to mediate the generative nature of the group's talk.

Molecular Analysis of Flood Deposits in the Tennessee River Valley: Implications for Understanding Carbon Cycling in Fluvial Environments and Anthropogenic Impacts

NASA Astrophysics Data System (ADS)

Blackaby, E.; Craven, O. D.; Hockaday, W. C.; Forman, S. L.; Stinchcomb, G. E.

2017-12-01

The middle Tennessee River Valley contains both historic and prehistoric (>AD 1600) flood deposits. Stratigraphic sequences of stacked flood deposits that often bury soils provide new insights on organic matter transported and preserved prior to and after European colonization. This study focused on understanding carbon cycling within a dynamic fluvial system and quantifying the anthropogenic effect on flood processes through the analysis of molecular components of the organic matter. The data may be helpful in discerning the organic geochemical fingerprint for historic and prehistoric flood deposits. Ten samples were collected from three sites at varying depths and dated using optically stimulated luminescence (OSL). All samples underwent solid-state cross polar 13C NMR analysis at twelve kilohertz, and a molecular mixing model (MMM) was used to determine the molecular components of the organic matter present in each sample. The MMM categorized carbon molecules present in each sample in terms of carbohydrate, protein, lipid, lignin, char, or pure carbonyl. Char was the most prominent molecular component of all ten samples ranging from 28.7 to 55.9% and comprised larger percentages in prehistoric deposits. The historic deposits, while still char dominated, showed more molecular diversity with higher percentages in non-char carbon groups. The carbonyl, lipid, and carbohydrate groups are present throughout all the samples with the carbonyl ranging from 9.3 to 31.4%, the lipid from 5.5 to 16.7%, and the carbohydrate from 4.4 to 16.9%. The high amount of carbonyl throughout the samples indicates that the deposits existed in a highly oxidizing environment. Differences in the presence and amount of carbon groups between historic and prehistoric flood deposits potentially reflect diagenic alternation of organic matter through time, changes in human land use, or some combination processes. These preliminary results possibly indicate changes in carbon pools accessed with European cultivation and continued degradation of organic moieties during a ca. 400 years burial, and mostly in oxidizing conditions.

Anti-stress effects of transcutaneous electrical nerve stimulation (TENS) on colonic motility in rats.

PubMed

Yoshimoto, Sazu; Babygirija, Reji; Dobner, Anthony; Ludwig, Kirk; Takahashi, Toku

2012-05-01

Disorders of colonic motility may contribute to symptoms in patients with irritable bowel syndrome (IBS), and stress is widely believed to play a major role in developing IBS. Stress increases corticotropin releasing factor (CRF) of the hypothalamus, resulting in acceleration of colonic transit in rodents. In contrast, hypothalamic oxytocin (OXT) has an anti-stress effect via inhibiting CRF expression and hypothalamic-pituitary-adrenal axis activity. Although transcutaneous electrical nerve stimulation (TENS) and acupuncture have been shown to have anti-stress effects, the mechanism of the beneficial effects remains unknown. We tested the hypothesis that TENS upregulates hypothalamic OXT expression resulting in reduced CRF expression and restoration of colonic dysmotility in response to chronic stress. Male SD rats received different types of stressors for seven consecutive days (chronic heterotypic stress). TENS was applied to the bilateral hind limbs every other day before stress loading. Another group of rats did not receive TENS treatment. TENS significantly attenuated accelerated colonic transit induced by chronic heterotypic stress, which was antagonized by a central injection of an OXT antagonist. Immunohistochemical study showed that TENS increased OXT expression and decreased CRF expression at the paraventricular nucleus (PVN) following chronic heterotypic stress. It is suggested that TENS upregulates hypothalamic OXT expression which acts as an anti-stressor agent and mediates restored colonic dysmotility following chronic stress. TENS may be useful to treat gastrointestinal symptoms associated with stress.

Characterization of acute phase proteins and oxidative stress response to road transportation in the dog.

PubMed

Fazio, Francesco; Casella, Stefania; Giannetto, Claudia; Giudice, Elisabetta; Piccione, Giuseppe

2015-01-01

Haptoglobin (Hp), serum amyloid A (SAA), C-reactive protein (CRP), white blood cells (WBC), reactive oxygen metabolites (ROMs), the antioxidant barrier (Oxy-adsorbent) and thiol groups of plasma compounds (SHp) were measured in ten dogs that had been transported a distance of about 230 km within 2 h (experimental group) and in ten dogs that had not been subjected to road transportation (control group). Blood was collected via cephalic venipuncture before road transportation (T0), after road transportation (T1), and more than 6 (T6) and 24 (T24) hours after road transportation in the experimental group (Group A) and at the same time points in the control group (Group B). The GLM (general linear model) Repeated Measures procedure showed a significant difference between the two groups (P<0.0001) and a significant rise (P<0.0001) in the concentrations of Hp, SAA, CRP, WBC, ROMs, Oxy-adsorbent and SHp after road transportation in Group A, underlining that physiological and homeostatic mechanisms are modified differently at various sampling times.

Transcutaneous Electrical Nerve Stimulation Reduces Post-Thoractomy Ipsilateral Shoulder Pain. A Prospective Randomized Study.

PubMed

Esteban González, Pedro; Novoa, Nuria M; Varela, Gonzalo

2015-12-01

The patient's position during an axillary thoracotomy can cause postoperative pain and decrease mobility of the ipsilateral shoulder. In this study, we assessed whether the implementation of a standardized analgesia program using transcutaneous electrical nerve stimulation (TENS) decreases local pain and improves ipsilateral shoulder mobility. Randomized, single-blind, single-center clinical trial of 50 patients who had undergone anatomical lung resection via axillary muscle-sparing thoracotomy. Patients were treated with TENS devices for 30 minutes every 8 hours, beginning on postoperative day 1. Pain and mobility of the affected limb were recorded at the same time on postoperative days 1 through 3. A visual analogue scale was used for pain assessment and shoulder mobility was assessed with a goniometer. Results were compared using a non-parametric test. Twenty-five patients were randomized to each group. Mean age of the control group was 62.7±9.3 years and 63.4±10.2 years in the experimental group. Shoulder mobility parameters were similar in both groups on all postoperative days. However, pain during flexion significantly decreased on day 2 (P=.03) and day 3 (P=.04) in the experimental group. The use of TENS decreases pain from shoulder flexion in patients undergoing axillary thoracotomy for pulmonary resection. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

Ten-week Whole-body Vibration Training Improves Body Composition and Muscle Strength in Obese Women

PubMed Central

Milanese, Chiara; Piscitelli, Francesco; Zenti, Maria Grazia; Moghetti, Paolo; Sandri, Marco; Zancanaro, Carlo

2013-01-01

This work explored the short-term effect of whole body vibration (WBV) training on anthropometry, body composition and muscular strength in obese women. Fifty obese women (age=46.8±7.81[SD]y; BMI=35.1±3.55kg/m2) were assigned to a ten-week WBV training period, two times a week (in each session, 14min vibration training, 5min rest; vibration amplitude 2.0-5.0mm, frequency 40-60Hz), with (n=18) or without (n=17) radiofrequency, or to a non-exercise control group (n=15). Subjects were instructed not to change their habitual lifestyle. Before and after the ten-week experimental period, anthropometric measurements, dual-energy X-ray absorptiometry (DXA), and the leg press, leg curl and leg extension strength tests were carried out. All changes in the two groups of WBV training, with or without radiofrequency, were similar and these groups were combined in a single WBV intervention group. As compared to controls, subjects submitted to WBV training had significantly lower BMI, total body and trunk fat, sum of skinfolds and body circumferences. On the other hand, lower limb strength tests were increased in the WBV group. These preliminary results suggest that WBV training may improve body composition and muscular strength in obese women and may be a useful adjuvant to lifestyle prescriptions. PMID:23423629

Transcutaneous electrical nerve stimulation (TENS) for chronic low-back pain.

PubMed

Khadilkar, A; Milne, S; Brosseau, L; Robinson, V; Saginur, M; Shea, B; Tugwell, P; Wells, G

2005-07-20

Chronic low-back pain (LBP) affects a significant proportion of the population. Transcutaneous electrical nerve stimulation (TENS) was introduced more than 30 years ago as an adjunct to the pharmacological management of pain. However, despite its widespread use, the usefulness of TENS in chronic LBP is still controversial. The aim of this systematic review was to determine the effectiveness of TENS in the management of chronic LBP. We searched the Cochrane Central Register of Controlled Trials (Issue 2, 2005), MEDLINE, EMBASE and PEDro up to April 1, 2005. Only randomized controlled clinical trials (RCTs) evaluating the effect of TENS on chronic LBP were included. Abstracts were excluded unless further data could be obtained from the authors. Two reviewers independently selected trials and extracted data using predetermined forms. Heterogeneity was tested with Cochrane's Q test. A fixed effect model was used throughout for calculating continuous variables, except where heterogeneity existed, in which case, a random effects model was used. Results are presented as weighted mean differences (WMD) with 95% confidence intervals (95% CI), where the difference between the treated and control groups was weighted by the inverse of the variance. Standardized mean differences (SMD) were calculated by dividing the difference between the treated and control by the baseline variance. SMD were used when different scales were used to measure the same concept. Dichotomous outcomes were analyzed with odds ratios. The only two RCTs (175 patients) meeting eligibility criteria differed in study design, methodological quality, inclusion and exclusion criteria, type and method of TENS application, treatment schedule, co-interventions and final outcomes. In one RCT, TENS produced significantly greater pain relief than the placebo control. However, in the other RCT, no statistically significant differences between treatment and control groups were shown for multiple outcome measures. Pre-planned subgroup analyses, intended to examine the impact of different stimulation parameters, sites of TENS application, treatment durations and baseline patient characteristics were not possible due to the small number of included trials. There is inconsistent evidence to support the use of TENS as a single treatment in the management of chronic LBP. Larger, multi-center, randomized controlled trials are needed to better assess the true effectiveness of TENS. Special attention should be given to the risks and benefits of long-term use, which more appropriately addresses the realities of managing chronic low-back pain.

Does daily kangaroo care provide sustained pain and stress relief in preterm infants?

PubMed

Mitchell, A J; Yates, C C; Williams, D K; Chang, J Y; Hall, R Whit

2013-01-01

1. Determine whether stress in preterm infants, measured with salivary cortisol, decreases after five days of Kangaroo Care (KC) compared to five days of Standard Care (SC). 2. To determine whether kangaroo care provides sustainable pain relief beyond the period of skin-to-skin holding. Preterm infants (n = 38) born at 27-30 weeks gestational age were randomized to either the KC or the SC group and received the allocated intervention starting on day of life (DOL) five and continuing for five days. Salivary cortisol was collected on DOL five and again on DOL ten. Differences were analyzed using repeated measures ANOVA and t tests. Pain during nasal suctioning over five days was assessed using the Premature Infant Pain Profile (PIPP). 1. Adequate saliva samples for salivary cortisol were collected for 13 KC infants and 11 SC infants. There was no main effect of group (p = 0.49), but there was a significant main effect of age (DOL five versus DOL ten), with salivary cortisol levels decreasing in both groups (p = 0.02). 2. Pain scores for both groups (n = 38) indicted mild to moderate pain during suctioning, with no significant difference in pain scores between groups. 1. KC did not affect salivary cortisol levels in preterm neonates, but levels in both the KC and SC groups decreased over time from DOL five to ten. Salivary cortisol may vary with age of infant. 2. Infants experience pain during routine suctioning and may require pain management.

A Randomized Control Study on Psycho-Education Group on Improving Health-Related Quality of Life of Chinese Persons with Major Neurocognitive Disorder.

PubMed

Young, Kim-Wan

2016-01-01

People with a major neurocognitive disorder (PwND) are found to have a lower health related quality of life (HRQoL) than those without neurocognitive disorder. This research study aims to evaluate the effectiveness of a psycho-education group in improving the HRQoL of Chinese PwND. By adopting randomized control trial (RCT), Chinese PwND were randomly assigned to either a 10-session psycho-education group or the control group. Family caregivers of treatment group were encouraged to take part in two sessions focusing on the caring and communication skills. Control group and their family caregivers received standardized educational materials on basic information on neurocognitive disorder for them to read at home. Standardized assessment was conducted both with PwND and their caregivers independently to give the self-rated and caregiver-rated HRQoL of PwND in the pre- and post- treatment periods by a research assistant who was blind to the group assignment of the participants. Moreover, qualitative interviews were also conducted for ten participants and five family caregivers of the treatment group to identify those group elements relating to its effectiveness. 2 × 2 repeated measures ANCOVA demonstrated that the treatment group (n = 32) was significantly more effective than the control group (n = 32) in improving the caregiver-rated HRQoL (F[1, 61] = 4.35, p = .04 < .05) with a moderate effect size, but not self-rated HRQoL, Qualitative analysis suggested several group elements relating to its effectiveness. This present RCT shows that the psycho-education group significantly improves caregiver-rated HRQoL of PwND, supporting the feasibility and effectiveness of the psycho-education group.

Best practice workplace HIV/AIDS programmes in South Africa: A review of case studies and lessons learned

PubMed Central

2009-01-01

ABSTRACT Background A group of experts attending a tripartite interregional meeting on best practices in HIV/AIDS workplace policies and programmes organised by the International Labour Organisation (ILO) in Geneva, Switzerland, identified 34 best practice workplace HIV programmes from across the world. Method The ten criteria that were used for reviewing best practice workplace HIV/AIDS programmes in South Africa include acceptability, accessibility, ethical soundness, perceived impact, relevance, appropriateness, innovativeness, efficiency, sustainability and replicability. Results More than one-third (35.3%) of the 34 best practice workplace interventions identified were found in businesses and industries in South Africa. This constitutes a significant and encouraging effort to deal with HIV/AIDS in the workplace. Approximately 16.7% of the best practice workplace HIV/AIDS interventions focused on policy and legal frameworks, 50% of these interventions focused on prevention, 16.7% provided links beyond the workplace and a further 16.7% were interventions that focused on knowledge and evidence. A third (33.3%) of practices were found in the mining industry, 16.7% in the motor industry, 16.7% from workers’ unions, and the rest (33.3%) were found in a sugar company, an electricity supply company, a pharmaceutical company and the ministry of Public Service and Administration. Conclusion It is encouraging that over one-third of all best practice workplace HIV interventions identified by the ILO experts were found in South Africa. The majority of these policies and programmes were focused on HIV prevention.

Transcutaneous Electrical Nerve Stimulation (TENS) for the Control of Pain during Rehabilitation Following Total Knee Arthroplasty (TKA): A Randomized, Blinded, Placebo-Controlled Trial

PubMed Central

Rakel, Barbara; Zimmerman, M. Bridget; Geasland, Katharine; Embree, Jennie; Clark, Charles R; Noiseux, Nicolas O; Callaghan, John J; Herr, Keela; Walsh, Deirdre; Sluka, Kathleen A

2014-01-01

This study evaluated the efficacy of TENS in reducing pain and hyperalgesia and increasing function following total knee arthroplasty (TKA). We hypothesized participants using TENS during rehabilitation exercises would: 1) report significantly lower pain during range-of-motion (ROM) and fast walking but not at rest; 2) have less hyperalgesia; and, 3) have better function than participants receiving Placebo-TENS or Standard Care. We also hypothesized that change in ROM pain would differ based on psychological characteristics (trait anxiety, pain catastrophizing and depression) and treatment group. This prospective, randomized study used intent-to-treat analyses on 317 subjects after primary, unilateral TKA. Assessors, blinded to treatment allocation, measured pain, function (ROM and gait speed), and hyperalgesia (quantitative sensory tests) postoperatively and 6 weeks after surgery. Analgesic intake, anxiety, depression, and pain catastrophizing were also assessed. TENS participants used it 1–2 times/day at 42 mA (on average) and had less pain postoperatively during active knee extension (p=0.019) and fast walking (p=0.006) than Standard Care participants. TENS and Placebo-TENS were not significantly different. TENS participants who scored low on anxiety and pain catastrophizing had a greater reduction in ROM pain at 6 weeks than those scoring high on these factors (p=0.002 and 0.03). Both TENS and Placebo-TENS participants had less postoperative mechanical hyperalgesia (p=0.03 – 0.01) than Standard Care participants. Supplementing pharmacologic analgesia with TENS during rehabilitation exercises reduces movement pain postoperatively but a placebo influence exists and the effect is gone by 6 weeks. Patients with low anxiety and pain catastrophizing may benefit most from TENS. PMID:25270585

Changing Course: Ten Years of Tracking Online Education in the United States

ERIC Educational Resources Information Center

Allen, I. Elaine; Seaman, Jeff

2013-01-01

"Changing Course: Ten Years of Tracking Online Education" in the United States is the tenth annual report on the state of online learning in U.S. higher education. The survey is designed, administered and analyzed by the Babson Survey Research Group. Data collection is conducted in partnership with the College Board. This year's study, like those…

[Determination of the profiles of secondary metabolites characteristic of Alternaria strains isolated from tomato].

PubMed

Benavidez Rozo, Martha Elizabeth; Patriarca, Andrea; Cabrera, Gabriela; Fernández Pinto, Virginia E

2014-01-01

Many Alternaria species have been studied for their ability to produce bioactive secondary metabolites, such as tentoxin (TEN), some of which have toxic properties. The main food contaminant toxins are tenuazonic acid, alternariol (AOH), alternariol monomethyl ether (AME), altenuene, and altertoxins i, ii and iii. To determine the profiles of secondary metabolites characteristic of Alternaria strains isolated from tomato for their chemotaxonomic classification. The profiles of secondary metabolites were determined by HPLC MS. The Alternaria isolates obtained from spoiled tomatoes belong, according to their morphological characteristics, to the species groups Alternaria alternata, Alternaria tenuissima and Alternaria arborescens, with A. tenuissima being the most frequent. The most frequent profiles of secondary metabolites belonging to the species groups A. alternata (AOH, AME, TEN), A. tenuissima (AOH, AME, TEN, tenuazonic acid) and A. arborescens (AOH, AME, TEN, tenuazonic acid) were determined, with some isolates of the latter being able to synthesize AAL toxins. Secondary metabolite profiles are a useful tool for the differentiation of small spored Alternaria isolates not easily identifiable by their morphological characteristics. Copyright © 2013 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

Does sacral pulsed electromagnetic field therapy have a better effect than transcutaneous electrical nerve stimulation in patients with neurogenic overactive bladder?

PubMed

Fergany, Lamyaa A; Shaker, Husain; Arafa, Magdy; Elbadry, Mohamed S

2017-06-01

To compare the effectiveness of pulsed electromagnetic field therapy (PEMFT) and transcutaneous electrical nerve stimulation (TENS) on neurogenic overactive bladder dysfunction (OAB) in patients with spinal cord injury (SCI). In all, 80 patients [50 men and 30 women, with a mean (SD) age of 40.15 (8.76) years] with neurogenic OAB secondary to suprasacral SCI were included. They underwent urodynamic studies (UDS) before and after treatment. Patients were divided into two equal groups: Group A, comprised 40 patients who received 20 min of TENS (10 Hz with a 700 s generated pulse), three times per week for 20 sessions; Group B, comprised 40 patients who received PEMFT (15 Hz with 50% intensity output for 5 s/min for 20 min), three times per week for 20 sessions. In Group B, there was a significant increase in the maximum cystometric capacity ( P  < 0.001), volume at first uninhibited detrusor contraction ( P  < 0.002), and maximum urinary flow rate ( P  < 0.02). The UDS showed that the effects of PEMFT in patients with neurogenic OAB secondary to suprasacral SCI was better than TENS for inducing an inhibitory effect on neurogenic detrusor overactivity.

Focus on function: a cluster, randomized controlled trial comparing child- versus context-focused intervention for young children with cerebral palsy.

PubMed

Law, Mary C; Darrah, Johanna; Pollock, Nancy; Wilson, Brenda; Russell, Dianne J; Walter, Stephen D; Rosenbaum, Peter; Galuppi, Barb

2011-07-01

This study evaluated the efficacy of a child-focused versus context-focused intervention in improving performance of functional tasks and mobility in young children with cerebral palsy. A randomized controlled trial cluster research design enrolled 128 children (49 females, 79 males; age range 12 mo to 5 y 11 mo; mean age 3 y 6 mo, SD -1 y 5 mo) who were diagnosed with cerebral palsy. Children across levels I to V on the Gross Motor Classification System (GMFCS) were included in the study. Children were excluded if there were planned surgical or medication changes during the intervention period. Therapists from 19 children's rehabilitation centers were block randomized (by occupational therapist or physical therapist) to a treatment arm. Children from consenting families followed their therapists into their assigned group. Children received child-focused (n=71) or context-focused intervention (n=57) over 6 months, returning to their regular therapy schedule and approach between 6 and 9 months. The primary outcome measure was the Pediatric Evaluation of Disability Inventory (PEDI). Secondary outcome measures included the Gross Motor Function Measure (GMFM-66), range of motion of hip abduction, popliteal angle and ankle dorsiflexion, the Assessment of Preschool Children's Participation (APCP), and the Family Empowerment Scale (FES). Outcome evaluators were masked to group assignment and completed assessments at baseline, 6 months, and 9 months. Ten children did not complete the full intervention, six in the child group and four in context group. GMFCS levels for children in the study were level I (n=37), level II (n=23), level III (n=21), level IV (n=21), and level V (n=26). There were no significant differences at baseline between the treatment groups for GMFCS level, parental education, or parental income. For the PEDI, there was no significant difference between the treatment groups, except for a small effect (p<0.03) on the Caregiver Assistance Mobility subscale between baseline and 9 months. The mean scores of both groups changed significantly on the Functional Skills Scales (p<0.001) and Caregiver Assistance Scales (p<0.02) of the PEDI after the 6-month intervention. There was no additional statistically significant change on the PEDI during the follow-up period from 6 to 9 months. A subgroup effect was found for age (p<0.001), with children younger than 3 years changing significantly more than older children. GMFCS level at baseline did not influence the amount of change on the PEDI scales. There were no significant differences between the treatment groups on the GMFM, range of motion measures, APCP or FES assessments. For the GMFM, there was a significant change over time from baseline to 6 months (p<0.001) and no significant change between 6 and 9 months. There was no adverse side effect as range of motion did not decrease in either group. Hip abduction increased significantly (p<0.01) at the 9-month assessment for both groups. For the APCP, significant changes for both treatment groups were found between baseline and 6 months for play intensity (p<0.04), physical activity intensity and diversity (p<0.001), and total score intensity (p<0.01). This study shows that child- or context-focused therapy approaches are equally effective and that frequency of intervention may be a critical component of successful intervention. Further evaluation is required to identify the various 'dose-response' relations of amount of treatment and changes in functional abilities. © The Authors. Developmental Medicine & Child Neurology © 2011 Mac Keith Press.

Food security and development in South Sudan: a call to action.

PubMed

Tappis, Hannah; Doocy, Shannon; Paul, Amy; Funna, Sonya

2013-09-01

To examine household food insecurity and coping mechanisms in two relatively politically stable states of South Sudan. Cross-sectional assessment including structured interviews and focus group discussions with food aid programme beneficiaries and staff. Structured interview findings were analysed with descriptive statistics using the statistical software package STATA version 11. Rural households in four payams (sub-county administrative districts) benefiting from a multi-year assistance programme funded by the US Agency for International Development. The study was conducted in January 2012, six months after independence. Study subjects included eighty mothers of children aged 6–23 months in structured interviews and eight focus groups, each with six to ten participants, of mothers of children aged 6–23 months. Ninety-three per cent of households surveyed in Warrap and 100% of households in Northern Bahr el Ghazal states were severely food access insecure. Nearly all households (97?5%) surveyed in both states reported there were months in 2011 without enough food to eat. The majority of households (88%) reported sometimes or often going to bed hungry in the month preceding the study. A number of coping mechanisms were used when households did not have enough food, including reduced meal size, skipping meals, selling assets and engaging in some kind business in order to generate money to buy food. Given the highly volatile political, economic and humanitarian situation in South Sudan, the priorities of the international community are understandably focused on securing greater stability in South Sudan and preventing humanitarian needs from escalating significantly. There is a need, however, for simultaneous emphasis on food assistance and longer-term development strategies throughout South Sudan, particularly in areas of agriculture, livelihoods and food security.

The emerging dental workforce: short-term expectations of, and influences on dental students graduating from a London dental school in 2005.

PubMed

Gallagher, Jennifer E; Clarke, Wendy; Wilson, Nairn H F

2008-07-01

The aim of this research was to identify short-term career aspirations and goals of final-year dental students at a London dental school and the perceived factors that influenced these aspirations. Two methods were used to collect data on final-year students' short-term career plans and influences. Qualitative data were collected through focus groups and analysed using 'framework methodology'. These findings informed a questionnaire survey of all students at the end of their final undergraduate year. Data were entered into and analysed using a statistical software package. Thirty-five students participated in focus groups, with recruitment continuing until data were saturated. Ninety per cent (n=126) of the total population (140) responded to the questionnaire survey; the majority were Asian (70%), female (58%), and aged 23 years (59%). Short-term professional expectations focused around 'achieving professional status within a social context', 'gaining professional experience', 'developing independence' and 'achieving financial stability'. 'Achieving financial stability' was ranked as the most important influence in decision-making about their career in the short term (77%), followed by 'balance of work and other aspects of life' (75%) and 'good lifestyle' (75%). Four out of ten intended to work towards membership of a Royal College and/or becoming a specialist. Proximity to family (81%) and friends (79%) was an important or very important influence on location in the short term. Asian students were significantly more likely to rate 'proximity to family' (p=0.042), working in an 'urban area' (p=0.001) and 'opportunities for private care' (p=0.043) of greater importance than their White counterparts. Short-term aspirations involve 'achieving professional status within a social context', and personal, social, professional and financial goals. Location of future practice was significantly associated with ethnicity.

The Patient Educator Presentation in Dental Education: Reinforcing the Importance of Learning About Rare Conditions.

PubMed

Edwards, Paul C; Graham, Jasmine; Oling, Rebecca; Frantz, Kate E

2016-05-01

The aim of this study was to determine whether a patient educator presentation (PEP) on pemphigus vulgaris would increase second-year dental students' awareness of the importance of learning about rare conditions and improve their retention of rare disease knowledge. The study involved students' subjective assessments of a PEP experience at two U.S. dental schools. In this mixed methods study, cross-sectional data were obtained by surveys and in-depth interviews. Questions focused on students' assessment of the messages acquired from the PEP and its likely impact on their future clinical care. At University 1, students completed paper surveys with open-ended questions and participated in a focus group. At University 2, students completed an online survey consisting of rating scale and open-ended questions. Responses to open-ended questions were categorized into themes. At University 1, 79 students (out of a possible 102; response rate 77.5%) completed the survey, and an additional ten students participated in a focus group. At University 2, 30 students (out of a possible 104; response rate 28.8%) completed the survey. At Universities 1 and 2, 88% and 100%, respectively, of respondents stated the PEP would influence their future clinical decision making. The vast majority of respondents (94% and 100% at University 1 and University 2, respectively) were of the opinion that the personal testimonial from a patient would help them recall information about pemphigus vulgaris in five years' time. Respondents from both universities commented that the PEP emphasized the importance of not dismissing a patient's concerns. These results suggest that a presentation by a patient with a rare condition can be an effective educational tool for preclinical dental students.

Task conflicts and exclusive professionalism in nursing in South Korea.

PubMed

Jung, Minsoo

2014-01-01

Task conflicts among medical professions are essential problems to be solved in health care organizations. This study examined job conflicts between practical nurses (PNs) and registered nurses (RNs) in their duties and tasks with representative panelists from South Korea. This qualitative study used the Dacum Task Analysis process. Subject-matter experts in practical nursing were recruited utilizing stratified sampling: Ten experts developed job descriptions of PNs, and 20 validated the descriptions. The on-site tasks and duties of the PNs were measured by means of Dacum, and the results were reviewed by RNs using 3 focus-group interviews. The job description of PNs consisted of 10 duties and 117 tasks, overlapping with some tasks of RNs. Core tasks performed by PNs, such as invasive activities, led to task conflicts between the 2 groups, as these activities were regarded as the inherent duty of nursing professions. Thus, the RNs did not concede the expanded job scope of the PNs in terms of exclusive professionalism. To reduce task conflict, there is a need for the balanced development of nursing professionalism.

Institutional profile: the national Swedish academic drug discovery & development platform at SciLifeLab

PubMed Central

Arvidsson, Per I; Sandberg, Kristian; Sakariassen, Kjell S

2017-01-01

The Science for Life Laboratory Drug Discovery and Development Platform (SciLifeLab DDD) was established in Stockholm and Uppsala, Sweden, in 2014. It is one of ten platforms of the Swedish national SciLifeLab which support projects run by Swedish academic researchers with large-scale technologies for molecular biosciences with a focus on health and environment. SciLifeLab was created by the coordinated effort of four universities in Stockholm and Uppsala: Stockholm University, Karolinska Institutet, KTH Royal Institute of Technology and Uppsala University, and has recently expanded to other Swedish university locations. The primary goal of the SciLifeLab DDD is to support selected academic discovery and development research projects with tools and resources to discover novel lead therapeutics, either molecules or human antibodies. Intellectual property developed with the help of SciLifeLab DDD is wholly owned by the academic research group. The bulk of SciLifeLab DDD's research and service activities are funded from the Swedish state, with only consumables paid by the academic research group through individual grants. PMID:28670468

Living with systemic lupus erythematosus: A patient engagement perspective.

PubMed

Mazzoni, Davide; Cornet, Alain; van Leeuw, Bernadette; Myllys, Kirsi; Cicognani, Elvira

2018-03-01

Patient engagement is recognized as a crucial component of high-quality healthcare services. Among rheumatic diseases, systemic lupus erythematosus (SLE) appears particularly challenging for the engagement of patients in their own care. According to the patient health engagement (PHE) model, patient engagement is a dynamic phenomenon that proceeds through four experiential positions (blackout, arousal, adhesion and eudaimonic project). The aim of the present study was to describe the engagement process from the point of view and the experiences of SLE patients. Ten in-depth interviews and four focus groups were conducted with an international sample of SLE patients from different European countries. Transcripts were analysed through thematic content analysis. Findings showed that a fully engaged patient results from reframing emotional, cognitive and behavioural dimensions. The advances along the process depends on how the patient succeeds in each position. In conclusion, PHE represents an appropriate model by which to understand the engagement process of SLE patients. In order to meet patients' needs, healthcare providers and patient support groups should consider the specific position of SLE patients, providing adequate and tailored support. Copyright © 2017 John Wiley & Sons, Ltd.

Wide-field microscopy using microcamera arrays

NASA Astrophysics Data System (ADS)

Marks, Daniel L.; Youn, Seo Ho; Son, Hui S.; Kim, Jungsang; Brady, David J.

2013-02-01

A microcamera is a relay lens paired with image sensors. Microcameras are grouped into arrays to relay overlapping views of a single large surface to the sensors to form a continuous synthetic image. The imaged surface may be curved or irregular as each camera may independently be dynamically focused to a different depth. Microcamera arrays are akin to microprocessors in supercomputers in that both join individual processors by an optoelectronic routing fabric to increase capacity and performance. A microcamera may image ten or more megapixels and grouped into an array of several hundred, as has already been demonstrated by the DARPA AWARE Wide-Field program with multiscale gigapixel photography. We adapt gigapixel microcamera array architectures to wide-field microscopy of irregularly shaped surfaces to greatly increase area imaging over 1000 square millimeters at resolutions of 3 microns or better in a single snapshot. The system includes a novel relay design, a sensor electronics package, and a FPGA-based networking fabric. Biomedical applications of this include screening for skin lesions, wide-field and resolution-agile microsurgical imaging, and microscopic cytometry of millions of cells performed in situ.

Institutional profile: the national Swedish academic drug discovery & development platform at SciLifeLab.

PubMed

Arvidsson, Per I; Sandberg, Kristian; Sakariassen, Kjell S

2017-06-01

The Science for Life Laboratory Drug Discovery and Development Platform (SciLifeLab DDD) was established in Stockholm and Uppsala, Sweden, in 2014. It is one of ten platforms of the Swedish national SciLifeLab which support projects run by Swedish academic researchers with large-scale technologies for molecular biosciences with a focus on health and environment. SciLifeLab was created by the coordinated effort of four universities in Stockholm and Uppsala: Stockholm University, Karolinska Institutet, KTH Royal Institute of Technology and Uppsala University, and has recently expanded to other Swedish university locations. The primary goal of the SciLifeLab DDD is to support selected academic discovery and development research projects with tools and resources to discover novel lead therapeutics, either molecules or human antibodies. Intellectual property developed with the help of SciLifeLab DDD is wholly owned by the academic research group. The bulk of SciLifeLab DDD's research and service activities are funded from the Swedish state, with only consumables paid by the academic research group through individual grants.

Constructions and experiences of sexual health among young, heterosexual, unmarried Muslim women immigrants in Australia.

PubMed

Wray, Anneke; Ussher, Jane M; Perz, Janette

2014-01-01

Minority ethnic immigrant women are frequently vulnerable to poor sexual health outcomes, due to poor use of sexual health services, lack of knowledge and social stigma associated with the discussion of sexuality. This paper explores the sexual health accounts provided by a group of young, unmarried heterosexual Muslim women immigrants residing and studying in Sydney, an under-researched group in the Australian context. Ten semi-structured interviews were conducted, focusing on sex before marriage, spouse selection and contraceptive use. Feminist discourse analysis identified 'purity versus corruption' as the primary construction of women's sexuality, where women positioned their sexual behaviour as that of purity and uninvolvement or corruption through unwedded participation. The subthemes 'maintaining ignorance and naivety', 'remaining virginal', 'sex segregation' and 'the fallen woman' capture women's personal sexuality-related experiences and values within the context of their religious and cultural communities. Additional research with this community is needed to examine the effects of negative social constructions of sex on young sexually active Muslim women, as well as further research on young women's sexual health within immigrant communities.

Academic requirements for Certificate of Completion of Training in surgical training: Consensus recommendations from the Association of Surgeons in Training/National Research Collaborative Consensus Group.

PubMed

Lee, Mathew J; Bhangu, A; Blencowe, Natalie S; Nepogodiev, D; Gokani, Vimal J; Harries, Rhiannon L; Akinfala, M; Ali, O; Allum, W; Bosanquet, D C; Boyce, K; Bradburn, M; Chapman, S J; Christopher, E; Coulter, I; Dean, B J F; Dickfos, M; El Boghdady, M; Elmasry, M; Fleming, S; Glasbey, J; Healy, C; Kasivisvanathan, V; Khan, K S; Kolias, A G; Lee, S M; Morton, D; O'Beirne, J; Sinclair, P; Sutton, P A

2016-11-01

Surgical trainees are expected to demonstrate academic achievement in order to obtain their certificate of completion of training (CCT). These standards are set by the Joint Committee on Surgical Training (JCST) and specialty advisory committees (SAC). The standards are not equivalent across all surgical specialties and recognise different achievements as evidence. They do not recognise changes in models of research and focus on outcomes rather than process. The Association of Surgeons in Training (ASiT) and National Research Collaborative (NRC) set out to develop progressive, consistent and flexible evidence set for academic requirements at CCT. A modified-Delphi approach was used. An expert group consisting of representatives from the ASiT and the NRC undertook iterative review of a document proposing changes to requirements. This was circulated amongst wider stakeholders. After ten iterations, an open meeting was held to discuss these proposals. Voting on statements was performed using a 5-point Likert Scale. Each statement was voted on twice, with ≥80% of votes in agreement meaning the statement was approved. The results of this vote were used to propose core and optional academic requirements for CCT. Online discussion concluded after ten rounds. At the consensus meeting, statements were voted on by 25 delegates from across surgical specialties and training-grades. The group strongly favoured acquisition of 'Good Clinical Practice' training and research methodology training as CCT requirements. The group agreed that higher degrees, publications in any author position (including collaborative authorship), recruiting patients to a study or multicentre audit and presentation at a national or international meeting could be used as evidence for the purpose of CCT. The group agreed on two essential 'core' requirements (GCP and methodology training) and two of a menu of four 'additional' requirements (publication with any authorship position, presentation, recruitment of patients to a multicentre study and completion of a higher degree), which should be completed in order to attain CCT. This approach has engaged stakeholders to produce a progressive set of academic requirements for CCT, which are applicable across surgical specialties. Flexibility in requirements whilst retaining a high standard of evidence is desirable. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Examining the need assessment process by identifying the need profiles of elderly care recipients in the Ten-year Long-Term Care Project (TLTCP) of Taiwan.

PubMed

Liu, Li-Fan; Yao, Hui-Ping

2014-12-01

To deal with the increasing long-term care (LTC) needs of elderly people in Taiwan, the government launched the Ten-year Long-term Care Project (TLTCP) in 2007, and through the care management system, care plans for those in need were distributed and implemented by care managers according to the single assessment process. Based on the emphasis of linking the right need assessment to the care plan, this study aimed to explore the need profiles of LTC recipients with regard to their health indicators to serve as a validity check on the identified dependency levels and care plans in the current care management system. A model based on latent class analysis (LCA) was used for dealing with the issue of health heterogeneity. LCA provides an empirical method that examines the interrelationships among health indicators and characterizes the underlying set of mutually exclusive latent classes that account for the observed indicators. The analysis included a total of 2901 elderly care recipients in the LTC dataset from a southern city, 1 of the 5 major metropolitan areas in Taiwan. The identified dependency levels of the samples and their care plans in need assessment were compared and discussed. Four need profiles were explored in the LTC dataset. Apart from the low (LD) (32.95%) and moderate dependent groups (MD) (17.48%), there were 2 groups identified among the high-dependency levels, including the severe physical and psychological dependency (SPP) (26.37%) and the comorbidities and severe dependency (CSD) groups (23.20%), which in sum were approximately identified as high dependency (HD) by care managers in the LTC dataset. In addition, the CSD group currently costs more for their care plans on average in LTC services (NT. 277,081.15, approximately 9200 USD) than the SPP group (NT. 244,084.21) and the other groups. Need assessment is a key to success in care management in LTC. The results of this study showed the importance of focusing on multifacet indicators, especially the mental and social health indicators in need assessments by improving the unified assessment process to sensitively detect those with various needs and then link them to the right care plan. Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

High Faculty Morale: What Exemplary Colleges Do Right.

ERIC Educational Resources Information Center

Rice, R. Eugene; Austin, Ann E.

1988-01-01

The relationship between faculty morale/satisfaction and various dimensions of the organizational culture of liberal arts colleges was examined, with focus on ten colleges. The power of organizational culture is made evident and reinforced through symbolic events and structures. (MLW)

Case Studies in CAL!

ERIC Educational Resources Information Center

Rogers, David F., Ed.; Smith, P. R., Ed.

1984-01-01

Ten papers focus on applications in specific curriculum areas, modelling and simulation, and computer managed learning. Projects described include voice support for the visually handicapped, distance education, and industrial training, as well as teaching applied mathematics, several facets of engineering, zoology, and, with videodisc, observation…

The impact of an online Facebook support group for people with multiple sclerosis on non-active users

PubMed Central

Steadman, Jacqui

2014-01-01

Background Multiple sclerosis (MS) is a debilitating disease and there is little research on support networks for people with MS (PwMS). More specifically, most studies on online support groups focus on those who actively participate in the group, whereas the majority of those who utilise online support groups do so in a passive way. Objectives This study therefore aimed to explore the experiences of non-active users of an online Facebook support group for PwMS. Emphasis was placed on the facilitators and the barriers that were associated with membership to this group. Method An exploratory qualitative research design was implemented, whereby thematic analysis was utilised to examine the ten semi-structured interviews that were conducted. Results Several facilitators were acquired through the online support group; namely emotional support (constant source of support, exposure to negative aspects of the disease), informational support (group as a source of knowledge, quality of information) and social companionship (place of belonging). Some barriers were also identified; namely emotional support (emotions lost online, response to messages, exposure to negative aspects of the disease), informational support (information posted on the group, misuse of group) and social companionship (non-active status) Conclusion These findings demonstrate that the non-active members of the online support group for PwMS have valid reasons for their non-active membership status. More important, the findings suggest that the online Facebook support group provided the group members with an important support network in the form of emotional support, informational support and social companionship, despite their non-active membership status or the barriers that have been identified. PMID:28730005

Growth inhibition in a brain metastasis model by antibody delivery using focused ultrasound-mediated blood-brain barrier disruption.

PubMed

Kobus, Thiele; Zervantonakis, Ioannis K; Zhang, Yongzhi; McDannold, Nathan J

2016-09-28

HER2-targeting antibodies (i.e. trastuzumab and pertuzumab) prolong survival in HER2-positive breast cancer patients with extracranial metastases. However, the response of brain metastases to these drugs is poor, and it is hypothesized that the blood-brain barrier (BBB) limits drug delivery to the brain. We investigated whether we could improve the response by temporary disruption of the BBB using focused ultrasound in combination with microbubbles. To study this, we inoculated 30 nude rats with HER2-positive cells derived from a brain metastasis of a breast cancer patient (MDA-MB-361). The animals were divided into three groups: a control-group that received no treatment; an antibody-only group that received six weekly treatments of trastuzumab and pertuzumab; and an ultrasound+antibody group that received trastuzumab and pertuzumab in combination with six weekly sessions of BBB disruption using focused ultrasound. In two animals, the leakiness of the tumors before disruption was evaluated using contrast-enhanced T1-weighted magnetic resonance imaging and found that the tumors were not leaky. The same technique was used to evaluate the effectiveness of BBB disruption, which was successful in all sessions. The tumor in the control animals grew exponentially with a growth constant of 0.042±0.011mm(3)/day. None of the antibody-only animals responded to the treatment and the growth constant was 0.033±0.009mm(3)/day during the treatment period. Four of the ten animals in the ultrasound+antibody-group showed a response to the treatment with an average growth constant of 0.010±0.007mm(3)/day, compared to a growth constant 0.043±0.013mm(3)/day for the six non-responders. After the treatment period, the tumors in all groups grew at similar rates. As the tumors were not leaky before BBB disruption and there were no responders in the antibody-only group, these results show that at least in some cases disruption of the BBB is necessary for a response to the antibodies in these brain metastases. Interestingly, only some of the rats responded to the treatment. We did not observe a difference in tumor volume at the start of the treatment, nor in HER2 expression or in contrast-enhancement on MRI between the responders and non-responders to explain this. Better understanding of why certain animals respond is needed and will help in translating this technique to the clinic. In conclusion, we demonstrate that BBB disruption using focused ultrasound in combination with antibody therapy can inhibit growth of breast cancer brain metastasis. Copyright © 2016 Elsevier B.V. All rights reserved.

Interventions for preventing obesity in children.

PubMed

Summerbell, C D; Waters, E; Edmunds, L D; Kelly, S; Brown, T; Campbell, K J

2005-07-20

Obesity prevention is an international public health priority. The prevalence of obesity and overweight is increasing in child populations throughout the world, impacting on short and long-term health. Obesity prevention strategies for children can change behaviour but efficacy in terms of preventing obesity remains poorly understood. To assess the effectiveness of interventions designed to prevent obesity in childhood through diet, physical activity and/or lifestyle and social support. MEDLINE, PsycINFO, EMBASE, CINAHL and CENTRAL were searched from 1990 to February 2005. Non-English language papers were included and experts contacted. Randomised controlled trials and controlled clinical trials with minimum duration twelve weeks. Two reviewers independently extracted data and assessed study quality. Twenty-two studies were included; ten long-term (at least 12 months) and twelve short-term (12 weeks to 12 months). Nineteen were school/preschool-based interventions, one was a community-based intervention targeting low-income families, and two were family-based interventions targeting non-obese children of obese or overweight parents. Six of the ten long-term studies combined dietary education and physical activity interventions; five resulted in no difference in overweight status between groups and one resulted in improvements for girls receiving the intervention, but not boys. Two studies focused on physical activity alone. Of these, a multi-media approach appeared to be effective in preventing obesity. Two studies focused on nutrition education alone, but neither were effective in preventing obesity. Four of the twelve short-term studies focused on interventions to increase physical activity levels, and two of these studies resulted in minor reductions in overweight status in favour of the intervention. The other eight studies combined advice on diet and physical activity, but none had a significant impact. The studies were heterogeneous in terms of study design, quality, target population, theoretical underpinning, and outcome measures, making it impossible to combine study findings using statistical methods. There was an absence of cost-effectiveness data. The majority of studies were short-term. Studies that focused on combining dietary and physical activity approaches did not significantly improve BMI, but some studies that focused on dietary or physical activity approaches showed a small but positive impact on BMI status. Nearly all studies included resulted in some improvement in diet or physical activity. Appropriateness of development, design, duration and intensity of interventions to prevent obesity in childhood needs to be reconsidered alongside comprehensive reporting of the intervention scope and process.

Ten-year Biochemical Disease-free Survival After High-intensity Focused Ultrasound (HIFU) for Localized Prostate Cancer: Comparison with Four Different Generation Devices

NASA Astrophysics Data System (ADS)

Uchida, T.; Nakano, M.; Shoji, S.; Omata, T.; Harano, Y.; Nagata, Y.; Usui, Y.; Terachi, T.

2010-03-01

HIFU has been recognized as a minimally invasive treatment option for localized prostate cancer. The purpose of the study was to assess with a long-term outcome of HIFU for prostate cancer. From January 1999, a total of 657 patients who had HIFU with at least 2 year follow-up were treated with four different types of Sonablate® (Focus Surgery, Indianapolis, USA) devices. Thirty-three patients were treated with Sonablate® 200 (S200) from 1999 to 2001, 406 patients with Sonablate® 500 (S500) from 2001 to 2005, 200 patients with Sonablate® 500 version 4 (V4) from 2005-2008 and 19 patients with Sonablate® 500 TCM (TCM) from 2007. Biochemical disease-free survival rate (bDFS) in all patients was 59% in 8 years. bDFS in 8 years in patients with S200 and S500 groups were 55% and 56%, and bDFS in 4 and 2 years in patients with V4 and TCM group were 72% and 84%, respectively. bDFS in low, intermediate, and high risk groups were 75%, 54%, and 43% in S200/S500 and 93%, 72%, and 58% in V4/TCM group. Negative prostate biopsy rate after HIFU was 97% in S200, 79% in S500, 94% in V4 and 100% in TCM group. HIFU as primary therapy for prostate cancer is indicated in patients with low- and intermediate-risk (T1-T2b N0M0 disease, a Gleason score of ⩽7, a PSA level of <20 ng/mL) and a prostate volume of less than 40 mL. The rate of clinical outcome has significantly improved over the years due to technical improvements in the device.

Reforming EIA systems: A critical review of proposals in Brazil

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fonseca, Alberto, E-mail: albertof@em.ufop.br; Sánchez, Luis Enrique; Ribeiro, José Claudio Junqueira

Environmental Impact Assessment (EIA) systems are under pressure in many countries, driven by a call for efficiency and streamlining. Such a phenomenon is particularly clear in Brazil, where, in the past few years, a number of influential associations put forward documents proposing significant changes to environmental licensing and impact assessment regulations. So far, there is no publicly available information about any initiative towards scrutinizing those proposals. The objective of this study was to critically review the merits and drawbacks of the changes proposed in those documents. The analysis triangulated content analysis, focus group and online survey data. The focus groupmore » included ten seasoned Brazilian EIA specialists; the survey, based on Likert-scale and open-ended questions, resulted in 322 valid responses from EIA professionals. Results show that the proposals generally agree that the current EIA system, while playing a key role in mitigating impacts and enhancing project design, needs many changes. Nonetheless, the proposals neither offered solutions to overcome political, technical and budget barriers, nor established a sense of priority of the most urgent issues. Findings from the focus group and the survey signaled that a number of proposed actions might face public outcry, and that those changes that do not depend on legislative action are more likely to be implementable. Previous studies about EIA reform focused mostly on the context of developed countries after changes had taken place. This study, while addressing the perspective of a large developing country in a “before-reform” stage, shows that capacity-building is a key requirement in EIA reform. - Highlights: • Brazil's EIA system is under strong pressure for change. • Findings corroborate ineffectiveness in current system. • There are tensions as to the best approaches to overcome problems. • Exact effects of proposals are uncertain. • Low institutional capacity can play strong role in driving EIA reform.« less

Design of the POINT study: Pharmacotherapy Optimisation through Integration of a Non-dispensing pharmacist in a primary care Team (POINT).

PubMed

Hazen, Ankie C M; Sloeserwij, Vivianne M; Zwart, Dorien L M; de Bont, Antoinette A; Bouvy, Marcel L; de Gier, Johan J; de Wit, Niek J; Leendertse, Anne J

2015-07-02

In the Netherlands, 5.6 % of acute hospital admissions are medication-related. Almost half of these admissions are potentially preventable. Reviewing medication in patients at risk in primary care might prevent these hospital admissions. At present, implementation of medication reviews in primary care is suboptimal: pharmacists lack access to patient information, pharmacists are short of clinical knowledge and skills, and working processes of pharmacists (focus on dispensing) and general practitioners (focus on clinical practice) match poorly. Integration of the pharmacist in the primary health care team might improve pharmaceutical care outcomes. The aim of this study is to evaluate the effect of integration of a non-dispensing pharmacist in general practice on the safety of pharmacotherapy in the Netherlands. The POINT study is a non-randomised controlled intervention study with pre-post comparison in an integrated primary care setting. We compare three different models of pharmaceutical care provision in primary care: 1) a non-dispensing pharmacist as an integral member of a primary care team, 2) a pharmacist in a community pharmacy with a predefined training in performing medication reviews and 3) a pharmacist in a community pharmacy (care as usual). In all models, GPs remain accountable for individual medication prescription. In the first model, ten non-dispensing clinical pharmacists are posted in ten primary care practices (including 5 - 10 000 patients each) for a period of 15 months. These non-dispensing pharmacists perform patient consultations, including medication reviews, and share responsibility for the pharmaceutical care provided in the practice. The two other groups consist of ten primary care practices with collaborating pharmacists. The main outcome measurement is the number of medication-related hospital admissions during follow-up. Secondary outcome measurements are potential medication errors, drug burden index and costs. Parallel to this study, a qualitative study is conducted to evaluate the feasibility of introducing a NDP in general practice. As the POINT study is a large-scale intervention study, it should provide evidence as to whether integration of a non-dispensing clinical pharmacist in primary care will result in safer pharmacotherapy. The qualitative study also generates knowledge on the optimal implementation of this model in primary care. Results are expected in 2016. NTR4389 , The Netherlands National Trial Register, 07-01-2014.

Ten steps or climbing a mountain: A study of Australian health professionals' perceptions of implementing the baby friendly health initiative to protect, promote and support breastfeeding

PubMed Central

2011-01-01

Background The Baby Friendly Hospital (Health) Initiative (BFHI) is a global initiative aimed at protecting, promoting and supporting breastfeeding and is based on the ten steps to successful breastfeeding. Worldwide, over 20,000 health facilities have attained BFHI accreditation but only 77 Australian hospitals (approximately 23%) have received accreditation. Few studies have investigated the factors that facilitate or hinder implementation of BFHI but it is acknowledged this is a major undertaking requiring strategic planning and change management throughout an institution. This paper examines the perceptions of BFHI held by midwives and nurses working in one Area Health Service in NSW, Australia. Methods The study used an interpretive, qualitative approach. A total of 132 health professionals, working across four maternity units, two neonatal intensive care units and related community services, participated in 10 focus groups. Data were analysed using thematic analysis. Results Three main themes were identified: 'Belief and Commitment'; 'Interpreting BFHI' and 'Climbing a Mountain'. Participants considered the BFHI implementation a high priority; an essential set of practices that would have positive benefits for babies and mothers both locally and globally as well as for health professionals. It was considered achievable but would take commitment and hard work to overcome the numerous challenges including a number of organisational constraints. There were, however, differing interpretations of what was required to attain BFHI accreditation with the potential that misinterpretation could hinder implementation. A model described by Greenhalgh and colleagues on adoption of innovation is drawn on to interpret the findings. Conclusion Despite strong support for BFHI, the principles of this global strategy are interpreted differently by health professionals and further education and accurate information is required. It may be that the current processes used to disseminate and implement BFHI need to be reviewed. The findings suggest that there is a contradiction between the broad philosophical stance and best practice approach of this global strategy and the tendency for health professionals to focus on the ten steps as a set of tasks or a checklist to be accomplished. The perceived procedural approach to implementation may be contributing to lower rates of breastfeeding continuation. PMID:21878131

Application of Early Nutrition Support in Neurosurgical Coma Patients.

PubMed

Ren, Guoqin

2015-12-01

The present study was conducted to investigate the clinical efficacy of early parenteral and enteral nutrition (PN + EN) support in neurosurgical coma patients. Eighty cases of neurosurgical coma patients were randomly divided into intervention group and control group. The intervention group received early PN + EN support, and the control group received only total enteral nutritional (TEN) support. The levels of hemoglobin (HGB), serum albumin (ALB), prealbumin (PA), and retinol-binding protein (RBP) in two groups on days 1, 10, and 20 were observed. The incidences of pneumonia, stress ulcer, abnormal liver function, abdominal distension, and diarrhea between two groups were also compared. Results found that, on day 10, compared with the control group, the levels of HGB, PA, and RBP in the intervention group were significantly increased (P < 0.05). On day 20, ALB in the intervention group significantly increased (P < 0.05), and the incidences of pneumonia, abdominal distension, and diarrhea in the intervention group were significantly lower than those in the control group (P < 0.05). Compared with only TEN support, early PN + EN support can obviously improve the nutritional status of neurosurgical coma patients and reduce the occurrence of complications.

Relationship Between Bariatric Surgery and Bone Mineral Density: a Meta-analysis.

PubMed

Ko, Byung-Joon; Myung, Seung Kwon; Cho, Kyung-Hwan; Park, Yong Gyu; Kim, Sin Gon; Kim, Do Hoon; Kim, Seon Mee

2016-07-01

A meta-analysis regarding bone loss after bariatric surgery, designed to compare surgical and nonsurgical groups, has not yet been performed. Therefore, we performed a meta-analysis to compare the differences between bariatric surgical groups and nonoperated controls with regard to bone mineral density. In March 2015, we performed a review of the literature using PubMed, EMBASE, and the Cochrane Library. The search focused on retrospective and prospective studies, including but not limited to randomized studies published in English. Among 1299 studies that were initially screened, ten met the selection criteria. For all types of bariatric surgery, bone density at the femoral neck was lower in the surgical group than in the nonsurgical control group (mean difference [MD] -0.05 g/cm(2); 95 % confidence interval [CI], -0.07 to -0.02; p = 0.001); no difference in bone density was found between the two groups at the lumbar spine (MD -0.01 g/cm(2); 95 % CI -0.07 to 0.05; p = 0.661). The analysis of Roux-en-Y gastric bypass showed similar results. Bone density at the femoral neck decreased after bariatric surgery, compared to that in nonsurgical controls, whereas bone density at the lumbar spine did not show a difference between groups. Further larger scale studies with comparative nonsurgical controls are warranted to overcome the heterogeneity among studies in this analysis and to add evidence of possible bone loss subsequent to bariatric surgical procedures.

The Australian longitudinal study on male health sampling design and survey weighting: implications for analysis and interpretation of clustered data.

PubMed

Spittal, Matthew J; Carlin, John B; Currier, Dianne; Downes, Marnie; English, Dallas R; Gordon, Ian; Pirkis, Jane; Gurrin, Lyle

2016-10-31

The Australian Longitudinal Study on Male Health (Ten to Men) used a complex sampling scheme to identify potential participants for the baseline survey. This raises important questions about when and how to adjust for the sampling design when analyzing data from the baseline survey. We describe the sampling scheme used in Ten to Men focusing on four important elements: stratification, multi-stage sampling, clustering and sample weights. We discuss how these elements fit together when using baseline data to estimate a population parameter (e.g., population mean or prevalence) or to estimate the association between an exposure and an outcome (e.g., an odds ratio). We illustrate this with examples using a continuous outcome (weight in kilograms) and a binary outcome (smoking status). Estimates of a population mean or disease prevalence using Ten to Men baseline data are influenced by the extent to which the sampling design is addressed in an analysis. Estimates of mean weight and smoking prevalence are larger in unweighted analyses than weighted analyses (e.g., mean = 83.9 kg vs. 81.4 kg; prevalence = 18.0 % vs. 16.7 %, for unweighted and weighted analyses respectively) and the standard error of the mean is 1.03 times larger in an analysis that acknowledges the hierarchical (clustered) structure of the data compared with one that does not. For smoking prevalence, the corresponding standard error is 1.07 times larger. Measures of association (mean group differences, odds ratios) are generally similar in unweighted or weighted analyses and whether or not adjustment is made for clustering. The extent to which the Ten to Men sampling design is accounted for in any analysis of the baseline data will depend on the research question. When the goals of the analysis are to estimate the prevalence of a disease or risk factor in the population or the magnitude of a population-level exposure-outcome association, our advice is to adopt an analysis that respects the sampling design.

Are we under-utilizing the talents of primary care personnel? A job analytic examination

PubMed Central

Hysong, Sylvia J; Best, Richard G; Moore, Frank I

2007-01-01

Background Primary care staffing decisions are often made unsystematically, potentially leading to increased costs, dissatisfaction, turnover, and reduced quality of care. This article aims to (1) catalogue the domain of primary care tasks, (2) explore the complexity associated with these tasks, and (3) examine how tasks performed by different job titles differ in function and complexity, using Functional Job Analysis to develop a new tool for making evidence-based staffing decisions. Methods Seventy-seven primary care personnel from six US Department of Veterans Affairs (VA) Medical Centers, representing six job titles, participated in two-day focus groups to generate 243 unique task statements describing the content of VA primary care. Certified job analysts rated tasks on ten dimensions representing task complexity, skills, autonomy, and error consequence. Two hundred and twenty-four primary care personnel from the same clinics then completed a survey indicating whether they performed each task. Tasks were catalogued using an adaptation of an existing classification scheme; complexity differences were tested via analysis of variance. Results Objective one: Task statements were categorized into four functions: service delivery (65%), administrative duties (15%), logistic support (9%), and workforce management (11%). Objective two: Consistent with expectations, 80% of tasks received ratings at or below the mid-scale value on all ten scales. Objective three: Service delivery and workforce management tasks received higher ratings on eight of ten scales (multiple functional complexity dimensions, autonomy, human error consequence) than administrative and logistic support tasks. Similarly, tasks performed by more highly trained job titles received higher ratings on six of ten scales than tasks performed by lower trained job titles. Contrary to expectations, the distribution of tasks across functions did not significantly vary by job title. Conclusion Primary care personnel are not being utilized to the extent of their training; most personnel perform many tasks that could reasonably be performed by personnel with less training. Primary care clinics should use evidence-based information to optimize job-person fit, adjusting clinic staff mix and allocation of work across staff to enhance efficiency and effectiveness. PMID:17397534

Transcutaneous electrical nerve stimulation (TENS) for pain management in labour

PubMed Central

Dowswell, Therese; Bedwell, Carol; Lavender, Tina; Neilson, James P

2014-01-01

Background Transcutaneous nerve stimulation (TENS) has been proposed as a means of reducing pain in labour. The TENS unit emits low-voltage electrical impulses which vary in frequency and intensity. During labour, TENS electrodes are generally placed on the lower back, although TENS may be used to stimulate acupuncture points or other parts of the body. The physiological mechanisms whereby TENS relieves pain are uncertain. TENS machines are frequently operated by women, which may increase a sense of control in labour. Objectives To assess the effects of TENS on pain in labour. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (30 April 2011) and reference lists of retrieved papers. Selection criteria Randomised controlled trials comparing women receiving TENS for pain management in labour versus routine care, alternative non-pharmacological methods of pain relief, or placebo devices. We included all types of TENS machines. Data collection and analysis Two review authors assessed for inclusion all trials identified by the search strategy, carried out data extraction and assessed risk of bias. We have recorded reasons for excluding studies. Main results Seventeen trials with 1466 women contribute data to the review. Thirteen examined TENS applied to the back, two to acupuncture points, and two to the cranium. Overall, there was little difference in pain ratings between TENS and control groups, although women receiving TENS to acupuncture points were less likely to report severe pain (average risk ratio 0.41, 95% confidence interval 0.31 to 0.54; measured in two studies). The majority of women using TENS said they would be willing to use it again in a future labour. Where TENS was used as an adjunct to epidural analgesia there was no evidence that it reduced pain. There was no consistent evidence that TENS had any impact on interventions and outcomes in labour. There was little information on outcomes for mothers and babies. No adverse events were reported. Authors’ conclusions There is only limited evidence that TENS reduces pain in labour and it does not seem to have any impact (either positive or negative) on other outcomes for mothers or babies. The use of TENS at home in early labour has not been evaluated. TENS is widely available in hospital settings and women should have the choice of using it in labour. PMID:19370680

Analysis of foot structure in athletes sustaining proximal fifth metatarsal stress fracture.

PubMed

Hetsroni, Iftach; Nyska, Meir; Ben-Sira, David; Mann, Gideon; Segal, Ofer; Maoz, Guy; Ayalon, Moshe

2010-03-01

In the past, several studies provided anecdotal descriptions of high-arched feet in individuals sustaining proximal fifth metatarsal stress fractures. This relationship has never been supported by scientific evidence. Our objective was to examine whether athletes who sustained this injury had an exceptional static foot structure or dynamic loading pattern. Ten injured professional soccer players who regained full professional activity following a unilateral proximal fifth metatarsal stress fracture and ten control soccer players were examined. Independent variables included static evaluation of foot and arch structure, followed by dynamic plantar foot pressure evaluation. Each variable was compared between injured, contra-lateral uninjured, and control feet. Static measurements of foot and arch structure did not reveal differences among the groups. However, plantar pressure evaluation revealed relative unloading of the fourth metatarsal in injured and uninjured limbs of injured athletes compared with control, while the fifth metatarsal revealed pressure reduction only in the injured limbs of injured athletes. Athletes who sustained proximal fifth metatarsal stress fracture were not characterized by an exceptional static foot structure. Dynamically, lateral metatarsal unloading during stance may either play a role in the pathogenesis of the injury, or alternately represent an adaptive process. Footwear fabrication for previously injured athletes should not categorically address cushioning properties designed for high-arch feet, but rather focus on individual dynamic evaluation of forefoot loading, with less attention applied to static foot and arch characteristics.

Development of the breastfeeding quality improvement in hospitals learning collaborative in New York state.

PubMed

Fitzpatrick, Eileen; Dennison, Barbara A; Welge, Sara Bonam; Hisgen, Stephanie; Boyce, Patricia Simino; Waniewski, Patricia A

2013-06-01

Exclusive breastfeeding is a public health priority. A strong body of evidence links maternity care practices, based on the Ten Steps to Successful Breastfeeding, to increased breastfeeding initiation, duration and exclusivity. Despite having written breastfeeding policies, New York (NY) hospitals vary widely in reported maternity care practices and in prevalence rates of breastfeeding, especially exclusive breastfeeding, during the birth hospitalization. To improve hospital maternity care practices, breastfeeding support, and the percentage of infants exclusively breastfeeding, the NY State Department of Health developed the Breastfeeding Quality Improvement in Hospitals (BQIH) Learning Collaborative. The BQIH Learning Collaborative was the first to use the Institute for Health Care Improvement's Breakthrough Series methodology to specifically focus on increasing hospital breastfeeding support. The evidence-based maternity care practices from the Ten Steps to Successful Breastfeeding provided the basis for the Change Package and Data Measurement Plan. The present article describes the development of the BQIH Learning Collaborative. The engagement of breastfeeding experts, partners, and stakeholders in refining the Learning Collaborative design and content, in defining the strategies and interventions (Change Package) that drive hospital systems change, and in developing the Data Measurement Plan to assess progress in meeting the Learning Collaborative goals and hospital aims is illustrated. The BQIH Learning Collaborative is a model program that was implemented in a group of NY hospitals with plans to spread to additional hospitals in NY and across the country.

Mental health network governance: comparative analysis across Canadian regions

PubMed Central

Wiktorowicz, Mary E; Fleury, Marie-Josée; Adair, Carol E; Lesage, Alain; Goldner, Elliot; Peters, Suzanne

2010-01-01

Objective Modes of governance were compared in ten local mental health networks in diverse contexts (rural/urban and regionalized/non-regionalized) to clarify the governance processes that foster inter-organizational collaboration and the conditions that support them. Methods Case studies of ten local mental health networks were developed using qualitative methods of document review, semi-structured interviews and focus groups that incorporated provincial policy, network and organizational levels of analysis. Results Mental health networks adopted either a corporate structure, mutual adjustment or an alliance governance model. A corporate structure supported by regionalization offered the most direct means for local governance to attain inter-organizational collaboration. The likelihood that networks with an alliance model developed coordination processes depended on the presence of the following conditions: a moderate number of organizations, goal consensus and trust among the organizations, and network-level competencies. In the small and mid-sized urban networks where these conditions were met their alliance realized the inter-organizational collaboration sought. In the large urban and rural networks where these conditions were not met, externally brokered forms of network governance were required to support alliance based models. Discussion In metropolitan and rural networks with such shared forms of network governance as an alliance or voluntary mutual adjustment, external mediation by a regional or provincial authority was an important lever to foster inter-organizational collaboration. PMID:21289999