Breast cancer survivors have reduced peak aerobic capacity (VO 2peak ) which may be related to latent or lingering chemotherapy induced cardiac damage. Nine, older (67 ± 3 years), long-term survivors (9.8 years) of anthracycline based chemotherapy and age- and sex-matched healthy controls were recruited and tested to determine whether: i) VO 2peak remains reduced in long-term survivorship; and ii) reductions in VO 2peak are due to cardiac dysfunction. VO 2peak was significantly reduced in breast cancer survivors relative to healthy controls (15.9 ± 2.0 vs 19.9 ± 3.1 ml/kg/min, p = 0.006), however the heart rate and stroke volume responses to exercise were normal (heart rate reserve; 88 ± 9 vs 85 ± 10 bpm, p = 0.62: stroke volume reserve; 13 ± 6 vs 13 ± 9 ml, p = 0.94). These findings indicate low-normal ventricular size in long-term breast cancer survivors, but normal reserve function.
Understanding the factors that influence trust in public health information is critical for designing successful public health campaigns during pandemics such as COVID‐19. We present findings from a cross‐sectional survey of 454 US adults—243 older (65+) and 211 younger (18–64) adults—who responded to questionnaires on human values, trust in COVID‐19 information sources, attention to information quality, self‐efficacy, and factual knowledge about COVID‐19. Path analysis showed that trust in direct personal contacts (B = 0.071, p = .04) and attention to information quality (B = 0.251, p < .001) were positively related to self‐efficacy for coping with COVID‐19. The human value of self‐transcendence, which emphasizes valuing others as equals and being concerned with their welfare, had significant positive indirect effects on self‐efficacy in coping with COVID‐19 (mediated by attention to information quality; effect = 0.049, 95% CI 0.001–0.104) and factual knowledge about COVID‐19 (also mediated by attention to information quality; effect = 0.037, 95% CI 0.003–0.089). Our path model offers guidance for fine‐tuning strategies for effective public health messaging and serves as a basis for further research to better understand the societal impact of COVID‐19 and other public health crises.
Purpose The use of outcome measures (OMs) is a hallmark of contemporary physical therapy in the USA. The effect of OM utilization on patient care decisions and the results of PT services remain poorly understood. The purpose of this study is to explore PTs perceptions about the relationship between balance OMs and decision-making and how that interaction impacts patient outcomes, particularly for patients with acquired brain injury. Materials and methods This qualitative study used semi-structured phone interviews with an interview guide. Maximum variation sampling was used. Thematic analysis was situated in a priori determined theory-based categories. Results Twenty-three physical therapists (PTs) from diverse geographic areas and practice settings participated. Therapists expressed diverse views on the impact of OM use on patient outcomes, but the majority perceived that using OMs improved rehabilitation outcomes. The use of OMs was related to the selection of optimal intervention type and intensity and justified continued high-frequency rehabilitation services. OMs were important to therapists’ decision-making. Conclusions In the present study, PTs reported that they believe the use of validated, clinically useful OMs may improve patient outcomes. • Implications For Rehabilitation • Balance outcome measures are considered an important tool to the optimal management of the profound impact of balance impairments after brain injury. • Most physical therapists in this study believe that using balance outcome measures results in better outcomes for patients with brain injury. • In this study, physical therapists reported using outcome measures in wide-ranging ways to guide clinical decisions about balance in those with brain injury.
Handwriting recognition has been an active and challenging area. Handwriting recognition system plays a very important role in today’s world. At present time it is very difficult to find the correct meaning of handwritten documents as different people have different ways of writing digits or texts. There are many areas where we need to recognize the words, alphabets and digits like postal addresses, bank cheques etc. The main aim of this project is to make a GUI based application that allows users to predict the digits drawn on the interface using machine learning and shows the results in percentage how likely the prediction is correct. The project will be built using python and the application will be trained with the help of dataset from MNIST using linear regression algorithm
Background There have been several reports of using video conferencing for health care simulations, but very limited information on using a telemedicine cart to conduct the actual physical assessment for the health care visit. Methods A telemedicine cart was utilized for an objective structured clinical examination with nurse practitioner students to conduct a virtual health care evaluation. Student surveys were collected after the activity to determine the student's perception of the experience. Results A total of 28 student surveys were analyzed and categorized as representing knowledge, skills, or attitudes toward the activity. Conclusions Student survey results indicated that the students perceived the experience as valuable and pertinent to their future careers.
The treatment of patients with knee osteoarthritis is typically focused on the involved lower extremity. There is a gap in the literature concerning the effectiveness of core stabilization training on the treatment of patients with knee osteoarthritis. This investigation aimed to determine whether core stabilization improved the gait and functional ability of patients with knee osteoarthritis. Eighteen participants with knee osteoarthritis completed the six-week core stabilization intervention. Participants completed the gait motion analysis and the Knee Injury and Osteoarthritis Outcome Score to assess self-perceived function, pre- and post-intervention. Gait speed improved (p = 0.006, d = 0.59), while the external knee adduction moment decreased (p = 0.034, d = −0.90). Moreover, self-reported function improved (p < 0.001, d = 1.26). The gait speed and external knee adduction moment changes met minimal detectable change thresholds, while gait speed also met the minimal clinically important difference. A six-week core stabilization program can thus improve gait speed and reduce the external knee adduction moment, which is tied to disease progression. Increased functional scores post-intervention indicate an important clinical improvement. Core stabilization training is a safe and potentially effective treatment option for this population.
Regular exercise that meets or exceeds the current physical activity guidelines is associated with a reduced risk of cardiovascular disease (CVD) and mortality. Therefore, exercise training plays an important role in primary and secondary prevention of CVD. In this part 1 of a 4-part focus seminar series, we highlight the mechanisms and physiological adaptations responsible for the cardioprotective effects of exercise. This includes an increase in cardiorespiratory fitness secondary to cardiac, vascular, and skeletal muscle adaptations and an improvement in traditional and nontraditional CVD risk factors by exercise training. This extends to the role of exercise and its prescription in patients with CVDs (eg, coronary artery disease, chronic heart failure, peripheral artery disease, or atrial fibrillation) with special focus on the optimal mode, dosage, duration, and intensity of exercise to reduce CVD risk and improve clinical outcomes in these patients.
An individual's sense of self and identity is a developmental cognition informed by the balance of intrinsic and extrinsic motivation, proximal others, and systems of belief. Today's identity-seeking adolescent may internalize pressures and expectations from a growing base of social narratives that extends beyond the reach of family and friends. Cultivating daily practices that foster hope and resilience can support positive well-being outcomes for individuals, families, and communities who are faced with distress or traumatic events. Overall well-being within a classroom can be nourished through collaborative growth mindsets, positive coping skills, and cognitive reappraisals. Hope and resilience can be fostered through daily habits of awareness, gratitude, and simple meditation exercises. An off-the-mat approach to the practice of yoga-inspired philosophy can be used in the classroom or at home to support the skills necessary to foster the constructs of hope, develop resilience, and support flexible cognition that builds and sustains positive social, emotional, mental, and physical well-being.
Study design Retrospective Diagnostic Cohort Study. Level of evidence Level 3b. Objectives To examine the concurrent and predictive validity of a novel clinical assessment tool, the Functional Lumbar Index (FLI). Background Lumbar surgeries have increased exponentially in the past decade, adding to healthcare costs without improving outcomes. Limitations in clinicians’ abilities to identify those individuals who are most likely to benefit from surgery may be enhanced with an effective physical assessment tool. Methods The FLI was assessed on 291 individuals (179 conservative and 113 pre-surgical) seeking care for low-back pain (LBP) over a 2.5-year period. The FLI consists of several physical performance tests (PPT) with a novel criterion-based scoring system. Pearson correlations and Poisson regression analysis were used to establish concurrent and predictive validity at alpha = 0.05. Results The subscale FLI components showed good to excellent inter-rater reliability with intraclass correlation coefficient values as follows: front plank = .993, right side plank = .824, left side plank .861, Sorensen = 0.836, overhead squat = 0.937. A statistically significant, moderate negative correlation was observed between FLI and modified Oswestry Disability Index (r = −0.540, p < .001). Regression analysis showed the FLI as the only significant predictor (p = .004) of failed conservative management for individuals with LBP. An ROC curve showed significant group prediction of the FLI with an AUC of 0.788 (p < .001) and cut-off score of 7.5. Conclusion The FLI is a reliable and valid measure for predicting failed conservative care management in patients with LBP. Clinicians are encouraged to use the FLI as part of their physical assessment when screening individuals with LBP who might need surgical intervention. Further research is needed to determine validity of the FLI in other patient populations. Public trial registry N/A.
Background When using an external ventricular drain (EVD) to monitor intracranial pressure (ICP), nurses need to know how long to wait after each manipulation of the transducer before the displayed ICP value represents an accurate signal. This study explores ICP signal equilibration time (EqT) under clinical conditions.Methods This was a prospective ex vivo study using a simulated skull, standard EVD tubing, and a strain gauge transducer. All 270 trials simulating 90 combinations of different pressures and common clinical conditions were completed in August 2021. Each trial was recorded on video. Videos were scored using video editing software to obtain the exact start and stop time for each trial.ResultsThe mean EqT was 44.90 (18.77) seconds. One hundred fifty (55.56%) observations did not reach their expected value within 60 s. The longest mean EqTs were noted when blood was present in the EVD tubing (57.67 [8.91] seconds), when air bubbles were in the tubing (57.41 [8.73] seconds), and when EVD tubing was not flat (level) (50.77 [15.43] seconds). An omnibus test comparing mean EqT for conditions with no variables manipulated (30.08 [16.07] seconds) against mean EqT for all others (47.18 [18.13] seconds) found that mean EqTs were significantly different (P < 0.001).Conclusions Even when no additional variables were introduced, the mean EqTs were ~ 30 s. Common clinical variables increase the length of time before a transducer connected to an EVD will provide an accurate reading. Nurses should wait at least 30 s after turning the EVD stopcock before assuming ICP value reflects accurate ICP.
Aging is a complex and highly regulated process of interwoven signaling mechanisms. As an ancient transcriptional regulator of thermal adaptation and protein homeostasis, the Heat Shock Factor, HSF-1, has evolved functions within the nervous system to control age progression; however, the molecular details and signaling dynamics by which HSF-1 modulates age across tissues remain unclear. Herein, we report a nonautonomous mode of age regulation by HSF-1 in the Caenorhabditis elegans nervous system that works through the bone morphogenic protein, BMP, signaling pathway to modulate membrane trafficking in peripheral tissues. In particular, HSF-1 represses the expression of the neuron-specific BMP ligand, DBL-1, and initiates a complementary negative feedback loop within the intestine. By reducing receipt of DBL-1 in the periphery, the SMAD transcriptional coactivator, SMA-3, represses the expression of critical membrane trafficking regulators including Rab GTPases involved in early (RAB-5), late (RAB-7), and recycling (RAB-11.1) endosomal dynamics and the BMP receptor binding protein, SMA-10. This reduces cell surface residency and steady-state levels of the type I BMP receptor, SMA-6, in the intestine and further dampens signal transmission to the periphery. Thus, the ability of HSF-1 to coordinate BMP signaling along the gut-brain axis is an important determinate in age progression.
Aims and objective: To identify the prevalence and severity of impostor phenomenon and burnout in newly licensed registered nurses, map the current literature on impostor phenomenon in nursing, and identify related factors affecting the new nurse's transition to practice. Background: Impostor phenomenon is an internalised intellectual phoniness resulting in persistent self-doubt despite prior success. It can evoke feelings of emotional exhaustion associated with burnout, negatively affecting employee retention. Due to changes in nursing education resulting from COVID-19, self-doubt and uncertainty among new nurses are expected to be heightened, leading to burnout which adversely effects nurse well-being, patient care and retention. Design: The scoping review follows the methodological framework developed by Arksey and O'Malley (2005) and the Reporting Checklist for Scoping Reviews (PRISMA-ScR) guidelines. Methods: The literature search was conducted utilising PubMed, CINAHL and PsycINFO. Inclusion criteria were studies published between 2011 and 2021, written in English, peer-reviewed, and focused on newly licensed registered nurses. Eighteen articles were reviewed. Results: Studies on impostor phenomenon in nursing are limited to nursing students and clinical nurse specialists. Prevalence of impostor feelings in these populations range from 36% to 75%, and 12.3% to 46% of new nurses report burnout. Impostor feelings arise from role ambiguity, lack of self-compassion, transitions, and minimal clinical experience. Burnout was associated with stress, feeling unprepared, inadequate socialisation, and lack of self-compassion. Overlap in these factors could increase impostor feelings and burnout in new nurses. Conclusions: Effects of impostor phenomenon and burnout can negatively impact the well-being of the new nurse. Currently, no studies simultaneously examine impostor phenomenon and burnout in new nurses. Further research on the relationship between these phenomena should be conducted. Relevance to clinical practice: Understanding the impact of impostor phenomenon and burnout on new nurses could help mitigate challenges they face transitioning into practice.
The Atheist Identity Concealment Scale (AICS) was developed as a tool to assess the degree to which atheists conceal their atheist identity from others. Drawing on concealable stigmatized identity (CSI) theory, the aim of this study was to provide researchers with a valid means to effectively assess atheist identity concealment. Using three separate samples of more than 500 adults in the USA, exploratory and confirmatory factor analyses were conducted which ultimately resulted in a short, robust measure comprised of eight items. Additional validity evidence was provided by examining the relationship between the AICS and several previously validated tools (i.e., outness, nonreligiosity, depression, anxiety, stress, and self-esteem).
Purpose: The purpose was to review published articles to examine the impact of advance care planning (ACP) and end-of-life (EOL) conversations on patients with cancer, and aimed to compare the findings for congruency with the goals of ACP. Design and method: The study was guided by Whittemore and Knafl's integrative review methodology. Articles published between 2015 to 2020 were identified through electronic databases. The search included: Cumulative Index for Nursing Allied Health Literature (CINAHL), PubMed, MEDLINE-Ovid, and MEDLINE full text, and using the MeSH terms. Two hundred and five (205) articles were identified and screened for eligibility, and 15 articles were appraised. Findings: The fifteen (15) articles that met the inclusion criteria included five (5) qualitative, eight (8) quantitative, and two (2) mixed methods. The review analysis revealed six themes emerged in three categories: cancer patients' experience with advance care planning (1) patients' prognostic awareness, (2) decision making; cancer patients' perceived outcomes with advance care planning (3) patient-provider relationship, (4) concordance in care based on goals, and cancer patients' propositions related to advance care planning, (5) timings of advance care planning discussions, and (6) support during ACP and/or EOL conversations. Conclusion: ACP and EOL conversations play a critical role in cancer patients' awareness of their disease and prognosis and help them in making end-of-life care decisions. Clinical relevance: There exists a need for earlier ACP and EOL conversations with cancer patients with emotional support during these conversations.
Smartphones have evolved from being a helpful tool in our days to be an indispensable complement. Its presence in our daily lives has grown to reach a problematic use on occasions. This fact is even more remarkable when we speak of young adults and adolescents, in which problematic situations can be identified as derived from its use. In this study, we analyze the self-perception of 409 young adults pursuing an Education university degree on the use and consumption of the smartphone via their responses to the Mobile Phone Problem Use Scale. The results show that, despite not perceiving the use of the mobile phone as problematic, some of the behaviors described by them as habitual would imply inappropriate use of the smartphone. Some outlined by the sample included mitigating loneliness, fear of isolation, or using it to feel better. Surprisingly, these are not recognized as problematic, despite being some of the most apparent indicators of misuse. The analysis of the results shows how younger populations and, mainly women, present this type of worrying and unconscious behavior. However, the increasing use of these devices within training areas offer new options to favor its proper use, mitigating the possible adverse effects of its use.
Background: Both aerobic exercise and whey protein can improve glucose regulation. The purpose of this study was to investigate how a single bout of vigorous-intensity aerobic exercise and whey protein, independently, as well as when combined, influence glycemia during an oral glucose tolerance test in sedentary, young men. Methods: Healthy males (n = 11) completed four randomized trials: no exercise/no whey protein (R); exercise (EX; walking at 70% VO2max for 60 min); 50 g of whey protein (W); and exercise combined with 50 g of whey protein (EXW). Each trial included a 75 g oral glucose tolerance test (OGTT) that was completed after an overnight fast. Blood samples were collected over a two-hour period during the OGTT. For EX and EXW, the exercise was performed the evening before the OGTT and the 50 g of whey protein was dissolved in 250 mL of water and was consumed as a preload 30 min prior to the OGTT. For R and EX, participants consumed 250 mL of water prior to the OGTT. Plasma samples were analyzed for glucose, insulin, C-peptide, glucagon, gastric inhibitory peptide (GIP) and glucagon like peptide 1 (GLP-1), and postprandial incremental area under the curve (iAUC) was calculated for each. Results: Glucose iAUC was reduced during W (- 32.9 ± 22.3 mmol/L) compared to R (122.7 ± 29.8 mmol/L; p < 0.01) and EX (154.3 ± 29.2 mmol/L; p < 0.01). Similarly, glucose iAUC was reduced for EXW (17.4 ± 28.9 mmol/L) compared to R and EX (p < 0.01 for both). There were no differences in iAUC for insulin, C-peptide, GIP, GLP-1, and glucagon between the four trials. Insulin, C-peptide, glucagon, GIP, and GLP-1 were elevated during the whey protein preload period for W and EXW compared to EX and R (p < 0.01). There were no differences for insulin, C-peptide, glucagon, GIP, or GLP-1 between trials for the remaining duration of the OGTT. Conclusions: Glucose responses during an oral glucose tolerance test were improved for W compared to EX. There were no additional improvements in glucose responses when vigorous-intensity aerobic exercise was combined with whey protein (EXW).
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