Rehabilitasi medik pada sindroma dekondisi pasca COVID-19 derajat berat

ABSTRACT Introduction: COVID-19 is characterized by complaints of fever, cough, weakness, respiratory and gastrointestinal disorders. The existence of treatment in the isolation room accompanied by prolonged bed rest will cause the patient to experience deconditioning syndrome. Case Report: A man, 58 years old, post severe COVID-19 patients with shortness of breath, ineffective cough and feeling weak in all four extremities due to prolonged bed rest (denconditioning syndrome). Deconditioning is defined as a reduction in anatomical and physiological function caused by disease, age, or physical inactivity.The patient was given active gradual mobilization, range of movement exercise, endurance, strengthening, balance and coordination exercise. Patient was also given breathing exercise, chest physical therapy and effective cough. Seven days after rehabilitation, patient could regulate his breathing pattern and ambulate independently. Patient was discharged and continue self training at home. Conclusion: Breathing exercise, chest physical therapy, aerobic exercise, muscle strengthening exercises in all four extremities, coordination, balance exercises and gradual mobilization training are very important in the recovery of  post severe COVID-19 patient. Key Words: breathing exercise, COVID-19, deconditioning syndrome, mobilizationABSTRAK Pendahuluan: COVID-19 ditandai dengan adanya keluhan demam, batuk, lemas, gangguan saluran napas dan saluran cerna. Perawatan pada ruang isolasi disertai dengan tirah baring lama akan membuat pasien mengalami sindroma dekondisi. Laporan Kasus: Pasien laki-laki, 58 tahun pasca COVID-19 derajat berat dengan keluhan sesak bila beraktivitas, mudah lelah, batuk tidak efektif, lemas pada keempat ekstremitas akibat tirah baring lama (sindrom dekondisi). Dekondisi diartikan sebagai berkurangnya fungsi anatomis dan fisiologis yang disebabkan oleh penyakit, usia, atau inaktivitas fisik. Pasien mendapatkan program latihan peningkatan lingkup gerak sendi, ketahanan aerobik, penguatan otot, keseimbangan dan koordinasi serta latihan mobilisasi bertahap. Pasien juga mendapatkan latihan pernapasan, terapi fisik dada dan latihan batuk efektif. Tujuh hari pasca rehabilitasi, Pasien telah dapat mengatur pola napas dan melakukan ambulasi mandiri. Pasien diperbolehkan pulang untuk melanjutkan terapi latihan mandiri di rumah. Simpulan:  Latihan pernapasan, terapi fisik dada, latihan aerobik, latihan penguatan otot pada keempat ekstremitas, latihan koordinasi dan keseimbangan serta latihan mobilisasi aktif secara bertahap sangat penting pada pemulihan pasien pasca COVID-19 derajat berat. Kata Kunci: COVID-19, latihan pernapasan, mobilisasi, sindroma dekondis

The association of health literacy and blood pressure reduction in a cohort of patients with hypertension: The heart healthy lenoir trial

Lower health literacy is associated with poorer health outcomes. Few interventions poised to mitigate the impact of health literacy in hypertensive patients have been published. We tested if a multilevel quality improvement intervention could differentially improve Systolic Blood Pressure (SBP) more so in patients with low vs. higher health literacy

The Association of Health Literacy and Blood Pressure Reduction in a Cohort of Patients with Hypertension: The Heart Healthy Lenoir Trial

OBJECTIVE: Lower health literacy is associated with poorer health outcomes. Few interventions poised to mitigate the impact of health literacy in hypertensive patients have been published. We tested if a multilevel quality improvement intervention could differentially improve Systolic Blood Pressure (SBP) more so in patients with low vs. higher health literacy. METHODS: We conducted a non-randomized prospective cohort trial of 525 patients referred with uncontrolled hypertension. Stakeholder informed and health literacy sensitive strategies were implemented at the practice and patient level. Outcomes were assessed at 0, 6, 12, 18 and 24 months. RESULTS: At 12 months, the low and higher health literacy groups had statistically significant decreases in mean SBP (6.6 and 5.3 mmHg, respectively), but the between group difference was not significant (Δ 1.3 mm Hg, P=.067). At 24 months, the low and higher health literacy groups reductions were 8.1 and 4.6 mm Hg, respectively, again the between group difference was not significant (Δ 3.5 mm Hg, p = 0.25). CONCLUSIONS/PRACTICE IMPLICATIONS: A health literacy sensitive multi-level intervention may equally lower SBP in patients with low and higher health literacy. Practical health literacy appropriate tools and methods can be implemented in primary care settings using a quality improvement approach

Design, Performance, and Calibration of CMS Hadron-Barrel Calorimeter Wedges

Extensive measurements have been made with pions, electrons and muons on four production wedges of the Compact Muon Solenoid (CMS) hadron barrel (HB) calorimeter in the H2 beam line at CERN with particle momenta varying from 20 to 300 GeV/c. Data were taken both with and without a prototype electromagnetic lead tungstate crystal calorimeter (EB) in front of the hadron calorimeter. The time structure of the events was measured with the full chain of preproduction front-end electronics running at 34 MHz. Moving-wire radioactive source data were also collected for all scintillator layers in the HB. These measurements set the absolute calibration of the HB prior to first pp collisions to approximately 4%

Energy Response and Longitudinal Shower Profiles Measured in CMS HCAL and Comparison With Geant4

The response of the CMS combined electromagnetic and hadron calorimeter to beams of pions with momenta in the range 5-300 GeV/c has been measured in the H2 test beam at CERN. The raw response with the electromagnetic compartment calibrated to electrons and the hadron compartment calibrated to 300 GeV pions may be represented by sigma = (1.2) sqrt{E} oplus (0.095) E. The fraction of energy visible in the calorimeter ranges from 0.72 at 5 GeV to 0.95 at 300 GeV, indicating a substantial nonlinearity. The intrinsic electron to hadron ratios are fit as a function of energy and found to be in the range 1.3-2.7 for the electromagnetic compartment and 1.4-1.8 for the hadronic compartment. The fits are used to correct the non-linearity of the e pi response to 5% over the entire measured range resulting in a substantially improved resolution at low energy. Longitudinal shower profile have been measured in detail and compared to Geant4 models, LHEP-3.7 and QGSP-2.8. At energies below 30 GeV, the data, LHEP and QGSP are in agreement. Above 30 GeV, LHEP gives a more accurate simulation of the longitudinal shower profile

Synchronization and Timing in CMS HCAL

The synchronization and timing of the hadron calorimeter (HCAL) for the Compact Muon Solenoid has been extensively studied with test beams at CERN during the period 2003-4, including runs with 40 MHz structured beam. The relative phases of the signals from different calorimeter segments are timed to 1 ns accuracy using a laser and equalized using programmable delay settings in the front-end electronics. The beam was used to verify the timing and to map out the entire range of pulse shapes over the 25 ns interval between beam crossings. These data were used to make detailed measurements of energy-dependent time slewing effects and to tune the electronics for optimal performance

Design, Performance and Calibration of the CMS Forward Calorimeter Wedges

We report on the test beam results and calibration methods using charged particles of the CMS Forward Calorimeter (HF). The HF calorimeter covers a large pseudorapidity region (3\l |\eta| \le 5), and is essential for large number of physics channels with missing transverse energy. It is also expected to play a prominent role in the measurement of forward tagging jets in weak boson fusion channels. The HF calorimeter is based on steel absorber with embedded fused-silica-core optical fibers where Cherenkov radiation forms the basis of signal generation. Thus, the detector is essentially sensitive only to the electromagnetic shower core and is highly non-compensating (e/h \approx 5). This feature is also manifest in narrow and relatively short showers compared to similar calorimeters based on ionization. The choice of fused-silica optical fibers as active material is dictated by its exceptional radiation hardness. The electromagnetic energy resolution is dominated by photoelectron statistics and can be expressed in the customary form as a/\sqrt{E} + b. The stochastic term a is 198% and the constant term b is 9%. The hadronic energy resolution is largely determined by the fluctuations in the neutral pion production in showers, and when it is expressed as in the electromagnetic case, a = 280% and b = 11%

Design, Performance, and Calibration of CMS Hadron Endcap Calorimeters

Detailed measurements have been made with the CMS hadron calorimeter endcaps (HE) in response to beams of muons, electrons, and pions. Readout of HE with custom electronics and hybrid photodiodes (HPDs) shows no change of performance compared to readout with commercial electronics and photomultipliers. When combined with lead-tungstenate crystals, an energy resolution of 8\% is achieved with 300 GeV/c pions. A laser calibration system is used to set the timing and monitor operation of the complete electronics chain. Data taken with radioactive sources in comparison with test beam pions provides an absolute initial calibration of HE to approximately 4\% to 5\%

Design, Performance, and Calibration of the CMS Hadron-Outer Calorimeter

The CMS hadron calorimeter is a sampling calorimeter with brass absorber and plastic scintillator tiles with wavelength shifting fibres for carrying the light to the readout device. The barrel hadron calorimeter is complemented with an outer calorimeter to ensure high energy shower containment in the calorimeter. Fabrication, testing and calibration of the outer hadron calorimeter are carried out keeping in mind its importance in the energy measurement of jets in view of linearity and resolution. It will provide a net improvement in missing \et measurements at LHC energies. The outer hadron calorimeter will also be used for the muon trigger in coincidence with other muon chambers in CMS

The Second Data Release of the Sloan Digital Sky Survey

The Sloan Digital Sky Survey (SDSS) has validated and made publicly available its Second Data Release. This data release consists of 3324 deg2 of five-band (ugriz) imaging data with photometry for over 88 million unique objects, 367,360 spectra of galaxies, quasars, stars, and calibrating blank sky patches selected over 2627 deg2 of this area, and tables of measured parameters from these data. The imaging data reach a depth of r ≈ 22.2 (95% completeness limit for point sources) and are photometrically and astrometrically calibrated to 2% rms and 100 mas rms per coordinate, respectively. The imaging data have all been processed through a new version of the SDSS imaging pipeline, in which the most important improvement since the last data release is fixing an error in the model fits to each object. The result is that model magnitudes are now a good proxy for point-spread function magnitudes for point sources, and Petrosian magnitudes for extended sources. The spectroscopy extends from 3800 to 9200 Å at a resolution of 2000. The spectroscopic software now repairs a systematic error in the radial velocities of certain types of stars and has substantially improved spectrophotometry. All data included in the SDSS Early Data Release and First Data Release are reprocessed with the improved pipelines and included in the Second Data Release. Further characteristics of the data are described, as are the data products themselves and the tools for accessing them