2,682 research outputs found

    Effects of municipal smoke-free ordinances on secondhand smoke exposure in the Republic of Korea

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    ObjectiveTo reduce premature deaths due to secondhand smoke (SHS) exposure among non-smokers, the Republic of Korea (ROK) adopted changes to the National Health Promotion Act, which allowed local governments to enact municipal ordinances to strengthen their authority to designate smoke-free areas and levy penalty fines. In this study, we examined national trends in SHS exposure after the introduction of these municipal ordinances at the city level in 2010.MethodsWe used interrupted time series analysis to assess whether the trends of SHS exposure in the workplace and at home, and the primary cigarette smoking rate changed following the policy adjustment in the national legislation in ROK. Population-standardized data for selected variables were retrieved from a nationally representative survey dataset and used to study the policy action’s effectiveness.ResultsFollowing the change in the legislation, SHS exposure in the workplace reversed course from an increasing (18% per year) trend prior to the introduction of these smoke-free ordinances to a decreasing (−10% per year) trend after adoption and enforcement of these laws (β2 = 0.18, p-value = 0.07; β3 = −0.10, p-value = 0.02). SHS exposure at home (β2 = 0.10, p-value = 0.09; β3 = −0.03, p-value = 0.14) and the primary cigarette smoking rate (β2 = 0.03, p-value = 0.10; β3 = 0.008, p-value = 0.15) showed no significant changes in the sampled period. Although analyses stratified by sex showed that the allowance of municipal ordinances resulted in reduced SHS exposure in the workplace for both males and females, they did not affect the primary cigarette smoking rate as much, especially among females.ConclusionStrengthening the role of local governments by giving them the authority to enact and enforce penalties on SHS exposure violation helped ROK to reduce SHS exposure in the workplace. However, smoking behaviors and related activities seemed to shift to less restrictive areas such as on the streets and in apartment hallways, negating some of the effects due to these ordinances. Future studies should investigate how smoke-free policies beyond public places can further reduce the SHS exposure in ROK

    Italian version of the Cerebellar Cognitive Affective Syndrome Scale: Preliminary data collection and analysis.

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    openThe Cerebellar Cognitive Affective Syndrome (CCAS) is caused by various types of cerebellare disease and injury and consists in deficit in the domains of executive functions, visuospatial and linguistic abilities and affects regulation. To detect the presence of this syndrome, Hoche et al. (2018) have developed the CCAS scale, that is now widely validated. The goal of the present project is to describe the preliminary collection of the CCAS scale italian population normative data and to conduct an initial analysis of the obtained results.The Cerebellar Cognitive Affective Syndrome (CCAS) is caused by various types of cerebellare disease and injury and consists in deficit in the domains of executive functions, visuospatial and linguistic abilities and affects regulation. To detect the presence of this syndrome, Hoche et al. (2018) have developed the CCAS scale, that is now widely validated. The goal of the present project is to describe the preliminary collection of the CCAS scale italian population normative data and to conduct an initial analysis of the obtained results

    Novel 129Xe Magnetic Resonance Imaging and Spectroscopy Measurements of Pulmonary Gas-Exchange

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    Gas-exchange is the primary function of the lungs and involves removing carbon dioxide from the body and exchanging it within the alveoli for inhaled oxygen. Several different pulmonary, cardiac and cardiovascular abnormalities have negative effects on pulmonary gas-exchange. Unfortunately, clinical tests do not always pinpoint the problem; sensitive and specific measurements are needed to probe the individual components participating in gas-exchange for a better understanding of pathophysiology, disease progression and response to therapy. In vivo Xenon-129 gas-exchange magnetic resonance imaging (129Xe gas-exchange MRI) has the potential to overcome these challenges. When participants inhale hyperpolarized 129Xe gas, it has different MR spectral properties as a gas, as it diffuses through the alveolar membrane and as it binds to red-blood-cells. 129Xe MR spectroscopy and imaging provides a way to tease out the different anatomic components of gas-exchange simultaneously and provides spatial information about where abnormalities may occur. In this thesis, I developed and applied 129Xe MR spectroscopy and imaging to measure gas-exchange in the lungs alongside other clinical and imaging measurements. I measured 129Xe gas-exchange in asymptomatic congenital heart disease and in prospective, controlled studies of long-COVID. I also developed mathematical tools to model 129Xe MR signals during acquisition and reconstruction. The insights gained from my work underscore the potential for 129Xe gas-exchange MRI biomarkers towards a better understanding of cardiopulmonary disease. My work also provides a way to generate a deeper imaging and physiologic understanding of gas-exchange in vivo in healthy participants and patients with chronic lung and heart disease

    Оптимизация лучевой терапии больных раком молочной железы

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    Работа направлена на оптимизацию дозовых нагрузок на критические органы для курса лучевой терапии рака молочной железы. Созданы планы облучения для выбранных случаев с использованием шести различных методик облучения. Дозовые нагрузки на критические органы для всех методик облучения находятся в толерантном уровне, однако, сочетание интраоперационного облучения с 3D конформной лучевой терапией позволяет доставить минимальную дозовую нагрузку.This work is aimed at optimization dose to critical organs for breast cancer radiotherapy taking into account modern approaches to dosimetric planning. Six different irradiation techniques were used to create treatment plans for selected cases. Dose delivered to the critical organs in all irradiation techniques were within the tolerance doses, however the technique intraoperative followed by 3D-conformal radiotherapy delivered the least dose

    “An interval of comfort”: postamputation pain & long-term consequences of amputation in British First World War veterans, 1914-1985

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    The First World War resulted in the largest amputee cohort in history, with 41,208 amputees in the UK alone; the majority injured as young men and surviving into the late 20th century. Recent studies have estimated that significant residual limb pain affects up to 85% of military amputees: applying this figure to the First World War amputee cohort raises the possibility that up to 35,000 British veterans may have experienced chronic postamputation pain. Despite this and the fact that 13% of injuries in this conflict resulted in amputation, there has been little research into the long-term impact on veterans’ health and quality of life. Recently catalogued historical medical and pension files held at The National Archives offer the opportunity to follow up this type of injury in a large group of veterans for the first time. This thesis will use these files to document and explore long-term outcomes of amputation and chronic postamputation pain, developments made in the treatment of this condition, the impact of aging on amputee veterans and their likelihood of developing a concomitant condition from 1914 to 1985. It will examine these issues from three perspectives: that of the injured servicemen, the civil servants attempting to value and compensate those injuries, and from the clinicians’ responsible for the veterans’ medical care and rehabilitation. This research has been based on a unique model of interdisciplinary collaboration, incorporating research methods from history and clinical medicine, and will present its findings from historical material with recommendations for current practice. Given the similarities in injury patterns and prevalence of chronic residual limb, phantom and neuropathic pain between the First World War cohort and contemporary casualties, it is anticipated that the findings of the project will assist in the strategic assessment and planning for long-term pain conditions by medical staff and care providers for today’s and future blast injury amputee cohorts.Open Acces

    Occupation, Work-Related Exposure, and SARS-CoV-2 Transmission

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    Background: Early evidence from the Coronavirus Disease 2019 (COVID-19) pandemic suggests that workers differ in their risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and adverse outcomes according to their occupation. The direct contribution of occupation to these inequalities in unclear, given a lack of comprehensively-adjusted estimates. Potential work-related mechanisms underlying differential risk are also poorly understood. / Objectives: This thesis aimed to investigate (1) how SARS-CoV-2 infection risk and (2) features of work-related contact varied between occupations and over time, (3) whether work-related contact mediated the relationship between occupation and infection risk, (4) how vaccination uptake varied across occupations overall and according to vulnerability status and work-related exposure, and (5) how implementation and perception of pandemic mitigation methods varied between occupations and over time. / Methods: All analyses were conducted using data from Virus Watch, a community prospective cohort study in England and Wales. Infection outcomes and vaccination status were ascertained based on linkage, weekly participant self-report, and – for infection outcomes – virological and serological testing within the study. Measures were developed to investigate workplace contact patterns and mitigations. / Results: Frontline workers from several sectors had elevated infection risk compared to office-based professional occupations. Differential risk was most marked in early waves, and only teaching, education, and childcare workers demonstrated elevated risk across all waves. Groups with elevated infection risk also tended to demonstrate greater workplace contact and exposure and, often, lower reporting of mitigations. Work-related close contact was a mediator of infection risk. Occupational differences in vaccination uptake emerged primarily amongst non-vulnerable workers. Workers had a high level of agreement with most mitigations. / Conclusions: Occupation is an important factor influencing SARS-CoV-2 infection risk. Workers differed substantially in workplace exposure, vaccination uptake, and work-related mitigations. Evidence-based suggestions for research and practice are made regarding pandemic preparation and endemic SARS-CoV-2 transmission

    Implementation of safe human robot collaboration for ultrasound guided radiation therapy

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    This thesis shows that safe human-robot-interaction and Human Robot Collaboration is possible for Ultrasound (US) guided radiotherapy. Via the chosen methodology, all components (US, optical room monitoring and robot) could be linked and integrated and realized in a realistic clinical workflow. US guided radiotherapy offers a complement and alternative to existing image-guided therapy approaches. The real-time capability of US and high soft tissue contrast allow target structures to be tracked and radiation delivery to be modulated. However, Ultrasound guided radiation therapy (USgRT) is not yet clinically established but is still under development, as reliable and safe methods of image acquisition are not yet available. In particular, the loss of contact of the US probe to the patient surface poses a problem for patient movements such as breathing. For this purpose, a Breathing and motion compensation (BaMC) was developed in this work, which together with the safe control of a lightweight robot represents a new development for USgRT. The developed BaMC can be used to control the US probe with contact to the patient. The conducted experiments have confirmed that a steady contact with the patient surface and thus a continuous image acquisition can be ensured by the developed methodology. In addition, the image position in space can be accurately maintained in the submillimeter range. The BaMC seamlessly integrates into a developed clinical workflow. The graphical user interfaces developed for this purpose, as well as direct haptic control with the robot, provide an easy interaction option for the clinical user. The developed autonomous positioning of the transducer represents a good example of the feasibility of the approach. With the help of the user interface, an acoustic plane can be defined and autonomously approached via the robot in a time-efficient and precise manner. The tests carried out show that this methodology is suitable for a wide range of transducer positions. Safety in a human-robot interaction task is essential and requires individually customized concepts. In this work, adequate monitoring mechanisms could be found to ensure both patient and staff safety. In collision tests it could be shown that the implemented detection measures work and that the robot moves into a safe parking position. The forces acting on the patient could thus be pushed well below the limits required by the standard. This work has demonstrated the first important steps towards safe robot-assisted ultrasound imaging, which is not only applicable to USgRT. The developed interfaces provide the basis for further investigations in this field, especially in the area of image recognition, for example to determine the position of the target structure. With the proof of safety of the developed system, first study in human can now follow
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