Home-Based Tele-Exercise in Musculoskeletal Conditions and Chronic Disease: A Literature Review

Exercise training is an essential component in the treatment or rehabilitation of various diseases and conditions. However, barriers to exercise such as the burdens of travel or time may hinder individuals' ability to participate in such training programs. Advancements in technology have allowed for remote, home-based exercise training to be utilized as a supplement or replacement to conventional exercise training programs. Individuals in these home-based exercise programs are able to do so under varying levels of supervision from trained professionals, with some programs having direct supervision, and others having little to no supervision at all. The purpose of this review is to examine the use of home-based, tele-exercise training programs for the treatment of different disease states and conditions, and how these programs compare to conventional clinic-based exercise training programs

Community-acquired pneumonia in children: cell-free plasma sequencing for diagnosis and management.

Community-acquired pneumonia (CAP) is a common cause of pediatric hospital admission. Empiric antibiotic therapy for hospitalized children with serious CAP now targets the most likely pathogen(s), including those that may demonstrate significant antibiotic resistance. Cell-free plasma next-generation sequencing (CFPNGS) was first made available for Pediatric Infectious Diseases physicians in June 1, 2017, to supplement standard-of-care diagnostic techniques. A retrospective chart review was performed for children hospitalized with CAP between June 1, 2017, and January 22, 2018, to evaluate the impact of CFPNGS. We identified 15 hospitalized children with CAP without other underlying medical conditions for whom CFPNGS was performed. CFPNGS identified a pathogen in 13 of 15 (86%) children compared with 47% for those using standard culture and PCR-based methods alone. Changes in antibiotic management were made in 7 of 15 (47%) of children as a result of CFPNGS

Applying the Socio-Ecological Model to barriers to implementation of ACL injury prevention programs: A systematic review

Background: Preventing anterior cruciate ligament (ACL) injuries is important to avoid long-term adverse health consequences. Identifying barriers to implementation of these prevention programs is crucial to reducing the incidence of these injuries. Our purpose was to identify barriers of implementation for ACL injury prevention programs and suggest mechanisms for reducing the barriers through application of a SocioEcological Model (SEM). Methods: Studies investigating ACL prevention program effectiveness were searched in Medline via PubMed and the Cochrane Library, and a subsequent review of the references of the identified articles, yielded 15 articles total. Inclusion criteria encompassed prospective controlled trials, published in English, with ACL injuries as the primary outcome. Studies were independently appraised by 2 reviewers for methodological quality using the PEDro scale. Barriers to implementation were identified when reported in at least 2 separate studies. A SEM was used to suggest ways to reduce the identified barriers. Results: Five barriers were identified: motivation, time requirements, skill requirements for program facilitators, compliance, and cost. The SEM suggested ways to minimize the barriers at all levels of the model from the individual through policy levels. Conclusion: Identification of barriers to program implementation and suggesting how to reduce them through the SEM is a critical first step toward enabling ACL prevention programs to be more effective and ultimately reducing the incidence of these injurie

Minimal breast milk transfer of rituximab, a monoclonal antibody used in neurological conditions.

ObjectiveTo determine the transfer of rituximab, an anti-CD20 monoclonal antibody widely used for neurologic conditions, into mature breast milk.MethodsBreast milk samples were collected from 9 women with MS who received rituximab 500 or 1,000 mg intravenous once or twice while breastfeeding from November 2017 to April 2019. Serial breast milk samples were collected before infusion and at 8 hours, 24 hours, 7 days, and 18-21 days after rituximab infusion in 4 patients. Five additional patients provided 1-2 samples at various times after rituximab infusion.ResultsThe median average rituximab concentration in mature breast milk was low at 0.063 μg/mL (range 0.046-0.097) in the 4 patients with serial breast milk collection, with an estimated median absolute infant dose of 0.0094 mg/kg/d and a relative infant dose (RID) of 0.08% (range 0.06%-0.10%). Most patients had a maximum concentration at 1-7 days after infusion. The maximum concentration occurred in a woman with a single breast milk sample and was 0.29 μg/mL at 11 days postinfusion, which corresponds with an estimated RID of 0.33%. Rituximab concentration in milk was virtually undetectable by 90 days postinfusion.ConclusionsWe determined minimal transfer of rituximab into mature breast milk. The RID for rituximab was less than 0.4% and well below theoretically acceptable levels of less than 10%. Low oral bioavailability would probably also limit the absorption of rituximab by the newborn. In women with serious autoimmune neurologic conditions, monoclonal antibody therapy may afford an acceptable benefit to risk ratio, supporting both maternal treatment and breastfeeding

The First Robust Constraints on the Relationship Between Dust-to-Gas Ratio and Metallicity in Luminous Star-forming Galaxies at High Redshift

We present rest-optical spectroscopic properties of a sample of four galaxies in the Atacama Large Millimeter/submillimeter Array Hubble Ultra Deep Field (ALMA HUDF). These galaxies span the redshift range $1.41 \leq z \leq 2.54$ and the stellar mass range $10.36\leq\log(M_*/{\rm M}_{\odot})\leq10.91$. They have existing far-infrared and radio measurements of dust-continuum and molecular gas emission from which bolometric star-formation rates (SFRs), dust masses, and molecular gas masses have been estimated. We use new $H$- and $K$-band near-infrared spectra from the Keck/MOSFIRE spectrograph to estimate SFRs from dust-corrected H$\alpha$ emission (SFR(H$\alpha$)) and gas-phase oxygen abundances from the ratio [NII]$\lambda 6584$/H$\alpha$. We find that the dust-corrected SFR(H$\alpha$) is systematically lower than the bolometric SFR by a factor of several, and measure gas-phase oxygen abundances in a narrow range, 12+\log(\mbox{O/H})=8.59-8.69 (0.8-1.0\: (\mbox{O/H})_{\odot}). Relative to a large $z\sim 2$ comparison sample from the MOSDEF survey, the ALMA HUDF galaxies scatter roughly symmetrically around the best-fit linear mass-metallicity relation, providing tentative evidence for a flattening in the SFR dependence of metallicity at high stellar mass. Combining oxygen abundances with estimates of dust and molecular gas masses, we show that there is no significant evolution in the normalization of the dust-to-gas ratio DGR vs. metallicity relation from $z\sim0$ to $z\sim2$. This result is consistent with some semi-analytic models and cosmological simulations describing the evolution of dust in galaxies. Tracing the actual form of the DGR vs. metallicity relation at high redshift now requires combined measurements of dust, gas, and metallicity over a significantly wider range in metallicity.Comment: 6 pages, 3 figures, accepted to ApJ Letter

Efficacy of Online Training for Improving Camp Staff Competency

Preparing competent staff is a critical issue within the camp community. This quasi-experimental study examined the effectiveness of an online course for improving staff competency in camp healthcare practices among college-aged camp staff and a comparison group (N = 55). We hypothesized that working in camp would increase competency test scores due to opportunities for staff to experientially apply knowledge learned online. Hierarchical linear modeling was used to analyse the cross-level effects of a between-individuals factor (assignment to experimental or comparison group) and within-individual effects of time (pre-test, post-test #1, and post-test #2) on online course test scores. At post-test #2, the difference in average test scores between groups was ~30 points, with the treatment group scoring lower on average than the comparison group. Factors that may have influenced these findings are explored, including fatigue and the limited durability of online learning. Recommendations for research and practice are discussed