System Evolution, Feedback and Compliant Architectures

Proceedings, International Workshop on Feedback and Evolution in Software and Business Processes (FEAST 2000), Imperial College, London. Supported by EPSRCPostprintNon peer reviewe

A Novel Use of Concussion Protocols in the Management of the Cognitive Effects in Long Haul COVID

Some individuals diagnosed with Long Haul COVID (lCOVID) have concurrently reported cognitive issues such as confusion, forgetfulness, decreased attention time, and difficulty focusing. This series of symptoms is termed brain fog. PURPOSE: Patients with reports of brain fog may benefit from the utilization of protocols associated with concussion rehabilitation to reduce the effects of confusion, frustration, and difficulty focusing on exercise instructions. This study looked at the novel application of the concussion rehabilitation protocol to mitigate the cognitive issues linked to brain fog through a course of physical therapy for lCOVID recovery. METHODS: This case report tracked a 57-year-old female who was being seen for cardiorespiratory and strengthening rehabilitation after a diagnosis of lCOVID. The patient underwent a pre- and post-Mini-Mental State Exam (MMSE) as well as a treatment satisfaction survey at the end of the study. Oxygen saturation was measured before, during, and after each date of visit. During the initial 10-week course of physical therapy, she expressed issues with confusion and occasional difficulty understanding tasks needed in physical therapy. A neurologist diagnosed her with brain fog and suggested that concussion protocols that help individuals with similar cognitive symptoms might facilitate her rehabilitation process. The plan of care was overhauled to incorporate salient features of the concussion rehab protocol and the patient continued with the revised care for another 6 weeks, resulting in a total care episode of 16 weeks. RESULTS: The patient completed 16 weeks of therapy with improvement in baseline to exercise O2 saturation with no noted decline during the strengthening and cardiovascular phase. The patient reported high satisfaction in the ability of the revised treatment plan from week 10 onwards in terms of helping her symptoms and her condition. The patient also reported no associated side effects with the concussion rehabilitation protocol. The patient also stated that there was no difficulty, no inconvenience, and no dissatisfaction associated with the use of the revised plan of care. She stated that the overall treatment plan challenged her, reporting fatigue and tiredness towards both the physical and mental aspects of the therapy. There was no noted cognitive impairment using the MMSE before and after the course of therapy. CONCLUSION: The utilization of the Concussion Rehabilitation Protocol is a no-cost, simple-to-integrate addition to lCOVID physical therapy recovery that may help individuals concurrently deal with brain fog. Individuals diagnosed with brain fog will benefit from concussion protocol hallmarks such as the provision of extended rest periods, when necessary, compensatory techniques when confused, facilitating exercise utilizing one to two-step instructions, monitoring of mood and symptoms, and education towards an optimistic full recovery from symptoms

Dynamics of the power-duration relationship during prolonged endurance exercise and influence of carbohydrate ingestion

This is the author accepted manuscript. The final version is available from the American Physiological Society via the DOI in this recordWe tested the hypotheses that the parameters of the power-duration relationship, estimated as the end-test power (EP) and work done above EP (WEP) during a 3-min all out exercise test (3MT), would be reduced progressively following 40 min, 80 min and 2 h of heavy-intensity cycling, and that carbohydrate (CHO) ingestion would attenuate the reduction in EP and WEP. Sixteen participants completed a 3MT without prior exercise (control), immediately after 40 min, 80 min and 2-h of heavy-intensity exercise while consuming a placebo beverage, and also after 2-h of heavy-intensity exercise while consuming a CHO supplement (60 g/h CHO). There was no difference in EP measured without prior exercise (260 ± 37 W) compared to EP following 40 min (268 ± 39 W) or 80 min (260 ± 40 W) of heavy-intensity exercise; however, after 2-h, EP was 9% lower compared to control (236 ± 47 W; P<0.05). There was no difference in WEP measured without prior exercise (17.9 ± 3.3 kJ) compared to after 40 min of heavy-intensity exercise (16.1 ± 3.3 kJ), but WEP was lower (P<0.05) than control after 80 min (14.7 ± 2.9 kJ) and 2-h (13.8 ± 2.7 kJ). Compared to placebo, CHO ingestion negated the reduction of EP following 2-h of heavy-intensity exercise (254 ± 49 W) but had no effect on WEP (13.5 ± 3.4 kJ). These results reveal a different time course for the deterioration of EP and WEP during prolonged endurance exercise and indicate that EP is sensitive to CHO availability

Physiological demands of running at 2-hour marathon race pace

This is the author accepted manuscript. The final version is available from the American Physiological Society via the DOI in this recordThe requirements of running a 2 hour marathon have been extensively debated but the actual physiological demands of running at ~21.1 km/h have never been reported. We therefore conducted laboratory-based physiological evaluations and measured running economy (O2 cost) while running outdoors at ~21.1 km/h, in world-class distance runners as part of Nike's 'Breaking 2' marathon project. On separate days, 16 male distance runners (age, 29 ± 4 years; height, 1.72 ± 0.04 m; mass, 58.9 ± 3.3 kg) completed an incremental treadmill test for the assessment of V̇O2peak, O2 cost of submaximal running, lactate threshold and lactate turn-point, and a track test during which they ran continuously at 21.1 km/h. The laboratory-determined V̇O2peak was 71.0 ± 5.7 ml/kg/min with lactate threshold and lactate turn-point occurring at 18.9 ± 0.4 and 20.2 ± 0.6 km/h, corresponding to 83 ± 5 % and 92 ± 3 % V̇O2peak, respectively. Seven athletes were able to attain a steady-state V̇O2 when running outdoors at 21.1 km/h. The mean O2 cost for these athletes was 191 ± 19 ml/kg/km such that running at 21.1 km/h required an absolute V̇O2 of ~4.0 L/min and represented 94 ± 3 % V̇O2peak. We report novel data on the O2 cost of running outdoors at 21.1 km/h, which enables better modelling of possible marathon performances by elite athletes. Using the value for O2 cost measured in this study, a sub-2 hour marathon would require a 59 kg runner to sustain a V̇O2 of approximately 4.0 L/min or 67 ml/kg/min.Nik

Consensus-based antimicrobial resistance and stewardship competencies for UK undergraduate medical students.

BACKGROUND: In the UK there is limited coverage of antimicrobial stewardship across postgraduate curricula and evidence that final year medical students have insufficient and inconsistent antimicrobial stewardship teaching. A national undergraduate curriculum for antimicrobial resistance and stewardship is required to standardize an adequate level of understanding for all future doctors. OBJECTIVES: To provide a UK national consensus on competencies for antimicrobial resistance and stewardship for undergraduate medical education. METHODS: Using the modified Delphi method over two online survey rounds, an expert panel comprising leads for infection teaching from 25 UK medical schools reviewed competency descriptors for antimicrobial resistance and stewardship education. RESULTS: There was a response rate of 100% with all 28 experts who agreed to take part completing both survey rounds. Following the first-round survey, of the initial 55 descriptors, 43 reached consensus (78%). The second-round survey included the 12 descriptors from the first round in which agreement had not been reached, four amended descriptors and 12 new descriptors following qualitative feedback from the panel members. Following the second-round survey, a total of 58 consensus-based competency descriptors within six overarching domains were identified. CONCLUSIONS: The consensus-based competency descriptors defined here can be used to inform standards, design curricula, develop assessment tools and direct UK undergraduate medical education

Insidious procedures: diversity awards legitimize unfair organizational practices

This is the author's version of an article subsequently published in Social Justice Research in final format. The final publication is available at Springer via http://dx.doi.org/10.1007/s11211-015-0240-zDoes the presence (versus absence) of an organizational diversity award increase the perceived fairness of biased personnel procedures? Participants examined fair or unfair personnel procedures at a company that had received a diversity award or an award unrelated to diversity. When the company had received a diversity award (versus a control award), participants perceived the unfair personnel procedure as fairer for minorities, and White participants were more supportive of enacting the biased procedure. These findings suggest that organizations perceived as successfully supporting diversity might be afforded particular legitimacy to enact policies and procedures that disadvantage the very groups they are perceived as valuing.National Science Foundatio

Plastic and Heritable Components of Phenotypic Variation in Nucella lapillus: An Assessment Using Reciprocal Transplant and Common Garden Experiments

Assessment of plastic and heritable components of phenotypic variation is crucial for understanding the evolution of adaptive character traits in heterogeneous environments. We assessed the above in relation to adaptive shell morphology of the rocky intertidal snail Nucella lapillus by reciprocal transplantation of snails between two shores differing in wave action and rearing snails of the same provenance in a common garden. Results were compared with those reported for similar experiments conducted elsewhere. Microsatellite variation indicated limited gene flow between the populations. Intrinsic growth rate was greater in exposed-site than sheltered-site snails, but the reverse was true of absolute growth rate, suggesting heritable compensation for reduced foraging opportunity at the exposed site. Shell morphology of reciprocal transplants partially converged through plasticity toward that of native snails. Shell morphology of F2s in the common garden partially retained characteristics of the P-generation, suggesting genetic control. A maternal effect was revealed by greater resemblance of F1s than F2s to the P-generation. The observed synergistic effects of plastic, maternal and genetic control of shell-shape may be expected to maximise fitness when environmental characteristics become unpredictable through dispersal

Current status of 5α-reductase inhibitors in the management of lower urinary tract symptoms and BPH

Benign prostatic hyperplasia (BPH) is a progressive disease that is commonly associated with bothersome lower urinary tract symptoms (LUTS) and might result in complications, such as acute urinary retention and BPH-related surgery. Therefore, the goals of therapy for BPH are not only to improve LUTS in terms of symptoms and urinary flow, but also to identify those patients at a risk of unfavorable disease progression and to optimize their management. This article reviews the current status of therapy with 5 alpha-reductase inhibitors (5ARIs), namely fiasteride and dutasteride, for men with LUTS and BPH. Data from key randomized controlled trials (Oxford level 1b) on the use of 5ARIs are analyzed. The efficacy of 5ARIs either as monotherapy or in combination with alpha(1)-adrenoceptor antagonists in the management of LUTS and the impact of monotherapy and combined therapy on BPH progression are discussed. Further promises, including the withdrawal of the alpha-blocker from the combined medical treatment and the potential clinical implications from the use of 5ARIs for prostate cancer chemoprevention in patients receiving 5ARIs for symptomatic BPH are highlighted. Current evidence shows that 5ARIs are effective in treating LUTS and preventing disease progression and represent a recommended option in treatment guidelines for men who have moderate to severe LUTS and enlarged prostates

Vertebral rotation measurement: a summary and comparison of common radiographic and CT methods

Current research has provided a more comprehensive understanding of Adolescent Idiopathic Scoliosis (AIS) as a three-dimensional spinal deformity, encompassing both lateral and rotational components. Apart from quantifying curve severity using the Cobb angle, vertebral rotation has become increasingly prominent in the study of scoliosis. It demonstrates significance in both preoperative and postoperative assessment, providing better appreciation of the impact of bracing or surgical interventions. In the past, the need for computer resources, digitizers and custom software limited studies of rotation to research performed after a patient left the scoliosis clinic. With advanced technology, however, rotation measurements are now more feasible. While numerous vertebral rotation measurement methods have been developed and tested, thorough comparisons of these are still relatively unexplored. This review discusses the advantages and disadvantages of six common measurement techniques based on technology most pertinent in clinical settings: radiography (Cobb, Nash-Moe, Perdriolle and Stokes' method) and computer tomography (CT) imaging (Aaro-Dahlborn and Ho's method). Better insight into the clinical suitability of rotation measurement methods currently available is presented, along with a discussion of critical concerns that should be addressed in future studies and development of new methods

Laboratory-based evaluation of legionellosis epidemiology in Ontario, Canada, 1978 to 2006

BACKGROUND: Legionellosis is a common cause of severe community acquired pneumonia and respiratory disease outbreaks. The Ontario Public Health Laboratory (OPHL) has conducted most testing for Legionella species in the Canadian province of Ontario since 1978, and represents a multi-decade repository of population-based data on legionellosis epidemiology. We sought to provide a laboratory-based review of the epidemiology of legionellosis in Ontario over the past 3 decades, with a focus on changing rates of disease and species associated with legionellosis during that time period. METHODS: We analyzed cases that were submitted and tested positive for legionellosis from 1978 to 2006 using Poisson regression models incorporating temporal, spatial, and demographic covariates. Predictors of infection with culture-confirmed L. pneumophila serogroup 1 (LP1) were evaluated with logistic regression models. Results: 1,401 cases of legionellosis tested positive from 1978 to 2006. As in other studies, we found a late summer to early autumn seasonality in disease occurrence with disease risk increasing with age and in males. In contrast to other studies, we found a decreasing trend in cases in the recent decade (IRR 0.93, 95% CI 0.91 to 0.95, P-value = 0.001); only 66% of culture-confirmed isolates were found to be LP1. CONCLUSION: Despite similarities with disease epidemiology in other regions, legionellosis appears to have declined in the past decade in Ontario, in contrast to trends observed in the United States and parts of Europe. Furthermore, a different range of Legionella species is responsible for illness, suggesting a distinctive legionellosis epidemiology in this North American region