Prevalence and Risk Factors for Neck and Shoulder Musculoskeletal Symptoms in Users of Touch-Screen Tablet Computers

Background and Purpose: Neck and upper extremity symptoms are common health complaints in the general population and cause a substantial financial burden to the health care system. Neck pain is known to be a multi factorial disorder, with head and spinal posture being one of the most important factors. Currently there is little evidence showing a relationship between touch-screen tablet computer usage and neck/upper extremity pathologies. However, it is fair to postulate that the incidence of neck/upper extremity pathologies is higher within touch-screen tablet computer users, considering how users maintain static postures while using the device. The primary purposes of the current study were to 1) investigate the prevalence of neck and shoulder symptoms and potential risk factors, 2) identify risk factors associated with symptoms during device use, especially in sitting postures. The secondary purpose was to investigate gender differences in device usage behavior, symptoms, and postural factors. Subjects: A cross-sectional survey study was conducted in a population of university students, staff, faculty, and alumni (N = 412). Methods and Results: Prevalence of symptoms during device use was 67.9 %. Most symptoms were reported in the neck (84.6%) and upper back/shoulder areas (65.4%). With sitting postures, significant symptoms during tablet use included sitting without back support (p= 0.016) and sitting with device in the lap (p= 0.002) based on Chi-square analyses. A multiple logistic regression analysis further demonstrated that female gender (p=0.004) and sitting in a chair without back support (p=0.006) are the predictors of experiencing symptoms during the use of tablets. For other general postures, the significant factors are lying on the side (p= 0.002) and lying on the back (p= 0.016) during tablet use. Furthermore, our results showed that 70.1% of the female respondents reported to have musculoskeletal symptoms during device usage, in comparison to 29.9% of the male respondents (p= 0.019). Additionally, women (75.7%) demonstrated significantly more symptoms at the upper back and shoulder regions than men (24.3%) (p = 0.014)

Development of a Teach-Back Educational Module for Heart Failure Discharge Teaching

Heart failure (HF) readmissions create a financial burden for healthcare nationwide and speak to the lack of effective discharge preparation for patients to be successful with self-care at home. The 183-bed hospital where this DNP quality initiative will take place currently reports an observed-over-expected (O/E) readmission rate for HF patients (Centers for Medicare and Medicaid [CMS]). Core measures on HF developed by the Joint Commission and the Centers for Medicare and Medicaid Services do not appear to be enough to ensure successful transitions of care from hospital to home. Guided by the LOGIC model, the purpose of this quality improvement initiative was to develop a HF educational module to improve patients\u27 readiness to learn in order to promote self-care and prevent readmission to the hospital within 30 days. The design of the educational program was supported by the evidence-based literature and incorporated best practices promoted by the Joint Commission, the Institute for Healthcare Improvement, and the Agency for Healthcare Research and Quality. Content evaluation of the newly developed HF educational program was conducted by 10 experts using a quantitative Likert-type scale and qualitative narrative feedback. Descriptive findings from the Likert scale showed a range of 3.9 to 4.0 in the content, process, and design of the program. Recommendations for improvement included more detail around pathophysiology, as well as how to initiate the process in the outpatient setting. Positive social change can result from the program which offers a relevant strategy to reduce readmissions for HF and has wide-application options for many chronic illnesses that can be better managed through effective discharge teaching

Predicting the Reactions of CS2 with Group IV and Group VI Transition Metal Oxides

Building onto a recent serious of ab initio studies of various acid-gas reactions with metal oxide sorbents, electronic structure methods are being used to study the addition of CS₂ to Group IV (MO₂)ₙ and Group VI (MO₃)ₙ (n = 1, 2, 3) nanoclusters, beginning with the MO₂ and MO₃ monomers according to a “bottom-up” approach. The preliminary density functional theory (DFT) calculations in this study provide structures and vibrational frequency thermodynamic corrections for later expanding upon by way of single point correlated molecular-orbital theory (MO) calculations, mainly CCSD(T) and MP2 to study the structures and energies which could arise from Lewis acid-base addition (physisorption) and formation of COS₂²⁻ (chemisorption) of CS₂ to these clusters will be predicted. For future work, these CS₂ ligand binding energies (LBE) will be compared to established CO₂ results in the literature and to any known experimental and computational values for the interactions of CS₂ with bulk metal oxides. These LBEs will then be analyzed for any correlation to any known trends in the metal oxide Lewis acidity, metal oxide redox chemistry, and acid gas basicity to establish useful thermodynamic benchmarks for the practicality of Group IV and Group VI transition metal oxides for the sequestration and conversion of CS₂. The results of this work and beyond could also have serious implications for the sequestration of CS₂ from high-sulfur areas of the arctic permafrost and could provide valuable mechanistic insights into the possible reactions and products of metal oxide degradation during the Claus Process.https://scholarworks.moreheadstate.edu/celebration_posters_2023/1062/thumbnail.jp

Comparative genomics of Steinernema reveals deeply conserved gene regulatory networks

Background: Parasitism is a major ecological niche for a variety of nematodes. Multiple nematode lineages have specialized as pathogens, including deadly parasites of insects that are used in biological control. We have sequenced and analyzed the draft genomes and transcriptomes of the entomopathogenic nematode Steinernema carpocapsae and four congeners (S. scapterisci, S. monticolum, S. feltiae, and S. glaseri). Results: We used these genomes to establish phylogenetic relationships, explore gene conservation across species, and identify genes uniquely expanded in insect parasites. Protein domain analysis in Steinernema revealed a striking expansion of numerous putative parasitism genes, including certain protease and protease inhibitor families, as well as fatty acid- and retinol-binding proteins. Stage-specific gene expression of some of these expanded families further supports the notion that they are involved in insect parasitism by Steinernema. We show that sets of novel conserved non-coding regulatory motifs are associated with orthologous genes in Steinernema and Caenorhabditis. Conclusions: We have identified a set of expanded gene families that are likely to be involved in parasitism. We have also identified a set of non-coding motifs associated with groups of orthologous genes in Steinernema and Caenorhabditis involved in neurogenesis and embryonic development that are likely part of conserved protein–DNA relationships shared between these two genera

Assessment of Surgical and Trauma Capacity in Potosí, Bolivia

Background: Scaling up surgical and trauma care in low- and middle-income countries could prevent nearly 2 million annual deaths. Various survey instruments exist to measure surgical and trauma capacity, including Personnel, Infrastructure, Procedures, Equipment, and Supplies (PIPES) and International Assessment of Capacity for Trauma (INTACT). Objective: We sought to evaluate surgical and trauma capacity in the Bolivian department of Potosí using a combined PIPES and INTACT tool, with additional questions to further inform intervention targets. Methods: In June and July 2014 a combined PIPES and INTACT survey was administered to 20 government facilities in Potosí with a minimum of 1 operating room: 2 third-level, 10 second-level, and 8 first-level facilities. A surgeon, head physician, director, or obstetrician-gynecologist completed the survey. Additional personnel responded to 4 short-answer questions. Survey items were divided into subsections, and PIPES and INTACT indices calculated. Medians were compared via Wilcoxon rank sum and Kruskal-Wallis tests. Findings: Six of 20 facilities were located in the capital city and designated urban. Urban establishments had higher median PIPES (8.5 vs 6.7, 'P' = .11) and INTACT (8.5 vs 6.9, 'P' = .16) indices compared with rural. More than half of surgeons and anesthesiologists worked in urban hospitals. Urban facilities had higher median infrastructure and procedure scores compared with rural. Fifty-three individuals completed short-answer questions. Training was most desired in laparoscopic surgery and trauma management; less than half of establishments reported staff with trauma training. Conclusions: Surgical and trauma capacity in Potosí was most limited in personnel, infrastructure, and procedures at rural facilities, with greater personnel deficiencies than previously reported. Interventions should focus on increasing the number of surgical and anesthesia personnel in rural areas, with a particular focus on the reported desire for trauma management training. Results have been made available to key stakeholders in Potosí to inform targeted quality improvement interventions

Surgical and Trauma Capacity Assessment in Rural Haryana, India

Background: Trauma is a major global health problem and majority of the deaths occur in low- and middle-income countries (LMICs), at even higher rates in the rural areas. The three-delay model assesses three different delays in accessing healthcare and can be applied to improve surgical and trauma healthcare delivery. Prior to implementing change, the capacities of the rural India healthcare system need to be identified. Objective: The object of this study was to estimate surgical and trauma care capacities of government health facilities in rural Nanakpur, Haryana, India using the Personnel, Infrastructure, Procedures, Equipment and Supplies (PIPES) and International Assessment of Capacity for Trauma (INTACT) tools. Methods: The PIPES and INTACT tools were administered at eight government health facilities serving the population of Nanakpur in June 2015. Data analysis was performed per tool subsection, and an overall score was calculated. Higher PIPES or INTACT indices correspond to greater surgical or trauma care capacity, respectively. Findings: Surgical and trauma care capacities increased with higher levels of care. The median PIPES score was significantly higher for tertiary facilities than primary and secondary facilities [13.8 (IQR 9.5, 18.2) vs. 4.7 (IQR 3.9, 6.2), p = 0.03]. The lower-level facilities were mainly lacking in personnel and procedures. Conclusions: Surgical and trauma care capacities at healthcare facilities in Haryana, India demonstrate a shortage of surgical resources at lower-level centers. Specifically, the Primary Health Centers were not operating at full capacity. These results can inform resource allocation, including increasing education, across different facility levels in rural India

SOSAS Study in Rural India: Using Accredited Social Health Activists as Enumerators

Background: Global estimates show five billion people lack access to safe, quality, and timely surgical care. The wealthiest third of the world’s population receives approximately 73.6% of the world’s total surgical procedures while the poorest third receives only 3.5%. This pilot study aimed to assess the local burden of surgical disease in a rural region of India through the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey and the feasibility of using Accredited Social Health Activists (ASHAs) as enumerators. Material and Methods: Data were collected in June and July 2015 in Nanakpur, Haryana from 50 households with the support of Indian community health workers, known as ASHAs. The head of household provided demographic data; two household members provided personal surgical histories. Current surgical need was defined as a self-reported surgical problem present at the time of the interview, and unmet surgical need as a surgical problem in which the respondent did not access care. Results: One hundred percent of selected households participated, totaling 93 individuals. Twenty-eight people (30.1%; 95% CI 21.0–40.5) indicated they had a current surgical need in the following body regions: 2 face, 1 chest/breast, 1 back, 3 abdomen, 4 groin/genitalia, and 17 extremities. Six individuals had an unmet surgical need (6.5%; 95% CI 2.45%–13.5%). Conclusions: This pilot study in Nanakpur is the first implementation of the SOSAS survey in India and suggests a significant burden of surgical disease. The feasibility of employing ASHAs to administer the survey is demonstrated, providing a potential use of the ASHA program for a future countrywide survey. These data are useful preliminary evidence that emphasize the need to further evaluate interventions for strengthening surgical systems in rural India

La Grange Comprehensive Plan 2018 - 2038

In the Fall of 2017, the City of La Grange and Texas Target Communities partnered to create a task force to represent the community. The task force was integral to the planning process, contributing the thoughts, desires, and opinions of community members—as well as their enthusiasm about La Grange’s future. This fifteen-month planning process ended in August 2018. The result of this collaboration is the La Grange Comprehensive Plan, which is the official policy guide for the community’s growth over the next twenty years.La Grange Comprehensive Plan 2018 - 2038 provides a guide for the future growth of the City. This document was developed by Texas Target Communities in partnership with the City of La Grange.Texas Target Communitie

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens