An evaluation of an educational intervention (physical assessment module), for the non medical work force to provide unscheduled services across the primary and secondary sector in one SHA

The purpose of this research was to establish how an educational intervention (the physical assessment module) enabled practitioners, drawn from the non medical workforce, to meet the modernising agenda of new ways of working, notably, to provide unscheduled care and to contribute to the transformation of chronic care provision in the acute care sector and Community.To gauge the impact of the physical assessment module on the evolution of competencies to fulfil the demands of new roles in practice a responsive evaluation model was used. Data were gathered from face to face interviews, analysis of relevant documents, and direct observation of working practises. Importantly the approach sought to report findings back into the communities from which these data have arisen to verify the findings but also to enrich and update issues in a rapidly changing context. Therefore, feedback via stakeholder conferences was a critical element in the process.Data were analysed using the constant comparative method. Data analysis ran concurrently with data collection and as emergent issues arose they were abstracted and the topics explored in subsequent interviews.Key findings are presented in three tiers: from theory to practice (learning physical assessment skills and techniques and applying these in practice; from policy to practice (tracking the way in which policy was transmitted from the central government through to organisations and how this impacted on the context in which the practitioners were required to use their skills; and finally from policy to users of the service (examining the evaluation of patients and their relatives about the services provided by nurses undertaking advanced physical assessment skills

Experiences With Chiropractic Care for Patients With Low Back or Neck Pain.

BackgroundMusculoskeletal disorders are the second leading cause of disability worldwide.ObjectiveExamine experiences of chiropractic patients in the United States with chronic low back or neck pain.MethodObservational study of 1853 chronic low back pain and neck pain patients (74% female) who completed an online questionnaire at the 3-month follow-up that included Consumer Assessment of Healthcare Providers and Systems (CAHPS) items assessing their experiences with care.ResultsWe found similar reports of communication for the chiropractic sample and patients in the 2016 CAHPS National Database, but 85% in the database versus 79% in the chiropractic sample gave the most positive response to the time spent with provider item. More patients in the CAHPS database rated their provider at the top of the scale (8 percentage points). More chiropractic patients reported always getting answers to questions the same day (16 percentage points) and always being seen within 15 minutes of their appointment time (29 percentage points).ConclusionsThe positive experiences of patients with chronic back and neck pain are supportive of their use of chiropractic care

Coping and Management Techniques Used by Chronic Low Back Pain Patients Receiving Treatment From Chiropractors.

OBJECTIVES:The purpose of this study was to describe coping strategies (eg, mechanisms, including self-treatment) that a person uses to reduce pain and its impact on functioning as reported by patients with chronic low back pain who were seen by doctors of chiropractic and how these coping strategies vary by patient characteristics. METHODS:Data were collected from a national sample of US chiropractic patients recruited from chiropractic practices in 6 states from major geographical regions of the United States using a multistage stratified sampling strategy. Reports of coping behaviors used to manage pain during the past 6 months were used to create counts across 6 domains: cognitive, self-care, environmental, medical care, social activities, and work. Exploratory analyses examined counts in domains and frequencies of individual items by levels of patient characteristics. RESULTS:A total of 1677 respondents with chronic low back pain reported using an average of 9 coping behaviors in the prior 6 months. Use of more types of behaviors were reported among those with more severe back pain, who rated their health as fair or poor and who had daily occurrences of pain. Exercise was more frequent among the healthy and those with less pain. Female respondents tended to report using more coping behaviors than men, and Hispanics more than non-Hispanics. CONCLUSION:Persons with chronic back pain were proactive in their coping strategies and frequently used self-care coping strategies like those provided by chiropractors in patient education. In alignment with patients' beliefs that their condition was chronic and lifelong, many patients attempted a wide range of coping strategies to relieve their pain

Gluino Contribution to the 3-loop QCD beta function in the Minimal Supersymmetric Standard Model

We deduce the gluino contribution to the three-loop QCD \beta function within the minimal supersymmetric Standard Model (MSSM) from its standard QCD expression. The result is a first step in the computation of the full MSSM three-loop \beta function. In addition, in the case of a light gluino it provides the strong three-loop SUSY correction to the extrapolation of the strong coupling constant from the low energy regime to the Z region and up to the squark threshold.Comment: 11 pages, RevTex, 4 Postscript figur

Silicon-based molecular electronics

Molecular electronics on silicon has distinct advantages over its metallic counterpart. We describe a theoretical formalism for transport through semiconductor-molecule heterostructures, combining a semi-empirical treatment of the bulk silicon bandstructure with a first-principles description of the molecular chemistry and its bonding with silicon. Using this method, we demonstrate that the presence of a semiconducting band-edge can lead to a novel molecular resonant tunneling diode (RTD) that shows negative differential resistance (NDR) when the molecular levels are driven by an STM potential into the semiconducting band-gap. The peaks appear for positive bias on a p-doped and negative for an n-doped substrate. Charging in these devices is compromised by the RTD action, allowing possible identification of several molecular highest occupied (HOMO) and lowest unoccupied (LUMO) levels. Recent experiments by Hersam et al. [1] support our theoretical predictions.Comment: Author list is reverse alphabetical. All authors contributed equally. Email: rakshit/liangg/ ghosha/[email protected]

Inhibition of IGF-I Receptor Signaling in Combination with Rapamycin or Temsirolimus Increases MYC-N Phosphorylation

BACKGROUND: It has been previously shown that blockade of the type 1 insulin-like growth factor receptor (IGF1R) signaling combined with mTOR inhibition decreased neuroblastoma proliferation in vitro. MYC-N inactivation occurs through phosphorylation by downstream elements of the IGF1R signaling pathway. It was hypothesized that inhibition of IGF1R signaling would increase the inactivation of MYC-N. MATERIALS AND METHODS: BE-2(c) and IMR-32 neuroblastoma cell lines were treated with varying concentrations of alphaIR3, rapamycin and temsirolimus either alone or in combination and the expression of MYC-N and phosphorylated MYC-N proteins were evaluated by Western blotting. The number of apoptotic cells was evaluated through cleaved caspase-3 expression. RESULTS: IGF1R signaling blockade in combination with mTOR inhibition decreased MYC-N protein expression, increased MYC-N phosphorylation and significantly increased cleaved caspase-3 expression in treated cells. CONCLUSION: The combination of rapamycin or temsirolimus with alphaIR3 decreases MYC-N expression, increases MYC-N phosphorylation and induces apoptosis in vitro which may have clinical relevance to children with neuroblastoma

Comparing inclination-dependent analyses of kilonova transients

The detection of the optical transient AT2017gfo proved that binary neutron star mergers are progenitors of kilonovae (KNe).Using a combination of numerical-relativity and radiative-transfer simulations, the community has developed sophisticated models for these transients for a wide portion of the expected parameter space. Using these simulations and surrogate models made from them, it has been possible to perform Bayesian inference of the observed signals to infer properties of the ejected matter. It has been pointed out that combining inclination constraints derived from the KN with gravitational-wavemeasurements increases the accuracy with which binary parameters can be estimated, in particular breaking the distance-inclination degeneracy from gravitational wave inference. To avoid bias from the unknown ejecta geometry, constraints on the inclination angle for AT2017gfo should be insensitive to the employed models. In this work, we compare different assumptions about the ejecta and radiative reprocesses used by the community and we investigate their impact on the parameter inference. While most inferred parameters agree, we find disagreement between posteriors for the inclination angle for different geometries that have been used in the current literature. According to our study, the inclusion of reprocessing of the photons between different ejecta types improves the modeling fits to AT2017gfo and, in some cases, affects the inferred constraints. Our study motivates the inclusion of large ~1-mag uncertainties in the KN models employed for Bayesian analysis to capture yet unknown systematics, especially when inferring inclination angles, although smaller uncertainties seem appropriate to capture model systematics for other intrinsic parameters. We can use this method to impose soft constraints on the ejecta geometry of the KN AT2017gfo