Cigarette Smoking and Low Back Pain

The purpose of this independent study is to define presently existing theories linking cigarette smoking and low back pain. It also provides a detailed description of nicotine and its physiological and psychological effects. There are four theories outlined in this study which could serve as explanations for the correlation of cigarette smoking and low back pain. The first is the chronic cough associated with smoking. This cough increases mechanical stress including higher disc pressures and poor union and healing following spinal fusion surgery. The second theory deals with the vascular changes caused by nicotine which decreases vertebral blood flow and solute transport. Thirdly, smoking accelerates osteoporosis. The last theory links cigarette smoking and low back pain with similar psychological and physiological traits. There is enough evidence to show a strong correlation between cigarette smoking and low back pain, however no conclusive evidence exists to demonstrate cigarette smoking as a causative factor of low back pain. The information is strong enough to alert the healthcare provider to not overlook cigarette smoking when treating a patient with low back pain

Maximizing Revenues for Online-Dial-a-Ride

In the classic Dial-a-Ride Problem, a server travels in some metric space to serve requests for rides. Each request has a source, destination, and release time. We study a variation of this problem where each request also has a revenue that is earned if the request is satisfied. The goal is to serve requests within a time limit such that the total revenue is maximized. We first prove that the version of this problem where edges in the input graph have varying weights is NP-complete. We also prove that no algorithm can be competitive for this problem. We therefore consider the version where edges in the graph have unit weight and develop a 2-competitive algorithm for this problem

Recent Decisions

Comments on recent decisions by Walter B. Bieschke, Thomas Broden, John C. Castelli, Edward G. Coleman, Louis F. DiGiovanni, John L. Globensky, John H. O\u27Hara, L. G. Sculthorp, and Joseph V. Wilcox

Tough, Self-Healing Hydrogels Capable of Ultrafast Shape Changing

Achieving multifunctional shape-changing hydrogels with synergistic and engineered material properties is highly desirable for their expanding applications, yet remains an ongoing challenge. The synergistic design of multiple dynamic chemistries enables new directions for the development of such materials. Herein, a molecular design strategy is proposed based on a hydrogel combining acid-ether hydrogen bonding and imine bonds. This approach utilizes simple and scalable chemistries to produce a doubly dynamic hydrogel network, which features high water uptake, high strength and toughness, excellent fatigue resistance, fast and efficient self-healing, and superfast, programmable shape changing. Furthermore, deformed shapes can be memorized due to the large thermal hysteresis. This new type of shape-changing hydrogel is expected to be a key component in future biomedical, tissue, and soft robotic device applications.Funding was gratefully acknowledged from the Australian Research Council (DP180103918), and the ANU Futures Scheme. The authors thank Associate Professor Zbigniew Stachurski for assistance with tensile testing

Barriers to primary care responsiveness to poverty as a risk factor for health

<p>Abstract</p> <p>Background</p> <p>Poverty is widely recognized as a major determinant of poor health, and this link has been extensively studied and verified. Despite the strong evidentiary link, little work has been done to determine what primary care health providers can do to address their patients' income as a risk to their health. This qualitative study explores the barriers to primary care responsiveness to poverty as a health issue in a well-resourced jurisdiction with near-universal health care insurance coverage.</p> <p>Methods</p> <p>One to one interviews were conducted with twelve experts on poverty and health in primary care in Ontario, Canada. Participants included family physicians, specialist physicians, nurse practitioners, community workers, advocates, policy experts and researchers. The interviews were analysed for anticipated and emergent themes.</p> <p>Results</p> <p>This study reveals provider- and patient-centred structural, attitudinal, and knowledge-based barriers to addressing poverty as a risk to health. While many of its findings reinforce previous work in this area, this study's findings point to a number of areas front line primary care providers could target to address their patients' poverty. These include a lack of provider understanding of the lived reality of poverty, leading to a failure to collect adequate data about patients' social circumstances, and to the development of inappropriate care plans. Participants also pointed to prejudicial attitudes among providers, a failure of primary care disciplines to incorporate approaches to poverty as a standard of care, and a lack of knowledge of concrete steps providers can take to address patients' poverty.</p> <p>Conclusions</p> <p>While this study reinforces, in a well-resourced jurisdiction such as Ontario, the previously reported existence of significant barriers to addressing income as a health issue within primary care, the findings point to the possibility of front line primary care providers taking direct steps to address the health risks posed by poverty. The consistent direction and replicability of these findings point to a refocusing of the research agenda toward an examination of interventions to decrease the health impacts of poverty.</p

30-day morbidity and mortality of sleeve gastrectomy, Roux-en-Y gastric bypass and one anastomosis gastric bypass: a propensity score-matched analysis of the GENEVA data

Background: There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts. Materials and methods: This analysis utilised data collected from the GENEVA study which was a multicentre observational cohort study of bariatric and metabolic surgery (BMS) in 185 centres across 42 countries between 01/05/2022 and 31/10/2020 during the Coronavirus Disease-2019 (COVID-19) pandemic. 30-day complications were categorised according to the Clavien–Dindo classification. Patients receiving SG, RYGB, or OAGB were propensity-matched according to baseline characteristics and 30-day complications were compared between groups. Results: In total, 6770 patients (SG 3983; OAGB 702; RYGB 2085) were included in this analysis. Prior to matching, RYGB was associated with highest 30-day complication rate (SG 5.8%; OAGB 7.5%; RYGB 8.0% (p = 0.006)). On multivariate regression modelling, Insulin-dependent type 2 diabetes mellitus and hypercholesterolaemia were associated with increased 30-day complications. Being a non-smoker was associated with reduced complication rates. When compared to SG as a reference category, RYGB, but not OAGB, was associated with an increased rate of 30-day complications. A total of 702 pairs of SG and OAGB were propensity score-matched. The complication rate in the SG group was 7.3% (n = 51) as compared to 7.5% (n = 53) in the OAGB group (p = 0.68). Similarly, 2085 pairs of SG and RYGB were propensity score-matched. The complication rate in the SG group was 6.1% (n = 127) as compared to 7.9% (n = 166) in the RYGB group (p = 0.09). And, 702 pairs of OAGB and RYGB were matched. The complication rate in both groups was the same at 7.5 % (n = 53; p = 0.07). Conclusions: This global study found no significant difference in the 30-day morbidity and mortality of SG, RYGB, and OAGB in propensity score-matched cohorts

30-Day morbidity and mortality of bariatric metabolic surgery in adolescence during the COVID-19 pandemic – The GENEVA study

Background: Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. Objectives: This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in-hospital and 30-day COVID-19 and surgery-specific morbidity/mortality. Results: One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n = 122, 71.8%), underwent MBS during the study period. The mean pre-operative weight and body mass index were 122.16 ± 15.92 kg and 43.7 ± 7.11 kg/m2, respectively. Although majority of patients had pre-operative testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 146; 85.9%), only 42.4% (n = 72) of the patients were asked to self-isolate pre-operatively. Two patients developed symptomatic SARS-CoV-2 infection post-operatively (1.2%). The overall complication rate was 5.3% (n = 9). There was no mortality in this cohort. Conclusions: MBS in adolescents with obesity is safe during the COVID-19 pandemic when performed within the context of local precautionary procedures (such as pre-operative testing). The 30-day morbidity rates were similar to those reported pre-pandemic. These data will help facilitate the safe re-introduction of MBS services for this group of patients

Caring for Actively Dying Children and Their Parents in the Pediatric ICU: A Mixed Methods Study

A child’s death upends a family’s anticipated life cycle and embodied parental roles; resulting in a profound grieving process. Though most children die in the pediatric intensive care unit (PICU) following a planned withdrawal of life-sustaining treatments, little is known about how nursing care at end-of-life shapes parents’ bereavement. This dissertation examined how nursing care at end-of-life in the PICU shapes parents’ long-term bereavement using a sequential explanatory (QUAN → qual) mixed methods design that integrated quantitative clinical information with qualitative parent interview data. Mixed-effects models were used to identify associations between patient characteristics (age, illness trajectory, length of stay, circumstances of death) and patterns of daily outcomes (pain, sedation, and nursing care requirements). Patients’ pain and sedation scores were generally comfortable but showed episodic discomfort. Patients with cancer demonstrated higher peak daily pain scores than patients with acute illness trajectories. Patients with longer length of stay more frequently had pain and pain with agitation on day of death. Most patients continued with multiple invasive devices in place until death, regardless of illness trajectory or circumstances of death (i.e., withdrawal of life-support, failed resuscitation, brain death). Qualitative analysis revealed four domains that shifted in priority and intersected to amplify one another; (1) Being together, (2) Tending to evolving clinical needs, (3) Managing institutional, situational, and structural factors, and (4) Navigating an array of emotions in an unwelcome context. These data were integrated to explain and contextualize quantitative findings and examine similarities and differences between parents’ perceptions and documented nursing care. Parents of children with varying illness trajectories used different priorities and terminology when recalling their child’s comfort and symptoms at end-of-life. Parents’ memories of their child’s suffering more closely corresponded with peaks in clinical scores, rather than overarching averages. The findings from this dissertation show that the end-of-life and grief experience is unique for each child and family, but opportunities exist for nurses to tailor their caring actions to promote a meaningful death experience that grieving parents remember for a lifetime

Treatment and disposal of radioactive waste from a fusion power reactor

As part of the Safety and Environmental Assessment of Fusion Power project (SEAFP) two studies on activated waste management based on present practices and new perspectives for fusion waste have been performed by Studsvik RadWaste AB and JRC Ispra, respectively. German and Swedish practices and principles for classification, management, and final disposal of radioactive fission waste were used in the Studsvik study as a basis for a fusion waste management strategy. Results from the study include primary waste quantities, required repository volumes and doses to man from repositories with fusion waste. The waste management strategy proposed in the Ispra study envisages interim storage at the reactor site, then, depending on the residual radioactivity, the adoption of three alternative options: declassification to non-active waste, recycling and disposal of the remaining waste. Both studies show the advantages of adopting low activation materials