A protocol for a new methodological model for work-related shoulder complex injuries:From diagnosis to rehabilitation

Incluye 4 ficheros de datosBackground: Work-related injuries of the shoulder complex represent a challenge for clinicians because of the large variety of clinical entities involved and the broad anatomic structures that can be affected. Furthermore, commonly performed orthopedic tests have demonstrated limited accuracy for diagnosing the injury despite considerable research efforts. The aim of this study protocol is therefore to describe a comprehensive approach integrating both a clinical- and functional status-based pathology and an adapted rehabilitation prescription. Methods/Design: A longitudinal cohort study will be performed at the Department of Rehabilitation and Medical Assistance of a mutual insurance society for work-related injury management in Spain (Mutua Navarra, Pamplona, Navarra Spain). Patients will be attended by an occupational physician who specializes in work-related injuries and is part of the project team that will systematically visit all the participants. After the medical diagnosis and any requested supplementary evaluations (i.e., radiological examinations), the patients will be referred to the rehabilitation service. Before the physiotherapeutic rehabilitation program is initiated, the patients will undergo a comprehensive functional screening at the biomechanics laboratory. Using a decision-making scheme, the identified functional deficits will be used to customize the individual rehabilitation plan. Discussion: The proposed objective criteria-based shoulder diagnosis and rehabilitation model could be a new effective strategy for minimizing the time required to regain functional capacity and recover from symptoms among patients with work-related shoulder injuries

Comparison of Smartphone Pedometer Apps on a Treadmill versus Outdoors

Previous research has focused on the accuracy of smartphone pedometer apps in laboratory settings, however less information is available in outdoor (free living) environments. PURPOSE: Determine the accuracy of 5 smartphone apps at recording steps at a walking speed in a laboratory versus an outdoor setting. METHODS: Twenty-three healthy college students consented (Mean±SD; 22±3.8yrs; BMI 24.9±4.13kg/m2) to participate in 2 separate visits. During the first visit participants walked 500 steps at 3mph on a treadmill while wearing a pedometer and a smartphone placed in the pocket using 5 pedometer apps concurrently (Moves, Google Fit (G-Fit), Runtastic, Accupedo, S-Health). During the second visit, participants walked 400 meters at 3mph on a sidewalk outside. Actual steps for each visit were recorded using a hand tally counter device. Zero and negative values were replaced with the mean value for that trial. Statistical analyses were performed using IBM SPSS 23.0. Mean bias scores were calculated between the step count for each app and the respective tally count for each trial. Mean bias scores were correlated between trials for each app using Pearson correlations and significance was set at p\u3c0.05. Mean Absolute Percent Error (MAPE) values were also calculated for each app for both trials. RESULTS: G-Fit recorded 2 zero values and 2 negative values and Moves recorded 1 zero value. Mean bias scores were significantly correlated between the indoor and outdoor protocols for the pedometer (r=0.67, p\u3c0.01) and S-Health (r=0.46, p\u3c0.5). The remaining apps were not correlated between protocols. The outdoor protocol producing a greater mean bias for the outdoor protocol for G-Fit, Runtastic, and Accupedo (mean bias ± SD indoor, outdoor; -4.3±53.1, -19.3±120.0; -10.7±63.3, -33.4±118.7; 16.0±143.6, 79.0±75.0; respectively) and a greater mean bias for the indoor protocol for the pedometer, Moves, and S-Health (mean bias indoor, outdoor; -1.4±41.5, 0.0±34.1; -117.4±196.7, -42.2±209.6; 11.3±28.4, 0.0±58.7; respectively). MAPE was below 5% for the pedometer and S-Health for both trials. CONCLUSION: Apps with the lowest error in a controlled setting may be less affected when used in other settings, while apps with greater variation in a controlled setting may be affected when used in a different environment

Accuracy of Fitbit Activity Trackers During Walking in a Controlled Setting

Activity trackers are widely used to measure daily physical activity. Many devices have been shown to measure steps more accurately at higher intensities, however, it is also important to determine the accuracy of these new devices at measuring steps while walking at a pace similar to that used during most daily activities. PURPOSE: To assess the accuracy of 6 popular activity trackers at measuring steps while walking on a treadmill. METHODS: Twenty-six college students (Mean±SD; 22.1±3.7yrs; 25.1±4.0kg/m2; 13 male) walked 500 steps at 3mph on a treadmill while wearing 6 different activity trackers (Pedometer, Fitbit Blaze, Charge HR, Alta, Flex, Zip, One). The Charge HR was placed two fingers above the right wrist while the Flex was next to the wrist bone. The Blaze was placed two fingers above the left wrist while the Alta was next to the wrist bone. The Fitbit Zip and the One were aligned with the hipbone on the left and right waistband respectively. Steps were counted by a trained researcher using a hand tally counter. Missing values were replaced with the mean value for that device. Step counts were correlated between Fitbit devices and the pedometer and tally counter using Pearson correlations. Significance was set at p\u3c0.05. Mean bias scores were calculated between the step counts for each device and the tally counter. Mean Absolute Percent Error (MAPE) values were also calculated for each device relative to the tally counter. RESULTS: Fitbit Zip and One were significantly correlated with the tally counter (r=0.50, p\u3c0.05; r=0.68, p\u3c0.01, respectively) while the other devices were not significantly correlated. Mean bias and MAPE values were as follows: Device (Mean Bias/MAPE) Pedometer (-0.2±39.2/3.8±6.8), Blaze (34.5±67.1/9.9±11.3), Charge HR (-12.6±61.5/7.0±10.3), Alta (-85.0±70.8/17.1±14.1), Flex (49.5±242.4/19.7±45.3), Zip (1.8±3.4/0.4±0.6), One (0.2±2.1/0.3±0.3). Fitbit Zip and One were within one half percent of actual steps while wrist-worn Fitbits ranged from 7.0-19.7% from actual step counts. CONCLUSION: Consistent with previous research, activity trackers worn at the waist provide the most accurate step counts compared to wrist-worn models. Differences found in wrist-worn models may result in significant over- or underestimation of activity levels when worn for long periods of time

Cervical cancer cell lines expressing NKG2D-ligands are able to down-modulate the NKG2D receptor on NKL cells with functional implications

<p>Abstract</p> <p>Background</p> <p>Cervical cancer represents the third most commonly diagnosed cancer and the fourth leading cause of cancer-related deaths in women worldwide. Natural killer (NK) cells play an important role in the defense against viruses, intracellular bacteria and tumors. NKG2D, an activating receptor on NK cells, recognizes MHC class I chain-related molecules, such as MICA/B and members of the ULBP/RAET1 family. Tumor-derived soluble NKG2D-ligands have been shown to down-modulate the expression of NKG2D on NK cells. In addition to the down-modulation induced by soluble NKG2D-ligands, it has recently been described that persistent cell-cell contact can also down-modulate NKG2D expression. The goal of this study was to determine whether the NKG2D receptor is down-modulated by cell-cell contact with cervical cancer cells and whether this down-modulation might be associated with changes in NK cell activity.</p> <p>Results</p> <p>We demonstrate that NKG2D expressed on NKL cells is down-modulated by direct cell contact with cervical cancer cell lines HeLa, SiHa, and C33A, but not with non-tumorigenic keratinocytes (HaCaT). Moreover, this down-modulation had functional implications. We found expression of NKG2D-ligands in all cervical cancer cell lines, but the patterns of ligand distribution were different in each cell line. Cervical cancer cell lines co-cultured with NKL cells or fresh NK cells induced a marked diminution of NKG2D expression on NKL cells. Additionally, the cytotoxic activity of NKL cells against K562 targets was compromised after co-culture with HeLa and SiHa cells, while co-culture with C33A increased the cytotoxic activity of the NKL cells.</p> <p>Conclusions</p> <p>Our results suggest that differential expression of NKG2D-ligands in cervical cancer cell lines might be associated with the down-modulation of NKG2D, as well as with changes in the cytotoxic activity of NKL cells after cell-cell contact with the tumor cells.</p

The Use of Virtual Reality Facilitates Dialectical Behavior Therapy® “Observing Sounds and Visuals” Mindfulness Skills Training Exercises for a Latino Patient with Severe Burns: A Case Study

Sustaining a burn injury increases an individual's risk of developing psychological problems such as generalized anxiety, negative emotions, depression, acute stress disorder, or post-traumatic stress disorder. Despite the growing use of Dialectical Behavioral Therapy® (DBT®) by clinical psychologists, to date, there are no published studies using standard DBT® or DBT® skills learning for severe burn patients. The current study explored the feasibility and clinical potential of using Immersive Virtual Reality (VR) enhanced DBT® mindfulness skills training to reduce negative emotions and increase positive emotions of a patient with severe burn injuries. The participant was a hospitalized (in house) 21-year-old Spanish speaking Latino male patient being treated for a large (&gt;35% TBSA) severe flame burn injury.Methods: The patient looked into a pair of Oculus Rift DK2 virtual reality goggles to perceive the computer-generated virtual reality illusion of floating down a river, with rocks, boulders, trees, mountains, and clouds, while listening to DBT® mindfulness training audios during 4 VR sessions over a 1 month period. Study measures were administered before and after each VR session.Results: As predicted, the patient reported increased positive emotions and decreased negative emotions. The patient also accepted the VR mindfulness treatment technique. He reported the sessions helped him become more comfortable with his emotions and he wanted to keep using mindfulness after returning home.Conclusions: Dialectical Behavioral Therapy is an empirically validated treatment approach that has proved effective with non-burn patient populations for treating many of the psychological problems experienced by severe burn patients. The current case study explored for the first time, the use of immersive virtual reality enhanced DBT® mindfulness skills training with a burn patient. The patient reported reductions in negative emotions and increases in positive emotions, after VR DBT® mindfulness skills training. Immersive Virtual Reality is becoming widely available to mainstream consumers, and thus has the potential to make this treatment available to a much wider number of patient populations, including severe burn patients. Additional development, and controlled studies are needed

The Big Yes and the Little No

Program for the sixth annual RISD Cabaret held in the cellar at the top of the Waterman Building. Design and layout by Nonie Close.https://digitalcommons.risd.edu/liberalarts_cabaret_programs/1005/thumbnail.jp

Lipid-lowering drugs in ischaemic heart disease : a quasi-experimental uncontrolled before-and-after study of the effectiveness of clinical practice guidelines

Background: Cardiovascular diseases(CVD), specifically ischaemic heart disease(IHD), are the main causes of death in industrialized countries. Statins are not usually prescribed in the most appropriate way. To ensure the correct prescription of these drugs, it is necessary to develop, disseminate and implement clinical practice guidelines(CPGs), and subsequently evaluate them. The main objective of this study is to evaluate the effectiveness of the implementation of consensual Lipid-lowering drugs (LLD) prescription guidelines in hospital and primary care settings, to improve the control of Low-Density Lipoprotein Cholesterol (LDL-C) levels in patients with IHD in the Terres de l'Ebre region covered by the Catalonian Health Institute. Secondary bjectives are to assess the improvement of the prescription profile of these LLDs, to assess cardiovascular morbimortality and the professional profile and participant centre characteristics that govern the control of LDL-C. Methods/Design Design: Quasi-experimental uncontrolled before and after study. The intervention consists of the delivery of training strategies for guideline implementation (classroom clinical sessions and on-line courses) aimed at primary care and hospital physicians. The improvement in the control of LDL-C levels in the 3,402 patients with IHD in our territory is then assessed. Scope: Primary care physicians from 11 basic health areas(BHAs) and two hospital services (internal medicine and cardiology). Sample: 3,402 patients registered with IHD in the database of the Catalan Institute of Health(E-cap) before December 2008 and patients newly diagnosed during 2009-2010. Variables: Percentage of patients achieving good control of LDL-C, measured in milligrams per decilitre. The aim of the intervention is to achieve levels of LDL-C < 100 mg/dl in patients with IHD. Secondary variables measure type and time of diagnosis of IHD, type and dose of prescribed cholesterol-lowering drugs, level of physician participation in training activities and their professional profile. Discussion: The development of prescription guidelines previously agreed by various medical specialists involved in treating IHD patients have usually improved drug prescription. The guideline presented in this study aims to improve the control of LDL-C by training physicians through presential and on-line courses on the dissemination of this guideline, and by providing feedback on their personal results a year after this training intervention