Self-Management Education in Hispanic Women with Gestational Diabetes Mellitus (GDM)

The purpose of this Practice Inquiry Project was to develop, implement, and evaluate the effectiveness of a diabetes self-management education intervention in a population of Hispanic women at risk for gestational diabetes mellitus within a CenteringPregnancy(R) model of care

BALANCE TRAINING ALTERS POSTURAL DYNAMICS UNIQUELY FOR STANCE ON COMPLIANT VS. NON-COMPLIANT SURFACES

Balance training is a common clinical modality used for improving postural control and preventing injury during sports training and participation. However, a number of empirical studies have failed to support the efficacy of balance training. One factor that may have limited the previous empirical studies is a lack of sensitivity with regard to the traditional descriptive statistics used to characterize postural control. Recent developments in non-linear dynamic analyses have led researchers to revaluate the way in which postural control is measured and understood. The advantage of nonlinear analyses for assessing postural behavior is their sensitivity to changes in the time-dependent structures of continuous postural sway. Lyapunov Exponent (LyE) is defined as the slope of the average logarithmic divergence of neighboring trajectories in a state space (Wolf, 1985). The purpose of this study was to evaluate the effects of balance training on postural control in a healthy population using both a traditional (position variability; as measured by standard deviation) and non-linear (Lyapunov Exponent; LyE) measure of postural sway variability

Effects of present-day deglaciation in Iceland on mantle melt production rates

Ongoing deglaciation in Iceland not only causes uplift at the surface but also increases magma production at depth due to decompression of the mantle. Here we study glacially induced decompression melting using 3‐D models of glacial isostatic adjustment in Iceland since 1890. We find that the mean glacially induced pressure rate of change in the mantle increases melt production rates by 100–135%, or an additional 0.21–0.23 km3 of magma per year beneath Iceland. Approximately 50% of this melt is produced underneath central Iceland. The greatest volumetric increase is found directly beneath Iceland's largest ice cap, Vatnajökull, colocated with the most productive volcanoes. Our models of the effect of deglaciation on mantle melting predict a significantly larger volumetric response than previous models which only considered the effect of deglaciation of Vatnajökull, and only mantle melting directly below Vatnajökull. Although the ongoing deglaciation significantly increases the melt production rate, the increase in melt supply rate at the base of the lithosphere is delayed and depends on the melt ascent velocity through the mantle. Assuming that 25% of the melt reaches the surface, the upper limit on our deglaciation‐induced melt estimates for central Iceland would be equivalent to an eruption the size of the 2010 Eyjafjallajökull summit eruption every seventh year

EFFECT OF RESPIRATION DYNAMICS ON POSTURAL CONTROL FOLLOWING A 5K RUN

Research has shown postural control during upright stance can be diminished for up to twenty minutes following aerobic exercise of different types, intensities, and durations (Lepers et al., 1997; Nagy et al., 2002). Researchers have posited that this is caused by neuromuscular changes associated with aerobic exercise and fatigue such as the reduced excitability and central drive to peripheral muscles (Lepers et al., 2002), vestibular desensitization (Lepers et al., 1997), and peripheral somatosensory desensitization (Lepers et al., 1997). However, no research has measured or attempted to control for the influence that changes in respiration dynamics (e.g., rate and volume) alone might have on postural sway. The aim of the current study was to examine these effects in order decipher whether changes to postural control following intense aerobic exercise (a 5-kilometer run performed with maximal effort) can be attributed to effects of exercise and fatigue or simply changes in respiration

Tissue Stromal Vascular Fraction Improves Early Scar Healing:A Prospective Randomized Multicenter Clinical Trial

Background Wound healing and scar formation depends on a plethora of factors. Given the impact of abnormal scar formation, interventions aimed to improve scar formation would be most advantageous. The tissue stromal vascular fraction (tSVF) of adipose tissue is composed of a heterogenous mixture of cells embedded in extracellular matrix. It contains growth factors and cytokines involved in wound-healing processes, eg, parenchymal proliferation, inflammation, angiogenesis, and matrix remodeling.Objectives The aim of this study was to investigate the hypothesis that tSVF reduces postsurgical scar formation.Methods This prospective, double-blind, placebo-controlled, randomized trial was conducted between 2016 and 2020. Forty mammoplasty patients were enrolled and followed for 1 year. At the end of the mammoplasty procedure, all patients received tSVF in the lateral 5 cm of the horizontal scar of 1 breast and a placebo injection in the contralateral breast to serve as an intrapatient control. Primary outcome was scar quality measure by the Patient and Observer Scar Assessment Scale (POSAS). Secondary outcomes were obtained from photographic evaluation and histologic analysis of scar tissue samples.Results Thirty-four of 40 patients completed follow-up. At 6 months postoperation, injection of tSVF had significantly improved postoperative scar appearance as assessed by the POSAS questionnaire. No difference was observed at 12 months postoperation. No improvement was seen based on the evaluation of photographs and histologic analysis of postoperative scars between both groups.Conclusions Injection of tSVF resulted in improved wound healing and reduced scar formation at 6 months postoperation, without any noticeable advantageous effects seen at 12 months.</p

Dynamic Computed Tomography Angiography for capturing vessel wall motion:A phantom study for optimal image reconstruction

Background Reliably capturing sub-millimeter vessel wall motion over time, using dynamic Computed Tomography Angiography (4D CTA), might provide insight in biomechanical properties of these vessels. This may improve diagnosis, prognosis, and treatment decision making in vascular pathologies. Purpose The aim of this study is to determine the most suitable image reconstruction method for 4D CTA to accurately assess harmonic diameter changes of vessels. Methods An elastic tube (inner diameter 6 mm, wall thickness 2 mm) was exposed to sinusoidal pressure waves with a frequency of 70 beats-per-minute. Five flow amplitudes were set, resulting in increasing sinusoidal diameter changes of the elastic tube, measured during three simulated pulsation cycles, using ECG-gated 4D CTA on a 320-detector row CT system. Tomographic images were reconstructed using one of the following three reconstruction methods: hybrid iterative (Hybrid-IR), model-based iterative (MBIR) and deep-learning based (DLR) reconstruction. The three reconstruction methods where based on 180 degrees (half reconstruction mode) and 360 degrees (full reconstruction mode) raw data. The diameter change, captured by 4D CTA, was computed based on image registration. As a reference metric for diameter change measurement, a 9 MHz linear ultrasound transducer was used. The sum of relative absolute differences (SRAD) between the ultrasound and 4D CTA measurements was calculated for each reconstruction method. The standard deviation was computed across the three pulsation cycles. Results MBIR and DLR resulted in a decreased SRAD and standard deviation compared to Hybrid-IR. Full reconstruction mode resulted in a decreased SRAD and standard deviations, compared to half reconstruction mode. Conclusions 4D CTA can capture a diameter change pattern comparable to the pattern captured by US. DLR and MBIR algorithms show more accurate results than Hybrid-IR. Reconstruction with DLR is &gt;3 times faster, compared to reconstruction with MBIR. Full reconstruction mode is more accurate than half reconstruction mode.</p

Tumor copy number alteration burden is a pan-cancer prognostic factor associated with recurrence and death

Prostate Cancer Foundation, American Cancer Society (RSG-15-067-01-TBG), Prostate Cancer Foundation, National Cancer Institute (R01 CA204749), Howard Hughes Medical Institute, National Institutes of Health (CA193837),(CA092629), (CA155169), (CA008748)

Quantified health and cost effects of faster endovascular treatment for large vessel ischemic stroke patients in the Netherlands

BACKGROUND: The effectiveness of endovascular treatment (EVT) for large vessel occlusion (LVO) stroke severely depends on time to treatment. However, it remains unclear what the value of faster treatment is in the years after index stroke. The aim of this study was to quantify the value of faster EVT in terms of health and healthcare costs for the Dutch LVO stroke population. METHODS: A Markov model was used to simulate 5-year follow-up functional outcome, measured with the modified Rankin Scale (mRS), of 69-year-old LVO patients. Post-treatment mRS was extracted from the MR CLEAN Registry (n=2892): costs per unit of time and Quality-Adjusted Life Years (QALYs) per mRS sub-score were retrieved from follow-up data of the MR CLEAN trial (n=500). Net Monetary Benefit (NMB) at a willingness to pay of €80 000 per QALY was reported as primary outcome, and secondary outcome measures were days of disability-free life gained and costs. RESULTS: EVT administered 1 min faster resulted in a median NMB of €309 (IQR: 226;389), 1.3 days of additional disability-free life (IQR: 1.0;1.6), while cumulative costs remained largely unchanged (median: -€15, IQR: -65;33) over a 5-year follow-up period. As costs over the follow-up period remained stable while QALYs decreased with longer time to treatment, which this results in a near-linear decrease of NMB. Since patients with faster EVT lived longer, they incurred more healthcare costs. CONCLUSION: One-minute faster EVT increases QALYs while cumulative costs remain largely unaffected. Therefore, faster EVT provides better value of care at no extra healthcare costs