Teaching a Person with Memory Impairment Smartphone Use for Emergencies during Outdoors Walking Case Report

Safety issues arise during the performance of activities as dementia advances. Occupational therapists collaborate with dementia clients and their caregivers to find solutions and strategies to prolong safe activity participation. Additionally, occupational therapists teach through demonstration showing engagement in specific activities may no longer be safe. We present the case of a 70-year-old male with mild dementia. His caregiver believes he needs to use a smartphone for safety during outdoors walking; the client’s enjoyed and valued occupation. This case report illustrates smartphone use may be difficult to learn for a person with mild dementia. It highlights the need for the caregiver and person with dementia to receive education together for best understanding. New technologies for community mobility such as outdoors walking are considered

Space-Based Sentinels for Measurement of Infrared Cooling in the Thermosphere for Space Weather Nowcasting

Infrared radiative cooling by nitric oxide (NO) and carbon dioxide (CO2) modulates the thermospheres density and thermal response to geomagnetic storms. Satellite tracking and collision avoidance planning require accurate density forecasts during these events. Over the past several years, failed density forecasts have been tied to the onset of rapid and significant cooling due to production of NO and its associated radiative cooling via emission of infrared radiation at 5.3 m. These results have been diagnosed, after the fact, through analyses of measurements of infrared cooling made by the Sounding of the Atmosphere using Broadband Emission Radiometry instrument now in orbit over 16 years on the National Aeronautics and Space Administration Thermosphere, Ionosphere, Mesosphere Energetics and Dynamics satellite. Radiative cooling rates for NO and CO2 have been further shown to be directly correlated with composition and exospheric temperature changes during geomagnetic storms. These results strongly suggest that a network of smallsats observing the infrared radiative cooling of the thermosphere could serve as space weather sentinels. These sentinels would observe and provide radiative cooling rate data in real time to generate nowcasts of density and aerodynamic drag on space vehicles. Currently, radiative cooling is not directly considered in operational space weather forecast models. In addition, recent research has shown that different geomagnetic storm types generate substantially different infrared radiative response, and hence, substantially different thermospheric density response. The ability to identify these storms, and to measure and predict the Earths response to them, should enable substantial improvement in thermospheric density forecasts

Patient clinical documentation in telehealth environment: Are we collecting appropriate and sufficient information for best practice?

BACKGROUND: During the COVID-19 pandemic, the use of telehealth for patient visits grew rapidly and served an important role as a valuable and necessary resource. Although clinical documentation is critical for telehealth patient visits, there is limited information about how healthcare facilities manage telehealth patient visit documentation, technology used for telehealth visits, and challenges encountered with telehealth patient visit documentation. This study aimed to assess the use of telehealth during the pandemic, the quality of clinical documentation in telehealth practice and to identify challenges and issues encountered with telehealth patient visits in order to develop a strategy for best practices for telehealth documentation and data management. METHODS: Data were collected for this cross-sectional study in January-February 2021 via a self-designed survey of administrators/managers from physicians\u27 offices and mental health facilities. Survey questions included four categories: health organization demographic information; telehealth visits; clinical documentation for telehealth visit; and challenges and barriers related to telehealth documentation technology use. RESULTS: Of 76 respondents, more than half (62%) of the healthcare facilities started using telehealth for patient visits within one year of the onset of the COVID-19 pandemic, with 94% of respondents indicating an increased use of telehealth for patient visits since the pandemic. The most common types of telehealth patient care provided during the pandemic included pediatrics, primary care, cardiology, and women\u27s health. The most consistent data documentation of telehealth visits included: date of service, patient identification number, communication methods, patient informed consent, diagnosis and impression, evaluation results, and recommendations. The telehealth visit data was most commonly used for patient care and clinical practice, billing and reimbursement, quality improvement and patient satisfaction, and administrative planning. The top barriers to telehealth use by the healthcare professionals included patient challenges with telehealth services, such as inequities in quality of technology, lack of patient understanding, and lack of patient satisfaction; this was followed by frustration with constant updates of telehealth guidelines and procedures, understanding required telehealth documentation for reimbursement purposes, payer denial for telehealth visits, and legal and risk issues. CONCLUSIONS: Findings from this study can assist government entities, policymakers, and healthcare organizations in developing and advocating best practices in telehealth usage and clinical documentation improvement strategies

Patterns of Local-Regional Management Following Neoadjuvant Chemotherapy in Breast Cancer: Results From ACOSOG Z1071 (Alliance)

AXXXXX ZXXXX was a prospective trial evaluating the false negative rate of sentinel node (SLN) surgery after neoadjuvant chemotherapy (NAC) in breast cancer patients with initial node-positive disease. Radiation therapy (RT) decisions were at the discretion of treating physicians, providing an opportunity to evaluate variability in practice patterns following NAC

Molecular Gas in NUclei of GAlaxies (NUGA) III. The warped LINER NGC3718

16 pages, 17 figures.-- Published in: A&A 442, 479-493 (2005), publisher version available at: http://dx.doi.org/10.1051/0004-6361:20041731.We present the first interferometric observations of CO(1–0) and CO(2–1) line emission from the warped LINER NGC 3718, obtained with the IRAM Plateau de Bure Interferometer (PdBI). This L1.9 galaxy has a prominent dust lane and on kiloparsec scales, a strongly warped atomic and molecular gas disk. The molecular gas is closely associated with the dust lane across the nucleus and its kinematic center is consistent with the millimeter continuum AGN. A comparison of our interferometric mosaic data, which fully cover the ~ 9 kpc warped disk, with a previously obtained IRAM 30m single dish CO(1–0) map shows that the molecular gas distribution in the disk is heavily resolved by the PdBI map. On the nucleus the interferometric maps alone contain less than one half of the single dish line flux, and the overall mosaic accounts for about a tenth of the total molecular gas mass of ~ 2.4 × 108M⊙. After applying a short-spacing correction with the IRAM 30m data to recover the missing extended flux, we find in total six main source components within the dust lane: one associated with the nucleus, four symmetrically positioned on either side at galactocentric distances of about 1.3 kpc and 4.0 kpc from the center, and a sixth on the western side at ~ 3 kpc with only a very weak eastern counterpart. In the framework of a kinematic model using tilted rings, we interpret the five symmetric source components as locations of strong orbital crowding. We further find indications that the warp appears not only on kpc scales, but continues down to ~ 250 pc. Besides the sixth feature on the western side, the lower flux (a factor of ~ 2) of the eastern components compared to the western ones indicates an intrinsic large scale asymmetry in NGC 3718 that cannot be explained by the warp. Indications for a small scale asymmetry are also seen in the central 600 pc. These asymmetries might be evidence for a tidal interaction with a companion galaxy (large scales) and gas accretion onto the nucleus (small scales). Our study of NGC 3718 is part of the NUclei of GAlaxies (NUGA) project that aims at investigating the different processes of gas accretion onto Active Galactic Nuclei (AGN).The research presented in this paper has been financially supported in part by the SFB 494. Stéphane Léon is partially supported by DGI Grant AYA 2002-03338 and Junta de Andalucía.Peer reviewe

The choice between hip prosthetic bearing surfaces in total hip replacement:a protocol for a systematic review and network meta-analysis

BACKGROUND: Prosthetic hip implants have many combinations of bearing surface materials, sizes, and fixation techniques, which can determine the quality of life of patients after primary total hip replacement (THR) and the likelihood of needing revision surgery. When an implant fails, patients require revision THR, which is distressing to the patient and expensive for the health care payer. Primary THR is one of the most common elective procedures performed worldwide, with over 300,000 performed annually in the USA and over 80,000 in England and Wales. It is important to review all available randomised controlled trial (RCT) evidence to determine which implant bearing surface materials, size, and fixation technique are most effective for patients. METHODS/DESIGN: This is a protocol for a systematic review and meta-analysis of RCTs comparing outcomes of hip implant bearing surfaces, size, and fixation techniques used in THR. Implant combinations compared in the literature include four bearing surface combinations (metal-on-polyethylene, metal-on-metal, ceramic-on-polyethylene, and ceramic-on-ceramic); two femoral head sizes (large vs small heads); and four fixation techniques (uncemented, cemented, hybrid, and reverse hybrids). The primary outcome will be revision surgery. We will also collect data on patient characteristics, mortality, quality of life, and other outcomes. In network meta-analysis, we will estimate the relative effectiveness of every implant bearing surface, head size (large vs small), and fixation permutation, using evidence where implants have been compared directly in an RCT and indirectly through common comparators in different RCTs. DISCUSSION: There has been much debate about materials used for prosthetic implants in THR. Different combinations of prosthetic materials, sizes, and fixation, can vary widely in cost and fail at different rates for different patient groups. Given the number of THRs performed yearly, and the increasing use of expensive implants, it is important to review evidence to inform surgeons, patients, and health care providers of optimal implant bearing combinations for given patient characteristics. This review will inform a cost-effectiveness model that will include evidence from other sources, to determine the most effective and cost-effective implant bearing combination for patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD4201501943

Comparison of Assertive Community Treatment Fidelity Assessment Methods: Reliability and Validity

Assertive community treatment is known for improving consumer outcomes, but is difficult to implement. On-site fidelity measurement can help ensure model adherence, but is costly in large systems. This study compared reliability and validity of three methods of fidelity assessment (on-site, phone-administered, and expert-scored self-report) using a stratified random sample of 32 mental health intensive case management teams from the Department of Veterans Affairs. Overall, phone, and to a lesser extent, expert-scored self-report fidelity assessments compared favorably to on-site methods in inter-rater reliability and concurrent validity. If used appropriately, these alternative protocols hold promise in monitoring large-scale program fidelity with limited resources

Radiometric Stability of the SABER Instrument

The SABER instrument on the National Aeronautics and Space Administration Thermosphere‐Ionosphere‐Mesosphere Energetics and Dynamics satellite continues to provide a long‐term record of Earth\u27s stratosphere, mesosphere, and lower thermosphere. The SABER data are being used to examine long‐term changes and trends in temperature, water vapor, and carbon dioxide. A tacit, central assumption of these analyses is that the SABER instrument radiometric calibration is not changing with time; that is, the instrument is stable. SABER stratospheric temperatures and those derived from Global Positioning System Radio Occultation measurements are compared to examine SABER\u27s stability. Global Positioning System Radio Occultation measurements are inherently stable due to the accuracy and traceability of the measured phase delay rate to the Système Internationale definition of the second. Differences in global annual mean SABER and COSMIC lower stratospheric temperatures show little significant change with time in the 11 years spanning 2007–2017. From this analysis we infer that SABER temperatures are stable to better than 0.1 to 0.2 K per decade