Increasing blood pressure variability predicts poor functional outcome following acute stroke

Introduction: Increasing blood pressure variability has been reported following acute stroke, but there is uncertainty about how best to measure it and about the impact on prognosis following acute ischaemic stroke and transient ischaemic attack. Methods: Enhanced casual blood pressure and ambulatory blood pressure monitoring were completed at baseline (≤48 hours post symptom onset). Blood pressure variability was defined by standard deviation and coefficient of variation of systolic, diastolic, mean arterial pressure, and pulse pressure. Modified Rankin scale score ≥3 described poor functional outcome assessed at 1- and 12-months post-stroke. Multivariable logistic regression models incorporating blood pressure variability measurement and other factors were performed, and odds ratio and 95% confidence intervals reported. Results: 232 patients were recruited; 45 were dependent at 1-month, and 37 at 12-months. Dependent patients were more likely to be older, with a higher burden of pre-morbid conditions, and with increased blood pressure variability. Enhanced casual standard deviations of diastolic blood pressure [1.19 (1.02 to 1.39)] and mean arterial pressure [1.20 (1.00 to 1.43)] predicted dependency at 1-month. Predictors of 12-month dependency included: enhanced casual standard deviation of mean arterial pressure [1.21 (1.0-1.46)]; 24-hour ambulatory monitor standard deviations of diastolic blood pressure [2.30 (1.08-4.90)] and mean arterial pressure [1.72 (1.09-2.72)], and the coefficient of variation of mean arterial pressure [1.76 (1.05-2.94)]; day-time ambulatory monitor coefficient of variation of systolic blood pressure [1.44 (1.02-2.03)] and mean arterial pressure [1.46 (1.02-2.08)]; and night-time ambulatory standard deviation of diastolic blood pressure [1.65 (1.03 -2.63)], and the coefficient of variation of mean arterial pressure and [1.38 (1.00- 1.90)] and pulse pressure [1.29 (1.00–1.65)]. Conclusion: Increasing blood pressure variability is independently and modestly associated with poor functional outcome at 1- and 12-months following acute stroke

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Non-market Strategies and Building Digital Trust in Sharing Economy Platforms

Although research on non-market strategies and the sharing economy (SE) have grown exponentially, there remains limited insight on how actors in the sharing economy ecosystem engage in non-market activities to achieve their goals. In this paper, we develop and present digital trust building as a crucial building block of a successful sharing economy ecosystem. We develop a conceptual framework to highlight the different non-market strategies that sharing economy platform providers (SEPPs) cultivate and leverage trust for enhanced performance among stakeholders in the sharing economy

Effects of two Exercise Training Techniques on Walking Function In Adult Patients with Stroke

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Nosocomial infections: knowledge and source of information among clinical health care students in Ghana

Ajediran I Bello1, Eunice N Asiedu1, Babatunde OA Adegoke2, Jonathan NA Quartey1, Kwadwo O Appiah-Kubi1, Bertha Owusu-Ansah11Department of Physiotherapy, School of Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana; 2Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, NigeriaBackground: This study determined and compared the knowledge of nosocomial infections among clinical health care students at the College of Health Sciences, University of Ghana.Methods: Two hundred undergraduate health care students from four academic programs participated in the study. The study sample was drawn from each academic program by a simple random sampling technique using the class directory from each course. The Infection Control Standardized Questionnaire (ICSQ) was used to assess the knowledge of students about three main domains, ie, hand hygiene, nosocomial infections, and standard precautions. A maximum score of 50 was obtainable, and respondents with scores &amp;ge;70% were classified as having a satisfactory knowledge. The response on each item was coded numerically to generate data for statistical analysis. Comparison of knowledge on the domains among categories of students was assessed using the Kruskal&amp;ndash;Wallis test, while associations between courses of study and knowledge about nosocomial infections were determined using the Chi-square test. All statistical tests had a significant level of 5% (P &amp;lt; 0.05)Results: Overall mean percentage score of the participants on ICSQ was 65.4 &amp;plusmn; 2.58, with medical, physiotherapy, radiography, and nursing students recording mean percentage scores of 70.58 &amp;plusmn; 0.62, 65.02 &amp;plusmn; 2.00, 64.74 &amp;plusmn; 1.19, and 61.31 &amp;plusmn; 2.35, respectively. The main source of information about the prevention of nosocomial infections as cited by participants was their routine formal training in class. There was no significant association (P &amp;gt; 0.05) between course of study and knowledge of students about preventive measures for nosocomial infections.Conclusion: The students sampled demonstrated moderate knowledge of nosocomial infections and this was acquired largely through formal classroom training. These findings underscore the need for more emphasis on education about this important source of infection in the clinical training curriculum.Keywords: knowledge, prevention, nosocomial infection

CERVICAL ERECTOR SPINAE INTERMUSCULAR COORDINATIONWHILE USING NOISE CANCELLATION HEADPHONES DURING WALKING

Kia Golzari1, Ali Boolani2, Zacharias Papadakis3, Sergi Garcia-Retortillo4, Andreas Stamatis, FACSM5, Emily Locke2, Ryan McCarthy2, Kwadwo Osei Appiah-Kubi2, Ahmed Kadry2, Ahmed Torad2, Mostafa Elwan2, Hugo Posada-Quintero1. 1University of Connecticut, Storrs, CT. 2Clarkson University, Potsdam, NY. 3Barry University, Miami Shores, FL. 4Wake Forest University, Winston-Salem, NC. 5State University of New York Plattsburgh, Plattsburgh, NY. BACKGROUND: People that want to “zone-out” may use noise cancellation headphones. Balance between primary and secondary stabilizing muscles ensures proper body posture free of musculoskeletal problems. Headphones use may be a neck stressor placing increased weight on cervical spinae muscles altering their stabilizing effect. The intermuscular coordination of the cervical erector spinae using headphones while walking is unexplored. METHODS: Participants (M = 13, F= 13, age = 21 ± 6 yrs) asked to walk (20-meter track for 30 minutes), while wearing noise cancellation headphones. Electromyographic (EMG) activity from right and left cervical erector (CER, CEL) was collected. For each muscle and at a 5-min interval, we obtained 10 time series of EMG band power. For each pair of EMG frequency bands between CER and CEL, cross-frequency interactions among EMG frequency bands were examined by bivariate equal-time Pearson’s cross-correlations. Hierarchical structure of the network’s links strength was dissected into separate network modules for low (F1, F2, F3), intermediate (F4, F5, F6, F7), and high (F8, F9, F10) EMG frequency bands, representing the activation of different muscle fiber types. RESULTS: The CER-CEL network showed a hierarchical organization with a clear stratification profile, with corresponding dominant links strength interactions to low-low ([F1-F2]—[F1-F2]), intermediate-high ([F3-F7]—[F8-F10]) and high-high ([F8-F10]—[F8-F10]) EMG frequency bands. While this hierarchical organization is preserved across the six 5-min intervals, the average link strength of the CER-CEL network is significantly reduced for all network modules (p \u3c 0.05). CONCLUSION: The CER-CEL network shows overexpressed/excessive inter-muscular connectivity at the beginning of the trial, reflecting reduced efficiency and lower degree of adaptability (i.e., rigidity) due to headphones’ use. As participants get adapted to the walking and the headphones, the CER-CEL network becomes sparser, indicating improved intermuscular network functionality. Neck musculature needs approximately 10 minutes to acclimate to the weight of the headphones. Clinicians working with people, who have vestibular issues, may place a weight in the form of headphones (or comparable apparatus/weight) while performing walking activities to facilitate neural activity of the cervical extensors through the process of vestibular adaptation and/or habituation