Alien Registration- Keegan, Annie T. (Bangor, Penobscot County)

https://digitalmaine.com/alien_docs/11960/thumbnail.jp

Critical care support of patients with nicotine addiction

Over 500 million of the current world population will die from diseases caused by smoking cigarettes. The symptoms and signs of nicotine withdrawal are not well described in the critically ill. Since the various conditions of critical illness may lead to clinical manifestations mimicking nicotine withdrawal, describing its specific manifestations may not be easy. A few case reports suggest that nicotine replacement therapy may ameliorate nicotine withdrawal in the critically ill. However, retrospective studies have found that it may increase mortality. Despite the abundance of active smokers, there is a paucity of data describing nicotine withdrawal, and its prevention and treatment options in the critically ill. Future studies are warranted to address these issues

Secondary acute lymphoblastic leukemia is a distinct clinical entity with prognostic significance.

The effect of prior malignancy on the risk of developing, and prognosis of, acute lymphoblastic leukemia (ALL) is unknown. This observational study utilized the California Cancer Registry to estimate the risk of developing ALL after a prior malignancy using standardized incidence ratios (SIRs, 95% confidence intervals). ALL occurring after a malignancy with an SIR>1 (increased-risk (IR) malignancies) was considered secondary ALL (s-ALL). Adjusted hazard ratios (aHRs, 95% confidence intervals) compared the effect of s-ALL with de novo ALL on overall survival. A total of 14 481 patients with ALL were identified (1988-2012) and 382 (3%) had a known prior malignancy. Any prior malignancy predisposed patients to developing ALL: SIR 1.62 (1.45-1.79). Hematologic malignancies (SIR 5.57, 4.38-6.98) and IR-solid tumors (SIR 2.11, 1.73-2.54) increased the risk of developing ALL. s-ALL increased the risk of death compared with de novo ALL (aHR 1.38 (1.16-1.63)) and this effect was more pronounced among younger patients (age<40 years: aHR 4.80 (3.15-7.30); age⩾40 years: aHR 1.40 (1.16-1.69)) (interaction P<0.001). This population-based study demonstrates that s-ALL is a distinct entity that occurs after specific malignancies and carries a poor prognosis compared with de novo ALL, particularly among patients <40 years of age

Exploring socioeconomic inequities in access to palliative and end-of-life care in the UK: a narrative synthesis

Background: Efforts inequities in access to palliative and end-of-life care require comprehensive understanding about the extent of and reasons for inequities. Most research on this topic examines differences in receipt of care. There is a need, particularly in the UK, for theoretically driven research that considers both receipt of care and the wider factors influencing the relationship between socioeconomic position and access to palliative and end-of-life care. Methods: This is a mixed studies narrative synthesis on socioeconomic position and access to palliative and end-of-life care in the UK. Study searches were conducted in databases AMED, Medline, Embase, CINAHL, SocIndex, and Academic Literature Search, as well as grey literature sources, in July 2020. The candidacy model of access, which describes access as a seven-stage negotiation between patients and providers, guided study searches and provided a theoretical lens through which data were synthesised. Results: Searches retrieved 5303 studies (after de-duplication), 29 of which were included. The synthesis generated four overarching themes, within which concepts of candidacy were evident: identifying needs; taking action; local conditions; and receiving care. Conclusion: There is not a consistent or clear narrative regarding the relationship between socioeconomic position and receipt of palliative and end-of-life care in the UK. Attempts to address any inequities in access will require knowledge and action across many different areas. Key evidence gaps in the UK literature concern the relationship between socioeconomic position, organisational context, and assessing need for care

Aeromedical Issues in Diabetic Aviators

Diabetes mellitus is a common disease that poses a serious health and safety threat to civilian aviators. Complications secondary to diabetes can be severe and result in sudden incapacitation. The Federal Aviation Administration (FAA) has developed regulations for certifying aviators with diabetes, as well as guidelines for in-flight management of blood glucose levels. Advances in medical technology have led to treatments and countermeasures for diabetes that enable many individuals to engage in physically and mentally demanding activities. This paper presents a basic overview of the pathophysiology, diagnosis, and management of diabetes mellitus in civil aviators. In addition, current FAA regulations for medical certification and blood glucose management will be outlined

THE EFFECTS OF MARKER SIZE ON THE ACCURACY OF THE ARlEL PERFORMANCEANALYSIS SYSTEM (APASTM)

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THE EFFECTS OF MARKER SIZE ON THE ACCURACY OF THE ARlEL PERFORMANCEANALYSIS SYSTEM (APAStm)

INTRODUCTION In order to increase the efficiency of today's motion analysis systems, most systems are capable of auto digization. In order for the APAS system to auto digitize, retroreflective markers must be used for accurate tracing of the movement. During auto digization, the computer's software will search a given area for pixels that are above a pre-determined light threshold. From these threshold pixels, the software will calculate the center of the marker. To increase the accuracy of the measurements, it has been suggested that the larger the marker, the more accurate the measurement. The purpose of this study was to examine the effects of marker size on the accuracy of the APAS system. METHODS Eight retroreflective markers were placed upon an inverted T-shaped pendulum. Tbelve reference angles were calculated from these markers. Four different starting positions were used (static, a 45 deg, a 90 deg, and a 120 deg. release position) while using four different marker sizes (0.45,0.95, 1.27, and 1.91 cm.) for a total of 16 different conditions. Ten trials were done for each condition. Tbenty frames were auto-digitized from each trial. Frame 10 represented the low point of the trajectory for the dynamic conditions. Deviations were calculated by taking the average angle over the 20 frames and subtracting it from the reference angle. The data was analyzed using a Mixed Effects ANOVA. Inter-trial variability was determined by subtracting the reconstructed angle from the reference angle on a frame by frame basis. RESULTS Significance was found in the ANOVA of marker [F (3,1893) = 6.39, p < 0.00031 and position [F (3,1893) = 350.41, p < 0.00011. Contrast tests indicate that markers 1-3 were all statistically different from marker 4 (p < 0.001, p < 0.0003, p < 0.0106). The least square means of marker showed that as the marker size increased the deviation on average decreased (0.4339 deg. to 0.3883 deg.). Examination of the inter-trial variability showed that the variability increased from the static position up to the 120 deg. position. CONCLUSION Marker size was shown to have a significant effect upon the accuracy of the APAS system. Examination of the least square means seems to indicate that the smallest marker size had the most error and the largest marker size had the least error. It should be noted though that regardless of marker size the error was no greater than 0.5 degrees. For most motion analysis procedures an error of this magnitude is probably an acceptable error