Toe metastasis: A rare pattern of cervical cancer spread

• Toe metastasis is a rare pattern of cervical cancer spread. • Enlarged erythematous toe is an important sign suggesting bone metastasis. • Toe metastasis represents a grave prognostic indicator of cervical cancer

Anesthesia-to-Post Anesthesia Care Unit Handoff Standardization

Abstract The exchange of medical information from one medical professional to another is known as the handoff. Communication errors during the transition period of handoffs can lead to medication errors, delays in care, high stress within the work environment, and increased burnout of the nursing staff. Approximately 1,744 deaths and a total of $1.7 billion in malpractice costs were related to healthcare communication failures from 2012 to 2017. One of the areas of the hospital where effective handoffs are critically important, given the high frequency, is in the post-anesthesia care unit (PACU). Major organizations such as the Joint Commission, the World Health Organization, and the American Association of Nurse Anesthetists have created goals to standardize PACU handoffs in efforts to address the problem. PACU handoff standardization has also been voiced as a priority for the project organization. The purpose of this evidence-based quality improvement project is to implement a standardized handoff tool at the project organization site. After searching for and critically appraising the literature, the project team will implement the Written Anesthesia Handoff Tool (WHAT). This project’s development, implementation, and evaluation will be guided by a framework called the Evidence-Based Practice Improvement Model. The aim of the project is increasing nurse satisfaction with the utilization of a handoff tool. The goals of the project are to implement a checklist as a handoff tool to evaluate nurse satisfaction before and after the handoff tool is implemented. Keywords: handoff, post-anesthesia care unit, PACU, PACU handoffs, standardization, PACU handoff standardization, standardized handoff, Evidence-Based Practice Improvement Model, Written Anesthesia Handoff Tool, WHAT Tool, handoff tool, handoff checklist, nurse satisfactio

The miscarriage circle of care:towards leveraging online spaces for social support

BACKGROUND: Lack of social support during and after miscarriage can greatly affect mental wellbeing. With miscarriages being a common experience, there remains a discrepancy in the social support received after a pregnancy is lost. METHOD: 42 people who had experienced at least one miscarriage took part in an Asynchronous Remote Community (ARC) study. The study involved 16 activities (discussions, creative tasks, and surveys) in two closed, secret Facebook groups over eight weeks. Descriptive statistics were used to analyse quantitative data, and content analysis was used for qualitative data. RESULTS: There were two main miscarriage care networks, formal (health care providers) and informal (friends, family, work colleagues). The formal care network was the most trusted informational support source, while the informal care network was the main source of tangible support. However, often, participants’ care networks were unable to provide sufficient informational, emotional, esteem, and network support. Peers who also had experienced miscarriage played a crucial role in addressing these gaps in social support. Technology use varied greatly, with smartphone use as the only common denominator. While there was a range of online support sources, participants tended to focus on only a few, and there was no single common preferred source. DISCUSSION: We propose a Miscarriage Circle of Care Model (MCCM), with peer advisors playing a central role in improving communication channels and social support provision. We show how the MCCM can be used to identify gaps in service provision and opportunities where technology can be leveraged to fill those gaps

Determinants of Time to Fatigue during Non-Motorized Treadmill Exercise

Treadmill exercise is commonly used for aerobic and anaerobic conditioning. During non-motorized treadmill exercise, the subject must provide the power necessary to drive the treadmill belt. The purpose of this study was to determine what factors affected the time to fatigue on a pair of non-motorized treadmills. Twenty subjects (10 males/10 females) attempted to complete five minutes of locomotion during separate trials at 3.22, 4.83, 6.44, 8.05, 9.66, and 11.27 km (raised dot) h(sup -1). Total exercise time (less than or equal to 5 min) was recorded. Exercise time was converted to the amount of 15 second intervals completed. Peak oxygen uptake (VO2) was measured using a graded exercise test on a standard treadmill, and anthropometric measures were collected from each subject before entering into the study. A Cox proportional hazards regression model was used to determine significant predictive factors in a multivariate analysis. Non-motorized treadmill speed and absolute peak VO2 were found to be significant predictors of exercise time, but there was no effect of anthropometric characteristics. Gender was found to be a predictor of treadmill time, but this was likely due to a higher peak VO2 in males than in females. These results were not affected by the type of treadmill tested in this study. Coaches and therapists should consider the cardiovascular fitness of an athlete or client when prescribing target speed since these factors are related to the total exercise time than can be achieved on a non-motorized treadmill

Roughness and wettability of surfaces in boundary lubricated scuffing wear

The diversity of multidisciplinary approaches suggests that fundamentals of scuffing require systemic, complex multi-scale and multi-physics analysis of an irreversible process as it is postulated in present study. That is probably one of the reasons of lack of unequivocal model of this irreversible transitional process from stable more or less lubricated wear to scuffing described only by one or few authors in equation(s) form. Therefore, it is useful to characterize the tribological surface properties in frame of systemic approach looking simultaneously for the optimal compromise between rheological, morphological and physicochemical features of contacting surface's layer. Hypothetical role connected to any group of features in the topological approach is elucidated and experimentally confirmed via the wettability, strongly combined with surface roughness and surface free energy. Due to the fact that the free energy is directly related to the surface wettability it can as well affect the scuffing activation process. For scientific and rhetoric reasons some selected results of limited boundary lubrication investigations under double blind trial conditions in case of gear oil with anti-wear (AW) and extreme pressure (EP) additives are elucidated here. The results issued from scuffing tests on AISI 4140 ground steel burnished under different forces in order to generate different surface roughness, residual stresses and surface energy are analysed. It was stated and numerically correlated that the wettability by lubricating medium influences the scuffing resistance. Additionally, the dependence of wettability on selected parameters of roughness and a time to scuffing activation have been stated. On that basis, it is proposed to reinforce concept of "oleophilic" and "oleophobic" properties of metallic surfaces as autonomous invariants determining the activation of catastrophic wear process under boundary lubricated conditions

On the use of CO2 laser induced surface patterns to modify the wettability of Poly(methyl methacrylate) (PMMA)

CO2 lasers can be seen to lend themselves to materials processing applications and have been used extensively in both research and industry. This work investigated the surface modification of PMMA with a CO2 laser in order to vary the wettability characteristics. The wettability characteristics of the PMMA were modified by generating a number of patterns of various topography on the surface using the CO2 laser. These induced patterns were trench and hatch with scan dimensions of 50 and 100 μm. Through white light interferometry it was found that for all laser patterned samples the surface roughness had significantly increased by up to 3.1 μm. The chemical composition of selected samples were explored using X-ray photoelectron spectroscopy and found that the surface oxygen content had risen by approximately 4% At. By using a sessile drop device it was found that, in comparison to the as-received sample, 50 μm dimensions gave rise to a more hydrophilic surface; whereas 100 μm dimensions gave rise to either no change in contact angle or an increase making the PMMA hydrophobic. This can be explained by combinations of surface roughness and γp contributing to the observed contact angle, in addition to the possibility of different wetting regimes taking place owed to the variation of topographies over the as-received and laser patterned samples

Kinematic Differences Between Motorized and Nonmotorized Treadmill Locomotion

There are few scientific publications comparing human locomotion between motorized and nonmotorized treadmills. Lakomy (1987) and Gamble et al (1988) reported that forward lean is greater on a nonmotorized treadmill to aid in the generation of horizontal force necessary for belt propulsion, but there are no data concerning lower limb kinematics. During long-term spaceflight, astronauts use locomotive exercise to mitigate the physiological effects caused by long-term exposure to microgravity. A critical decision for mission planners concerns the requirements for a treadmill to be used during potential trips to the Moon and Mars. Treadmill operation in an un-powered configuration could reduce mission resource demands, but also may impact the efficacy of treadmill exercise countermeasures. To ascertain the most appropriate type of treadmill to be used, it is important to understand biomechanical differences between motorized (M) and nonmotorized (NM) locomotion. The purpose of this evaluation was to test for differences in lower limb kinematics that occur during M and NM treadmill locomotion at two speeds. It was hypothesized that hip and knee joint angle trajectories would differ between the conditions

Immersed superhydrophobic surfaces: Gas exchange, slip and drag reduction properties

Superhydrophobic surfaces combine high aspect ratio micro- or nano-topography and hydrophobic surface chemistry to create super water-repellent surfaces. Most studies consider their effect on droplets, which ball-up and roll-off. However, their properties are not restricted to modification of the behaviour of droplets, but potentially influence any process occurring at the solid-liquid interface. Here, we highlight three recent developments focused on the theme of immersed superhydrophobic surfaces. The first illustrates the ability of a superhydrophobic surface to act as a gas exchange membrane, the second demonstrates a reduction in drag during flow through small tubes and the third considers a macroscopic experiment demonstrating an increase in the terminal velocity of settling spheres

NEOLAF, an LLM-powered neural-symbolic cognitive architecture

This paper presents the Never Ending Open Learning Adaptive Framework (NEOLAF), an integrated neural-symbolic cognitive architecture that models and constructs intelligent agents. The NEOLAF framework is a superior approach to constructing intelligent agents than both the pure connectionist and pure symbolic approaches due to its explainability, incremental learning, efficiency, collaborative and distributed learning, human-in-the-loop enablement, and self-improvement. The paper further presents a compelling experiment where a NEOLAF agent, built as a problem-solving agent, is fed with complex math problems from the open-source MATH dataset. The results demonstrate NEOLAF's superior learning capability and its potential to revolutionize the field of cognitive architectures and self-improving adaptive instructional systems