Focus on optimal health, not ideal health

Providers strive to help patients live the best, healthiest life they are capable of living. However, those efforts should involve a careful assessment of what the patient’s optimal health status is. It is deleterious to the therapeutic relationship to drive a patient towards a health status they are not able to attain. This article provides a brief commentary on the author’s experience as a patient to illustrate this point. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Learning Factories 4.0 in technical vocational schools: can they foster competence development?

Learning Factories 4.0 are thought to prepare vocational students for the challenges of Industry 4.0. The implementation of those interconnected Learning Factories 4.0 at technical vocational schools may promote the development of subject-related technical competencies as well as multidisciplinary digital competencies. Still, research is scarce with regard to the development of competencies supported through Learning Factories 4.0 in technical vocational schools. Hence this research focusses on subject-related technical and multidisciplinary digital competencies of technical vocational students change due to different levels of Learning Factory 4.0 interaction over time. Three subsequent competence tests with N = 63 technical vocational students were conducted. Findings indicate the benefits of integrating Learning Factories 4.0 for developing subject-related competencies in technical vocational schools. However, the study could not identify a positive development of multidisciplinary digital competencies. The findings of this study can help educators to further develop learning environments with support from Learning Factories 4.0 as well as preparing their learners for the demanding competencies of Industry 4.0

study protocol for two randomized pragmatic trials

Background Chronic low back pain (LBP) and neck pain (NP) are highly prevalent conditions resulting in high economic costs. Treatment guidelines recommend relaxation techniques, such as progressive muscle relaxation, as adjuvant therapies. Self-care interventions could have the potential to reduce costs in the health care system, but their effectiveness, especially in a usual care setting, is unclear. The aim of these two pragmatic randomized studies is to evaluate whether an additional app-delivered relaxation is more effective in the reduction of chronic LBP or NP than usual care alone. Methods/design Each pragmatic randomized two-armed study aims to include a total of 220 patients aged 18 to 65 years with chronic (>12 weeks) LBP or NP and an average pain intensity of ≥ 4 on a numeric rating scale (NRS) in the 7 days before recruitment. The participants will be randomized into an intervention and a usual care group. The intervention group will be instructed to practice one of these 3 relaxation techniques on at least 5 days/week for 15 minutes/day over a period of 6 months starting on the day of randomization: autogenic training, mindfulness meditation, or guided imagery. Instructions and exercises will be provided using a smartphone app, baseline information will be collected using paper and pencil. Follow-up information (daily, weekly, and after 3 and 6 months) will be collected using electronic diaries and questionnaires included in the app. The primary outcome measure will be the mean LBP or NP intensity during the first 3 months of intervention based on daily pain intensity measurements on a NRS (0 = no pain, 10 = worst possible pain). The secondary outcome parameters will include the mean pain intensity during the first 6 months after randomization based on daily measurements, the mean pain intensity measured weekly as the average pain intensity of the previous 7 days over 3 and 6 months, pain acceptance, ‘LBP- and NP-related’ stress, sick leave days, pain medication intake, adherence, suspected adverse reaction, and serious adverse events. Discussion The designed studies reflect a usual self- care setting and will provide evidence on a pragmatic self-care intervention that is easy to combine with care provided by medical professionals

Relationship between corneal tissue and shape in short-term soft contact lens wear

AbstractPurposeTo investigate which morphometric and ocular surface tissue parameters are affected by short‐term soft contact lens (CL) wear and to assess whether they carry related or independent information.MethodsTwenty‐two healthy participants wore silicone hydrogel (SiHy; MyDay, CooperVision) soft CLs for 8 h in their left eye. Corneal tomography and corneoscleral topography were captured before and immediately after CL wear. Central corneal thickness (CCT), corneoscleral parameters (limbus position and corneoscleral junction [CSJ] angle) and corneal tissue parameters (corneal transparency and homogeneity) were evaluated.ResultsCorneoscleral parameters (limbus position and CSJ angle) were independent of corneal tissue parameters (transparency and homogeneity) at baseline and after CL wear. CCT was independent of all the other parameters examined at baseline, but baseline values of corneal tissue parameters were moderately correlated with CCT change (transparency: r = −0.51; p = 0.007), homogeneity: r = −0.46; p = 0.02).ConclusionsA complete characterisation of ocular surface changes following CL wear should consider corneoscleral topography and corneal densitometry simultaneously, since they carry complementary information

Temperature dependence of the energy dissipation in dynamic force microscopy

The dissipation of energy in dynamic force microscopy is usually described in terms of an adhesion hysteresis mechanism. This mechanism should become less efficient with increasing temperature. To verify this prediction we have measured topography and dissipation data with dynamic force microscopy in the temperature range from 100 K up to 300 K. We used 3,4,9,10-perylenetetracarboxylic-dianhydride (PTCDA) grown on KBr(001), both materials exhibiting a strong dissipation signal at large frequency shifts. At room temperature, the energy dissipated into the sample (or tip) is 1.9 eV/cycle for PTCDA and 2.7 eV/cycle for KBr, respectively, and is in good agreement with an adhesion hysteresis mechanism. The energy dissipation over the PTCDA surface decreases with increasing temperature yielding a negative temperature coefficient. For the KBr substrate, we find the opposite behaviour: an increase of dissipated energy with increasing temperature. While the negative temperature coefficient in case of PTCDA agrees rather well with the adhesion hysteresis model, the positive slope found for KBr points to a hitherto unknown dissipation mechanism

Cortical thickness of planum temporale and pars opercularis in native language tone processing

The present study investigated the relationship between linguistic tone processing and cortical thickness of bilateral planum temporale (PT) and pars opercularis of the inferior frontal gyrus (IFGpo). Swedish tones on word stems function as cues to upcoming endings. Correlating structural brain imaging data with participants’ response time patterns for suffixes, we found that thicker cortex in the left PT was associated with greater reliance on tones to anticipate upcoming inflections on real words. On inflected pseudoword stems, however, the cortical thickness of left IFGpo was associated with tone-suffix processing. Thus cortical thickness of the left PT might play a role in processing tones as part of stored representations for familiar speech segments, most likely when inflected forms are accessed as whole words. In the absence of stored representations, listeners might need to rely on morphosyntactic rules specifying tone-suffix associations, potentially facilitated by greater cortical thickness of left IFGpo