Effects of footwear variations on three-dimensional kinematics and tibial accelerations of specific movements in American football

American football is associated with a high rate of non-contact chronic injuries. Players are able to select from both high and low cut footwear. The aim of the current investigation was to examine the influence of high and low cut American football specific footwear on tibial accelerations and three-dimensional (3D) kinematics during three sport specific movements. Twelve male American football players performed three movements, run, cut and vertical jump whilst wearing both low and high cut footwear. 3D kinematics of the lower extremities were measured using an eight-camera motion analysis system alongside tibial acceleration parameters which were obtained using a shank mounted accelerometer. Tibial acceleration and 3D kinematic differences between the different footwear were examined using either repeated measures or Friedman’s ANOVA. Tibial accelerations were significantly greater in the low cut footwear in comparison to the high cut footwear for the run and cut movements. In addition, peak ankle eversion and tibial internal rotation parameters were shown to be significantly greater in the low cut footwear in the running and cutting movement conditions. The current study indicates that the utilization of low cut American football footwear for training/performance may place American footballers at increased risk from chronic injuries

Integrating Palliative Care Into the Care of Neurocritically Ill Patients: A Report From the Improving Palliative Care in the ICU Project Advisory Board and the Center to Advance Palliative Care.

OBJECTIVES: To describe unique features of neurocritical illness that are relevant to provision of high-quality palliative care; to discuss key prognostic aids and their limitations for neurocritical illnesses; to review challenges and strategies for establishing realistic goals of care for patients in the neuro-ICU; and to describe elements of best practice concerning symptom management, limitation of life support, and organ donation for the neurocritically ill. DATA SOURCES: A search of PubMed and MEDLINE was conducted from inception through January 2015 for all English-language articles using the term palliative care, supportive care, end-of-life care, withdrawal of life-sustaining therapy, limitation of life support, prognosis, or goals of care together with neurocritical care, neurointensive care, neurological, stroke, subarachnoid hemorrhage, intracerebral hemorrhage, or brain injury. DATA EXTRACTION AND SYNTHESIS: We reviewed the existing literature on delivery of palliative care in the neurointensive care unit setting, focusing on challenges and strategies for establishing realistic and appropriate goals of care, symptom management, organ donation, and other considerations related to use and limitation of life-sustaining therapies for neurocritically ill patients. Based on review of these articles and the experiences of our interdisciplinary/interprofessional expert advisory board, this report was prepared to guide critical care staff, palliative care specialists, and others who practice in this setting. CONCLUSIONS: Most neurocritically ill patients and their families face the sudden onset of devastating cognitive and functional changes that challenge clinicians to provide patient-centered palliative care within a complex and often uncertain prognostic environment. Application of palliative care principles concerning symptom relief, goal setting, and family emotional support will provide clinicians a framework to address decision making at a time of crisis that enhances patient/family autonomy and clinician professionalism

Safety and efficacy of a testosterone patch for the treatment of hypoactive sexual desire disorder in surgically menopausal women: a randomized, placebo-controlled trial.

Background: Oophorectomy reduces serum testosterone levels. We studied the efficacy and safety of transdermal testosterone in treating hypoactive sexual desire disorder in surgically menopausal women

Nurse-Initiated Treatment Reduces Costs for Acute Asthma in a Pediatric Emergency Department

Standardized emergency department (ED) pathways can improve care delivery to children with acute asthma, though their impact on hospitalization and costs is unclear. An Acute Asthma Care Pathway (AACP) that facilitates nurse initiation of treatment was implemented at a tertiary care pediatric ED using standard quality improvement methodology. The impact of implementation was assessed using process control methodology and multivariable time series analyses between pre- and post-implementation periods. Provision of a steroid within 30 minutes and 60 minutes of arrival increased by 21 and 22 percentage points respectively, IV magnesium sulfate administration increased by 30 percentage points, the proportion hospitalized decreased from 44.8% to 32.2%, and mean direct costs per patient decreased from $2,663 to$2,303 (13.5%). In multivariable analysis, these improvements remained significant. Implementation of the AACP improved timeliness of treatment, hospitalization, and direct costs of children receiving ED treatment for acute asthma

A Cohort Study of Public Health Insurance Coverage Loss among Oregon Adolescents

ABSTRACT Introduction: Churning on and off and/or experiencing coverage gaps is common among public health insurance recipients. Although the Affordable Care Act (ACA) provisions to extend parental coverage for adolescents transitioning to young adulthood on private insurance plans were implemented in 2010, no such protection was mandated for adolescents with public health insurance. Methods: Oregon public health insurance enrollment and electronic health record data from community health centers were used to conduct a retrospective, observational cohort study of Oregon adolescents (17-19 years of age) with public coverage [January 1, 2011-December 31, 2013 (n=51,988)] to assess loss. Time-to-event methods determined the association of coverage loss with sociodemographic characteristics. Results: Although adolescents are vulnerable to coverage loss as they age out of child public health insurance coverage, \u3e35% of 19 year olds in this study kept their coverage for up to one year after their 19th birthday. Conclusions: Our findings suggest that the support many community health centers offer to help their patients maintain insurance coverage may be having an impact, especially during this important transition period. Additional research to understand how these 19 year olds were able to keep coverage will provide recommendations for future adolescents as they transition to young adulthood

Maternal effects on anogenital distance in a wild marmot population

Peer reviewedPublisher PD

Does the risk of cerebral palsy increase or decrease with increasing gestational age?

BACKGROUND: It is generally accepted that the risk of cerebral palsy decreases with increasing gestational age of live born infants. However, recent studies have shown that cerebral palsy often has prenatal antecedents including congenital malformations, vascular insults and maternal infection. Cerebral palsy is therefore better viewed as occurring among fetuses, rather than among infants. We explored the epidemiologic implications of this change in perspective. METHODS: We used recently published data from Shiga Prefecture, Japan and from North-East England to examine the pattern of gestational age-specific rates of cerebral palsy under these alternative perspectives. We first calculated gestational age-specific rates of cerebral palsy as per convention, by dividing the number of cases of cerebral palsy identified among live births within any gestational age category by the number of live births in that gestational age category. Under the alternative formulation, we calculated gestational age-specific rates of cerebral palsy by dividing the number of cases of cerebral palsy identified among live births within any gestational age category by the number of fetuses who were at risk of being born at that gestation and being afflicted with cerebral palsy. RESULTS: Under the conventional formulation, cerebral palsy rates decreased with increasing gestational age from 63.9 per 1,000 live births at <28 weeks gestation to 0.9 per 1,000 live births at 37 or more weeks gestation. When fetuses were viewed as potential candidates for cerebral palsy, cerebral palsy rates increased with increasing gestational age from 0.08 per 1,000 fetuses at risk at <28 weeks gestation to 0.9 per 1,000 fetuses at risk at 37 or more weeks gestation. CONCLUSIONS: The fetuses-at-risk approach is the appropriate epidemiologic formulation for calculating the gestational age-specific rate of cerebral palsy from a causal perspective. It shows that the risk of cerebral palsy increases as gestational duration increases. This compelling view of cerebral palsy risk may help refocus research aimed at understanding and preventing cerebral palsy

The consistency between treatments provided to nursing facility residents and orders on the physician orders for lifesustaining treatment form. J Am Geriatr Soc

OBJECTIVES: To evaluate the consistency between treatments provided and Physician Orders for Life-Sustaining Treatment (POLST) orders. DESIGN: Retrospective chart abstraction. SETTING: Stratified, random sample of 90 nursing facilities in Oregon, Wisconsin, and West Virginia. PARTICIPANTS: Eight hundred seventy living and deceased nursing facility residents aged 65 and older with a minimum 60-day stay. MEASUREMENTS: Chart data about POLST form orders and related treatments over a 60-day period were abstracted. Decision rules were created to determine whether the rationale for each treatment was consistent with POLST orders. RESULTS: Most residents (85.2%) had the same POLST form in place during the review period. A majority of treatments provided to residents with orders for comfort measures only (74.3%) and limited antibiotics (83.3%) were consistent with POLST orders because they were primarily comfort focused rather than life-prolonging, but antibiotics were provided to 32.1% of residents with orders for no antibiotics. Overall consistency rates between treatments and POLST orders were high for resuscitation (98%), medical interventions (91.1%), and antibiotics (92.9%) and modest for feeding tubes (63.6%). In all, POLST orders were consistent with treatments provided 94.0% of the time. CONCLUSION: With the exception of feeding tubes and antibiotic use in residents with orders for no antibiotics, the use of medical treatments was nearly always consistent with POLST orders to provide or withhold life-sustaining interventions. The POLST program is a useful tool for ensuring that the treatment preferences of nursing facility residents are honored. J Am Geriatr Soc 59:2091-2099, 2011. Key words: ethics; end of life; comfort care; palliative care; nursing facility A primary goal of advance care planning is to ensure that treatments are consistent with patient preferences near the end of life. Advance directives have been promoted as an important advance care planning tool that enables individuals to record their preferences to guide treatment decisions in the event of incapacitation, but research suggests that advance directives are generally ineffective at ensuring that treatment preferences are honored because of numerous limitations. 1-3 An alternative approach is the use of medical orders such as do not resuscitate (DNR) that communicate preferences in a format that other healthcare professionals can follow. However, such orders typically focus on one type of life-sustaining treatment and do not address the broad range of potential treatments that may be needed