A Case Report of Acute Heart Failure Due to Infective Aortic Endocarditis Diagnosed by Point-of-care Ultrasound

Introduction: Infective endocarditis (IE) is a life-threatening condition with significant morbidity and mortality, and can require surgical repair.Case Report: A 36-year-old man presented to the emergency department for worsening dyspnea and chest pain. Point-of-care echocardiography demonstrated a mobile oscillating mass on the aortic valve with poor approximation of the valve leaflets, suggesting aortic valve insufficiency secondary to IE as the cause of acute heart failure. The patient underwent emergent aortic valve replacement within 24 hours.Discussion: While point-of-care echocardiography has been well documented in identifying tricuspid vegetations, aorticvalve involvement and subsequent heart failure is less well described. Earlier recognition of aortic valve vegetations and insufficiency can expedite surgical intervention, with decreased complication rates linked to earlier antimicrobial therapy.Conclusion: This case report highlights the ability of point-of-care ultrasound to identify aortic vegetations, allowing for the earlier diagnosis and therapy

Comparison of an ankle-foot-orthosis and neuroprosthesis during level and non-level walking for individuals post-stroke

This study used gait analysis to compare the efficacy of the two foot drop treatments (ankle-foot-orthosis and neuroprosthesis) and to contrast the stimulation control of the two different neuroprosthesis sensors during level and non-level ambulation of post-stroke individuals. Eight subjects completed two gait analysis sessions, once while using a study-provided articulated AFO and the other while using a WalkAide. After four weeks of acclimation to the device, each subject performed two minute walking trials on a level, inclined and declined treadmill. Kinematic and heart rate data were collected for all sessions. Plantar pressure and WalkAide tilt, heel loading, and stimulation timing data were collected during WalkAide sessions. Temporal parameters, kinematic gait asymmetry (GA), toe clearance, as well as WalkAide stimulation reliability (StR) and stimulation timing, were computed from Vicon and WalkAide data. Wilcoxon signed rank and Friedman tests were conducted to identify significant differences between treatments and amongst treadmill orientations, respectively. Significantly greater minimum and mean ankle GA during initial swing was observed during AFO versus WalkAide ambulation for all treadmill orientations. Further analysis revealed that the ankle range of motion between affected and unaffected limbs was significantly different for the AFO, but not the WalkAide. Review of functional assessments indicated that these differences in ankle GA during initial swing may be attributed to the rigidity of the AFO, not functional gains with the WalkAide. Comparison of the two sensor control options yielded mixed results. More optimal StR values were observed during heel sensor-based stimulation by 25% of the post-stroke subjects. Changes in StI on non-level surfaces occurred with the tilt sensor, but not the heel sensor. However, progressively delayed StI timing from declined to inclined walking with the tilt sensor may result in increased ankle plantar flexion during PS, providing beneficial during inclined ambulation. Improved kinematic gait symmetry and StI changes on inclined surfaces with the WalkAide may be beneficial for community stroke ambulators on inclined surfaces; however, the lower StR and increased stimulating timing variability raise concerns about safety of the WalkAide while using tilt sensor controlled stimulation. The WalkAide heel sensor may provide a consistent, safer substitute

Evidence Based Practice: Assessing the educational outcome

Healthcare providers and patients strive for optimal outcomes with a growing trend to embed the principles of evidence-based practice (EBP) into mainstream care delivery by practicing dentists. The foundations of future best practice are built at dental school. How do we evaluate the outcome of an EBP syllabus? This study describes the use of the KACE assessment tool to assess the learning outcomes of final year DDS students who had completed an EBP program. The use of a validated instrument to measure four dimensions, knowledge, attitudes about it, familiarity with sources for accessing evidence and confidence in critical appraisal skills can be an important outcomes assessment tool. 90 dental students from the final year completed the questionnaire in 2016. 84% demonstrated good knowledge of evidence hierarchy. 92% agreed of the value to future practice and improvement in quality of patient care with 88% agreeing with the value of it as an integral part of a dental school curriculum. Students demonstrate confidence in appraising study design, recognizing bias, generalizability and value of the research report. However, even with electronic access to databases, when it came to accessing evidence over 75% would ask a friend with less than 25% consulting the Cochrane Database. The outcome of the training had been positive in providing the skills for EBP. The use of a validated tool ensured the graduating students received a good foundation to provide their future patients with the best clinical evidence for optimal and cost-effective dental care

Effect of implant design and material on subsidence following dynamic loading of intervertebral devices

Introduction: Subsidence is not the consequence of a single loading event. More specifically, subsidence may be interpreted as the continuous sinking due to continuous loading. As such, a single static load may not be appropriate. Few studies involving cage subsidence have employed continuous cyclic loading. The goal of this study was to address the mechanical subsidence performance via prediction of the final subsidence depth and the rate of subsidence. It is hypothesized that those spacer designs, which engage the stronger vertebral body periphery, enable endplate stress distribution through increased contact area, and reduced stress concentrations would display more favorable performance characteristics with respect to subsidence. Materials and Methods: Three intervertebral spacer designs were evaluated; threaded titanium, endplate-sparing titanium, and Polyetheretherketone (PEEK). Devices were randomly but equally assigned to porcine L4 and L5 vertebral bodies with endplates prepared as per recommended surgical procedure. Specimens were loaded from –50 N to –350 N at 1 Hz for 600 cycles with continuous load versus deformation acquired at cycle 10 and at 25 cycle intervals thereafter. For each cycle interval, the net deformation between the maximum and minimal applied load (or subsidence) was computed. The deformation for all six samples of each design were averaged across each cycle interval and subjected to a nonlinear exponential analysis. More specifically, the subsidence is represented by the independent variable Y. Initial subsidence is calculated at the 10th loading cycle and was represented by the variable Y0. From the subsidence versus cycle data, the rate of subsidence (K) was determined as well as the plateau, or asymptotic limit, of the subsidence. All parameters were compared using a one way ANOVA with a Tukey posthoc test for determination of statistical difference (α \u3c 0.05) between designs. Results and Discussion: All implants displayed an exponential relationship with respect to the number of applied cycles. Significant differences among all three designs were determined for initial subsidence Y0 (P \u3c 0.001) and subsidence limit (plateau) (P \u3c 0.001). For both parameters, the endplate-sparing titanium device displayed the least subsidence when compared with the other designs. The subsidence rate K displayed a statistically reduced rate for the endplate-sparing titanium device when compared with the threaded or PEEK designs. (P \u3c 0.001). Clinically, such a condition results in a slow and gradual settling of the titanium implant upon the endplate surface. The PEEK implant displayed a more rapid and greater subsidence than either the endplate-sparing or threaded titanium designs. Conclusions: Under continuous loading, an endplate-sparing titanium device displayed significantly reduced initial and final subsidence and subsidence rate when compared with threaded and PEEK designs. The clinical implication of these results is that implant material modulus is not the sole determinant for subsidence. Acknowledgements: This work is the result of a sponsored research grant from Titan Spine LLC, 6140 Executive Drive, Mequon, WI 52092

Loneliness and perceived social support as potential mediators of the longitudinal relationship between adolescent social anxiety symptoms and suicidal ideation

Recent research has shown that social anxiety may be related to increased risk for suicidal ideation in teens. A sample of 144 adolescents 12-15 years old was assessed during psychiatric inpatient hospitalization and followed up at 9 and 18 months postbaseline. Symptoms of social anxiety, depression, suicidal ideation, loneliness, and perceived social support were assessed via structured interviews and self-report instruments. Structural equation modeling revealed a significant direct relationship between baseline social anxiety symptoms and suicidal ideation at 18 months postbaseline, even after controlling for baseline depressive symptoms and ideation. Loneliness at 9 months postbaseline was shown to have a significant indirect effect on the relationship between baseline social anxiety and suicidal ideation at 18 months postbaseline. Perceived social support from parents and close friends did not have a significant indirect effect. Findings suggest that loneliness may be particularly implicated in the relationship between social anxiety and suicidality in teens.Master of Art

What matters most? Students' rankings of simulation components which contribute to clinical judgement

As the pedagogy of health care simulation matures, the level of guidance provided and types of simulation components included increasingly vary. To prepare students for professional practice, one university embedded Tanner’s model of clinical judgment within the nursing curricula and integrated simulations. There was interest in seeking students’ opinions of “what matters most” in the design and delivery of simulations, which may vary from the academic’s viewpoint. Senior undergraduate nursing students (N = 150) from three types of study programs rated 11 simulation components in relation to clinical judgment. The three student groups rated all components above 2.9 on a 5-point Likert scale, with some variation across groups for component rankings. The highest ranking components for applying clinical judgment were facilitated debriefing, postsimulation reflection, and guidance by the academic. The lowest ranked components were patient case notes and briefing and orientation to the simulation area. Age and previous nursing experience did not influence the study variables

Next-Generation Invaders? Hotspots for Naturalised Sleeper Weeds in Australia under Future Climates

Naturalised, but not yet invasive plants, pose a nascent threat to biodiversity. As climate regimes continue to change, it is likely that a new suite of invaders will emerge from the established pool of naturalised plants. Pre-emptive management of locations that may be most suitable for a large number of potentially invasive plants will help to target monitoring, and is vital for effective control. We used species distribution models (SDM) and invasion-hotspot analysis to determine where in Australia suitable habitat may occur for 292 naturalised plants. SDMs were built in MaxEnt using both climate and soil variables for current baseline conditions. Modelled relationships were projected onto two Representative Concentration Pathways for future climates (RCP 4.5 and 8.5), based on seven global climate models, for two time periods (2035, 2065). Model outputs for each of the 292 species were then aggregated into single ‘hotspot’ maps at two scales: continental, and for each of Australia’s 37 ecoregions. Across Australia, areas in the south-east and south-west corners of the continent were identified as potential hotspots for naturalised plants under current and future climates. These regions provided suitable habitat for 288 and 239 species respectively under baseline climates. The areal extent of the continental hotspot was projected to decrease by 8.8% under climates for 2035, and by a further 5.2% by 2065. A similar pattern of hotspot contraction under future climates was seen for the majority of ecoregions examined. However, two ecoregions - Tasmanian temperate forests and Australian Alps montane grasslands - showed increases in the areal extent of hotspots of >45% under climate scenarios for 2065. The alpine ecoregion also had an increase in the number of naturalised plant species with abiotically suitable habitat under future climate scenarios, indicating that this area may be particularly vulnerable to future incursions by naturalised plants.11 page(s