Use of Standardized Patient Scenarios to Train Medical Assistants in an Ambulatory Rehabilitation Medicine Clinic

Objectives: To improve the efficiency of our outpatient Rehabilitation Medicine clinic without sacrificing high value/quality patient care. To clarify the responsibilities of the MA and identify areas of redundancy in the rooming process. To demonstrate the utility of in-situ simulation for MA training. To reduce the time it takes for MAs to complete all assigned tasks to 10 minutes or less per encounter in at least 50% of patient encounters within two months from the time of intervention. To potentially highlight other areas in which to improve clinic efficiency and overall patient satisfaction (e.g. front desk registration process, resident and attending physician encounters, clinic and exam room accessibility).https://jdc.jefferson.edu/patientsafetyposters/1051/thumbnail.jp

Understanding the Thermal Properties of Precursor-Ionomers to Optimize Fabrication Processes for Ionic Polymer-Metal Composites (IPMCs)

Ionic polymer-metal composites (IPMCs) are one of many smart materials and have ionomer bases with a noble metal plated on the surface. The ionomer is usually Nafion, but recently Aquivion has been shown to be a promising alternative. Ionomers are available in the form of precursor pellets. This is an un-activated form that is able to melt, unlike the activated form. However, there is little study on the thermal characteristics of these precursor ionomers. This lack of knowledge causes issues when trying to fabricate ionomer shapes using methods such as extrusion, hot-pressing, and more recently, injection molding and 3D printing. To understand the two precursor-ionomers, a set of tests were conducted to measure the thermal degradation temperature, viscosity, melting temperature, and glass transition. The results have shown that the precursor Aquivion has a higher melting temperature (240 °C) than precursor Nafion (200 °C) and a larger glass transition range (32–65°C compared with 21–45 °C). The two have the same thermal degradation temperature (~400 °C). Precursor Aquivion is more viscous than precursor Nafion as temperature increases. Based on the results gathered, it seems that the precursor Aquivion is more stable as temperature increases, facilitating the manufacturing processes. This paper presents the data collected to assist researchers in thermal-based fabrication processes

Separation of Oligosaccharides from Lotus Seeds via Medium-pressure Liquid Chromatography Coupled with ELSD and DAD

peer-reviewedLotus seeds were identified by the Ministry of Public Health of China as both food and medicine. One general function of lotus seeds is to improve intestinal health. However, to date, studies evaluating the relationship between bioactive compounds in lotus seeds and the physiological activity of the intestine are limited. In the present study, by using medium pressure liquid chromatography coupled with evaporative light-scattering detector and diode-array detector, five oligosaccharides were isolated and their structures were further characterized by electrospray ionization-mass spectrometry and gas chromatography-mass spectrometry. In vitro testing determined that LOS3-1 and LOS4 elicited relatively good proliferative effects on Lactobacillus delbrueckii subsp. bulgaricus. These results indicated a structure-function relationship between the physiological activity of oligosaccharides in lotus seeds and the number of probiotics applied, thus providing room for improvement of this particular feature. Intestinal probiotics may potentially become a new effective drug target for the regulation of immunity

A Case of Postoperative Tuberculous Spondylitis with a Bizarre Course

Postoperative infections following spine surgery are usually attributable to bacterial organisms. Staphylococcus aureus is known to be the most common single pathogen leading to this infection, and the number of infections caused by methicillin-resistant Staphylococcus aureus is increasing. However, there is a paucity of literature addressing postoperative infection with Mycobacterium tuberculosis. We encountered a case of tuberculous spondylitis after spine surgery. A man had fever with low back pain three weeks after posterior interbody fusion with instrumentation for a herniated intervertebral disc at the L4-L5 level. He had been treated with antibiotics for an extended period of time under the impression that he had a bacterial infection, but his symptoms and laboratory data had not improved. Polymerase chain reaction for Mycobacterium tuberculosis turned out to be positive. The patient's symptoms finally improved when he was treated with antituberculosis medication

The Spleen CD4+ T Cell Response to Blood-Stage Plasmodium chabaudi Malaria Develops in Two Phases Characterized by Different Properties

The pivotal role of spleen CD4+ T cells in the development of both malaria pathogenesis and protective immunity makes necessary a profound comprehension of the mechanisms involved in their activation and regulation during Plasmodium infection. Herein, we examined in detail the behaviour of non-conventional and conventional splenic CD4+ T cells during P. chabaudi malaria. We took advantage of the fact that a great proportion of CD4+ T cells generated in CD1d-/- mice are I-Ab-restricted (conventional cells), while their counterparts in I-Ab-/- mice are restricted by CD1d and other class IB major histocompatibility complex (MHC) molecules (non-conventional cells). We found that conventional CD4+ T cells are the main protagonists of the immune response to infection, which develops in two consecutive phases concomitant with acute and chronic parasitaemias. The early phase of the conventional CD4+ T cell response is intense and short lasting, rapidly providing large amounts of proinflammatory cytokines and helping follicular and marginal zone B cells to secrete polyclonal immunoglobulin. Both TNF-α and IFN-γ production depend mostly on conventional CD4+ T cells. IFN-γ is produced simultaneously by non-conventional and conventional CD4+ T cells. The early phase of the response finishes after a week of infection, with the elimination of a large proportion of CD4+ T cells, which then gives opportunity to the development of acquired immunity. Unexpectedly, the major contribution of CD1d-restricted CD4+ T cells occurs at the beginning of the second phase of the response, but not earlier, helping both IFN-γ and parasite-specific antibody production. We concluded that conventional CD4+ T cells have a central role from the onset of P. chabaudi malaria, acting in parallel with non-conventional CD4+ T cells as a link between innate and acquired immunity. This study contributes to the understanding of malaria immunology and opens a perspective for future studies designed to decipher the molecular mechanisms behind immune responses to Plasmodium infection

Resistance Training in Spontaneously Hypertensive Rats with Severe Hypertension

Background: Resistance training (RT) has been recommended as a non-pharmacological treatment for moderate hypertension. In spite of the important role of exercise intensity on training prescription, there is still no data regarding the effects of RT intensity on severe hypertension (SH). Objective: This study examined the effects of two RT protocols (vertical ladder climbing), performed at different overloads of maximal weight carried (MWC), on blood pressure (BP) and muscle strength of spontaneously hypertensive rats (SHR) with SH. Methods: Fifteen male SHR [206 +/- 10 mmHg of systolic BP (SBP)] and five Wistar Kyoto rats (WKY; 119 +/- 10 mmHg of SBP) were divided into 4 groups: sedentary (SED-WKY) and SHR (SED-SHR); RT1-SHR training relative to body weight (similar to 40% of MWC); and RT2-SHR training relative to MWC test (similar to 70% of MWC). Systolic BP and heart rate (HR) were measured weekly using the tail-cuff method. The progression of muscle strength was determined once every fifteen days. The RT consisted of 3 weekly sessions on non-consecutive days for 12-weeks. Results: Both RT protocols prevented the increase in SBP (delta -5 and -7 mmHg, respectively; p > 0.05), whereas SBP of the SED-SHR group increased by 19 mmHg (p 0.05). Conclusions: Our data indicated that both RT protocols were effective in preventing chronic elevation of SBP in SH. Additionally, a higher RT overload induced a greater increase in muscle strength.Fundamentos: O treinamento de força (TF) tem sido recomendado como tratamento não farmacológico para hipertensão arterial moderada. Apesar do papel importante que a intensidade do exercício desempenha sobre a prescrição do treinamento, ainda não há nenhum dado avaliando os efeitos da intensidade do TF sobre a hipertensão arterial grave (HAG). Objetivo: Este estudo analisou os efeitos de dois protocolos do TF(subida em escada vertical), realizados com diferentes sobrecargas do peso máximo carregado (PMC), sobre a pressão arterial (PA) e a força muscular de ratos espontaneamente hipertensos (SHR) com HAG. Métodos: Quinze SHR machos (206 ± 10 mmHg de PA sistólica (PAS)) e cinco ratos Wistar Kyoto (WKY; 119 ± 10 mmHg de PAS) foram divididos em 4grupos:sedentários: (SED-WKY) e SHR (SED-SHR); treinados: TF1-SHR conforme o peso corporal (~40% do PMC); e TF2-SHR conforme o teste de PMC (~70% do PMC). Foram coletadas medidas de PAS e a frequência cardíaca (FC) semanalmente usando o método de pressão arterial caudal. A progressão da força muscular foi determinada a cada 15 dias. O TF consistiu de 3 sessões semanais em dias não consecutivos durante 12 semanas. Resultados: Os dois protocolos de TF preveniram o aumento da PAS(respectivamente, delta - 5 e -7 mmHg; p > 0, 05), enquanto que a PAS do grupo SED-SHR aumentou em 19 mmHg (p 0, 05). Conclusões: Nossos dados indicam que ambos os protocolos de TF foram efetivos na prevenção da elevação crônica da PAS na HAG. Além disso, sobrecargas maiores de TF induziram a um maior aumento de força muscular.CapesCNPqUniv Catolica Brasilia, Programa Posgrad Educ Fis, Brasilia, DF, BrazilUniv Fed Sao Paulo, Programa Posgrad Med Translac, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Div Nefrol, Lab Imunol Clin & Expt, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Med, Div Nefrol, Sao Paulo, SP, BrazilUniv Sao Paulo, Escola Artes Ciencias & Humanidades, Sao Paulo, SP, BrazilUniv Sao Paulo, Inst Ciencias Biomed, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Fisiol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Programa Posgrad Med Translac, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Div Nefrol, Lab Imunol Clin & Expt, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Med, Div Nefrol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Fisiol, Sao Paulo, SP, BrazilWeb of Scienc

Rotation, activity, and lithium abundance in cool binary stars

We have used two robotic telescopes to obtain time-series high-resolution spectroscopy and V I and/or by photometry for a sample of 60 active stars. Orbital solutions are presented for 26 SB2 and 19 SB1 systems with unprecedented phase coverage and accuracy. The total of 6,609 R=55,000 echelle spectra are also used to systematically determine effective temperatures, gravities, metallicities, rotational velocities, lithium abundances and absolute H{\alpha}-core fluxes as a function of time. The photometry is used to infer unspotted brightness, V - I and/or b - y colors, spot-induced brightness amplitudes and precise rotation periods. Our data are complemented by literature data and are used to determine rotation-temperature-activity relations for active binary components. We also relate lithium abundance to rotation and surface temperature. We find that 74% of all known rapidly-rotating active binary stars are synchronized and in circular orbits but 26% are rotating asynchronously of which half have Prot > Porb and e > 0. Because rotational synchronization is predicted to occur before orbital circularization active binaries should undergo an extra spin-down besides tidal dissipation. We suspect this to be due to a magnetically channeled wind with its subsequent braking torque. We find a steep increase of rotation period with decreasing effective temperature for active stars. For inactive, single giants with Prot > 100 d, the relation is much weaker. Our data also indicate a period-activity relation for H{\alpha} of the form RH{\alpha} \propto P - 0.24 for binaries and RH{\alpha} \propto P -0.14 for singles. Lithium abundances in our sample increase with effective temperature. On average, binaries of comparable effective temperature appear to exhibit 0.25 dex less surface lithium than singles. We also find a trend of increased Li abundance with rotational period of form log n(Li) \propto - 0.6 log Prot

A vespa-da-madeira : área de ocorrência, medidas de prevenção e controle

Apesar de ser conhecida como praga secundária nos países de origem, a vespa-da-madeira, Sirex noctilio F., 1793, passou a ser considerada como praga de importância econômica nos povoamentos de Pinus spp., nos países onde foi introduzida acidentalmente, como Nova Zelândia, Austrália, Uruguai, Argentina, Brasil e, mais recentemente, África do Sul

Exercise during pregnancy protects adult mouse offspring from diet-induced obesity

Physical exercise induces positive alterations in gene expression involved in the metabolism of obesity. Maternal exercise provokes adaptations soon after birth in the offspring. Here, we investigated whether adult mouse offspring of swim-trained mothers is protected against the development of the deleterious effects of high fat diet (HFD). Our study comprises two parts. First, female C57BL/6 mice were divided into one sedentary and one swim-trained group (before and during pregnancy, n = 18). In the second part, adult offspring (n = 12) of trained and sedentary mothers was challenged to HFD for 16 weeks. Notably, most of the analysis was done in male offspring. Our results demonstrate that maternal exercise has several beneficial effects on the mouse offspring and protects them from the deleterious effects of HFD in the adult. Specifically, swimming during pregnancy leads to lower birth weight in offspring through 2 months of age. When subjected to HFD for 4 month in the adulthood, our study presents novel data on the male offspring’s metabolism of trained mothers. The offspring gained less weight, which was accompanied by less body fat, and they used more calories during daytime compared with offspring of sedentary mothers. Furthermore, we observed increased adiponectin expression in skeletal muscle, which was accompanied by decreased leptin levels and increased insulin sensitivity. Decreased interleukin-6 expression and increased peptide PYY levels were observed in sera of adult offspring of mothers that swam during pregnancy. Our results point to the conclusion that maternal exercise is beneficial to protect the offspring from developing obesity, which could be important for succeeding generations as well12FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP2013/04757-

Photocatalytic water splitting with noble-metal free cocatalysts for a comprehensive study of two nonidentical photoreactors designs

Here, the authors (i) discuss the most prominent co-catalyst for H2 generation struc tured in the form of Me-TiO2/MCM-41 (Me: Ag, Co, Cu, Ni) based on structural, electronic, textural, morphological and optical characterization techniques, such as XRD, wide and small angle, XPS, Fourier-transform infrared spectroscopy, scanning electron microscopy, B.E.T., textural analysis, photoacoustic spectroscopy and photo luminescence spectroscopy; and (ii) evaluate the difference in hydrogen production in two distinct geometric reactors based on a theoretical study of light distribution inside the reactors supported by the experimental quantum yield calculation. As a result, copper-doped photocatalyst generated higher hydrogen amount compared to the others. The high photocatalyst performance was due to the greater lamp spec trum absorption, marked by the low bandgap value, and high photoactivity justified by the low rate of electronic recombination. The hydrogen generation in the quartz reactor was seven times higher than the annular one, and when at maximum light power, it is comparable to the most sophisticated reaction systems found in litera ture. The larger light exposure area per unit volume of the quartz reactor compared to the annular one is the reason why it obtained better results due to the lower emit ted photon blockade, with a 1.81% apparent quantum yield