Cardiovascular Effects of Long Term Androgenic Anabolic Steroid Use

Background: Anabolic steroids have been a consistent area of debate when it comes to athletes. Anabolic steroids are very common in certain sports like powerlifting and bodybuilding. Negative health effects have been found to be associated with the long term use of anabolic steroids. The objective of this review is to determine if there are negative cardiovascular effects associated with chronic androgenic anabolic steroid use when compared to non-steroid users. Methods: A literature review of past research articles was performed. Pertinent information was obtained from the sources and compiled as evidence for the topic of this paper. Results: Using primarily bodybuilder populations, the findings obtained from the articles supported decreased left ventricular function, increase in blood pressure, atherosclerosis of blood vessels, and an increase in LDL with a decrease in HDL. Conclusion: Anabolic steroids can be contributed to decreased left ventricular function, increased blood pressure, atherosclerosis, and increase LDL and decrease HDL leading to an overall decrease in cardiovascular function. Improving education on the cardiovascular impact anabolic steroids can have can ultimately decrease the risk of individuals abusing these drugs and having a decrease in overall health

Effect of subsequent vaginal delivery on bowel symptoms and anorectal function in women who sustained a previous obstetric anal sphincter injury.

INTRODUCTION AND HYPOTHESIS: Our primary objective was to prospectively evaluate anorectal symptoms, anal manometry and endoanal ultrasound (EAUS) in women who followed the recommended mode of subsequent delivery following index obstetric anal sphincter injuries (OASIs) using our unit's standardised protocol. Our secondary objectives were to evaluate the role of internal anal sphincter defects and also to compare outcomes in a subgroup of symptomatic women with normal anorectal physiology. METHODS: This is a prospective follow-up study of pregnant women with previous OASIs who were counselled regarding subsequent mode of delivery between January 2003 and December 2014. Assessment involved the St Mark's Incontinence Score (SMIS), anal manometry and EAUS at both antepartum and 3-month postpartum visits. Data were analysed using Wilcoxon and Mann-Whitney U tests. RESULTS: Three hundred and fifty women attended the perineal clinic over the study period, of whom 122 met the inclusion criteria (99 vaginal delivery [VD], 23 caesarean section). No significant worsening of anorectal symptoms was observed following subsequent delivery in the VD group (p = 0.896), although a reduced squeeze pressure was observed at 3 months postpartum (p < 0.001). There were no new defects on EAUS in either group. CONCLUSIONS: This study showed no significant worsening of bowel symptoms and sphincter integrity apart from lower squeeze pressures at 3 months postpartum in the VD group when our standardised protocol was used to recommend subsequent mode of delivery. In the absence of a randomised study, use of this protocol can aid clinicians in their decision-making

Measuring the Quality of Postgraduate Physician Assistant Fellowship/Residency Programs with a Surgical Focus

Introduction Postgraduate programs for PAs provide formal postgraduate training for clinical specialty areas. These programs are intended to provide intense specialty training in various fields, as well as to standardize education beyond the entry level. The purpose of this descriptive study was to determine if there are consistent trends or clear differences in program length, approach to training, validation of learning, and accreditation through the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) for postgraduate programs with a surgical focus in the United States. Methods This study is a non-experimental and descriptive research design. Program directors were mailed a survey consisting of questions about program information, prerequisites, curriculum, training, evaluation, and perspective of graduates after completion of program. Results Of the 29 program directors who were mailed a survey, 62% responded with completed surveys (n=18). 38% of respondents (n=11) stated the annual salary ranged from $40,000 to$60,000. Five programs were accredited by the ARC-PA and four programs were actively seeking accreditation. The majority of program directors believed the attitude of the medical community is higher towards PAs who complete a postgraduate education program. Conclusion As postgraduate programs increase in popularity, it is important to evaluate the standardization of the programs nationally. Papers like this will help drive a consistent approach to PA fellowship development and evolution. As healthcare evolves, there is a need to develop highly specialized physician assistants and place a premium on retaining them within the healthcare systems. Obtaining information on standard practices across postgraduate PA programs helps determine what requirements should be upheld nationally

Over-the-Counter Analgesic Use Patterns in Appalachian Older Adults, Focusing on Non-Steroidal Anti-Inflammatory Drugs

Introduction Over-the-counter (OTC) medications are commonly used by elderly patients to self-manage pain symptoms. Medications such as non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen and topical analgesics are readily available and therefore may seem harmless to patients. In the growing population of those 65 years and older, providers need to inquire about OTC medication use due to the increased risk for adverse reactions in this population. Complications related to these medications can be worsened by chronic disease, variable metabolism, polypharmacy, etc. which become more common in the older adults. Methods A survey was created to determine the prevalence and habits of OTC use in the central Appalachian population, as well as the potential harms involved related to provider awareness, chronic disease, and polypharmacy. Results Of surveyed Appalachian seniors (n = 307), 86.3% take OTC medications. Of these, 57.4% report that they do not tell their provider and 51.3% do not take the medication as directed. Within this population, 19.2% of those on blood thinners, 22.4% of those with hypertension, 34.8% of those with chronic kidney disease, and 30.6% of those with gastrointestinal issues are not only using NSAIDs but also do not inform their physician nor follow the packaging instructions. Discussion Potential complications of NSAID use related to these medical comorbidities are well known. Providers need to regularly ask their older adult patients about the use of OTC medication to prevent adverse events in this vulnerable population

Direct observation of growth and collapse of a Bose-Einstein condensate with attractive interactions

The dynamical behavior of Bose-Einstein condensation (BEC) in a gas with attractive interactions is striking. Quantum theory predicts that BEC of a spatially homogeneous gas with attractive interactions is precluded by a conventional phase transition into either a liquid or solid. When confined to a trap, however, such a condensate can form provided that its occupation number does not exceed a limiting value. The stability limit is determined by a balance between self-attraction and a repulsion arising from position-momentum uncertainty under conditions of spatial confinement. Near the stability limit, self-attraction can overwhelm the repulsion, causing the condensate to collapse. Growth of the condensate, therefore, is punctuated by intermittent collapses, which are triggered either by macroscopic quantum tunneling or thermal fluctuation. Previous observation of growth and collapse has been hampered by the stochastic nature of these mechanisms. Here we reduce the stochasticity by controlling the initial number of condensate atoms using a two-photon transition to a diatomic molecular state. This enables us to obtain the first direct observation of the growth of a condensate with attractive interactions and its subsequent collapse.Comment: 10 PDF pages, 5 figures (2 color), 19 references, to appear in Nature Dec. 7 200

Calcitization of aragonitic bryozoans in Cenozoic tropical carbonates from East Kalimantan, Indonesia

© The Author(s) 2016. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The file attached is the published version of the article

A Multi-commodity network flow model for cloud service environments

Next-generation systems, such as the big data cloud, have to cope with several challenges, e.g., move of excessive amount of data at a dictated speed, and thus, require the investigation of concepts additional to security in order to ensure their orderly function. Resilience is such a concept, which when ensured by systems or networks they are able to provide and maintain an acceptable level of service in the face of various faults and challenges. In this paper, we investigate the multi-commodity flows problem, as a task within our D 2 R 2 +DR resilience strategy, and in the context of big data cloud systems. Specifically, proximal gradient optimization is proposed for determining optimal computation flows since such algorithms are highly attractive for solving big data problems. Many such problems can be formulated as the global consensus optimization ones, and can be solved in a distributed manner by the alternating direction method of multipliers (ADMM) algorithm. Numerical evaluation of the proposed model is carried out in the context of specific deployments of a situation-aware information infrastructure

Does implementation matter if comprehension is lacking? A qualitative investigation into perceptions of advance care planning in people with cancer

Purpose: While advance care planning holds promise, uptake is variable and it is unclear how well people engage with or comprehend advance care planning. The objective of this study was to explore how people with cancer comprehended Advance Care Plans and examine how accurately advance care planning documentation represented patient wishes. Methods: This study used a qualitative descriptive design. Data collection comprised interviews and an examination of participants’ existing advance care planning documentation. Participants included those who had any diagnosis of cancer with an advance care plan recorded: Refusal of Treatment Certificate; Statement of Choices; and/or Enduring Power of Attorney (Medical Treatment) at one cancer treatment centre. Results: Fourteen participants were involved in the study. Twelve participants were female (86%). The mean age was 77 (range: 61-91) and participants had completed their advance care planning documentation between 8 and 72 weeks prior to the interview (mean 33 weeks). Three themes were evident from the data: Incomplete advance care planning understanding and confidence; Limited congruence for attitude and documentation; Advance care planning can enable peace of mind. Complete advance care planning understanding was unusual; most participants demonstrated partial comprehension of their own advance care plan, and some indicated very limited understanding. Participants’ attitudes and their written document congruence was limited, but advance care planning was seen as helpful. Conclusions: This study highlighted advance care planning was not a completely accurate representation of patient wishes. There is opportunity to improve how patients comprehend their own advance care planning documentation

Evaluating Effects of Divided Hemispheric Processing on Word Recognition in Foveal and Extrafoveal Displays: The Evidence from Arabic

Background: Previous studies have claimed that a precise split at the vertical midline of each fovea causes all words to the left and right of fixation to project to the opposite, contralateral hemisphere, and this division in hemispheric processing has considerable consequences for foveal word recognition. However, research in this area is dominated by the use of stimuli from Latinate languages, which may induce specific effects on performance. Consequently, we report two experiments using stimuli from a fundamentally different, non-Latinate language (Arabic) that offers an alternative way of revealing effects of split-foveal processing, if they exist. Methods and Findings: Words (and pseudowords) were presented to the left or right of fixation, either close to fixation and entirely within foveal vision, or further from fixation and entirely within extrafoveal vision. Fixation location and stimulus presentations were carefully controlled using an eye-tracker linked to a fixation-contingent display. To assess word recognition, Experiment 1 used the Reicher-Wheeler task and Experiment 2 used the lexical decision task. Results: Performance in both experiments indicated a functional division in hemispheric processing for words in extrafoveal locations (in recognition accuracy in Experiment 1 and in reaction times and error rates in Experiment 2) but no such division for words in foveal locations. Conclusions: These findings from a non-Latinate language provide new evidence that although a functional division i