Intra-professional and inter-professional referral patterns of chiropractors

BACKGROUND: With the increasing popularity of chiropractic care in the United States, inter-professional relationships between conventional trained physicians (MDs and DOs) and chiropractors (DCs) will have an expanding impact on patient care. The objectives of this study are to describe the intra-professional referral patterns amongst DCs, describe the inter-professional referral patterns between DCs and conventional trained medical primary care physicians (MDPCPs), and to identify provider characteristics that may affect these referral behaviors. METHODS: A survey instrument to assess the attitudes and patterns of referral and consultation between MD primary care physicians (MDPCPs) and DCs was developed and sent to all DCs in the state of Iowa. Multivariable logistic regression models were built to assess the impact of provider characteristics on intra-professional and inter-professional referral patterns. RESULTS: Of all DCs contacted, 452 (40.7%) participated in the study. Close to 8% of DCs reported that they never send a case report when referring a patient to another DC, while 13% never send a case report to a MDPCP. About 10% of DCs never send follow-up clinical information to referring doctors. DCs that perform differential diagnosis were significantly more likely to have engaged in inter-professional referral than DCs who did not perform differential diagnosis. CONCLUSION: The tendency toward informality, in both referral practices and sharing of clinical documentation for referred patients between MDPCPs and DCs, is an explicit marker of concerns that need to be addressed in order to improve coordination and continuity of care for patients shared between these provider types

PPARs in Alveolar Macrophage Biology

PPARs, most notably PPAR-γ, play a crucial role in regulating the activation of alveolar macrophages, which in turn occupy a pivotal place in the immune response to pathogens and particulates drawn in with inspired air. In this review, we describe the dual role of the alveolar macrophage as both a first-line defender through its phagocytotic activity and a regulator of the immune response. Depending on its state of activation, the alveolar macrophage may either enhance or suppress different aspects of immune function in the lung. We then review the role of PPAR-γ and its ligands in deactivating alveolar macrophages—thus limiting the inflammatory response that, if unchecked, could threaten the essential respiratory function of the alveolus—while upregulating the cell's phagocytotic activity. Finally, we examine the role that inadequate or inappropriate PPAR-γ responses play in specific lung diseases

Rethinking the concepts of “local or global processors”: evidence from Williams syndrome, Down syndrome, and Autism Spectrum Disorders

Both Williams syndrome (WS) and Autism Spectrum Disorder (ASD) have been characterised as preferentially processing local information, whereas in Down syndrome (DS) the reported tendency is to process stimuli globally. We designed a cross-syndrome, cross-task comparison to reveal similarities and differences in local/global processing in these disorders. Our in-depth study compared local/global processing across modalities (auditory-verbal/visuo-spatial) and levels of processing (high/low) in the three syndromes. Despite claims in the literature, participants with ASD or WS failed to show a consistent local processing bias, while those with DS failed to show a reliable global processing bias. Depending on the nature of the stimuli and the task, both local and global processing biases were evident in all three neurodevelopmental disorders. These findings indicate that individuals with neurodevelopmental disorders cannot simply be characterised as local or global processors

Why my photos look sideways or upside down? Detecting Canonical Orientation of Images using Convolutional Neural Networks

Image orientation detection requires high-level scene understanding. Humans use object recognition and contextual scene information to correctly orient images. In literature, the problem of image orientation detection is mostly confronted by using low-level vision features, while some approaches incorporate few easily detectable semantic cues to gain minor improvements. The vast amount of semantic content in images makes orientation detection challenging, and therefore there is a large semantic gap between existing methods and human behavior. Also, existing methods in literature report highly discrepant detection rates, which is mainly due to large differences in datasets and limited variety of test images used for evaluation. In this work, for the first time, we leverage the power of deep learning and adapt pre-trained convolutional neural networks using largest training dataset to-date for the image orientation detection task. An extensive evaluation of our model on different public datasets shows that it remarkably generalizes to correctly orient a large set of unconstrained images; it also significantly outperforms the state-of-the-art and achieves accuracy very close to that of humans

Accumulated Oxygen Deficit During Arm Cranking in Hypoxia: A Bayesian Perspective and Methodological Considerations

International Journal of Exercise Science 14(3): 1090-1098, 2021. The purpose of this investigation was to observe the effects of normobaric hypoxia on accumulated oxygen deficit (AOD) with evaluation using both Bayesian and Frequentist analyses. Eighteen recreationally active men performed a graded exercise test (GXT) in normobaric normoxia (N; FiO2~20%) and normobaric hypoxia (H; FiO2~14%) to determine peak power output (PPO). Time to exhaustion trials were later conducted at 110% and 120% PPO under both N, and H. AOD and %AN (% anaerobic energy contribution) were calculated in three conditions: N, H, and H using the N regression equation (HN). Bayesian repeated measures ANOVA revealed differences in AOD and %AN between regression equations while Frequentist Repeated measures ANOVA revealed non-significant differences for AOD (p = .148) and %AN (p = .150). Using predicted oxygen consumption extrapolated from a normoxic environment during exercise in hypoxia may lead to overestimation of AOD and %AN with a Bayesian approach and contrasting results using frequentist statistics

Reliability of the Tuck Jump Assessment Using Standardized Rater Training

# BACKGROUND The Tuck Jump Assessment (TJA) is a test used to assess technique flaws during a 10-second, high intensity, jumping bout. Although the TJA has broad clinical applicability, there is no standardized training to maximize the TJA measurement properties. # HYPOTHESIS/PURPOSE To determine the reliability of the TJA using varied healthcare professionals following an online standardized training program. The authors hypothesized that the total score will have moderate to excellent levels of intra- and interrater reliability. # STUDY DESIGN Cross-sectional reliability. # METHODS A website was created by a physical therapist (PT) with videos, written descriptors of the 10 TJA technique flaws, and examples of what constituted no flaw, minor flaw, or major flaw (0,1,2) using published standards. The website was then validated (both face and content) by four experts. Three raters of different professions: a PT, an AT, and a Strength and Conditioning Coach Certified (SCCC) were selected due to their expertise with injury and movement. Raters used the online standardized training, scored 41 videos of participants' TJAs, then scored them again two weeks later. Reliability estimates were determined using intraclass correlation coefficients (ICCs) for total scores of 10 technique flaws and Krippendorff α (K α) for the individual technique flaws (ordinal). # RESULTS Eleven of 50 individual technique flaws were above the acceptable level (K α = 0.80). The total score had moderate interrater reliability in both sessions (Session 1: ICC~2,2~ = 0.64; 95% CI (Confidence Interval) (0.34-0.81); Standard Error Measurement (SEM) = 0.66 technique flaws and Session 2: ICC~2,2~ = 0.56; 95% CI (0.04-0.79); SEM = 1.30). Rater 1had a good reliability (ICC~2,2~ = 0.76; 95% CI (0.54-0.87); SEM = 0.26), rater 2 had a moderate reliability (ICC~2,2~ = 0.62; 95% CI (0.24-0.80); SEM =0.41) and rater 3 had excellent reliability (ICC~2,2~ = 0.98; 95% CI (0.97-0.99); SEM =0.01). # CONCLUSION All raters had at least good reliability estimates for the total score. The same level of consistency was not seen when evaluating each technique flaw. These findings suggest that the total score may not be as accurate when compared to individual technique flaws and should be used with caution. # LEVEL OF EVIDENCE: 3

Regenerative Fuel Cell Power Systems for Lunar and Martian Surface Exploration

This paper presents the preliminary results of a recent National Aeronautics and Space Administration (NASA) study funded under the Advanced Exploration Systems (AES) Modular Power Systems (AMPS) project. This study evaluated multiple surface locations on both the Moon and Mars, with the goal of establishing a common approach towards technology development and system design for surface power systems that use Regenerative Fuel Cell (RFC) energy storage methods. One RFC design may not be applicable to all surface locations; however, AMPS seeks to find a unified architecture, or series of architectures, that leverages a single development approach to answer the technology need for RFC systems. Early system trades were performed to select the most effective fuel cell and electrolyzer architectures based on current state-of-the-art technology, whereas later trades will establish a detailed system design to enable a near-term ground (non-flight) demonstration. This paper focuses on the initial trade studies, presents the selected fuel cell and electrolyzer architectures for follow-on system design studies, and suggests areas for further technology investment

Effect of Oral Iron Repletion on Exercise Capacity in Patients With Heart Failure With Reduced Ejection Fraction and Iron Deficiency: The IRONOUT HF Randomized Clinical Trial.

Importance: Iron deficiency is present in approximately 50% of patients with heart failure with reduced left ventricular ejection fraction (HFrEF) and is an independent predictor of reduced functional capacity and mortality. However, the efficacy of inexpensive readily available oral iron supplementation in heart failure is unknown. Objective: To test whether therapy with oral iron improves peak exercise capacity in patients with HFrEF and iron deficiency. Design, Setting, and Participants: Phase 2, double-blind, placebo-controlled randomized clinical trial of patients with HFrEF ( Interventions: Oral iron polysaccharide (n = 111) or placebo (n = 114), 150 mg twice daily for 16 weeks. Main Outcomes and Measures: The primary end point was a change in peak oxygen uptake (V̇o2) from baseline to 16 weeks. Secondary end points were change in 6-minute walk distance, plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, and health status as assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ, range 0-100, higher scores reflect better quality of life). Results: Among 225 randomized participants (median age, 63 years; 36% women) 203 completed the study. The median baseline peak V̇o2 was 1196 mL/min (interquartile range [IQR], 887-1448 mL/min) in the oral iron group and 1167 mL/min (IQR, 887-1449 mL/min) in the placebo group. The primary end point, change in peak V̇o2 at 16 weeks, did not significantly differ between the oral iron and placebo groups (+23 mL/min vs -2 mL/min; difference, 21 mL/min [95% CI, -34 to +76 mL/min]; P = .46). Similarly, at 16 weeks, there were no significant differences between treatment groups in changes in 6-minute walk distance (-13 m; 95% CI, -32 to 6 m), NT-proBNP levels (159; 95% CI, -280 to 599 pg/mL), or KCCQ score (1; 95% CI, -2.4 to 4.4), all P \u3e .05. Conclusions and Relevance: Among participants with HFrEF with iron deficiency, high-dose oral iron did not improve exercise capacity over 16 weeks. These results do not support use of oral iron supplementation in patients with HFrEF. Trial Registration: clinicaltrials.gov Identifier: NCT02188784

Does Media Affect Learning: Where Are We Now?

It is time to extinguish the argument as to whether or not the media of 1983 could, should or would affect learning outcomes. The technological advances that have occurred in the 20 years since Clark sparked the debate and Kozma fanned the flames have made the question irrelevant. High-speed, portable, reasonably priced computers, the Internet, and the World Wide Web have changed the face of how, when, and where learning occurs. The media of 2004 does affect learning. The question is no longer if; the question is how