Patient Perceptions of Pain Before and After Cupping

Cupping is an ancient modality that has many benefits. Benefits include improving blood flow, decreasing pain, and increasing function to the applied (Cage et. al., 2020). Research has shown that cupping and its effectiveness can be manipulated by perceptiveness and perceived thoughts about the modality itself, by the clinician and patient (Cage et. al., 2020, Silva et. al. 2019). PURPOSE: The purpose of this study was to collect data that will assist in making clinical decisions regarding cupping as a therapy. The research question that this study aims to answer is: Does cupping therapy decrease patient-reported pain due to injury? The ensuing research examines different aspects of perceived pain before and after cupping, type of injury, type of cupping treatment, time and type of pain. METHODS: The method used included a researcher-designed survey. The survey was taken twice, once before and once after treatment. The pre-treatment survey asked for demographic information including: participants’ age, race and ethnicity, injury site, duration of injury, type of pain, and sport participation. The survey included Likert scales that were rated from 0-5. The pre-treatment Likert question asked about current pain levels. During the second survey, the participants were only asked about pain during treatment, helpfulness of the treatment, and pain scale after the treatment, with no demographic questions. RESULTS: The survey resulted in 44 responses, for a total participation of 22 participants. Cupping was used for many different injuries across different sports. Cupping was predominantly used for tightness (81.8%). Moreover, it was also used for tendonitis and strains (9%) and other unlisted injuries (9%). Injury site was also observed with back (54.5%) and shoulder (18%) observed the most. Time with the injury was shown that most injuries had been bothering the athlete for four or more weeks (36%). Track and football utilized cupping the most, at 36% each. Two-tailed paired samples t-test showed that there was an increase in pain after cupping was used. The result of the two-tailed paired samples t-test was significant based on an alpha value of .05, t(21) = -4.12, p \u3c .001. This finding suggests the difference in the mean of pre-treatment pain levels and the mean of post-treatment pain levels were significantly different from zero. The mean of the pre-treatment pain level datum was significantly lower than the mean of the post-treatment pain level datum. There was not a significant difference in pain during treatment between fire and suction cupping. Time duration of injury did not have a significant impact on pain levels before or after treatment. Type of pain also had no significant correlation to pain levels. CONCLUSION: Cupping is a treatment that is used best when in combination with a proper rehabilitation program. While both fire and suction cupping were observed, suction cupping was used the most (72.3%). Patient-reported pain levels were significantly higher post-treatment. This is interesting as it was thought that cupping would help alleviate pain. Further research needs to be done to examine if pain levels decrease hours or days after treatment instead of directly after treatment

In Actu Et In Silicio: Linear and Nonlinear Photophysical Characterization of a Novel Europium Complex, and Incorporating Computational Calculations in the Analysis of Novel Organic Compounds

Despite not being a tangible substance, light is becoming an increasingly valuable tool in numerous areas of science and technology: the use of laser excitation of a fluorescent probe can generate incredibly detailed images of cellular structures without the need for large amounts of dissection; new types of solar cells are being produced using organic dyes to harvest light; computer data can be stored by inducing a chemical change in a compound through irradiation with light. However, before any of these materials can be applied in such a way, their properties must first be analyzed for them to be deemed viable. The focus of this dissertation is the photophysical characterization, linear and nonlinear, of a several novel organic compounds, and a europium complex, as well as using quantum chemical calculation techniques to understand some of the phenomena that are witnessed and begin to develop predictive capability. The nonlinear characterization of compounds utilizes wavelengths outside of their linear absorption range, where a focused beam can achieve the same excitation as one at half the wavelength, though this effect has a quadratic dependence on power. The potential for nonlinear excitation, or two-photon absorption (2PA), is becoming of increasing interest and importance for organic chromophores. Exciting only a small volume of material at a focal point makes it possible to nondestructively image samples in 3-dimensions, record data in multiple layers, and fabricate intricate structures through photopolymerization reactions. Lanthanides such as europium are known to exhibit sharp emission bands when excited, typically through an antenna effect due to the low probability of achieving direct excitation. This emission is long-lived, and through gating systems can readily be separated from background noise and autofluorescence (often observed in biological samples) that have much shorter lifetimes. Thus, one of the foci of this dissertation is the photophysical investigation of a series of novel lanthanide complexes, with particular attention to a europium complex

Drawbar Pull (DP) Procedures for Off-Road Vehicle Testing

As NASA strives to explore the surface of the Moon and Mars, there is a continued need for improved tire and vehicle development. When tires or vehicles are being designed for off-road conditions where significant thrust generation is required, such as climbing out of craters on the Moon, it is important to use a standard test method for evaluating their tractive performance. The drawbar pull (DP) test is a way of measuring the net thrust generated by tires or a vehicle with respect to performance metrics such as travel reduction, sinkage, or power efficiency. DP testing may be done using a single tire on a traction rig, or with a set of tires on a vehicle; this report focuses on vehicle DP tests. Though vehicle DP tests have been used for decades, there are no standard procedures that apply to exploration vehicles. This report summarizes previous methods employed, shows the sensitivity of certain test parameters, and provides a body of knowledge for developing standard testing procedures. The focus of this work is on lunar applications, but these test methods can be applied to terrestrial and planetary conditions as well. Section 1.0 of this report discusses the utility of DP testing for off-road vehicle evaluation and the metrics used. Section 2.0 focuses on test-terrain preparation, using the example case of lunar terrain. There is a review of lunar terrain analogs implemented in the past and a discussion on the lunar terrain conditions created at the NASA Glenn Research Center, including methods of evaluating the terrain strength variation and consistency from test to test. Section 3.0 provides details of the vehicle test procedures. These consist of a review of past methods, a comprehensive study on the sensitivity of test parameters, and a summary of the procedures used for DP testing at Glenn

New constraints on equatorial temperatures during a Late Neoproterozoic snowball Earth glaciation

Intense glaciation during the end of Cryogenian time (∼635 million years ago) marks the coldest climate state in Earth history – a time when glacial deposits accumulated at low, tropical paleolatitudes. The leading idea to explain these deposits, the snowball Earth hypothesis, predicts globally frozen surface conditions and subfreezing temperatures, with global climate models placing surface temperatures in the tropics between −20 °C and −60 °C. However, precise paleosurface temperatures based upon geologic constraints have remained elusive and the global severity of the glaciation undetermined. Here we make new geologic observations of tropical periglacial, aeolian and fluvial sedimentary structures formed during the end-Cryogenian, Marinoan glaciation in South Australia; these observations allow us to constrain ancient surface temperatures. We find periglacial sand wedges and associated deformation suggest that ground temperatures were sufficiently warm to allow for ductile deformation of a sandy regolith. The wide range of deformation structures likely indicate the presence of a paleoactive layer that penetrated 2–4 m below the ground surface. These observations, paired with a model of ground temperature forced by solar insolation, constrain the local mean annual surface temperature to within a few degrees of freezing. This temperature constraint matches well with our observations of fluvial deposits, which require temperatures sufficiently warm for surface runoff. Although this estimate coincides with one of the coldest near sea-level tropical temperatures in Earth history, if these structures represent peak Marinaon glacial conditions, they do not support the persistent deep freeze of the snowball Earth hypothesis. Rather, surface temperatures near 0 °C allow for regions of seasonal surface melting, atmosphere–ocean coupling and possible tropical refugia for early metazoans. If instead these structures formed during glacial onset or deglaciation, then they have implications for the timescale and character for the transition into or out of a snowball state

A Click Chemistry Strategy for the Synthesis of Efficient Photoinitiators for Two‐Photon Polymerization

It is reported that efficient photoinitiators, suitable for two‐photon polymerization, can be obtained using the copper catalyzed azide/alkyne cycloaddition reaction. This click chemistry strategy provides a modular approach to the assembly of photoinitiators that enables the rapid variation of key fragments to produce photoinitiators with desirable properties. To assess the performance of the first‐in‐class photoinitiators generated by this approach, a screening method is developed to enable the rapid determination of polymerization and damage thresholds in numerous photoresists during two‐photon polymerization. The degree of consumption of vinyl groups (DC) and homogeneity of the polymerization are further assessed by micro‐Raman spectroscopy. Finally, more complex structures are fabricated to demonstrate that the efficient two‐photon polymerization of stable 3D microarchitectures can be achieved using triazole‐based photoinitiators

NRG Oncology-Radiation Therapy Oncology Group Study 1014: 1-Year Toxicity Report From a Phase 2 Study of Repeat Breast-Preserving Surgery and 3-Dimensional Conformal Partial-Breast Reirradiation for In-Breast Recurrence.

PURPOSE: To determine the associated toxicity, tolerance, and safety of partial-breast reirradiation. METHODS AND MATERIALS: Eligibility criteria included in-breast recurrence occurring \u3e1 year after whole-breast irradiation, \u3c3 \u3ecm, unifocal, and resected with negative margins. Partial-breast reirradiation was targeted to the surgical cavity plus 1.5 cm; a prescription dose of 45 Gy in 1.5 Gy twice daily for 30 treatments was used. The primary objective was to evaluate the rate of grade ≥3 treatment-related skin, fibrosis, and/or breast pain adverse events (AEs), occurring ≤1 year from re-treatment completion. A rate of ≥13% for these AEs in a cohort of 55 patients was determined to be unacceptable (86% power, 1-sided α = 0.07). RESULTS: Between 2010 and 2013, 65 patients were accrued, and the first 55 eligible and with 1 year follow-up were analyzed. Median age was 68 years. Twenty-two patients had ductal carcinoma in situ, and 33 had invasive disease: 19 ≤1 cm, 13 \u3e1 to ≤2 cm, and 1 \u3e2 cm. All patients were clinically node negative. Systemic therapy was delivered in 51%. All treatment plans underwent quality review for contouring accuracy and dosimetric compliance. All treatment plans scored acceptable for tumor volume contouring and tumor volume dose-volume analysis. Only 4 (7%) scored unacceptable for organs at risk contouring and organs at risk dose-volume analysis. Treatment-related skin, fibrosis, and/or breast pain AEs were recorded as grade 1 in 64% and grade 2 in 7%, with only 1 ( CONCLUSION: Partial-breast reirradiation with 3-dimensional conformal radiation therapy after second lumpectomy for patients experiencing in-breast failures after whole-breast irradiation is safe and feasible, with acceptable treatment quality achieved. Skin, fibrosis, and breast pain toxicity was acceptable, and grade 3 toxicity was rare

Nipple Sparing Mastectomy: A Review of Outcomes at a 1 Single Institution

Introduction Nipple sparing mastectomy (NSM) offers patients who are not candidates for breast conserving treatment an aesthetically pleasing alternative to traditional mastectomy. Some studies have demonstrated its oncologic safety while others have demonstrated residual occult tumor cells at the nipple areolar complex (NAC). These data prompt further review of oncologic outcomes after NSM. Methods A single institution retrospective chart review of all NSMs performed by 4 breast surgeons at Thomas Jefferson University Hospital over a span of 2012-2019. In this cohort we review the reconstruction performed, axillary lymph node status, surgical margins, final pathology, loss of the NAC, recurrence rates, and follow-up. Results In our cohort we reviewed 170 NSMs performed on 105 patients. All patients were female and the average age was 46.9 years. Prophylactic procedures were performed on 43% of patients with 17.1% of patients being BRCA positive. Of those undergoing NSM for cancer (n=94) the associated pathology was 28.8% DCIS, 32.9% IDC, and 3.5% ILC (This accounts for some patients with multiple diagnoses on final pathology). Sentinel lymph node biopsy (SLNB) was performed in 52.9% of cases with 10.6% of cases being positive for axillary disease. Margins were positive in 10.6% (n=10) of cases performed for cancer with 8.5% (n=8) of cases having positive margin at the NAC and the remainder being at the deep margin. Based on margin positivity 2.4% (n=4) of patients underwent redo surgery with 1 patient requiring re-resection at the NAC margin and 3 patients having total NAC resection. Total loss of NAC occurred in 5.9% (n=10) of cases due to positive margins (n=3) and necrosis (n=7). Recurrence occurred in 7.2% (n=7) of cases who underwent NSM for cancer. Locoregional recurrence in breast tissue, skin, or axilla occurred in 4.1% (n=4) of cases with 0 recurrences at the NAC. Distant recurrence occurred in 4.1% (n=4) of cases at both liver and bone. Average time to recurrence was 27.3 months. Of the 170 NSM performed 98% had immediate tissue expander placement with 60% converting to permanent sub-pectoral implant reconstruction, 14% latissimus dorsi flap reconstruction, 0.6% delayed deep inferior epigastric artery perforator free flap reconstruction, and 5.2% undergoing delayed free transversus abdominus muscle flap reconstruction. Of all the cases reviewed there was only 1 death. Our average follow-up was 26.7 months. Conclusion We demonstrate similar numbers in our analysis as other studies that have looked at oncologic outcomes after NSM. Although we demonstrate evidence of occult disease at the NAC margin when performing NSM there was no evidence of recurrence at the NAC demonstrating its efficacy and safety. With proper patient selection this procedure can be safely offered as an aesthetically appealing alternative to traditional mastectom

Spin-orbit coupling control of anisotropy, ground state and frustration in 5d2 Sr2MgOsO6

The influence of spin-orbit coupling (SOC) on the physical properties of the 5d2 system Sr2MgOsO6 is probed via a combination of magnetometry, specific heat measurements, elastic and inelastic neutron scattering, and density functional theory calculations. Although a significant degree of frustration is expected, we find that Sr2MgOsO6 orders in a type I antiferromagnetic structure at the remarkably high temperature of 108 K. The measurements presented allow for the first accurate quantification of the size of the magnetic moment in a 5d2 system of 0.60(2) μB –a significantly reduced moment from the expected value for such a system. Furthermore, significant anisotropy is identified via a spin excitation gap, and we confirm by first principles calculations that SOC not only provides the magnetocrystalline anisotropy, but also plays a crucial role in determining both the ground state magnetic order and the size of the local moment in this compound. Through comparison to Sr2ScOsO6, it is demonstrated that SOC-induced anisotropy has the ability to relieve frustration in 5d2 systems relative to their 5d3 counterparts, providing an explanation of the high TN found in Sr2MgOsO6

Coronary CT Angiography and 5-Year Risk of Myocardial Infarction.

BACKGROUND: Although coronary computed tomographic angiography (CTA) improves diagnostic certainty in the assessment of patients with stable chest pain, its effect on 5-year clinical outcomes is unknown. METHODS: In an open-label, multicenter, parallel-group trial, we randomly assigned 4146 patients with stable chest pain who had been referred to a cardiology clinic for evaluation to standard care plus CTA (2073 patients) or to standard care alone (2073 patients). Investigations, treatments, and clinical outcomes were assessed over 3 to 7 years of follow-up. The primary end point was death from coronary heart disease or nonfatal myocardial infarction at 5 years. RESULTS: The median duration of follow-up was 4.8 years, which yielded 20,254 patient-years of follow-up. The 5-year rate of the primary end point was lower in the CTA group than in the standard-care group (2.3% [48 patients] vs. 3.9% [81 patients]; hazard ratio, 0.59; 95% confidence interval [CI], 0.41 to 0.84; P=0.004). Although the rates of invasive coronary angiography and coronary revascularization were higher in the CTA group than in the standard-care group in the first few months of follow-up, overall rates were similar at 5 years: invasive coronary angiography was performed in 491 patients in the CTA group and in 502 patients in the standard-care group (hazard ratio, 1.00; 95% CI, 0.88 to 1.13), and coronary revascularization was performed in 279 patients in the CTA group and in 267 in the standard-care group (hazard ratio, 1.07; 95% CI, 0.91 to 1.27). However, more preventive therapies were initiated in patients in the CTA group (odds ratio, 1.40; 95% CI, 1.19 to 1.65), as were more antianginal therapies (odds ratio, 1.27; 95% CI, 1.05 to 1.54). There were no significant between-group differences in the rates of cardiovascular or noncardiovascular deaths or deaths from any cause. CONCLUSIONS: In this trial, the use of CTA in addition to standard care in patients with stable chest pain resulted in a significantly lower rate of death from coronary heart disease or nonfatal myocardial infarction at 5 years than standard care alone, without resulting in a significantly higher rate of coronary angiography or coronary revascularization. (Funded by the Scottish Government Chief Scientist Office and others; SCOT-HEART ClinicalTrials.gov number, NCT01149590 .)