Physiotherapy practice in pulmonary hypertension: physiotherapist and patient perspectives

Pulmonary hypertension (PH) is a life-limiting disease affecting circulation to the lungs. The primary symptom of PH is breathlessness, yet research has shown that patients with PH can exercise safely and can benefit from exercise to improve exercise capacity and maintain quality of life. This study aimed to investigate the nature of physiotherapy delivered to patients with PH in the UK. This was a two-phase sequential, exploratory, mixed-methods study. Interviews were conducted with seven lead physiotherapists at specialist pulmonary hypertension centers and three patients. Survey data came from 63 physiotherapists caring for patients with PH in specialist and non-specialist settings. The findings from the two phases were triangulated and analyzed. Findings showed that physiotherapists and patients see the benefit and potential of physical activity for patients with PH to maintain functional wellbeing. However, current physiotherapy provision focuses on acute inpatient care and planning for discharge and is not therefore aligned with research evidence and clinical guidelines. In the absence of inpatient rehabilitation facilities, physiotherapists will occasionally access existing community services, e.g. pulmonary rehabilitation; however, specialist knowledge of this rare condition can be lacking in local services. There is aspiration among physiotherapists and patients for a new approach which supports patients from diagnosis with PH to end of life. This includes promoting and delivering rehabilitation and exercise interventions to achieve better health outcomes, in line with patient needs. Treatment would be commissioned and delivered within existing national health systems with physiotherapists developing strategies for health improvement

The Effects of Shoe Design on Lower Limb Running Kinematics

The preference of running as a form of exercise exposes more recreational athletes to the risk of injury. Stress fractures occur for 0.7-20% of all running injuries (Wilder & Sethi, 2004) and 24-50% of stress fractures occur in the tibia (Aweid, Aweid, Talibi, & Porter, 2013). Stress fractures have been associated with high vertical impact peaks while running (Willy & Davis, 2013) so methods such as barefoot running and minimalist shoes aim to reduce these impact peaks by enforcing a more forefoot running pattern. Shoes with a lower drop height have been shown to induce a more forefoot running pattern without the discomfort of running barefoot or in non-cushioned minimalist shoes (Horvais & Samozino, 2012). The purpose of this study was to compare ankle joint kinematics, dorsiflexor muscle activity, and tibial axial acceleration while wearing low and high heel-drop shoes. Six female participants (19.8(1.0) years, 163.0(3.8) cm, and 60.4(5.5) kg) who ran a minimum of 10 miles per week provided informed consent prior to testing. Participants were equipped with a 16g BioNomadix tri-axial accelerometer attached to the tibia, a Bi-axial electrogoniometer attached at the ankle, two Ag-AgCl surface electrodes attached to the tibialis anterior with adhesive discs, one reference electrode placed on the anteromedial aspect of the tibia (not above a muscle), and a heart rate monitor. Participants completed two data running trials at a target effort of 65-70% of the heart rate reserve. Trials were performed in different shoes (drop heights 4mm(S1) and 11.7mm(S2)) with a minimum 10-minute rest between trials. Paired t-tests were used to compare conditions for each variable. Mean ankle angles at ground contact (S1=100.9(3.8)°, S2=102.6(3.0)°) were not significantly different (t(5)=-1.465, p=0.203) and had a small effect size (Cohen d=0.598). Mean peak tibial accelerations (S1=5.22(2.51g), S2=5.90(2.90)g) were not significantly different (t(5)=-1.238, p=0.271) and had a small effect size (Cohen d=0.505). The mean percentages of maximal EMG for the tibialis anterior (S1=66.2(45.7)%, S2=55.6(38.5)%) were not significant (t(5)=1.380, p=0.226) and had a small effect size (Cohen d=0.563). Though differences were observed between shoe conditions for each participant, the shoe drop height did not significantly affect the measured variables and cannot be assumed to be responsible for these observed differences

Neck spasm after chemoradiotherapy for head and neck cancer: Natural history and dosimetric correlates

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102727/1/hed23284.pd

Total versus superficial parotidectomy for stage III melanoma

BackgroundThe primary purpose of this study was to describe the parotid recurrence rates after superficial and total parotidectomy.MethodsA retrospective cohort study was performed on patients with cutaneous melanoma metastatic to the parotid gland who underwent parotidectomy from 1998 through 2014. Primary outcome was parotid bed recurrence. Secondary outcomes were facial nerve function postoperatively and at last follow‐up.ResultsOne hundred twenty‐nine patients were included in the study. Thirty‐four patients (26%) underwent a total parotidectomy and 95 patients underwent superficial parotidectomy. Twelve patients (13%) developed parotid bed recurrence after superficial parotidectomy alone versus zero after total parotidectomy (P = .035). Facial nerve function, clinically detected disease, stage, and adjuvant treatment were not statistically different between the groups (P = .32, .32, .13, and 0.99, respectively).ConclusionParotid bed melanoma recurrence was more common after superficial parotidectomy compared to total parotidectomy, and recurrence resulted in significant facial nerve functional deficit. Our results support total parotidectomy when metastatic melanoma involves the parotid nodal basin.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137735/1/hed24810_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137735/2/hed24810.pd

Kaneohe Fishpond Master Plan

master plan intended to identify goals, directions, and measures to restore remaining fishponds for uses consistent with their historic function and intergrit

Cranial nerve outcomes in regionally recurrent head & neck melanoma after sentinel lymph node biopsy

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/156007/1/lary28243.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/156007/2/lary28243_am.pd

SeaWiFs Technical Report Series. Volume 34: The Third SeaWiFS Intercalibration Round-Robin Experiment (SIRREX-3), 19-30 September 1994

This report presents results of the third Sea-viewing Wide Field-of-view Sensor (SeaWiFS) Intercalibration Round- Robin Experiment (SIRREX-3), which was held at the San Diego State University (SDSU) Center for Hydro-Optics and Remote Sensing (CHORS) on 19-30 September 1994. Spectral irradiances of FEL lamps belonging to each participant were intercompared by reference to the National Institute of Standards and Technology (NIST) scale of spectral irradiance using secondary standard lamps F268, F269, and F182, with a Type A uncertainty between 1.1-1.5%. This level of uncertainty was achieved despite difficulties with lamp F269. The average spectral irradiances of FEL lamps, compared in both SIRREX-2 and SIRREX-3, differed between the two experiments by 1.5%, which probably indicates that the values assigned to the secondary standard lamp at the time of SIRREX-2 were in error. With two exceptions, spectral radiance values of integrating sphere sources were measured during SIRREX-3 with uncertainties in temporal stability of less than 0.3% and absolute uncertainties of 1.5-2.0%. This is a significant improvement over similar intercomparisons in SIRREX- I and SIRREX-2. Plaque reflectances were intercompared with an uncertainty of about 1-2%, but the absolute uncertainty is undefined. Although this is an improvement over results of previous SIRREXS, the sources and magnitude of uncertainty associated with transfers of spectral radiance using plaques requires further evaluation in future experiments