Validation of Practical Tools to Identify Walking Cadence to Reach Moderate Intensity

International Journal of Exercise Science 12(4): 1244-1253, 2019. It is recommended that adults get at minimum 150 minutes of moderate-to-vigorous physical activity in bouts of 10 minutes or greaterevery week. Walking cadence (steps per minute) is one easy way to estimate intensity required, however tools that claim to quantify walking intensity via walking cadence have not been validated in adults. We aimed to validate: 1- the accuracy of walking cadence measurement by the Piezo RxD pedometer, Polar Stride Sensor Bluetooth Smart foot pod, and Garmin Ant+ foot pod at different speeds and slopes and 2- the ability of the Piezo RxD to identify bouts of walking at moderate intensity using walking cadence. Inclusion criteria included being aged 19+ and the ability to reach moderate intensity when walking without incline as determined by a treadmill cardiorespiratory fitness test to determine 40% of VO2reserve. Walking cadence measured from the three tools was compared to a manual count of walking cadence during a series of walking stages at several speeds (2.5-5.5 km/h) and inclines (0-15%). The ability of the Piezo RxD to quantify a 10-minute bout was determined by walking for 12 minutes at 40% of VO2reserve measured by indirect calorimetry. All correlations between manual walking cadence counts and all devices were significant regardless of speed (r ranging from 0.469 to 0.999; p£0.05) and slope (r ranging from 0.887 to 0.996; p£0.05). The Piezo RxD was able to correctly measure a 10-minute bout of walking at moderate intensity for 50 of 51 participants. We found that all walking cadence devices provided accurate measurements of walking cadence. The Piezo RxD is an effective tool to quantify bouts of walking done at a minimum of moderate intensity

Management of Peritonsillar Abscess Within a Local Emergency Department: A Quality Analysis Study.

OBJECTIVE: Peritonsillar abscess (PTA) is the most common deep space infection of the head and neck, affecting thousands of people annually with high treatment costs. The purpose of this project was to determine how in-network emergency departments (EDs) adhere to generally accepted guidelines regarding diagnosis and management of potential PTAs. METHODS: The authors performed a retrospective chart review to identify patients with PTA in five EDs in one year. Information pertaining to diagnostic tests, treatment, and airway status was also collected. Descriptive analysis was used to assess if EDs were consistent with generally accepted guidelines. RESULTS: Six hundred twenty-one patient records were identified and 140 were included in final analysis. Out of 140 patients, 71 were admitted for inpatient management and 23 were admitted for observation. Of the 46 patients diagnosed and discharged from the ED, 61% received a computerized tomography (CT) scan and only 39% had PTA drainage performed. Four (3%) patients received a point of care ultrasound and a CT scan and no patient received only an ultrasound. Out of all patients, 116/140 received a CT scan and 22 received drainage in the ED. The remainder of these patients either had drainage performed by an otolaryngologist or had no drainage performed. Of the 94 patients admitted for inpatient or observation, 84 received a CT scan and six received drainage by an ED physician. Only 62% of patients were given a penicillin derivative and 29% were given clindamycin, which has no Gram-negative coverage. CONCLUSION: One-third of PTA patients were managed within the ED, far less than similar studies. Of these, over 50% received a CT scan and less than 50% had PTA drainage. PTA drainage can improve patients\u27 symptoms and antibiotic effectiveness. The majority of patients were prescribed a penicillin derivative with or without another antibiotic

Genetic consequences of multiple translocations of the banded hare-qallaby in Western Australia

Many Australian mammal species now only occur on islands and fenced mainland havens free from invasive predators. The range of one species, the banded hare-wallaby (Lagostrophus fasciatus), had contracted to two offshore islands in Western Australia. To improve survival, four conservation translocations have been attempted with mixed success, and all occurred in the absence of genetic information. Here, we genotyped seven polymorphic microsatellite markers in two source (Bernier Island and Dorre Island), two historic captive, and two translocated L. fasciatus populations to determine the impact of multiple translocations on genetic diversity. Subsequently, we used population viability analysis (PVA) and gene retention modelling to determine scenarios that will maximise demographic resilience and genetic richness of two new populations that are currently being established. One translocated population (Wadderin) has undergone a genetic bottleneck and lost 8.1% of its source population’s allelic diversity, while the other (Faure Island) may be inbred. We show that founder number is a key parameter when establishing new L. fasciatus populations and 100 founders should lead to high survival probabilities. Our modelling predicts that during periodic droughts, the recovery of source populations will be slower post-harvest, while 75% more animals—about 60 individuals—are required to retain adequate allelic diversity in the translocated population. Our approach demonstrates how genetic data coupled with simulations of stochastic environmental events can address central questions in translocation programmes

Evidence-based planning and costing palliative care services for children : novel multi-method epidemiological and economic exemplar

Background: Children’s palliative care is a relatively new clinical specialty. Its nature is multi-dimensional and its delivery necessarily multi-professional. Numerous diverse public and not-for-profit organisations typically provide services and support. Because services are not centrally coordinated, they are provided in a manner that is inconsistent and incoherent. Since the first children’s hospice opened in 1982, the epidemiology of life-limiting conditions has changed with more children living longer, and many requiring transfer to adult services. Very little is known about the number of children living within any given geographical locality, costs of care, or experiences of children with ongoing palliative care needs and their families. We integrated evidence, and undertook and used novel methodological epidemiological work to develop the first evidence-based and costed commissioning exemplar. Methods: Multi-method epidemiological and economic exemplar from a health and not-for-profit organisation perspective, to estimate numbers of children under 19 years with life-limiting conditions, cost current services, determine child/parent care preferences, and cost choice of end-of-life care at home. Results: The exemplar locality (North Wales) had important gaps in service provision and the clinical network. The estimated annual total cost of current children’s palliative care was about £5.5 million; average annual care cost per child was £22,771 using 2007 prevalence estimates and £2,437- £11,045 using new 2012/13 population-based prevalence estimates. Using population-based prevalence, we estimate 2271 children with a life-limiting condition in the general exemplar population and around 501 children per year with ongoing palliative care needs in contact with hospital services. Around 24 children with a wide range of life-limiting conditions require end-of-life care per year. Choice of end-of-life care at home was requested, which is not currently universally available. We estimated a minimum (based on 1 week of end-of-life care) additional cost of £336,000 per year to provide end-of-life support at home. Were end-of-life care to span 4 weeks, the total annual additional costs increases to £536,500 (2010/11 prices). Conclusions: Findings make a significant contribution to population-based needs assessment and commissioning methodology in children’s palliative care. Further work is needed to determine with greater precision which children in the total population require access to services and when. Half of children who died 2002-7 did not have conditions that met the globally used children's palliative care condition categories, which need revision in light of findings

Practice belief scales among private general dental practitioners

The document attached has been archived with permission from the Australian Dental Association (8th Jan 2008). An external link to the publisher’s copy is included.Background: Practice beliefs have been related to service rate variation. The aims of this study were to replicate practice belief scales in Australia and investigate associations with dentist and practice characteristics and services. Method: A random sample of Australian dentists completed mailed questionnaires (response rate 60.3 per cent). Results: Private general practitioners (n=345) provided service data from a typical day. Eight practice belief items were recorded on a five-point Likert scale, yielding four factor-based scales. Approximately 85 per cent of responses were on the agreement side of the midpoint for the scales of Information giving and Patient influence, 45 per cent for Preventive orientation and approximately 10 per cent for Controlling active disease rather than developing better preventive advice. Capital city dentists had higher agreement with the Preventive orientation scale, while males and older dentists showed less disagreement with the Controlling active disease item (Mann-Whitney, Kruskal-Wallis P<0.05). Those agreeing with the scales (that is scores ≤ the median) showed (Poisson regression P<0.05): a higher rate of crown and bridge, a rate ratio (RR) of 1.31, but lower rates of extraction (RR=0.76) and prosthodontic services (RR=0.64) for the Information giving scale; a higher rate of restorative (RR=1.22) and total services per visit (RR=1.06) for the Preventive orientation scale; a higher rate of preventive services (RR=1.14), but a lower rate of crown and bridge services (0.78) for the Patient influence scale; and higher rates of crown and bridge (RR=1.40) and prosthodontic (RR=1.59) but lower rates of periodontic (RR=0.60) and extraction services (RR=0.62) for the Controlling active disease item. Conclusions: These findings confirm the factor structure of practice beliefs and demonstrate small to moderate associations with variation in service rates.DS Brennan and AJ Spence

The influence of smoking, age and stage at diagnosis on the survival after larynx, hypopharynx and oral cavity cancers in Europe:The ARCAGE study

Head and neck cancer (HNC) is a preventable malignancy that continues to cause substantial morbidity and mortality worldwide. Using data from the ARCAGE and Rome studies, we investigated the main predictors of survival after larynx, hypopharynx and oral cavity (OC) cancers. We used the Kaplan-Meier method to estimate overall survival, and Cox proportional models to examine the relationship between survival and sociodemographic and clinical characteristics. 604 larynx, 146 hypopharynx and 460 OC cancer cases were included in this study. Over a median follow-up time of 4.6 years, nearly 50% (n=586) of patients died. Five-year survival was 65% for larynx, 55% for OC, and 35% for hypopharynx cancers. In a multivariable analysis, we observed an increased mortality risk among older (≥71 years) vs. younger (≤50 years) patients with larynx/hypopharynx combined (LH) and OC cancers [HR=1.61, 95% CI 1.09–2.38 (LH) and HR=2.12, 95% CI 1.35–3.33 (OC)], current vs. never smokers [HR=2.67, 95% CI 1.40–5.08 (LH) and HR=2.16, 95% CI 1.32–3.54 (OC)], and advanced vs. early stage disease at diagnosis [IV vs. I, HR=2.60, 95% CI 1.78–3.79 (LH) and HR=3.17, 95% CI 2.05–4.89 (OC)]. Survival was not associated with sex, alcohol consumption, education, oral health, p16 expression, presence of HPV infection, or body mass index 2 years before cancer diagnosis. Despite advances in diagnosis and therapeutic modalities, survival after HNC remains low in Europe. In addition to the recognized prognostic effect of stage at diagnosis, smoking history and older age at diagnosis are important prognostic indicators for HNC