Search

Background: Explored whether increased support for spiritual concerns between the healthcare team and patients through the provision of a Spiritual Care Advocate (SCA) would improve end of life outcomes in a metastatic cancer population. Design: Newly diagnosed metastatic cancer patients were recruited at the University of Chicago Medical Center and received spiritual support from a Spiritual Care Advocate during chemotherapy treatments. The final sample consisted of 42 patients (58% of those approached) who completed the baseline survey and had known survival status. Measurement: Patients completed pre/post surveys measuring spiritual support and palliative quality of life. Baseline measurements of religious practice and externalizing religious health beliefs were also obtained. Receipt of aggressive EOL care was derived from the electronic medical record. Result: Median age was 61 years, with 48% Black, and predominantly male (62%). Of the 42 patients, 30 (70%) had died by the time of this analysis. Perceived spiritual support from the medical team increased in 47% of those who received non-aggressive EOL care and by 40% in those who received aggressive EOL care (p=0.012). Patient perceptions of spiritual support from the medical community increased from 27% at baseline to 63% (p=0.005) after the SCA intervention. Only 20% of recipients received aggressive treatments at end of life. Conclusion: The SCA model improved the perceived spiritual support between the healthcare team and patients. Although limited by a small sample size, the model was also associated with an improvement in EOL patients' quality of life, spiritual wellbeing, and decreased aggressive EOL care. [ABSTRACT FROM AUTHOR]

Your Major Threats One of the major economic tenants of Obamacare is that the doctor will be paid less. That means as a doctor, you may be looking at an [...]

Purpose: The objective of this study was to determine whether physical examinations (flexion–abduction–external rotation [FABER], impingement, range-of-motion profiles) could be used to detect the bony abnormalities of femoroacetabular impingement (FAI) in an athletic population. Methods: We performed a prospective study of 65 male collegiate football players. Both hips were evaluated by 2 orthopaedic surgeons for radiographic signs of FAI. The alpha angle and head-neck offset were measured on frog-leg lateral films. The center-edge angle, acetabular index, crossover sign, and alpha angle were measured on anteroposterior films. Measurements were averaged for both observers. Maximum hip range of motion in flexion (supine) and internal/external rotation (supine, sitting, and prone) was measured with a goniometer. Pain provoked by the impingement and FABER tests was also recorded. Examinations were completed at 2 of 4 stations (2 duplicates), each staffed by 2 clinicians (1 examined and 1 measured). The relation between each range-of-motion and radiographic measure was determined. Data from each station were assessed separately. Only those regressions significant (P < .05) for paired stations were considered clinically significant. Results: The alpha angle and head-neck offset measured on the frog-leg lateral films were significantly correlated (all P < .01) to supine, sitting, and prone internal rotation for all stations. Correlation coefficients ranged from −0.59 to −0.35 for alpha angle and 0.42 to 0.57 for head-neck offset. Although 95% of the hips had at least 1 radiographic sign of FAI, pain was reported in only 8.5% and 2.3% during the impingement and FABER tests, respectively. Conclusions: Internal rotation correlates to radiographic measures of cam FAI in this cohort of collegiate football players. Football players with diminished internal rotation in whom hip pain develops should be evaluated for underlying cam FAI abnormalities. Level of Evidence: Level IV, therapeutic case series. [Copyright &y& Elsevier]

A state of light which is a superposition of the vacuum and the one-photon number state is the simplest state containing phase information. Recently we have shown how afield in such astate might be generated and here we explore its usefulness as a probe for measuring unknown states of light. We find that this probe can beused reasonably simply both todetermine completely some pure states of light and to measure the diagonal and nearest off-diagonal elements of the density matrix in the number state basis and hence toobtain the mean sine and cosine of the phase of an unknown mixed state. We suggest further how a field in a superposition of the vacuum and the two-photon number state might be generated and how this can be used as a probe, both to measure the off-diagonal matrix elements second nearest to the diagonal of a mixed state density matrix and to measure the variance of the cosine and the sine of the phase. We also examine the experimentally more likely case where the probe fields are in mixed states and show how the same information about the unknown state can still be retrieved. [ABSTRACT FROM AUTHOR]

The article reviews the open source content management system (CMS) and the open source Integrated Library System (ILS) from Katipo Communications Ltd.

Myocarditis and/or pericarditis (also known as myopericarditis) are inflammatory diseases involving the myocardium (with non-ischemic myocyte necrosis) and/or the pericardial sac. Myocarditis/pericarditis (MPC) may present with variable clinical signs, symptoms, etiologies and outcomes, including acute heart failure, sudden death, and chronic dilated cardiomyopathy. Possible undiagnosed and/or subclinical acute myocarditis, with undefined potential for delayed manifestations, presents further challenges for diagnosing an acute disease and may go undetected in the setting of infection as well as adverse drug/vaccine reactions. The most common causes of MPC are viral, with non-infectious, drug/vaccine associated hypersensitivity and/or autoimmune causes being less well defined and with potentially different inflammatory mechanisms and treatment responses. Potential cardiac adverse events following immunization (AEFIs) encompass a larger scope of diagnoses such as triggering or exacerbating ischemic cardiac events, cardiomyopathy with potential heart failure, arrhythmias and sudden death. The current published experience does not support a potential causal association with vaccines based on epidemiologic evidence of relative risk increases compared with background unvaccinated incidence. The only evidence supporting a possible causal association of MPC with a vaccine comes from case reports. Hypersensitivity MPC as a drug/vaccine induced cardiac adverse event has long been a concern for post-licensure safety surveillance, as well as safety data submission for licensure. Other cardiac adverse events, such as dilated cardiomyopathy, were also defined in the CDC definitions for adverse events after smallpox vaccination in 2006. In addition, several groups have attempted to develop and improve the definition and adjudication of post-vaccination cardiovascular events. We developed the current case definitions for myocarditis and pericarditis as an AEFI building on experience and lessons learnt, as well as a comprehensive literature review. Considerations of other etiologies and causal relationships are outside the scope of this document. [ABSTRACT FROM AUTHOR]

Recent literature suggests that adults do not necessarily develop osteoarthritis if they have an osteochondral lesion of the talus (OLT). The purpose of this study was to determine if children with OLT are at risk to develop any radiographic evidence of early joint degeneration despite treatment efforts. Fifty-six ankles were identified over 6 years with stable OLT that underwent operative treatment. Preoperatively, each lesion was classified according to Berndt-Hardy for radiographs, Hepple for MRI, and Ferkel and Sgaglione for computed tomography. Radiographs were also evaluated for physeal status, OLT characteristics (location, border, size), and signs of osteoarthritis (Kellgren and Lawrence Scale). Despite incomplete treatment to radiographic resolution, the Kellgren-Lawrence scores still worsened in 23% of the children (pre-op score: mean 0.42 and median 0 versus post-op score: mean 0.69 and median 1). No risk factors (preoperative classification, age, physeal patency) were associated with advancing radiographic evidence of articular degeneration utilizing univariate analysis. However, a classification and regression tree analysis revealed that a patient age of 11.5 years old could be predictive of advancing Kellgren-Lawrence scores with one-third of older children worsening (P = 0.038). Despite active treatment of OLT, the ultimate prognosis is guarded with approximately one out of four children advancing their Kellgren and Lawrence score during treatment. In contrast to the natural history of adult OLT, the short-term advancement of degenerative disease in childhood OLT suggests a potentially different outcome and warrants further investigation into better treatment methods to preserve ankle health in these young patients.

High-resolution magnetoelectric imaging is used to demonstrate electrical control of the perpendicular local magnetization associated with 125 nm-wide magnetic stripe domains in 100-nm-thick Ni films. This magnetoelectric coupling is achieved in zero magnetic field using strain from ferroelectric BaTiO3 substrates to control perpendicular anisotropy imposed by the growth stress. These findings may be exploited for perpendicular recording in nanopatterned hybrid media., (© 2015 The Authors. Published by WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Purpose: The objective of this study was to determine whether physical examinations (flexion-abduction-external rotation [FABER], impingement, range-of-motion profiles) could be used to detect the bony abnormalities of femoroacetabular impingement (FAI) in an athletic population., Methods: We performed a prospective study of 65 male collegiate football players. Both hips were evaluated by 2 orthopaedic surgeons for radiographic signs of FAI. The alpha angle and head-neck offset were measured on frog-leg lateral films. The center-edge angle, acetabular index, crossover sign, and alpha angle were measured on anteroposterior films. Measurements were averaged for both observers. Maximum hip range of motion in flexion (supine) and internal/external rotation (supine, sitting, and prone) was measured with a goniometer. Pain provoked by the impingement and FABER tests was also recorded. Examinations were completed at 2 of 4 stations (2 duplicates), each staffed by 2 clinicians (1 examined and 1 measured). The relation between each range-of-motion and radiographic measure was determined. Data from each station were assessed separately. Only those regressions significant (P < .05) for paired stations were considered clinically significant., Results: The alpha angle and head-neck offset measured on the frog-leg lateral films were significantly correlated (all P < .01) to supine, sitting, and prone internal rotation for all stations. Correlation coefficients ranged from -0.59 to -0.35 for alpha angle and 0.42 to 0.57 for head-neck offset. Although 95% of the hips had at least 1 radiographic sign of FAI, pain was reported in only 8.5% and 2.3% during the impingement and FABER tests, respectively., Conclusions: Internal rotation correlates to radiographic measures of cam FAI in this cohort of collegiate football players. Football players with diminished internal rotation in whom hip pain develops should be evaluated for underlying cam FAI abnormalities., Level of Evidence: Level IV, therapeutic case series., (Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Objective: To determine whether a device designed to provide low-intensity, low-frequency mechanical stimulation improves healing time of acute wounds., Design: Repeated measures using mechanical stimulation on one side of a rat and sham stimulation on the contralateral side., Setting: Academic animal facility., Participants: Six male Sprague-Dawley rats, approximately 400 g., Intervention: Mechanical stimulation of 4-mm biopsy wounds in rats was produced through the use of permanent magnets cyclically attracted and repelled by activation of an electromagnet by a square wave generator at a frequency of 1 Hz and a force equivalent to 64 mm Hg pressure., Main Outcome Measure: Days to complete closure of 4-mm biopsy punch wounds., Main Results: This form of stimulation reduced time to close the biopsy wounds by nearly 50%. Mechanically stimulated wounds closed in 3.8 +/- 1.6 days (mean +/- SD) compared with 6.8 +/- 1.9 days for sham-stimulated wounds (P = .0002)., Conclusion: Production of a mechanical stimulation device with a miniaturized controller and power source and trials on humans are needed to determine the efficacy and potential cost savings of such a device in the management of wounds.