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Spinal manipulation is a manual treatment technique that delivers a thrust, using specific biomechanical parameters to exert its therapeutic effects. These parameters have been shown to have a unique dose-response relationship with the physiological responses of the therapy. So far, however, there has not been a unified approach to standardize these biomechanical characteristics. In fact, it is still undetermined how they affect the observed clinical outcomes of spinal manipulation. This study, therefore, reviewed the current body of literature to explore these dosage parameters and evaluate their significance, with respect to physiological and clinical outcomes. From the experimental studies reviewed herein, it is evident that the modulation of manipulation's biomechanical parameters elicits transient physiological responses, including changes in neuronal activity, electromyographic responses, spinal stiffness, muscle spindle responses, paraspinal muscle activity, vertebral displacement, and segmental and intersegmental acceleration responses. However, to date, there have been few clinical trials that tested the therapeutic relevance of these changes. In addition, there were some inherent limitations in both human and animal models due to the use of mechanical devices to apply the thrust. Future studies evaluating the effects of varying biomechanical parameters of spinal manipulation should include clinicians to deliver the therapy in order to explore the true clinical significance of the dose-response relationship.

PURPOSE: The Coronavirus 2019 (COVID-19) pandemic is an international public health emergency. Vaccines, and acute infection drugs are currently unknown, and when available, expense and distribution issues may impede distribution in undeserved areas. The aim of this systematic review was to summarize the evidence regarding cinchona bark (CB) for its potential anti-viral properties against COVID-19 STUDY DESIGN: A current literature and historical text review was conducted, limited to articles having full text or abstracts available in English, using Google Scholar, Pubmed-NCBI, ScienceDirect, and WebMD, and online book publications, with key search words, including synthetic CB analogues: chloroquine-hydroxychloroquine (CQ/HCQ) derivatives. RESULTS: Several related in-vitro studies, editorials, and expert consensus papers on quinine analogue anti-viral treatment papers and historical treatises have been published. A March 2020 CQ drug trial ongoing in China, has just reported breakthrough efficacy evidence for COVID-19 pneumonia. However, there are severe CQ shortages and direct evidence for the anti-viral therapeutic use of CB is sparse, several centuries old, and controversial. CONCLUSION: CB was for centuries known to be a natural source of quinine from which modern synthetically manufactured analogues anti-viral purposed drugs such as CQ/HCQ are based. CB may also possess anti COVID-19 activity as its historical derivatives, but with the same potential for life-threatening adverse reactions and severe drug interaction complications akin to its analogues. Issues with herbal quality control, prescriber dose inexperience, perceived risk underestimation by self-prescribers, and a misinformed propensity for consumer fraud are other concerns. However, analogue drug risk-benefit ratios indicate CB may also have some value for acute COVID-19 (cytokine storm) infection management. The existing evidence and evolving breakthrough CQ efficacy findings in China, shadowed by CQ shortage, highlight a need for modern and timely investigation of CB as cost-effective alternative COVID-19 pneumonia monotherapy.

Radiographic osteoarthritis of the knee is very common in Saudi patients, especially in the patellofemoral compartment. Some studies have considered repetitive daily prayer activities as a factor of causation. However prevention and management recommendations appear to be non-existent in the literature. This report describes the case of chronic bilateral anterior knee pain in a devout adult male, which was dramatically alleviated by simply using a padded cushion under the prayer rug. Simple strategies of temporarily modifying prayer posture, insuring good prayer form, and adequate knee padding, may offer promise as low tech and economical solution for the management of anterior knee pain in this cultural group.

Burnout among millennial medical students is an important health issue with a possibility of potential professional dissatisfaction. The reason for burnout is multifactorial. The gender of the medical student may play a significant role when choosing a residency specialty and making a career choice. Gender may also influence while establishing the burnout seen in students. Here we tested the association between burnout in medical students based on gender and residency specialty choice during COVID-19.A multicentric cross-sectional study, using a questionnaire-based survey on the items related to gender, educational interest, status, residency aspiration, changes to career aspiration based on gender, and COVID-19 and an indigenous burnout assessment tool that was administered to all the medical students in the study. Reliability and validity of the tool were assessed, and the burnout was calculated for emotional exhaustion, personal achievement, and depersonalization domain.A total of 487 medical students (42.5% males, 57.2% females) completed the survey. A higher number of female participants felt that COVID-19 affected their energy levels (68.9%), interest in education (53.2%), and developed reservations about residency specialty of choice (46%); emotional and physical exhaustion (2.88 ± 0.692.34 ± 0.76) was higher than the male participants (3.16 ± 0.672.75 ± 0.85).More female participants experienced emotional distress, depersonalization or professional disengagement, and psychological and physical stress and exhaustion due to the COVID-19 pandemic. An important association observed in the study was between residency choice and burnout.

La presente investigación tiene como principal objetivo el diseño de un plan de marketing digital para el posicionamiento en redes sociales de una empresa privada, para así incrementar la cartera de clientes y por consiguiente aumentar sus ventas. Para la realización se tomaron en cuenta tres objetivos específicos: Primero, Diagnosticar la situación actual del marketing de una empresa privada, Guayaquil 2021; segundo, Diseñar estrategias de marketing digital para el posicionamiento de una empresa privada, Guayaquil 2021 y finalmente, Evaluar el posicionamiento en redes sociales de una empresa privada, Guayaquil 2021. Esta investigación se determina de tipo aplicada y propositiva, de diseño no experimental, de corte transversal y descriptiva, con una población tipo censo en la cual constaba la administradora de la empresa. Se utilizó la entrevista como método de recolección de datos. Finalmente se llegó a la conclusión mediante la información obtenida, que con una buena estrategia de marketing digital la empresa se podrá posicionar en redes sociales. Piura Escuela de Posgrado Modelo y Herramientas Gerenciales

Hand injury is the second most common work-related musculoskeletal injury among physical therapists (PTs) and other manual therapy professionals such as osteopaths, physiotherapists, chiropractors, acupuncturists and massage therapists. However, the nature and extent of this problem have not been fully explored yet. Therefore, the objective of this study was to review the existing literature published on the prevalence, risk factors, consequences, and prevention of hand injuries among PTs and similar healthcare professionals. The lifetime prevalence of hand injuries was about 15%–46%, and the annual prevalence was reported as 5%–30%. Thumb injuries were found to be the most prevalent of all injuries, accounting more than 50% of all hand-related problems. The most significant risk factors for job-related hand injuries were performing manual therapy techniques, repetitive workloads, treating many patients per day, continued work while injured or hurt, weakness of the thumb muscles, thumb hypermobility, and instability at the thumb joints. PTs reported modifying treatment technique, taking time off on sick leave, seeking intervention, shifting the specialty area, and decreasing patient contact hours as the major consequences of these injuries. The authors recommend that PTs should develop specific preventive strategies and put more emphasis on the use of aids and equipment to reduce the risk of an unnecessary injury.

My dissertation argues that the core beat trope of the subterranean can be developed as a productive means of literary analysis. I show that beat writers conceive of themselves and their work as existing within vast "underground" networks of radical and avant-garde art and literature, and by locating the beats within such assemblages, the subterranean offers, above all, a model for reconceptualizing beat geography. While the Beat Generation has been regarded as quintessentially American, beat writers are intensely interested in and engaged with the world at large, particularly third-world, colonial, and postcolonial spaces. After an introduction that lays out the history of subterranean thought in literature, philosophy, and cultural studies, Chapter One argues that the beats, in particular those associated with the San Francisco Renaissance of the 1950s and 60s, follow the American Renaissance writers of the previous century in asserting their worlded view of US literary history. Chapter Two reads a series of beat "travelogues"--including Kerouac's Mexico City Blues, Burroughs and Ginsberg's Yage Letters, and Brion Gysin's novel The Process--that reveal the complexities of beat writing at its most worldly. To situate the beats within in these wider contexts and longer trajectories of literary and cultural history is also to emphasize the role of female and minority voices in the beat movement. In the second half of my dissertation, which discusses the beats in relation to the twentieth-century avant-garde (futurism, dada, and chiefly surrealism), I argue that it is in the work of African-American Beat writers Amiri Baraka, Ted Joans, and Bob Kaufman that we find the strongest commitment to international avant-garde traditions. My dissertation concludes with the suggestion that contemporary writers such as Maxine Hong Kingston and Juliana Spahr can be characterized as "post-beat" insofar as their poetics of place, identity, and community borrow from and transform the practices and concerns of worlded beat writing.

Spinal manipulation has been an effective intervention for the management of various musculoskeletal disorders. However, the mechanisms underlying the pain modulatory effects of spinal manipulation remain elusive. Although both biomechanical and neurophysiological phenomena have been thought to play a role in the observed clinical effects of spinal manipulation, a growing number of recent studies have indicated peripheral, spinal and supraspinal mechanisms of manipulation and suggested that the improved clinical outcomes are largely of neurophysiological origin. In this article, we reviewed the relevance of various neurophysiological theories with respect to the findings of mechanistic studies that demonstrated neural responses following spinal manipulation. This article also discussed whether these neural responses are associated with the possible neurophysiological mechanisms of spinal manipulation. The body of literature reviewed herein suggested some clear neurophysiological changes following spinal manipulation, which include neural plastic changes, alteration in motor neuron excitability, increase in cortical drive and many more. However, the clinical relevance of these changes in relation to the mechanisms that underlie the effectiveness of spinal manipulation is still unclear. In addition, there were some major methodological flaws in many of the reviewed studies. Future mechanistic studies should have an appropriate study design and methodology and should plan for a long-term follow-up in order to determine the clinical significance of the neural responses evoked following spinal manipulation.

This thesis investigates the trend of cassava production and assesses the importance of the crop to livelihoods of Nigerians. Using qualitative analysis of secondary information obtained from reliable domestic and international organizations, the findings show that cassava serves as a major source of income and food for rural farmers, as well as people living in urban communities. Nonetheless, the study further shows that the industry is constantly bedevilled by problems ranging from soil infertility to poor quality of planting materials, as well as pests and diseases. These issues put a serious question mark on the future integrity of the country as the leading producer of the crop. By implication, cassava production, though ascending in terms of productivity and yield, yet, its future is precarious and unpredictable. Among the recommendations include, dealing with the spread of pests and diseases through careful selections amongst farm improved planting materials and conscious education for local farmers

The effects of maternal hormones upon the spine and pelvis, is not very well defined in the literature with evidence conflicting. Reports of hormonal effects (relaxin), appear to have mainly focused on the anterior cruciate, wrist ligaments, and anthropomorphic foot changes. Pregnancy hormonal influences upon peripheral joint capsulo-ligamentous structures, particular those of the lower limb, may also have indirect effects upon lumbo-pelvic structures by transferring ground reactive force (GRF) further up to kinetic chain. Objective: Review the current evidence base to increase awareness among clinicians managing maternal pain populations of how hormonal influences may affect the musculoskeletal system. Method: Literature published between 1982 and 2016 was reviewed through NCBI, Pubmed, Medline, and Ovid search engines. Additionally, a Google search of online media was conducted using the same terms. Conclusion: Hormonal changes occurring during pregnancy may affect the female musculoskeletal system in a number of ways, with potential later in life consequence. Pregnancy associated lower limb changes such as maternal reduction of the plantar arch, may indirectly contribute to lower back pain, by causing redistribution of ground reactive force (GRF) centripetally, thereby increasing axial load upon already hormonally-compromised lumbo-pelvic structures. Future research is warranted to validate and verify hormonal influences upon musculoskeletal pain and dysfunction in this population group. Despite the popularity of manual management (chiropractic/osteopathy) for pregnancy back pain management, the evidence base for this is sparse. Though a review of available literature indicated manual therapies are probably both safe and effective means of management further research is imperative support clinical practice.

Down-sloped or hooked acromion morphologies may cause bony encroachment on the soft tissues of the subacromial space, predisposing to shoulder impingement syndrome. Of the latter, a hooked or Type III acromion (T3A) has also been linked to rotator cuff (RC) pathology. However, as bony acromial impingement is typically thought to occur over the age of 40, its occurrence in younger shoulder athletes presenting with shoulder pain, impingement and RC pathology may be overlooked. This case serves to illustrate the occurrence of T3A in a younger shoulder athlete, and the importance of early imaging in achieving diagnostic accuracy. Appropriate surgical referrals are patients with subacromial impingement syndrome refractory to 3–6 months of appropriate conservative treatment. Surgery may be particularly beneficial in patients with a T3A.