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Eccentric-Emphasis Exercise Program For Supraspinatus Partial Tear in Retired Police Officer an Intervention Case Report
Full text linkAbstract
Background and Purpose: Eccentric exercise has been shown to reduce pain in patients with multiple comorbidities, orthopedic surgeries, and neurologic conditions, while providing safety for greater loading during resistance training. The purpose of this case report is to describe changes in function and pain of a patient with a partial rotator cuff tear, following rehabilitation exercises focusing on eccentric action.
Case Description: A 65 y/o retired police male officer who presented right shoulder pain secondary to a partial tear of the supraspinatus tendon. The case reported mild to severe pain under the visual analog scale (VAS) of 75mm that limited house activities, recreational pursuits like shooting, and disrupted sleep. Initial assessment using the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) scored 46 indicated moderate disability . The plan of care followed guidelines for rotator cuff tendinopathies with an emphasis on eccentric exercises.
Outcomes: After 12 weeks of intervention, the subject’s pain improved by 30mm on VAS during activities, and 12 points on DASH, allowing him to contribute more to household activities and go to the shooting range once a week.
Discussion: This case report intended to demonstrate the advantages of eccentric exercise in improving strength, tendon capacity, and reducing pain in rotator cuff tendinopathy. Although guidelines recommend exercise and manual therapy, limited evidence exists specifically for eccentric exercise in rotator cuff injuries. Further research, including images and outcome measures, is recommended to investigate the physiological effects of eccentric exercises on rotator cuff tendon healing
What are Considerations, Challenges, and Successes of Urban Elementary School Leaders When Designing Academic Multi-Tiered System of Supports Infrastructure?
Full text linkThis qualitative research answers the question, “What are considerations, challenges, and successes of urban elementary school leaders when designing academic Multi-Tiered System of Supports (MTSS) infrastructure?;” and the sub-question, “How does school leadership develop a consensus on academic MTSS practices?” This research gathered insight on the importance of the consensus process in customizing MTSS practices to a school’s unique needs and in avoiding the caveats of a one-size-fits-all approach. As a result, the key recommendation is schools need to reach a unified consensus on explicit MTSS practices for clarity and quality control to be most efficacious. This process was not found at any locations, as evidenced by the extent of challenge findings and the lack of interview responses about agreement and unique structures. This was exacerbated by ambiguity in literature and limited research on the role of consensus in MTSS. When properly accomplished, this agreement process could eliminate all contradictions and vagueness that exist in a school setting’s practice, as a unified determination should resolve ambiguity through explicit structures. This collaborative consensus process on how MTSS infrastructure should be designed in a school is an important step that was missed, and is critical for schools to be aware of and have the capacity to accomplish
Spices on the Winds of Trade: The Postcolonial Geopolitics of Food in Amitav Ghosh’s Fiction and Non-Fiction
Full text linkIn The Nutmeg’s Curse: Parables for a Planet in Crisis, Amitav Ghosh traces the journey of spices from the Spice Islands, or the Moluccas in Indonesia to Europe. Nestled between Celebes and New Guinea, these islands with their rich volcanic soil, emerged as the epicentre of global spice production, offering the world mace, nutmeg, cloves, and pepper in the 16th century. The nutmeg’s two hemispheres hold hidden meaning in today’s world: one shell portraying its commercial merits as a spice and the other elusive crust remaining open to interpretation. The inconspicuous nutmeg, a coveted spice during the ‘Spice Race’, was also a ‘spice of curse’ that sparked ‘spice wars’ and the ‘spice trade’. The West’s fascination for the East is evident in the Orientalist quest for spices resulted in the ensuing discovery of opium, rubber, and teak, thus resulting in monarchs of that time engaging in the ‘Spice Race’, one that is akin to our present-day ‘Space Race’ of the rich and the powerful. In colonial times, the flowering poppy, the mighty teak, and the little nutmeg assumed the status of powerful spices as they had erased dynasties, attracted invasions, created fortunes, and brought a new way of life into being. This paper shall refer to the spice wars, the rise of global capitalism, geopolitical conflicts around food and what these spices represent today in postcolonial times. We shall see how Ghosh’s postcolonial textual response in his fiction and non-fiction is typical of postcolonial material ecocriticism where the margins write back and lay bare materialistic colonial intent of the past by retelling the tale of the spice trade and recording the archive of the unfair colonial trade of spices. This paper shall thus consider the postcolonial geopolitics of food and consider the contemporary dynamics and economics of demand and supply
Alpha Lipoic Acid: A Review and Comparison to Current Treatment Guidelines of Diabetic Peripheral Neuropathy
Full text linkIn 2021, approximately 5.3% of the U.S. population experienced diabetic peripheral neuropathy (DPN). DPN results from uncontrolled glycemic control, causing peripheral nerve dysfunction, including pain, paresthesia, weakness, and infection due to metabolic stress, microvascular damage, and axonal degeneration. While medical organizations recommend symptomatic management with anticonvulsants, TCAs, SNRIs, and gabapentinoids, studies show only 1 in 3 patients are satisfied with treatment outcomes. Alpha Lipoic Acid (ALA) is an endogenously synthesized molecule with a role in cellular redox modulation, glycemic control, insulin sensitivity, advanced glycation end-product formation, and inflammatory markers. Though ALA has not been highly investigated in the management of DPN, current medical organizations acknowledge its potential medical benefits in the future. This paper summarizes the results of completed clinical trials that evaluated the efficacy of ALA as a monotherapy. Numerous trials found statistically significant improvement in the quality of pain, daily living, and quantitative objective testing that would support its use in managing DPN. Additionally, ALAs minimal drug interactions and favorable side effect profile along with its low cost offer a more accessible option compared to other first-line treatments. Although further clinical trials are essential to establish ALA\u27s efficacy, continued research, could help evolve ALA into a first- or second-line option for the millions affected by this condition
Comparing Long-Acting Injectable Cabotegravir (CAB-LA) to Oral Regimen for HIV Pre-Exposure Prophylaxis
No full textNew infections of HIV occur at only 2/3rd the incidence rate observed at the zenith of the epidemic, with a 12% decrease in new infections annually between 2018 (36,200) and 2022 (31,800). This change was driven by a combination of of safe sex and injection practices, as well as pre-exposure prophylaxis (PrEP) medication regimens. However, infections remain relatively prevalent and still represent a significant challenge to people living with HIV – for example, HIV has been shown to increase mean all-cause annual and cumulative medical costs sevenfold. Furthermore, while Black and Hispanic individuals represent 12% and 19% of the population respectively, they each represent 39% and 31% of new HIV infections, showing a lack of equity in HIV reduction . Daily oral regimens of TDF/FTC (Truvada) or TAF/FTC (Descovy) were the only two FDA approved options for PrEP until 2021 when long-acting injectable cabotegravir (CAB-LA) was first approved for use as PrEP. A systematic review comparing CAB-LA to placebo groups of TDF/FTC showed a pooled RR of developing HIV of 0.21with CAB-LA usage (95%:[.07, .61], p=.004). It is imperative for providers to understand CAB-LA and who will benefit the most from this novel preventative therapy. This CME article will outline this so that providers can be better stewards for the LGBTQ+ population and, in turn, promote a more equitable primary care environment for all patients
Enhancing Cancer Treatment with Mebendazole: Strategies for Clinical Implementation through Shared Decision Making
No full textApproximately 20% of Americans will receive a cancer diagnosis in their lifetime, with many facing intense therapy regimens that often yield poor outcomes. This paper aims to explore when and how to use Mebendazole—a commonly prescribed antihelmintic—as a repurposed anti-tumoral adjunct treatment in chemotherapy regimens, specifically; ovarian cancer, pancreatic cancer, and brain cancer
Hereditary Breast Cancer Screening in the Primary Care Setting
No full textBreast cancer affects approximately 1 in 8 women, with about 10% of cases having a hereditary component. In the primary care setting, providers play a crucial role in identifying individuals at increased risk for hereditary breast cancer and connecting them to appropriate resources. Various screening tools, including the GAIL/BCRAT, BCSC, and IBIS/Tyrer-Cuzick models, help identify high-risk individuals and potential carriers of high-risk genetic mutations. Key mutations associated with increased breast cancer risk include BRCA1, BRCA2, ATM, CDH1, PALB2, PTEN, STK11, and TP53, all of which require specific screening protocols. Additionally, risk-reducing strategies such as surgery and chemoprevention will be reviewed. This current breast cancer screening protocols, indications for genetic counseling referrals, commonly implicated genes, and risk-reduction strategies for hereditary breast cancer will be reviewed
The Emerging Role of Artificial Intelligence in Recognizing and Diagnosing Melanoma Skin Cancer
No full textMelanoma is the deadliest form of skin cancer that has only a 35% 5 year survival rate if it is found after it has metastasized. If it is found in early stages, the survival rate increases to approximately 94% 1. Early detection of malignant melanoma is crucial to give patient’s better outcomes and prevent invasive surgical procedures. Non-invasive imaging techniques do exist; however, the use of these techniques requires extensive training and are fallible to having inconsistent interpretations by practitioners. Artificial intelligence (AI) has become a rapidly progressing tool that has been utilized by the healthcare field in many ways already. This proposed article analyzes the utilization of AI in recognizing malignant melanomas early to prevent unnecessary procedures and improve patient outcomes
Pathophysiology, Risk Factors, Diagnosis and Management of Complex Regional Pain Syndrome (CRPS)
No full textComplex Regional Pain Syndrome (CRPS) is a debilitating neurological condition affecting up to 200,000 individuals annually in the United States. It is marked by pain that far exceeds the expected response to an injury, and is often accompanied by sensory, vasomotor, sudomotor, and motor disturbances. Although frequently triggered by physical trauma, CRPS can also arise spontaneously and without any significant finding on imaging, complicating diagnosis and treatment. The chronic nature of CRPS disrupts a person’s quality of life and is linked to psychological conditions such as depression and anxiety. Early recognition of its diverse symptoms with guidance by the Budapest Criteria which was created in 2004 is crucial. This article explores the risk factors; multifactorial pathophysiology of CRPS, including neurogenic inflammation, central and peripheral sensitization, and autonomic dysregulation; and aims to advocate for a multimodal treatment integrating physical therapy, pharmacologic interventions, psychological support, and interventional techniques. By increasing awareness among clinicians and patients, this article aims to enhance early intervention and improve outcomes for patients with CRPS
Platelet-Rich Plasma for Lateral Epicondylitis: Evaluating an Emerging Alternative
No full textLateral epicondylitis, also known as “tennis elbow”, is the inflammation or injury to the extensor tendons on the lateral aspect of the elbow, typically resulting from repetitive use. Current treatments include NSAIDs, corticosteroid injections, physical therapy, bracing and surgery (debridement, dry needling, etc.), however, long term relief is not always obtained from these therapeutic interventions. Platelet-Rich Plasma (PRP) is a regenerative therapy involving the injection of a mix of concentrated platelets, which promotes growth factors to the site of injury and may aid in healing and tissue repair1. Analyzing evidence from multiple studies reveals PRP can offer long-term pain relief and improved functional outcomes for patients with lateral epicondylitis (LE) in terms of strength and return to activity, especially when first-line conservative therapies prove unsuccessful. However, challenges such as high cost, lack of FDA regulation and variability in preparation methods remain. This article provides an overview of current PRP research, its clinical applications and ethical considerations to guide healthcare providers in the use of PRP and making evidence-based decisions