3103 research outputs found
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Fatty infiltration of the cervical multifidus musculature and their clinical correlates in spondylotic myelopathy
No full textCervical spondylotic myelopathy (CSM) is among the most common spinal cord disorders of the elderly. Muscle fat infiltration (MFI), a potential pathological sign of muscle adiposity, may contribute to or be associated with pain/disability/impairments in patients with CSM. We examined the relationship between MFI and CSM\u27s clinical manifestations by enrolling nine CSM patients and five aged-matched controls to undergo MRI imaging of the cervical spine with MFI. A blinded investigator calculated MFI for each of the bilateral multifidii muscles from C3 to C7 on the MRI images. Nurick scores, Neck Disability Index, and modified Japanese Orthopedic Association scores were collected for all patients. CSM patients and controls were equivalent with respect to age, height, weight, gender, race, smoking status, and employment status. MFI was higher in patients with CSM than in controls (31.7% v. 24.6%, respectively, p = 0.0178). Higher MFI was associated with increased disability on the Nurick scale (p = 0.0371). MJOA scores correlated linearly with MFI (R = 0.542, p = 0.0453), but not NDI (p = 0.3125). Increased MFI of the multifidus muscles is associated with cervical myelopathy and a clinically significant decline in sensorimotor function as measured by mJOA and Nurick scores. Spinal injury in CSM may lead to secondary muscle loss and muscle fat infiltration
Ultrasound-Guided Application of Percutaneous Electrolysis as an Adjunct to Exercise and Manual Therapy for Subacromial Pain Syndrome: A Randomized Clinical Trial
No full textThis randomized clinical trial compared the effects of adding ultrasound (US)-guided percutaneous electrolysis into a program consisting of manual therapy and exercise on pain, shoulder-related disability, function, and pressure sensitivity in subacromial pain syndrome. Fifty patients with subacromial pain syndrome were randomized into manual therapy and exercise or percutaneous electrolysis group. All patients received the same manual therapy and exercise program, 1 session per week for 5 consecutive weeks. Patients assigned to the electrolysis group also received the application of percutaneous electrolysis at each session. The primary outcome was assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Secondary outcomes included pain, function (Shoulder Pain and Disability Index [SPADI]) pressure pain thresholds (PPTs) and Global Rating of Change (GROC). They were assessed at baseline, post-treatment, and 3 and 6 months after treatment. Both groups showed similar improvements in the primary outcome (DASH) at all follow-ups (P =.051). Subjects receiving manual therapy, exercise, and percutaneous electrolysis showed significantly greater changes in shoulder pain (P \u3c.001) and SPADI (P \u3c.001) than did those receiving manual therapy and exercise alone at all follow-ups. Effect sizes were large (standardized mean difference \u3e.91) for shoulder pain and function at 3 and 6 months in favor of the percutaneous electrolysis group. No between-group differences in PPT were found. The current clinical trial found that the inclusion of US-guided percutaneous electrolysis in combination with manual therapy and exercise resulted in no significant differences for related disability (DASH) compared with the application of manual therapy and exercise alone in patients with subacromial pain syndrome. Nevertheless, differences were reported for some secondary outcomes such as shoulder pain and function (SPADI). Whether these effects are reliable should be addressed in future studies. Perspective: This study found that the inclusion of US-guided percutaneous electrolysis into a manual therapy and exercise program resulted in no significant differences for disability and pressure pain sensitivity compared with the application of manual therapy and exercise alone in patients with subacromial pain syndrome
Not all pavements lead to streams: Variation in impervious surface connectivity affects urban stream ecosystems
No full textWatershed urbanization leads to chemical and thermal pollution of urban streams and significant declines in aquatic biodiversity. Most investigators have focused on variation in total watershed impervious surface cover (ISC) as the primary driver of urban stream degradation. We asked instead whether the degree of connectivity between ISC and urban stream channels alters its effect. We compared 7 streams in the Raleigh–Durham metropolitan area of the southeastern USA that drained watersheds with similar amounts of pavement (ISC 5 7–16% of watershed area) but spanning a wide range of hydrologic connectivity between these pavements and their receiving streams via both subsurface (pipe density range: 1.1–6.9 km/km2) and surface (road density range: 5.8–10.7 km/ km2) flowpaths. Despite draining watersheds with similarly low levels of development, these 7 streams exhibited remarkable variability in their hydrologic and thermal regimes and varied in their macroinvertebrate diversity from a low of only 11 taxa to a high of 22. Both macroinvertebrate community composition and the tissue concentrations of Cu, Pb, and Zn in 3 stream invertebrate taxa (Cambaridae, Tipulidae, and Hydropsychidae) found across all sites were correlated with watershed hydrologic connectivity. These results suggest that the connectivity of ISC may drive considerable variation in the magnitude of ecosystem degradation associated with the same level of watershed development, with less connected or disconnected impervious surfaces having proportionally lower negative effects on aquatic organisms
The Safety and Efficacy of Low-Dose Naltrexone in the Management of Chronic Pain and Inflammation in Multiple Sclerosis, Fibromyalgia, Crohn\u27s Disease, and Other Chronic Pain Disorders
No full textChronic inflammatory diseases are complex to treat and have an impact on a large number of patients. Due to the difficulty of treating these diseases and the great impact on quality of life, patients often seek off-label, complimentary, or alternative medicines to gain relief from symptoms. Low-dose naltrexone has been used off-label for treatment of pain and inflammation in multiple sclerosis, Crohn\u27s disease, fibromyalgia, and other diseases. Naltrexone is a mu-opioid receptor antagonist indicated by the U.S. Food and Drug Administration for opioid and alcohol dependence. It is hypothesized that lower than standard doses of naltrexone inhibit cellular proliferation of T and B cells and block Toll-like receptor 4, resulting in an analgesic and antiinflammatory effect. It is the purpose of this review to examine the evidence of the safety, tolerability, and efficacy of low-dose naltrexone for use in chronic pain and inflammatory conditions. Currently, evidence supports the safety and tolerability of low-dose naltrexone in multiple sclerosis, fibromyalgia, and Crohn\u27s disease. Fewer studies support the efficacy of low-dose naltrexone, with most of these focusing on subjective measures such as quality of life or self-reported pain. These studies do demonstrate that low-dose naltrexone has subjective benefits over placebo, but evidence for more objective measures is limited. However, further randomized controlled trials are needed to determine the efficacy of low-dose naltrexone due to insufficient evidence supporting its use in these disease states. This review provides practitioners with the extent of low-dose naltrexone evidence so that they can be cognizant of situations where it may not be the most appropriate therapy
Leadership skills for licensed practical nurses working with the aging population
No full textThis textbook fills a gap in education for licensed practical nurses (LPN), providing information specific to their own needs and concerns. Firstly, it clarifies the leadership role of LPNs in the healthcare setting, and then identifies the knowledge, skills and abilities related to leadership, management, communication, culture change and person-directed care concepts. It also explains the efficacy of these concepts related to the LPN care of patients in the work setting and reviews the Nurse Practice Act (NPA) enacted in every US state. LPNs play an essential role in the patient care team and we have to ensure they receive advanced education as practitioners in healthcare settings that reach vulnerable populations such the elderly. They have been considered as the registered nurses’ right hand in acute care as well as many home-health settings. They provide basic medical and nursing care, ensure the comfort of patients, discuss health care with patients, and report the status of patients to registered nurses and doctors. But the LPNs are often expected to take on a real leadership role based on the perception that as licensed nurses they already have all the qualifications and education necessary for leadership roles. However, there is a gap in the education they receive and a limited body of literature dedicated to them. Written in honor of all LPNs, this educational textbook fills that gap. With learning objectives, review questions and scenarios, it is a valuable resource for courses for undergraduate students training to be LPNs
Removing Barriers for Contemporary Student Success
No full textThis paper examines the contemporary student in higher education and how to position this student for success. Through analysis of Leviticus chapter nineteen verse fourteen (19:14), which states “You shall not curse the deaf, and you shall not place a stumbling block before the blind”, the authors examine how to remove barriers often placed in front of the contemporary post-secondary student. Utilizing the analogy of the contemporary student and the institution of higher education being “blind” and/or “deaf” as in the Biblical verse, the authors propose institutional responses and institutional repercussions that can remove barriers and thereby allow the contemporary student to succeed in the complex arena of higher education
Compassion: A Way to Live in Community
No full textBeginning with a discussion about the meaning of compassion and its Judaic and Christian foundations, this article provides an understanding of how compassion builds and sustains community. It includes a model of the compassion process, a discussion of the barriers that prevent compassion from being expressed more freely, and examples about where compassion may need greater expression in our worl
Foliar pathogens are unlikely to stabilize coexistence of competing species in a California grassland
No full textPathogen infection is common in wild plants and animals, and may regulate their populations. If pathogens have narrow host ranges and increase with the density of their favored hosts, they may promote host species diversity by suppressing common species to the benefit of rare species. Yet, because many pathogens infect multiple co-occurring hosts, they may not strongly respond to the relative abundance of a single host species. Are natural communities dominated by specialized pathogens that respond to the relative abundance of a specific host or by pathogens with broad host ranges and limited responses to the relative abundance of single host? The answer determines the potential for pathogens to promote host coexistence, as often hypothesized, or to have negligible or even negative effects on host coexistence. We lack a systematic understanding of the impacts, identities, and host ranges of pathogens in natural communities. Here we characterize a community of foliar fungal pathogens and evaluate their host specificity and fitness impacts in a California grassland community of native and exotic species. We found that most of the commonly isolated fungal pathogens were multi-host, with intermediate to low specialization. The amount of pathogen damage each host experienced was independent of host species local relative abundance. Despite pathogen sharing among the host species, fungal communities slightly differed in composition across host species. Plants with high pathogen damage tended to have lower seed production but the relationship was weak, suggesting limited fitness impacts. Moreover, seed production was not dependent on the local relative abundance of each plant species, suggesting that stabilizing coexistence mechanisms may operate at larger spatial scales in this community. Because foliar pathogens in this grassland community are multi-host and have small fitness impacts, they are unlikely to promote negative frequency dependence or plant species coexistence in this system. Still, given that pathogen community composition differentiates across host species, some more subtle feedbacks between host relative abundance and pathogen community composition, damage, and fitness impacts are possible, which could, in turn, promote either coexistence or competitive exclusion