General Relaxation Research Articles

IMPROVEMENT OF THE QUALITY OF LIFE OF PATIENTS WITH CONCUSSION BY MEANS OF PHYSICAL THERAPY

Brain concussion from blast waves is one of the most common injuries in combat. This injury is three times more common than wounds. Blast wave brain concussion has significant consequences and impairs the quality of life for an indefinite period of time, so the use of physical therapy to improve the quality of life of patients with its consequences is an urgent issue. Purpose to prove the effectiveness of physical therapy in improving the quality of life of patients after blast concussion. Methods. To achieve the aim of the study, the scientific literature was analyzed and information was systematised using electronic databases such as PubMed, Google Scholar and others. To assess: sleep function, the Insomnia Severity Index (ISI) was used; pain perception, the Visual Analogue Scale (VAS) and the Verbal Rating Scale were used; changes in emotional functions, the Wessman-Ricks Emotional State Self-Assessment (WESA) was used; and quality of life, the Health Survey (SF-36 v2) was used. Research results. The initial treatment of concussion is of great importance and includes a number of important aspects that can be performed by a first responder. Since concussion leads to partial or complete disability and largely results in disability, which leads to other problems at different levels, the prerequisites for developing a physical therapy programme aimed at improving the quality of life of patients were the selection of ICF components appropriate to the patients' condition. The physical therapy programme was individualised, tailored to each patient individually, taking into account their condition and wishes, with special attention paid to the primary tasks of pain relief and normalisation of sleep function, which is key to reducing all other consequences of concussion and improving the quality of life. After the implementation of the proposed physical therapy programme, patients in the main group improved their sleep, decreased their pain levels and improved their emotional state. All indicators at the end of the study were better in the main group than in the control group, although at the beginning of the study the indicators in both groups did not differ significantly. Comparison of the results of the SF-36 v2 Health Survey proves the effectiveness of the developed physical therapy programme in combination with conventional treatment of blast injury. Conclusions. The results of the study proved the positive impact of the physical therapy programme for patients with blast concussion, which took into account the patient's condition and wishes, and whose primary objectives were to stop the manifestation of pain and normalise sleep function, actively involve the patient in the rehabilitation process through Pilates, Yoga, Nordic walking and an obstacle course with a sports focus. Motivation for action and normalisation of the emotional state are important during the rehabilitation period. The combination of active activities with massage therapy, namely Thai traditional massage, Thai foot massage, Tibetan singing bowl massage and Rebozo massage, contributed to general relaxation, reducing the effects of stress, muscle and emotional stress, harmonising the emotional state, improving blood circulation and restoring all body systems.

Magneto-viscoelastic rod model for hard-magnetic soft rods under 3D large deformation: Theory and numerical implementation

The main purpose of this work is to develop a three-dimensional (3D) viscoelastic rod model for hard-magnetic soft (HMS) rods under large deformation which are widely used active structures in soft robotics. To do so, the Simo’s viscoelasticity theory has been rationally incorporated into the geometrically exact 3D curved rod model. The proposed model includes the deformation modes of axial tension, shear, bending, and torsion, which is applicable to the HMS rods with arbitrarily initial curved and twisted geometries under 3D large deformation. The viscoelastic constitutive equations of the HMS rod in the present formulation are formulated, which include the general relaxation functions. To obtain the expression for the magnetic load, the rotation-based magnetic free energy density is introduced, and the governing equations of the HMS rod with magnetic load and body force are presented. To obtain the numerical implementation, an implicit time integration algorithm that simply extends the generalized-α method for the rotation group, and the corresponding variational formulation and its linearization of the rod model are derived. To validate the model, five numerical examples, including 2D dynamic buckling, 3D static, and 3D dynamic problem are presented. The dynamic problems include the dynamic snap-through behavior of a bistable HMS arch and damped oscillation of a quarter arc cantilever under 3D deformation. The simulation results show good agreement with the results reported in the literature.

A Comparative Study Between Intravenous Esmolol and Oral Clonidine in Attenuating Hyperdynamic Cardiovascular Response to Laryngoscopy and Endotracheal Intubation.

Background In today's era of anesthesia, balanced anesthesia is the main basis of patient care and pain management. Of all the medications given during general anesthesia, premedication, induction agents, and muscle relaxants play a major role in keeping the hemodynamics properly under control. When laryngoscopy is performed to intubate, a pain stimulus will be generated, leading to a rise in blood pressure and heart rate. This stimulus can be avoided without any complications if appropriate premedication is given to the patient at the appropriate dosage. In this research, we compare the influence of injection esmolol and oral clonidine during the time of induction as premedications to suppress the hemodynamic response. Material and methods In a prospective randomized controlled trial, 90 patients were divided into three groups: Group E (esmolol) received 2 mg/kg IV esmolol diluted in 0.9% NS two minutes pre-anesthesia; Group C (clonidine) received oral clonidine 4 mcg/kg 90 minutes pre-anesthesia; and Group P (placebo) received IV normal saline and oral water. Blood pressure, heart rate, and mean arterial pressure were measured at baseline and seven subsequent time points. Results The study compared systolic blood pressure (SBP), mean arterial pressure (MAP), and diastolic blood pressure (DBP) changes over seven minutes in three groups, clonidine (Group C), placebo (Group P), and esmolol (Group E). At one minute, Group E showed a consistent MAP decrease from 95.21 mmHg to 85.92 mmHg, while Group C and Group P exhibited fluctuating trends. DBP decreased across all groups, with Group P ending highest (77.7 mmHg) and Group C lowest (66.8 mmHg). Group E's SBP decreased steadily from 126.2 mmHg to 118.0 mmHg, Group C decreased from 128 mmHg to 116.1 mmHg, and Group P showed more erratic fluctuations in SBP, DBP, and MAP. Conclusion These findings suggest that intravenous esmolol shows a good hemodynamic response having superior control over heart rate and getting the pressure under control quickly without major drop compared with the clonidine and placebo groups.

Challenges of Thyroidectomy Anaesthesia for a Huge Retrosternal Goitre in a Jehovah’s Witness: A Case Report

In potential haemorrhagic surgical procedures, refusal of allogenic blood infusion poses a challenge to anaesthetists. This report is about a 65-year-old male, of the Jehovah’s Witness (JW) religious sect, known hypertensive, who presented with an anterior neck mass with retrosternal extension of three years. Laboratory investigations were normal, and the haemoglobin concentration was 13gm/dl. He consented to acute normovolaemic haemodilution (ANH). Therefore, two units of blood were drawn and replaced with isoplasma. The patient had a general anaesthesia relaxant technique. Intravenous tranexamic acid, morphine, and paracetamol were administered. A right-lobal thyroidectomy and sternotomy were performed. After securing haemostasis, the two blood units were infused, and the estimated blood loss was 1.5 litres. The surgery lasted for five and a half hours. After surgery, the patient was reversed of the neuromuscular blockade, extubated, transferred to the intensive care unit (ICU), and monitored for 24 hours. He had supplemental oxygenation, analgesia, and other supportive care. He was discharged on postoperative day seven and had attended the outpatient clinic for two months.

A relaxation viewpoint to Unbalanced Optimal Transport: Duality, optimality and Monge formulation

We present a general convex relaxation approach to study a wide class of Unbalanced Optimal Transport problems for finite non-negative measures with possibly different masses. These are obtained as the lower semicontinuous and convex envelope of a cost for non-negative Dirac masses. New general primal-dual formulations, optimality conditions, and metric-topological properties are carefully studied and discussed.

Government support in the European air transport sector during Covid-19: A Delphi study

Covid-19 has been a major shock for European aviation. After the general relaxation of state aid rules by the European Commission, Member States stepped in to support airlines, airports and other stakeholders in aviation. However, distribution of state resources raised significant doubts from competitors, as well as academic literature, with regard to the conditions of the aids and their effect on competition. A two-round Delphi study was employed in order to investigate the opinion of experts in European aviation, with the participation of thirty experts from airlines, airports, handling agents, government authorities and academia. The results show an overall appraisal of the European framework and its flexibility, but also desire for a greater degree of control, complaints over bureaucracy and procedural delays, as well as concern on the effects of state aid on competition in the internal aviation market.

Latihan Relaksasi Secara General terhadap Tingkat Mual dan Muntah pada Pasien Kanker dengan Induksi Kemoterapi

This study aims to determine the effectiveness of general relaxation exercises on the level of nausea and vomiting in cancer patients receiving chemotherapy induction. The method used in this research is a systematic review of several databases through searches of trusted journals, such as Scopus, EBSCOhost, Springer Link, Proquest and Science Direck, Google Schooler with article analysis using the PRISMA method. The results of the study showed that a total of 10 articles had been analyzed in which there were several relaxation exercise interventions that were given generally and successively proven to reduce the level of nausea and vomiting in cancer patients who received chemotherapy induction. Conclusion: Providing relaxation exercise interventions in general is flexible, simple, easy to learn, and helps reduce the level of nausea and vomiting in cancer patients receiving chemotherapy induction. Keywords: General relaxation exercises, Cancer, Nausea, Vomiting

GaLileo: General Linear Relaxation Framework for Tightening Robustness Certification of Transformers

Transformers based on attention mechanisms exhibit vulnerability to adversarial examples, posing a substantial threat to the security of their applications. Aiming to solve this problem, the concept of robustness certification is introduced to formally ascertain the presence of any adversarial example within a specified region surrounding a given sample. However, prior works have neglected the dependencies among inputs of softmax (the most complex function in attention mechanisms) during linear relaxations. This oversight has consequently led to imprecise certification results. In this work, we introduce GaLileo, a general linear relaxation framework designed to certify the robustness of Transformers. GaLileo effectively surmounts the trade-off between precision and efficiency in robustness certification through our innovative n-dimensional relaxation approach. Notably, our relaxation technique represents a pioneering effort as the first linear relaxation for n-dimensional functions such as softmax. Our novel approach successfully transcends the challenges posed by the curse of dimensionality inherent in linear relaxations, thereby enhancing linear bounds by incorporating input dependencies. Our evaluations encompassed a thorough analysis utilizing the SST and Yelp datasets along with diverse Transformers of different depths and widths. The experimental results demonstrate that, as compared to the baseline method CROWN-BaF, GaLileo achieves up to 3.24 times larger certified radii while requiring similar running times. Additionally, GaLileo successfully attains certification for Transformers' robustness against multi-word lp perturbations, marking a notable accomplishment in this field.

A partial Bregman ADMM with a general relaxation factor for structured nonconvex and nonsmooth optimization

A partial Bregman ADMM with a general relaxation factor for structured nonconvex and nonsmooth optimization

A dynamical system approach to relaxation in glass-forming liquids.

The "classical" thermodynamic and statistical mechanical theories of Gibbs and Boltzmann are both predicated on axiomatic assumptions whose applicability is hard to ascertain. Theoretical objections and an increasing number of observed deviations from these theories have led to sustained efforts to develop an improved mathematical and physical foundation for them, and the search for appropriate extensions that are generally applicable to condensed materials at low temperatures (T) and high material densities where the assumptions of these theories start to become particularly questionable. These theoretical efforts have largely focused on minimal models of condensed material systems, such as the Fermi-Ulam-Pasta-Tsingou model, and other simplified models of condensed materials that are amenable to numerical and analytic treatments and that can serve to illuminate essential features of relaxation processes in condensed materials under conditions approaching integrable dynamics where clear departures from classical thermodynamics and dynamics can be generally expected. These studies indicate an apparently general multi-step relaxation process, corresponding to an initial "fast" relaxation process (termed the fast β-relaxation in the context of cooled liquids), followed by a longer "equipartition time", namely, the α-relaxation time τα in the context of cooled liquids. This relaxation timescale can be enormously longer than the fast β-relaxation time τβ so that τα is the primary parameter governing the rate at which the material comes into equilibrium, and thus is a natural focus of theoretical attention. Since the dynamics of these simplified dynamical systems, originally intended as simplified models of real crystalline materials exhibiting anharmonic interactions, greatly resemble the observed relaxation dynamics of both heated crystals and cooled liquids, we adapt this dynamical system approach to the practical matter of estimating relaxation times in both cooled liquids and crystals at elevated temperatures, which we identify as weakly non-integrable dynamical systems.

Evaluating the Communicative Competence of EFL Students in Iraqi Universities

Abstract Recent teaching methods have made communication competence (CC) a central component, and the enhancement of EFL students' communicative competence has been given a great deal of attention in recent years. Within this context, this study was designed to assess the CC of Iraqi students majoring in English Language and literature at the tertiary level. In order to achieve this objective, the researchers aimed to collect responses from 509 Iraqi EFL students who are affiliated to six universities in different geographical regions of Iraq. The questionnaire used for this purpose consisted of 36 items which addressed six themes, namely General Competence, Behavioral Flexibility, Empathy, Affiliation/Support, Social Relaxation, and Interaction Management. The study addressed five research questions. The quantitative analyses of the collected data showed that Iraqi EFL students have, generally speaking, a moderate level of CC, and that their CC was significantly affected by their age. However, the gender and affiliation of the participants did not have any statistically significant impact on their CC. In addition, the results showed that there is a positive correlation between the five facets of CC. Based on the study results, it can be concluded that the CC of Iraqi EFL students is not well-developed and need to be improved. Therefore, the study suggested some pedagogical implications to improve their communicative competence.

On strictly convex entropy functions for the reactive Euler equations

This work is concerned with entropy functions of the reactive Euler equations describing inviscid compressible flow with chemical reactions. In our recent work (W. Zhao, Math. Comput. 91 (2022) 735–760.) we point out that for these equations as a hyperbolic system, the classical entropy function associated with the thermodynamic entropy is no longer strictly convex under the equation of state (EoS) for the ideal gas. In this work, we propose two strategies to address this issue. The first one is to correct the entropy function. Namely, we present a class of strictly convex entropy functions by adding an extra term to the classical one. Such strictly entropy functions contain that constructed in (W. Zhao, Math. Comput. 91 (2022) 735–760.) as a special case. The second strategy is to modify the EoS. We show that there exists a family of EoS (for the nonideal gas) such that the classical entropy function is strictly convex. Under these new EoS, the reactive Euler equations are proved to satisfy the Conservation-Dissipation Conditions for general hyperbolic relaxation systems, which guarantee the existence of zero relaxation limit. Additionally, an elegant eigen-system of the Jacobian matrix is derived for the reactive Euler equations under the proposed EoS. Numerical experiments demonstrate that the proposed EoS can also generate ZND detonations. Extension of the present results to high dimensions is direct.

Tocolytic Effect of White Pepper (Piper nigrum Linn.) on Isolated Rat Uterine Contraction in vitro

Piper nigrum Linn. (Pepper) is a very well-known spice used for different purposes such as human dietaries, medicine and preservative. In Thai traditional medicine, white pepper is a component of herbal formulas used to treat many disorders including symptoms of dysmenorrhea. It is of interest to investigate the effect of methanolic extract of white pepper (MEWP) on the isolated rat uterus contractions induced by various uterine stimulants and the possible mechanism(s) involved. Strips of uterus were prepared from estrogen-primed female Wistar rats, fixed in the organ bath filled with an appropriate physiological solution with carbogen bubbled continuously at 37 °C. The measurement of isometric tension was then performed using force transducer attached to a polygraph. MEWP was tested its effect on the uterine contraction and found the inhibitory effects on the contraction induced by oxytocin, PGF2α and depolarizing solution. TEA inhibited the uterine relaxing effect of MEWP while glibenclamide had no effects when the uterus was induced to contract with oxytocin. Propranolol abolished the uterine relaxing effect of isoproterenol while it had no effects on the relaxing effect of MEWP. The results suggested that MEWP is likely to be a general uterine relaxant. The effects may be due to the interference on Ca2+ influx into the uterine muscle cells which may involve the opening of KCa channel. The effect was unlikely to occur via the KATP-channel and may not involve the interaction of MEWP on b-adrenergic receptor on the uterine muscle cells. HIGHLIGHTS Methanolic extract of white pepper (MEWP) is likely to be a general uterine relaxant. The uterine relaxing effect of MEWP may involve an inhibition of a rise in intracellular Ca2+ from both Ca2+ influx via plasma membrane of the uterine smooth muscle cell and probably Ca2+ release from internal storage. The effect of MEWP may be mediated mainly through a reduction in Ca2+ influx, possibly through voltage dependent Ca2+ The effect of MEWP may involve with the opening of KCa channel, which may arise from direct action of MEWP on the calcium channel or be a consequence of an increase in [Ca2+]i. The uterine relaxing effect of MEWP is unlikely to be mediated by an activation of β2 –adrenergic receptor. GRAPHICAL ABSTRACT

Impact of Pulmonary Rehabilitation on Recuperation of Moderate-to-Severe Coronavirus Disease 2019 Patients in Western India

Background: Coronavirus disease 2019 (COVID-19) virus has caused widespread Acute Respiratory Disease globally since 2020. Patients with evidence of lower respiratory illness either clinically or radiologically had moderate-to-severe illness. COVID respiratory and nonrespiratory symptoms (psychological and cognitive) noticed after 4–8 weeks of primary disease were called long COVID syndrome. Survivors of moderate-to-severe disease had a poor quality of life. The main objective of this retrospective study was to assess the role of outpatient pulmonary rehabilitation (PR) done in moderate-severe COVID-19 survivors who had symptoms after 4–8 weeks at Shaivam Lung Rehabilitation Centre, Ahmedabad. Methods: We analyzed the impact of PR on 30 patients' post-COVID-19 who were willing to participate during the ongoing pandemic. It was an outpatient 6–8 weeks of program designed to target respiratory and general muscle training, relaxation technique, nutritional counseling, occupational and psychological support. Patients were tested with of combination of self-assessment quality of life scale (adapted from short form 36 questionnaire), muscle training, dyspnea scale, and physical assessment. The standard objective assessment included oxygenation index (SpO2/FiO2 ratio), 6 min walk distance (6 MWD), Modified Medical Research Council (MMRC) score, manual muscle testing (MMT) along with pulmonary function testing. All these subjective and objective variables were tested pre- and post-PR program to assess the impact on defined parameters. Results: From December 2020 to March 2022, we studied the impact of PR on 30 out of 55 patients fitting into the inclusion criteria. Significant benefit was noted in subjective Short Form 36 (SF 36) score and objective (6 MWD, MMRC, oxygenation, MMT) quality of life post-PR program ( P < 0.001). Improvement in spirometry was not statistically significant, indicating structural chronicity of COVID pulmonary fibrosis. Conclusion: PR is safe, effective, and feasible on an outpatient basis in COVID-19 survivors of illness with poor quality of life. Further research is required to prove its widespread benefit in such patients.

Enhancing Olfactory Loss in COVID-19: The Impact of Body Position

Objective: To understand that COVID-19-induced hyposmia may fluctuate with spatial position. Introduction: COVID-19-induced hyposmia, exacerbated by supination, has yet to heretofore been described. Methods: Case Study: A 52-year-old right-handed woman was ansate until two years before presentation when she developed cold symptoms and sudden onset of loss of smell and taste, with a positive Reverse Transcription-Polymerase Chain Reaction test for COVID-19. Over three weeks, her smell and taste gradually returned to 85% of normal. She reported that her smell and taste would markedly worsen when she would lie down, to 30% of normal, but would improve with standing, moving, and sitting. Even reclining for a short nap would cause her sense of smell to drop, requiring her to stand for hours before her smell would recover, which caused her to fear sleeping and forced her to move around constantly. She markedly altered her lifestyle because of her fear of sleeping and assiduously avoided lying down: when so overwhelmed by tiredness that she must sleep, she would sleep sitting up. Results: Chemosensory Testing: Olfaction: Brief Smell Identification Test: 9 (normosmia). Alcohol Sniff Test: 3 (anosmia). Dirhinus amyl (pentyl) acetate Test: -7.0 (hyperosmia). Retronasal Olfaction: Retronasal Index: 8 (normosmia). Gustation: Phenylthiocarbamide Taste Test: 10 (normogeusia). Discussion: Despite cerebral autoregulation, recumbency may function to decrease venous return, altering calcium concentrations and hence olfactory ability. In the supine orientation, intrathoracic pressure increases, thus mimicking the Valsalva maneuver. This further increases intracranial pressure, decreases cerebral blood flow, and increases cerebral carbon dioxide. Perhaps this causes increased gamma-aminobutyric acid, an inhibitory neurotransmitter within the olfactory bulb, which reduces associated olfactory ability. Peradventure assuming the supine position induces general relaxation and stage. One sleep. Sleep reduces the intensity of perceptual experiences of all the senses, including the olfactory sense [1]. On the other hand, the supine and relaxed state may induce a positive effect. Based on Wolpe's reciprocal inhibition principle, such a relaxed effect causes fear inhibition, whereby there cannot be coexistent simultaneous opposite emotions [2]. Since fear has been demonstrated to improve olfactory ability, assuming the supine position induces relaxation and thus reduces fear-induced increased olfactory ability (Yakov, 2013; Keedwel, 2005). On the other hand, assuming the supine position may induce a kinesthetic distraction, changing the focus of attention away from chemosensation to a change in position. Lying in the lateral decubitus position possibly causes a modification in the olfactory cycle with greater engorgement in the inferiorly situated nostril, which may have a lesser olfactory ability [1]. In those with olfactory deficits after COVID-19 or other conditions, a reduced olfactory ability with lying down may have significant health risks. Further investigation into the impact of position on those with olfactory deficits from all sources, including COVID-19, is warranted.

Halted-pendulum Relaxation: Application to White Dwarf Binary Initial Data

Studying compact-star binaries and their mergers is integral to determining progenitors for observable transients. Today, compact-star mergers are typically studied via state-of-the-art computational fluid dynamics codes. One such numerical technique, smoothed particle hydrodynamics (SPH), is frequently chosen for its excellent mass, energy, and momentum conservation. The natural treatment of vacuum and the ability to represent highly irregular morphologies make SPH an excellent tool for the study of compact-star binaries and mergers. For many scenarios, including binary systems, the outcome of simulations is only as accurate as the initial conditions. For SPH, it is essential to ensure that the particles are distributed regularly, representing the initial density profile but without long-range correlations. Particle noise in the form of high-frequency local motion and low-frequency global dynamics must be damped out. Damping the latter can be as computationally intensive as the actual simulation. We discuss a new and straightforward relaxation method, halted-pendulum relaxation (HPR), to remove global oscillation modes of SPH particle configurations. In combination with effective external potentials representing gravitational and orbital forces, we show that HPR has an excellent performance in efficiently relaxing SPH particles to the desired density distribution and removing global oscillation modes. We compare the method to frequently used relaxation approaches and test it on a white dwarf binary model at its Roche-lobe overflow limit. We highlight the importance of our method in achieving accurate initial conditions and its effect on achieving circular orbits and realistic accretion rates when compared with other general relaxation methods.

Pattern and outcome of Anaesthesia techniques in patients presenting with pre-eclampsia/eclampsia for caesarean section in a Teaching Hospital

Objectives: To review the pattern of anaesthesia techniques among pregnant women with pre-eclampsia or eclampsia who had caesarean section in our health facility and their management outcomeMethods: A retrospective analysis was undertaken for all the obstetric patients with pre-eclampsia or eclampsia who had caesarean sections under different types of anaesthesia in a tertiary hospital between January 1st 2014 and December 31st 2018.Results: A total of one hundred and eighty-two patients who presented with pre-eclampsia and eclampsia had emergency caesarean sections. Of these, 134 (74%) were diagnosed pre-eclampsia and 48 (26%) had eclampsia. The mean age was 29.71±6.40years. Subarachnoid block was performed in 165 (90.66 %), 15 (8.24 %) had general anaesthesia relaxant technique, and the remaining two (1.10 %) had local anaesthetic infiltration ± total intravenous anaesthesia. Peri-operative anaesthetic complications encountered included post-anaesthetic shivering 19 (10.44%), hypotension 16 (8.79 %) and nausea 1 (0.55 %). Incidence of death on table was six percent (11 patients). Among those that died, the anaesthesia technique was general anaesthesia in eight cases (73%) while three patients (27%) had subarachnoid blocks.Conclusion: Spinal anaesthesia was the most commonly used anaesthesia technique in this centre for patients with pre-eclampsia and conscious eclamptic patients, and it proved to be a relatively safe technique with few mortality.

Prospective Cohort Study Quantifying the Effect of the LevaLap 1.0 on the Distance between the Abdominal Wall and Intra-abdominal Viscera

More than 13 million laparoscopic procedures are performed globally every year. The LevaLap 1.0 device may facilitate safe abdominal access when using the Veress needle for initial abdominal insufflation during laparoscopic surgery. We undertook this study to test the hypothesis that use of the LevaLap 1.0 would increase the distance from the abdominal wall to underlying viscera and the retroperitoneum, including from major vessels. Prospective cohort study. Referral center. Eighteen patients scheduled to undergo an interventional radiology procedure under general anesthesia and muscle relaxation. Application of the LevaLap 1.0 device on the umbilicus and on Palmer's point, during computed tomography scanning. Distance from the abdominal wall to the underlying bowel and to retroperitoneal blood vessels and more distant intra-abdominal organs before and after vacuum was applied to the LevaLap 1.0. The device did not significantly increase the distance from the abdominal wall to the immediate underlying bowel. Alternatively, the LevaLap 1.0 created a significant increase in the distance between the abdominal wall at the access point and more distant intra-abdominal organs at the umbilicus and at Palmer's point (mean ± SD: +3.91 ± 2.32 cm, p=.001, and +3.41 ± 3.12 cm, p=.001, respectively). At the umbilicus, the device increased the distance between the abdominal wall and the anterior wall of the vena cava by +5.32 ± 1.22 cm (p=.004) or the anterior wall of the aorta by 5.49 ± 1.40 cm (p=.004). At Palmer's point, the device increased the distance between the anterior abdominal wall and the colon and/or small bowel by 2.13 ± 1.81 cm (p=.023). No adverse events were reported. The LevaLap 1.0 increased the distance between abdominal wall and major retroperitoneal blood vessels by >5 cm, promoting safer access during Veress needle insufflation when performing laparoscopic surgery.

General convex relaxations of implicit functions and inverse functions

General convex relaxations of implicit functions and inverse functions

Intramuscular vaccine administrations including the adoption of “Zeta-track technique” & “without aspiration slow injection technique” (ZTT & WASiT): a prospective review

Abstract Objective To review the current literature on the practice of intramuscular injections (IMIs), focusing on immunizations. Methods The present study comprises 2 reviews, characterized by high-quality evidence, pertaining to the deployment of the slow injection technique without aspiration (referred to in this paper as the without-aspiration slow injection technique [WASiT]) and combined with the Zeta-track technique (ZTT). The literature review is oriented toward the analysis of 2 features associated with IMIs techniques: safety and pain, integrating new evidence on vaccinee positioning for each muscle site and general relaxation techniques in the multi-parametric analysis. Results The rigorous and in-depth reviews in the current study reveal the usefulness of including, among the international guidelines for via intramuscular immunizations, the adoption of WASiT only for compliant vaccinees, and in combination with all validated techniques for IMIs, and the use of ZTT limitedly if specific well-developed muscles are indicated. All the technique’s limitations are exposed. Conclusions Future research directions are presented by including the author’s study designs to provide indirect evidence for the validity of the rationale of the slow injection technique using scientific methods, and for the conduction of future randomized controlled trials (RCTs) focused on revisiting the adoption of ZTT in a dynamic and integrated immunizations protocol in anterolateral thigh (ALT), ventrogluteal (VG), and also in the deltoid muscle, in the specific cases analyzed.