Significant Improvement In Comfort Research Articles

The New York Section EMPIRE Collaborative: Piloting a Multi-Institutional, Simulation-Based Surgical Skills Boot Camp for Junior Urology Residents.

Since the integration of the intern year into urology residencies, programs are mandated to introduce fundamental skills to junior residents. Our goal was to assess the impact of one such program: the 2023 New York Section of the AUA (NYS-AUA) EMPIRE (Educational Multi-institutional Program for Instructing REsidents) Boot Camp. Junior urology residents from all 10 NYS-AUA institutions attended a free EMPIRE Boot Camp on June 9, 2023. The seminar covered procedural skills including urethral catheterization, cystoscopy, renal and bladder ultrasound, transrectal prostate ultrasound with biopsy, and an introduction to robotics/laparoscopy. Sessions focused on urologic emergencies and postoperative scenarios. Participants completed questionnaires before, immediately after, and 6 months post course, assessing comfort with procedures and overall program quality using a 5-point Likert scale and free text responses. t Tests compared pre and immediate/6-month post scores. Forty junior residents, along with faculty and resident instructors from all 10 NYS-AUA programs, participated. Of the 40 trainees, 35 (87.5%) completed pre- and immediate post-boot camp surveys, while 23 (57.5%) responded to the 6-month follow-up survey. Ratings showed significant improvement in comfort with basic urologic technical skills for 13 out of 14 domains (93%) immediately after the course and at the 6-month mark. Attendees reported notably higher comfort levels in managing obstructive pyelonephritis (P = .003) and postoperative complications (P = .001) following didactic sessions. A skills-based, free collaborative urology boot camp for junior residents is feasible and can be effective. Trainees reported improved comfort performing certain technical skills and managing urologic emergencies both immediately after the course and at 6 months of follow-up.

Implementing a formal curriculum on surgical ethics and palliative care for otolaryngology residents

ObjectiveResidents are faced with ethical issues every day but most residency curriculums do not routinely include formal ethics skills training. In order to address this, a comprehensive curriculum on ethics and surgical palliative care was implemented for otolaryngology residents. MethodsAn 8-h ethics didactics curriculum was designed in collaboration with our institution's Institute of Ethics. Varied strategies were used to cover basic principles and practical skills. Anonymous assessments were completed by learners at 3 points during the curriculum on a 5-point scale. ResultsNine residents were surveyed. Prior to the curriculum, a large majority of residents (85 %) expressed little to no familiarity with basic ethical principles. There was statistically significant improvement in understanding of and familiarity with bioethics topics, including the four principles of bioethics (Δ = 2.4, p = 0.004). There was also statistically significant improvement in comfort with the implementation of ethical decision making and palliative care skills, including with difficult conversations with patients (Δ = 1.3, p = 0.03). Participation in sessions was excellent with positive qualitative feedback. ConclusionAn interactive curriculum in ethics and palliative care can be engaging and practical for busy surgical residents, with measurable improvement in comfort with challenging cases and ethical, patient-centered care.

Daily Dose of Development: Feasibility of an App-Based Curriculum of Normal Child Development for Pediatric Residents

Pediatric resident education in child development has historically not been taught in a formal manner despite it being identified as a priority for residency education.1 A significant proportion of children with developmental delays are not identified until they enter school, representing a lost opportunity for early intervention and underscoring the importance of targeted resident education in child development.The advent and acceleration of technology enhanced learning (TEL) led to the development of innovative educational curricula flexibly accessed by a learner. Prior TEL endeavors teaching child development relied on strategies employing passive review of videos or online material. Spaced education is a framework centered on presentation of concepts delivered longitudinally and repeated at varied intervals, improving retention of knowledge. Prior studies demonstrate improved knowledge recall, with few that examined impact on clinical care or optimal integration into clinical rotations.2Daily Dose of Development (3D) is a web or mobile application with a comprehensive database of clinical vignettes mapped to updated developmental milestones. Vignettes are presented through cycles of multimedia questions, allowing spaced interactive application of knowledge in realistic scenarios. Curriculum development was informed by 2 feasibility studies assessing different delivery mechanisms, a targeted needs assessment of resident learners, and qualitative interviews with child developmental experts.A randomized control study was performed to evaluate the feasibility, acceptability, and preliminary effectiveness of the 3D app. All pediatric residents (n=90) at a single training institution were invited to participate in the study, 30 of whom were randomized to either the app or control group. Baseline demographic data were collected prior to launch of the app curriculum, which cycled over 3 months. Control group residents participated in existing curricular opportunities in child development without access to the app until study conclusion. Feasibility was assessed using surveys at the beginning, midpoint, and end of the study period, examining comfort level in child development, app usability and impact on clinical care, and open-ended questions. App usage data from Google Analytics were also collected.Out of 30 residents, 17 were randomized to the app and 13 to the control group. Fifty-seven percent (17 of 30) of residents completed all surveys: 8 (47%) in the app and 9 (53%) in the control group. Baseline demographics were comparable between groups.All 17 residents accessed the app during the study period. Of those responding to all surveys, 63% (5 of 8) accessed daily. The mean number of responses per quiz was 8.9 (ranging from 2-16 responses). Identified features to enhance the app included ability to download content, zoom in on multimedia, reference article links, customize push notifications, and stack missed questions.At study conclusion, 100% of the app arm endorsed 3D as effective for learning child development. Statistically significant improvement in comfort with milestone recall (P=.007), development evaluation methods (P=.001), and identification of developmental delay (P=.046) were noted between groups. Fifty percent (4 of 8) of the app group reported improvement in patient developmental assessments, compared to 33% (3 of 9) in controls (P=.49). Feedback demonstrated desire for ongoing education in child development, enthusiasm, and desire for incorporation of the app into existing traditional curricula. Loss to follow-up and small sample size limited analysis.This study demonstrated feasibility, acceptability, and preliminary effectiveness of app-based spaced curriculum as an adjunct to clinical rotations. Self-reported behavior change in clinical care as a result of participation in the app curriculum is a novel area of impact for this type of curriculum and requires further study. Future iterations focused on optimal implementation strategies are needed to develop best practices of integrating TEL curricula with traditional clinical teaching.

The Larry Tube: Customized 3D Printed Laryngectomy Tubes Following Total Laryngectomy.

To determine whether a custom laryngectomy tube can improve airway symptoms in total laryngectomy patients with atypical anatomy who are unable to use commercial laryngectomy tubes. Furthermore, to exemplify the power of customizable 3D printed medical devices when combined with the expanded access pathway through the FDA. A custom-fabricated laryngectomy tube, manufactured at in-house clinical engineering labs, was utilized for each patient following typical laryngectomy tube protocols. All participants had previously undergone a total laryngectomy. Patients were selected based on critical airway obstruction posing potentially life-threatening scenarios while using commercially available laryngectomy tubes. For all patients involved, there were no further airway obstruction complications or events, and they reported a subjective, significant improvement in comfort after placement of the custom laryngectomy tube. Custom laryngectomy tubes can provide patients with atypical anatomy relief from airway obstructions and improve comfort when commercial options fail to address the anatomic restriction. The process used to develop custom laryngectomy tubes may be relevant for other diseases and patients with atypical anatomies through the expanded access pathway.

Teen Actors Teaching Communication Skills.

IntroductionTo provide high-quality care, physicians must effectively communicate with adolescents while addressing difficult and sensitive subjects. Our program aimed to (1) cost-effectively incorporate teenage actors into a pediatric simulation program and (2) increase residents' self-perceived comfort level with adolescent patients by practicing interview skills with teens.MethodsIn 2013, the authors established a Teen Acting Program, in which volunteer theater students created and simulated patient characters and provided feedback to learners. Residents on the adolescent medicine rotation participated in the program, completed a survey on self-perceived comfort level with adolescent patients, and answered open-ended questions regarding the program.ResultsA total of 70 residents participated in the program and pre-survey; 46 completed both the pre- and the post-survey. Of 46 participants, 37 (80%) reported that the program was helpful and four (9%) stated it was the best thing about the rotation; 35 (80%) described the program as “high-yield” for the time spent. Between the pre- and post-surveys, residents demonstrated statistically significant improvement in comfort interacting with adolescent patients, addressing confidentiality, and taking histories on sexuality, substance use, mental health, diet, and safety, whether they were the interviewer or observer. Residents that reported the teens taught them specific skills and concepts related to communication. A calculation of program costs demonstrated a 10-fold decrease in cost from traditional simulation patient encounters.ConclusionThe Teen Acting Program was cost-effective and improved resident comfort with interviewing adolescents about sensitive topics, while giving adolescent actors experience honing their acting skills.

Role of Integrative Oncology and Palliative Care Services in Improving Comfort Level and Compliance among Patients with Advanced Fungating Breast Cancer - Experience from a Rural Hospital of North Eastern India during the COVID-19 Pandemic.

Objectives:Malignant fungating breast cancers are a definite challenge to treatment due to limited knowledge and prevailing distressing symptoms. Various treatment protocols with regard to radiotherapy (RT) and chemotherapy have been reported in the literature but the knowledge of proper integration of these regimes with effective palliative care nursing care, particularly in resource poor settings, is not well understood. Hence, this study was undertaken to assess the change in the degree of comfort achieved before and after treatment of these fungating breast cancer wounds along with issues regarding compliance to such treatment in a peripheral rural medical college hospital.Materials and Methods:A total of 20 patients were selected from the medical records files of the RT department of North Bengal Medical College and Hospital who were registered and treated during the period 1 June 2019– 31 July 2021. Palliative care nursing of malodour, bleeding, maggots, pain and assessment of psychological parameters was done based on the 11-point revised Edmonton Symptom Assessment Scale at the beginning and at each subsequent follow-up visits. Patients were also individualised for receiving palliative RT, chemotherapy, surgery and hormone therapy based on their clinicodemographic profiles. Informed consent was taken from all patients and every treatment was in accordance with the ethical permissions as sought from the Institutional Ethics Committee. Statistical analysis was done based on descriptive statistics and SPSS version 22.Results:Median follow-up was 13 months. Overall, there was a significant improvement in comfort and well-being as assessed by paired t-test before and after treatment (paired t-test = 16.548; P = 0.000). However, there was no significant correlation with palliative radiation dose and schedule as per spearman’s correlation coefficient. The mean radiation dose was BED 48.56 Gy3 (EQD2 = 29.3 Gy3) and the median number of fractions used was 10. Almost 50% of patients were noncompliant to treatment and this might be attributed to the prevailing COVID-19 pandemic situation. There was maximum relief with regard to bleeding control (100%), malodour dissipation (76.9%) and control of maggots infestation (71%) and these results were also found to be strongly associated with treatment as per analysis done by Chi-square test of difference of proportions.Conclusion:Effective comfort can be achieved with proper judicious combination of palliative care nursing and other oncological treatment such as radiation, chemotherapy and surgery.

Multi-objective optimization for autonomous driving strategy based on Deep Q Network

Autonomous driving is an important development direction of automobile technology, and driving strategy is the core of the autonomous driving system. Most works in this area focus on single-objective tasks, such as maximizing vehicle speed or lane-keeping, and rare attention has been paid to the quality of driving skills. Therefore, a multi-objective learning method is proposed for autonomous driving strategy based on deep Q-network, where two optimization objectives are involved, i.e., vehicle speed and passenger comfort. An end-to-end autonomous driving model is designed by using vehicle front camera images as inputs to the Q-network and makes decisions based on the output Q values. Considering the vehicle speed and passenger comfort, the reward function is designed for multi-objective optimization. To evaluate the effectiveness of the method, training and testing are performed in a simulator, and a single-objective strategy with the goal of maximizing speed is designed for comparison. The results show that the proposed multi-objective autonomous driving strategy can strike a balance between vehicle speed and passenger comfort. Compared with the single-objective strategy, the multi-objective strategy has a significant improvement in comfort, while the average speed is only slightly reduced.

Health History Skills for Interprofessional Learners in Transgender and Nonbinary Populations.

Transgender and nonbinary peoplehave been identified as vulnerable and clinically underserved and experience health disparities. Lack of health care provider knowledge about transgender and gender diverse populations is a barrier to care, impacting health outcomes. The aim of this project was to develop, implement, and evaluate a simulation learning activity for midwifery and women's health nurse practitioner students and obstetrics and gynecology residents to interact with transgender and nonbinary individuals, with the goal of enhancing health history taking comfort and skills. A partnership was formed among University faculty and simulation educators, a community clinic providing gender-affirming care, and members of transgender and gender diverse populations who served as patient-teachers. Two cases frequently encountered in clinics providing care to transgender individuals were developed for the simulation. Learners were divided into interprofessional groups of 3 and completed one of 2 case scenarios with a patient-teacher. Learners and patient-teachers debriefed after the simulation to discuss and reflect on the experience. Thirty-three learners participated in the simulation, 12 midwifery students, 16 women's health nurse practitioner students and 5 obstetrics and gynecology residents. Significant differences were observed for all comfort and skills questions, showing increased perceived comfort and skills from pre- to postsimulation. There were no significant differences in attitude responses. We successfully created and implemented a new sexual and reproductive history taking skills simulation in partnership with community clinic staff and transgender and nonbinary persons. The session was well received by learners and patient-teachers. Learners demonstrated significant improvements in comfort and skills in history taking in this setting and provided favorable feedback about the experience. This simulation can serve as a guide to others providing education to future midwives, women's health nurse practitioners, and obstetrician-gynecologists.

Auto-titrating versus fixed-EPAP intelligent volume-assured pressure support (iVAPS) ventilation in patients with COPD and hypercapnic respiratory failure.

Intelligent volume-assured pressure support (iVAPS) is a new noninvasive ventilation (NIV) mode that can automatically adjust pressure support to deliver effective ventilation. Our aim was to compare treatment efficacy and level of satisfaction between auto-titrating expiratory positive airway pressure (auto-EPAP) and fixed expiratory positive airway pressure (fixed-EPAP) during iVAPS treatment in stable hypercapnic chronic obstructive pulmonary disease (COPD) patients. In this prospective single-blinded, randomized study, 50 patients with chronic stable hypercapnia (COPD) who met the study criteria were randomized into a group I treated with auto-EPAP and a group II who received fixed-EPAP during iVAPS treatment for 5 consecutive days. The patients' characteristics, arterial blood gases, and lung function test were recorded. Numeric rating scale (NRS), dyspnea and comfort scale were obtained. The study subjects were evaluated and followed up after initiating therapy for 5 consecutive days. Outcome measures were recorded at baseline (T0) and after three (T1) and five (T2) days of each consecutive period All parameters were collected and statistically analyzed. No significant differences were found regarding age, sex, or BMI between the both groups. It was noted that daytime PaCO2 decreased significantly over the follow-up period in the group I patients treated with auto-EPAP as compared with fixed-EPAP. Regarding the patient comfort and dyspnea during iVAPS treatment, dyspnea sensation was significantly lower with auto-EPAP 7.9 ± 1.8 (T0) vs 3.5 ± 1.1 (T2), p = 0.001 and fixed-EPAP 7.7 ± 1.9 (T0) vs 3.4 ± 1.6 (T2), p = 0.001, but no significance was reached between the both groups. However, auto-EPAP demonstrated significant improvement in comfort when compared with fixed-EPAP modality. However, the overall satisfaction of the patients receiving auto-EPAP modality was significantly increased. Mean tidal volume tended to be higher in auto-EPAP 698 ± 213 mL compared with 628 ± 178 mL in fixed-EPAP (p = 0.001). The air leak was significantly lower in auto-adjusting mode (2.5 ± 1.3 vs 3.7 ± 2.2 L/ min) in fixed-EPAP modality. Auto-titrating NIV mode may provide additional benefit in decreasing PaCO2 more efficiently and improve patient comfort and satisfaction.

1098 Rapid Fire Hepatology: A Pilot Study of a Near-Peer, Speed-Teaching Hepatology Curriculum on a Dedicated Inpatient Liver Service

INTRODUCTION: Near-peer teaching, trainees educating other trainees, is a valuable form of teaching in residency, valued equally or greater to faculty-led sessions. While resident teaching has been shown to improve clinical performance, concern exists over this type of education encroaching on clinical duties. Our study seeks to determine whether a resident-led, speed-teaching hepatology curriculum leads to improvement in resident comfort with independent management and teaching of core hepatology topics. METHODS: PGY2&3 residents at an academic liver transplant center received teaching scripts based on published practice guidelines to lead 15-minute teaching sessions on 8 hepatology topics. The curriculum was given to interns and residents (4 per month) over 4 weeks. Anonymous pre- and post-rotation surveys assessing comfort with independent management and teaching on these topics were performed (Likert scale 1-5). Statistical analysis used independent sample T-tests of pre- and post-rotation survey responses. RESULTS: A total of 18 residents completed the pre- and post-intervention surveys (N = 11 PGY1, N = 7 PGY2/3). In the intervention cohort, there was significant improvement in comfort with independent management and teaching of all topics between the pre- and post-intervention surveys (all P < 0.05) (Table 1). Post-intervention respondents, including PGY1 and 2 residents, showed no difference in comfort with independent management of core topics compared to graduating PGY3s who did not have the intervention, with the exception of hyponatremia, which graduating residents felt more comfort managing (4.32 vs 3.56; P = 0.03). In addition, the post-intervention group felt more comfort than graduating residents teaching on hepatorenal syndrome (4.11 vs 3.38; P = 0.02) and trended towards increased comfort teaching on post-liver transplant complications (2.89 vs 2.08; P = 0.0502) (Table 1). CONCLUSION: Our study shows a near-peer resident-led speed-teaching hepatology curriculum is feasible to implement on a busy hepatology inpatient service and leads to improvement in comfort in independently managing and teaching on core hepatology topics. We also found a mixed resident group including PGY1-2s reported comfort with teaching and management similar to that of graduating residents, suggesting that our near-peer curriculum may lead to more rapid knowledge acquisition and trainee confidence with hepatology.

Significance of PCM arrangement in cooling vest for enhancing comfort at varied working periods and climates: Modeling and experimentation

Personal cooling vests that incorporate phase change material (PCM) have been utilized to improve thermal sensation of people working outdoors in different fields (firefighting, construction, military, police, etc.). In this study, an integrated fabric-PCM and bio-heat model was validated through human subject testing to determine the extent to which it could detect thermal and comfort responses when varying the arrangement of a fixed number of PCM packets in the cooling vest. The modeling approach was utilized for given PCM melting temperature to determine the number of packets needed and their optimal arrangement at moderate (35 °C) and hot (40 °C) environments for 45, 60 and 90 min working durations. The findings showed that when full coverage of the torso is not needed, optimal arrangements were those having full back coverage with the remaining packets on the upper front. Lower front cooling did not show significant improvement in comfort over upper front cooling. That effect was more evident when lower front PCM packets were used at the 40 °C hot environment. As the working duration increased, less differences were detected in skin temperatures and comfort between the optimal and worst cases since a higher PCM coverage area was necessary.

Beyond Men, Women, or Both: A Comprehensive, LGBTQ-Inclusive, Implicit-Bias-Aware, Standardized-Patient-Based Sexual History Taking Curriculum.

This standardized-patient-based module prepares medical students to take inclusive, comprehensive sexual histories from patients of all sexual orientations and gender identities. Health disparities faced by lesbian, gay, bisexual, transgender, and queer (LGBTQ) people are at least partially the result of inadequate access to health care and insufficient provider training. This module incorporates implicit bias activities to emphasize the important role providers can play in mitigating these disparities through compassionate, competent care. Furthermore, two of the three included cases highlight the negative impact sexual dysfunction can have on emotional well-being. Over 3 hours, students participate in a 30-minute large-group lecture and three 40-minute small-group standardized patient encounters with debrief. Prework consists of a short video on sexual history taking, assigned readings, and an implicit bias activity. These materials are included in this resource, along with lecture slides, facilitator guide, and standardized patient cases. Though the cases are adaptable to all levels of medical education, this module is designed for second-year and early third-year medical students. Qualitative student evaluations were positive, and postparticipation surveys revealed statistically significant improvement in comfort with their ability to take a sexual history in general, and take one from patients with a differing sexual orientation. Deployed in the second year of our Doctoring curriculum, this module continues to receive positive evaluations. Introducing these skills begins to address the curricular deficiencies seen across medical education and lays the foundation for a more competent health care workforce to address the needs of LGBTQ patients.

Nurse-Administered Hand Massage: Integration Into an Infusion Suite's Standard of Care .

Nurse-delivered hand massage is a safe and effective intervention that has potential for positively affecting nursing and patient outcomes. . Nurses in a National Cancer Institute-designated academic health center outpatient chemotherapy infusion suite were taught how to administer a hand massage to strengthen the nurse-patient relationship and improve patient experience, comfort, satisfaction, stress, and anxiety. . A pre-/postimplementation group comparison design was used. Patients in both groups completed self-reported measures of stress, comfort, satisfaction, and anxiety. Nurses completed Likert-type scales pre- and postimplementation on the perceived benefits of hand massage to the patient and nursing practice, impact on patient anxiety, and preparation in providing a hand massage. . A positive trend was seen in all indicators. Patients who received a hand massage had a statistically significant improvement in comfort (p = 0.025) compared to those who did not. A statistically significant improvement was seen in all nurse indicators pre- to postimplementation.

Single mandibular implant study - denture satisfaction in the elderly.

To investigate whether there are differences in patients' denture satisfaction when an implant placed in the midline of the edentulous mandible is loaded either immediately or three months later, after second-stage surgery. One hundred and fifty-eight edentulous patients received a single implant in the midline of the mandible. After randomisation, it was loaded either immediately after implant placement (N = 81, group A) or three months later, after a submerged healing phase and a second-stage surgery (N = 77, group B). Patients' denture satisfaction aspects were assessed, using visual analogue scales (VAS), before treatment, one month after implant placement during the submerged healing phase (only group B) and one and four months after implant loading. The statistical analysis was performed using the Wilcoxon signed-rank and rank-sum tests. One month after loading, a significant improvement in comfort, function and stability of the mandibular denture could be observed in both groups (P ≤ 0·05). A slight but not significant improvement was found between one and four months after loading. Patients with second-stage surgery and delayed loading rated the stability and fit of the mandibular denture as significantly better than patients who had immediate loading. A single implant in the edentulous mandible significantly increased patients' denture satisfaction. After four months, stability and fit of the mandibular denture were considered better when a delayed loading protocol had been followed. A single mandibular implant in the edentulous mandible significantly increases patients' denture satisfaction, regardless of the loading protocol.

Standardized patient simulation versus didactic teaching alone for improving residents’ communication skills when discussing goals of care and resuscitation: A randomized controlled trial

Background: Communication skills are important when discussing goals of care and resuscitation. Few studies have evaluated the effectiveness of standardized patients for teaching medical trainees to communicate about goals of care. Objective: To determine whether standardized patient simulation offers benefit over didactic sessions alone for improving skill and comfort discussing goals of care. Design and intervention: Single-blind, randomized, controlled trial of didactic teaching plus standardized patient simulation versus didactic teaching alone. Participants: First-year internal medicine residents. Main measures: Changes in communication comfort and skill between baseline and 2 months post-training assessed using the Consultation and Relational Empathy measure. Key results: We enrolled 94 residents over a 2-year period. Both groups reported a significant improvement in comfort when discussing goals of care with patients. There was no difference in Consultation and Relational Empathy scores following the workshop (p = 0.79). The intervention group showed a significant increase in Consultation and Relational Empathy scores post-workshop compared with pre-workshop (35.0 vs 31.7, respectively; p = 0.048), whereas there was no improvement in Consultation and Relational Empathy scores in the control group (35.6 vs 36.0; p = 0.4). However, when the results were adjusted for baseline differences in Consultation and Relational Empathy scores in a multivariable regression analysis, group assignment was not associated with an improvement in Consultation and Relational Empathy score. Improvement in comfort scores and perception of benefit were not associated with improvements in Consultation and Relational Empathy scores. Conclusion: Simulation training may improve communication skill and comfort more than didactic training alone, but there were important confounders in this study and further studies are needed to determine whether simulation is better than didactic training for this purpose.

Evaluation and improvement of the energy performance of a building's equipment and subsystems through continuous monitoring

Abstract This study proposes an experimental method for the evaluation of a building's equipment and subsystems through the continuous monitoring of electrical and environmental process variables. The aim of the study is to improve the building's comfort and energy performance using an automatic control system. A case study of a building's air-conditioning system is presented using the proposed method. A dynamic equipment-control model for an artificially conditioned environment is described. Additionally, empirical models are developed that relate equipment variables, the conditioned environment and a building's surroundings and occupation characteristics using representation through transfer functions and auto-regressive models with exogenous inputs (ARX). The empirical models were created using continuous monitoring data via the Internet and a low-cost platform known as the end use monitoring centre (EUMC). These models represent the relevant characteristics of the involved variables in consideration of the complexity of the modelled phenomena. An automatic equipment control system was designed and installed. The systems resulted in significant improvements in comfort and energy efficiency. The proposed method can be applied to diverse types of equipment and subsystems in buildings.

Long Backboard versus Vacuum Mattress Splint to Immobilize Whole Spine in Trauma Victims in the Field: a Randomized Clinical Trial

Patients with possible spinal injury must be immobilized properly during transport to medical facilities. The aim of this research was comparing spinal immobilization using a long backboard (LBB) with using a vacuum mattress splint (VMS) in trauma victims transported by an Emergency Medical Services (EMS) system. In this randomized clinical trial, 60 trauma victims with possible spinal trauma were divided to two groups, each group immobilized with one of the two instruments. Speed and ease of application, immobilization rate, and the patients' comfort were recorded. In this survey, LBB was faster to apply: 211.66 (SD = 28.53) seconds vs 654.00 (SD = 16.61) seconds. Various measures of immobilization were better by LBB. Also, LBB offered a significant improvement in comfort over a VMS for the patient with possible spinal injury. All of the results were statistically significant. The results of this study showed that immobilization using LBB was easier, faster, and more comfortable for the patient, and provided additional decrease in spinal movement when compared with a VMS.

Improving Suspension Control by an Optimal Control Component and Disturbance Compensation

AbstractThe paper presents an optimal control component to enhance the comfort achieveable by an existing reference model based controller. The basic controller concept controls a hybrid suspension system by emulating a timevarying damping and stiffness between wheel and chassis, resulting in significant improvements in comfort and safety compared to a passive suspension. It is extended by an optimal control strategy to increase its performance when passing single excitations critical for suspension deflection. The optimal control component uses offline calculated optimal control solutions for the actual vehicle states to react at an early stage of the compression movement leading to a smoother and lower chassis acceleration when passing critical excitations. The presented additional disturbance compensation uses information about the road excitation to beneficially influence the wheel movement. The feedforward filter influences the wheel dynamics such that a significant reduction of wheel load deviations is reached while additionally reducing chassis acceleration.

A clinical longitudinal evaluation of pre-fabricated, semi-rigid foot orthoses prescribed to improve foot function

Background Custom-made foot orthoses whilst effective can be expensive and time-consuming to manufacture making ready made devices an attractive option. This study, with follow up after 12 months provides longitudinal data not frequently available. Objectives Longitudinal evaluation of the efficacy of a slim, ready made, 3/4th length semi-rigid foot orthosis. Method Data was collected from 21 participants at baseline, at 4 weeks and via postal questionnaire after 12 months. Powerstep orthoses (Cuxson-Gerrard & Co Ltd., Oldbury, UK) were given to participants with the therapeutic aim of resolving or reducing their lower limb symptoms. Results Participants reported an initial marked decrease in foot pain, found the orthoses fitted in footwear readily, had a sense of increased foot stability and a significant improvement in comfort ( p < 0.0001). Some increase in pain levels reported after 4-weeks ( p = 0.01), was accompanied by an equally significant increase in mobility ( p = 0.01) which triangulated closely against diary records. After a mean of 15.1 months, 73% of participants still found the orthoses beneficial. Conclusion Participants found ready made orthoses enhanced sense of stability and generally reduced symptoms over a period of at least 1 year.

Incomplete Recuperation of WMSDs after an Office Ergonomic Intervention

Survey data on the effects of an office ergonomic intervention (negative-tilt keyboard tray, upper mouse platform, chair, and training) were analyzed. Baseline and one-year post-intervention data on work activities, individual factors and the frequency and severity of upper body work-related musculoskeletal disorders (WMSDs) were compared. Results showed that post-intervention the sample prevalence of any upper body symptoms decreased from 73% to 47.3% and the upper body symptom mean severity score decreased by 30.7%. There was an 8% reduction in the frequency of symptoms for each body region for symptomatic workers. The ergonomic intervention resulted in significant improvements in comfort and in WMSDs, but for many workers MSD symptoms persisted above background levels, suggesting that other factors may be affecting symptom etiology.