Within-subjects Analysis Of Variance Research Articles

Vaccine preparation time, errors, satisfaction, and preference of prefilled syringes versus RSV vaccines requiring reconstitution: randomized, time and motion study

Aim The current study compared preparation time, errors, satisfaction, and preference for a prefilled syringe (PFS) versus two RSV vaccines requiring reconstitution (VRR1 and VRR2) in a randomized, single-blinded time and motion study. Methods Pharmacists, nurses, and pharmacy technicians were randomized to a preparation sequence of the three vaccines. Participants read instructions, then consecutively prepared the three vaccines with a 3–5-min washout period in between. Preparations were video recorded and reviewed by a trained pharmacist for preparation time and errors using predefined, vaccine-specific checklists. Participant demographics, satisfaction with vaccine preparation, and vaccine preference were recorded. Within-subjects analysis of variance was used to compare preparation time. Mixed-effects Poisson and ordered logistic regression models were used to compare the number of preparation errors and satisfaction scores, respectively. Results Sixty-three pharmacists (60%), nurses (35%), and pharmacy technicians (5%) participated at four sites in the United States. The least squares mean preparation time per dose for PFS was 141.8 s (95% CI = 156.8–126.7; p <.0001) faster than for VRR1, 103.6 s (95% CI = 118.7–88.5; p <.0001) faster than for VRR2, and 122.7 s (95% CI = 134.2–111.2; p <.0001) faster than the pooled VRRs. Overall satisfaction (combined “Very” and “Extremely”) was 87.3% for PFS, 28.6% for VRR1, and 47.6% for VRR2. Most participants (81.0%) preferred the PFS vaccine. Limitations The study is limited by the inability to completely blind observers. To minimize the effects of order, we utilized a 3-sequence block design; however, the order in which the vaccines were prepared may have affected outcomes. Participants were assessed once, whereas if repeated preparations were performed there may have been trained efficiencies gained for each vaccine. Conclusion PFS vaccines can greatly simplify the vaccine preparation process, allowing administrators to prepare almost four times more doses per hour than with vial and syringe systems.

Executive functioning skills in early childhood children with autism, intellectual disability, and co-occurring autism and intellectual disability

BackgroundMany children with autism and intellectual disability (ID) experience executive functioning (EF) difficulties. However, there is minimal research on EF skills in children with autism, ID, and co-occurring autism/ID in early childhood. AimsTo address this gap in the research, we evaluated EF profiles using the BRIEF-P among early childhood children (2–5 years of age) with autism, ID, and co-occurring autism/ID. Method and proceduresParticipants in the current study were 87 children between the ages of 24 and 71 months (M = 46.8, SD = 12.7) diagnosed with autism (n = 24, 27.6 %), ID (n = 23, 26.4 %), or co-occurring autism/ID (n = 40, 46.0 %) that completed a comprehensive psychological evaluation at a university development center. We used a mixed Analysis of Variance (ANOVA) and between- and within-subjects ANOVAs as follow-up analyses. Outcomes and resultsResults suggested that early childhood children with autism, ID, and autism/ID may have unique EF skill profiles. Children with ID exhibited the most significant EF impairments and children with autism had the least. Working memory was the most impaired EF domain across all diagnostic groups. Conclusions and implicationsOverall, our findings show that early childhood children with autism, ID, and autism/ID exhibit difficulties in EF skills. Children with ID exhibit the most significant EF impairments whereas children with autism show the least. However, regardless of diagnosis, working memory is the most impaired EF skill.

Unravelling delayed therapy escape after thalamic deep brain stimulation for essential tremor? – Additional clinical and neuroimaging evidence

BackgroundDelayed therapy escape after thalamic deep brain stimulation (DBS) for essential tremor is a serious yet frequent condition. It is often difficult to detect this process at onset due to its gradual evolution. ObjectiveHere we aim to identify clinical and neuroimaging hallmarks of delayed therapy escape. MethodsWe retrospectively studied operationalized and quantitative analyses of tremor and gait, as well as [18F]fluorodeoxyglucose (FDG) PET of 12 patients affected by therapy escape. All examinations were carried out with activated DBS (ON) and 72 h after deactivation (OFF72h); gait and tremor were also analyzed directly after deactivation (OFF0h). Changes of normalized glucose metabolism between stimulation conditions were assessed using within-subject analysis of variance and statistical parametric mapping. Additionally, a comparison to the [18F]FDG PET of an age-matched control group was performed. Exploratory correlation analyses were conducted with operationalized and parametric clinical data. ResultsOf the immediately accessible parametric tremor data (i.e. ON or OFF0h) only the rebound (i.e. OFF0h) frequency of postural tremor showed possible correlations with signs of ataxia at ON. Regional glucose metabolism was significantly increased bilaterally in the thalamus and dentate nucleus in ON compared to OFF72h. No differences in regional glucose metabolism were found in patients in ON and OFF72h compared with the healthy controls. ConclusionsRebound frequency of postural tremor seems to be a good diagnostic marker for delayed therapy escape. Regional glucose metabolism suggests that this phenomenon may be associated with increased metabolic activity in the thalamus and dentate nucleus possibly due to antidromic stimulation effects. We see reasons to interpret the delayed therapy escape phenomenon as being related to long term and chronic DBS.

School-Based Prevention of Screen-Related Risk Behaviors during the Long-Term Distant Schooling Caused by COVID-19 Outbreak.

The COVID-19 outbreak and related restrictions meant a higher incidence of screen-related risk behaviors in both children and adolescents. Our goal was to assess the perceived importance and extent of school-based preventions related to these risks during the long-term, nation-wide distant schooling period in the Czech Republic. The online survey was responded to by the school-based prevention specialists (N = 1698). For the analysis, within-subject analysis of variance (ANOVA) and binominal logistic regression were used. At-risk internet use and cyber-bullying were perceived as pressing, but other risks, for example, excessive internet use or the use of cyberpornography, received substantially less priority. The differences in all grades were significant and moderate to large (η2G between 0.156 and 0.288). The proportion of schools which conducted prevention interventions of screen-related risks was low (between 0.7% and 27.8%, depending on the grade and the type of the risk). The probability of delivering prevention intervention was in all grades significantly predicted by the presence of screen-related problems in pupils (OR 3.76–4.88) and the perceived importance of the screen-related risks (OR 1.55–1.97). The limited capacity of schools to deliver prevention interventions during distant schooling as well as the low awareness and impaired ability to recognize the importance of some screen-related risks should be addressed.

Predictors of the importance of everyday preferences for older adults with cognitive impairment.

Among older people with cognitive impairment and mild dementia, relatively little is known about the factors that predict preferences for everyday living activities and experiences and that influence the relative importance of those activities and experiences. Cross-sectional study. Participants were recruited from the Massachusetts Alzheimer's Disease Research Center (MADRC) Clinical Core longitudinal cohort. The sample included 62 community-dwelling older adults with cognitive impairment (Clinical Dementia Rating global score ≥ 0.5). We used the Preferences for Everyday Living Inventory (PELI) to assess preferences for activities and lifestyle experiences among persons with cognitive impairment. Within-subjects analysis of variance was used to test for significant differences in the mean ratings of importance for four domains of the PELI ("autonomous choice," "social engagement," "personal growth," and "keeping a routine"). Multiple regression models were used to relate predictors, including neuropsychiatric symptoms, to importance ratings for each domain. Significant differences were noted in the mean importance ratings of the preferences domains: "social engagement" preferences were rated as most important, followed by "autonomous choice," "personal growth," and "keeping a routine." For the "social engagement" preferences domain, female sex was significantly associated with higher importance of "social engagement," while depressive symptoms (Geriatric Depression Scale-15 scores) were significantly associated with lower importance. This study adds novel insight into the everyday preferences of community-dwelling older adults with cognitive impairment and highlights the impact of a number of factors, particularly level of depression, on how important various everyday experiences are perceived.

Integration of Audiovisual Input via TED-ED Videos and Language Skills to Enhance Vocabulary Learning

Vocabulary knowledge plays a primary role in the ability to communicate in a second/foreign language. The present study examined how different input or output modalities combined with audiovisual input provided by TED-ED videos could foster vocabulary learning. In doing so, some written tasks and exercises were used to facilitate the process. Participants were 56 upper-intermediate EFL learners in four classes who were selected based on convenience sampling. They were randomly assigned to one control and three experimental groups. Audiovisual input was employed in the experimental groups and was followed by speaking (n=13), listening (n=14), and reading (n=15) activities. The control group (n=14) practiced the same materials via reading and listening to control the audiovisual input effect. A Vocabulary Knowledge Scale (VKS) administered at the outset helped in selecting 60 unknown words. After the instruction treatment, the participants took immediate and delayed post-tests. Multivariate analysis of variance (MANOVA) showed that audiovisual input, followed by speaking activities was more effective than other types of classroom practices. The frequency of target words in the tasks and the results of statistical analysis (mixed between within-subjects analysis of variance) on the exercises confirmed the MANOVA results. The retrospective questionnaire underlined the role of the films in vocabulary learning. The researchers concluded that audiovisual input followed by spoken output was more useful than audiovisual input, alone, followed by listening or reading. In addition, although facilitative, written tasks and exercises did not have a differential role in the results. The study has implications for SLA researchers, language teachers, and practitioners.

Relationship between ratings of performance in the simulated and workplace environments among emergency medicine residents

The Emergency Medicine (EM) Specialty Committee of the Royal College of Physicians and Surgeons of Canada (RCPSC) specifies that resuscitation entrustable professional activities (EPAs) can be assessed in the workplace and simulated environments. However, limited validity evidence for these assessments in either setting exists. We sought to determine if EPA ratings improve over time and whether an association exists between ratings in the workplace v. simulation environment. All Foundations EPA1 (F1) assessments were collected for first-year residents (n = 9) in our program during the 2018-2019 academic year. This EPA focuses on initiating and assisting in the resuscitation of critically ill patients. EPA ratings obtained in the workplace and simulation environments were compared using Lin's concordance correlation coefficient (CCC). To determine whether ratings in the two environments differed as residents progressed through training, a within-subjects analysis of variance was conducted with training environment and month as independent variables. We collected 104 workplace and 36 simulation assessments. No correlation was observed between mean EPA ratings in the two environments (CCC(8) = -0.01; p = 0.93). Ratings in both settings improved significantly over time (F(2,16) = 18.8; p < 0.001; η2 = 0.70), from 2.9 ± 1.2 in months 1-4 to 3.5 ± 0.2 in months 9-12. Workplace ratings (3.4 ± 0.1) were consistently higher than simulation ratings (2.9 ± 0.2) (F(2,16) = 7.2; p = 0.028; η2 = 0.47). No correlation was observed between EPA F1 ratings in the workplace v. simulation environments. Further studies are needed to clarify the conflicting results of our study with others and build an evidence base for the validity of EPA assessments in simulated and workplace environments.

Accelerometry evaluation of shoulder movement and its association with patient-reported and clinical outcomes following reverse total shoulder arthroplasty

Accelerometers provide a new method to objectively measure recovery of movement and physical activity in patients following reverse total shoulder arthroplasty (RTSA) and may overcome common limitations associated with patient-reported outcome measures (PROMs). The aim of this study was to assess changes in upper limb movement using accelerometers following RTSAand investigate their association with other clinical outcome measures. Thirty-six patients who underwent RTSA wore accelerometers on both wrists and arms for 3 days at 3, 6, and 12 months postsurgery. PROMs (Constant score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, visual analog scale for pain, Single Assessment Numerical Evaluation, Shoulder Activity Level) and isometric shoulder strength were also assessed. Accelerometer outcomes were calculated to quantify counts of forearm and arm activityand the contribution of both arms to activity (limb symmetry and magnitude ratio). Changes and differences in all clinical measuresand objective movement measures were evaluated with within-subjects analysis of variance. Correlations between limb activity and other clinical measures were investigated using Spearman correlation coefficients. Objective movement of the operated arm increased from 3-6 months postsurgery (P = .004), but not from 6-12 months (P = .240). Limb asymmetries were observed at 3 and 6 monthsand improved by 12 months postsurgery. No associations were demonstrated between PROMs and objective upper limb movement at 12 months postsurgery. Despite early recovery of function and pain relief assessed by PROMs, objective movement using accelerometers showed delayed recovery of the operated arm postoperatively, before normalizing by 12 months postsurgery. Accelerometers provide a unique insight into functional recovery following RTSA.

1217-P: Improvement of Metabolic Control in Type 1 Diabetes after Transition Is Independent from Referral Center and Insulin Regimen

Background and Aim: Our previous data showed that transition from pediatric to an adult care center (ACC) improves glycaemic control in youth with type 1 diabetes (T1D). However, factors that might impact the success of transition are still unclear. In this study we aimed to evaluated whether metabolic control after transition differs by different ACC, insulin regimens and age at transition. Methods: In this retrospective observational study we evaluated data from 178 patients with T1D moving from two pediatric clinics to two different ACC in Rome. The transition process was performed according to the American Diabetes Association Standard of Care. A1c was reassessed three and six months after transition and compared to baseline values by within-subjects analysis of variance, fitting interaction terms with referral center, baseline insulin regimen (multiple daily insulin injection [MDI] and continuous subcutaneous insulin infusion [CSII]) and age. Results: At baseline, mean ± SD age was 28.4 ± 6.7 years, disease duration was 18.6 ± 8 years and A1c was 7.9 % ± 1.3. Mean transition gap was 8.0 ± 6.2 months. A1c values significantly improved both three (ΔA1c: -0.2%, p &amp;lt;0.001), and six months (ΔA1c: -0.4 %, p &amp;lt;0.001) after transitioning. At 6 months, ΔA1c was similar in the two centers (-0.4±1.0% and -0.4±0.7, p-value for interaction: 0.58) and in subjects on MDI or CSII at baseline (-0.5±1.0% and -0.4±0.6%, p-value for interaction: 0.37). No interaction between age at baseline and time was found (p-value: 0.22) The number of subjects on CSII increased from 46 (26.9%) at baseline to 64 (37.4%) after 6 months. There was no difference in A1c improvement between subjects changing compared to those not changing insulin regimen (p-value: 0.71). Conclusion: This study shows a rapid improvement of metabolic control in T1D after transition, regardless of referral center, insulin regimen and age at transition. Further analysis evaluating different educational programs are needed. Disclosure S. Pieralice: None. E. Maddaloni: Consultant; Self; Merck KGaA. Speaker’s Bureau; Self; Abbott, AstraZeneca, Pikdare. C. Moretti: None. A. Maurizi: Employee; Self; AstraZeneca. C. Mignogna: Research Support; Self; Eli Lilly and Company. Other Relationship; Self; AstraZeneca. S. Dinatale: None. P. Pozzilli: Advisory Panel; Self; Abbott, AstraZeneca, Eli Lilly and Company. Research Support; Self; Medtronic, Sanofi. R. Buzzetti: Advisory Panel; Self; Sanofi. Speaker’s Bureau; Self; AstraZeneca, Lilly Diabetes, Merck Sharp &amp; Dohme Corp.

Identifying cardiovascular risk factors that impact cerebrovascular reactivity: An ASL MRI study.

To maintain cerebral blood flow (CBF), cerebral blood vessels dilate and contract in response to blood supply through cerebrovascular reactivity (CR). Cardiovascular (CV) disease is associated with increased stroke risk, but which risk factors specifically impact CR is unknown. Prospective longitudinal. Fifty-three subjects undergoing carotid endarterectomy or stenting. 3T, 3D pseudo-continuous arterial spin labeling (PCASL) ASL, and T1 3D fast spoiled gradient echo (FSPGR). We evaluated group differences in CBF changes for multiple cardiovascular risk factors in patients undergoing carotid revascularization surgery. PRE (baseline), POST (48-hour postop), and 6MO (6 months postop) whole-brain CBF measurements, as 129 CBF maps from 53 subjects were modeled as within-subject analysis of variance (ANOVA). To identify CV risk factors associated with CBF change, the CBF change from PRE to POST, POST to 6MO, and PRE to 6MO were modeled as multiple linear regression with each CV risk factor as an independent variable. Statistical models were performed controlling for age on a voxel-by-voxel basis using SPM8. Significant clusters were reported if familywise error (FWE)-corrected cluster-level was P < 0.05, while the voxel-level significance threshold was set for P < 0.001. The entire group showed significant (cluster-level P < 0.001) CBF increase from PRE to POST, decrease from POST to 6MO, and no significant difference (all voxels with P > 0.001) from PRE to 6MO. Of multiple CV risk factors evaluated, only elevated systolic blood pressure (SBP, P = 0.001), chronic renal insufficiency (CRI, P = 0.026), and history of prior stroke (CVA, P < 0.001) predicted lower increases in CBF PRE to POST. Over POST to 6MO, obesity predicted lower (P > 0.001) and cholesterol greater CBF decrease (P > 0.001). The CV risk factors of higher SBP, CRI, CVA, BMI, and cholesterol may indicate altered CR, and may warrant different stroke risk mitigation and special consideration for CBF change evaluation. 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2020;51:734-747.

A stress management intervention for adults living with HIV in Nigerian community settings: An effects study.

This study evaluated the effectiveness of a group-based cognitive-behavioral stress management intervention among community-dwelling adults living with HIV in Southeastern Nigeria. A total of 28 HIV-positive adults meeting the criteria for high perceived stress, anxiety, and depression were randomized into 1 of 2 groups: treatment group (n = 14); and no-treatment control group (n = 14). Stress level was measured using the 10-item Perceived Stress Scale (PSS-10). Depression and anxiety symptoms were assessed using Hospital Anxiety and Depression Scale (HADS). Secondary outcome measure was Satisfaction with Life Scale (SWLS). The intervention was delivered over the course of 10 weeks, using an evidence-based cognitive-behavioral stress management manual. We employed repeated-measures between and within-subjects analysis of variance (ANOVA) and Eta squared in the analyses and interpretation of data collected from the study participants at 3 time points. Our results showed that, after benefitting from the cognitive behavioral stress management intervention, the PSS-10 and HADS scores were lowered significantly in the treatment group participants than those in the no-treatment control group during evaluations of post-treatment and 3 months follow-up outcomes. Significant improvements were also recorded in the treatment group participants' SWLS scores at post-treatment and follow-up compared with participants in the no-treatment group. The present results suggest the need for further implementation of group-based cognitive-behavioral stress management interventions for people living with HIV. Cognitive-behavioral stress management clinicians should make efforts toward identifying HIV-positive adults experiencing psychological distress and design cognitive-behavioral stress management interventions in order to better assist them.

Can stress act as a sleep inertia countermeasure when on-call?

The nature of on-call work is such that workers can be called and required to respond immediately after being woken. However, due to sleep inertia, impaired performance immediately upon waking is typical. We investigated the impact of a preceding stressor (an alarm/mobilisation procedure) on sleepiness and performance upon waking. Healthy, adult males (n = 16) attended the sleep laboratory for four consecutive nights which included two, counterbalanced on-call sleeps where participants were woken at 04:00 h by (a) an alarm/mobilisation procedure (Alarm) or (b) gently by a researcher (Control). Following waking was a 2-h testing session comprising the repeated administration of the Karolinska Sleepiness Scale (KSS) and 5-min Psychomotor Vigilance Task (PVT). Results from within-subjects analysis of variance in both the Control and Alarm conditions showed that for subjective sleepiness (KSS) there was a significant fixed effect of time (p = 0.012), with participants becoming less sleepy as time post-wake increased. In terms of PVT performance outcomes, in neither the Alarm or Control conditions were there measurable signs of sleep inertia with performance remaining stable across the 2-h testing period. Based on previous research measuring impact of sleep inertia when woken near the circadian nadir, performance findings in particular were unexpected. We propose that stress caused by study procedures (i.e. finger pricks using lancets) unrelated to the simulated wake-up protocols may have countered any impact of sleep inertia on performance.

The Effectiveness of Two Positive Career Counseling Modules for Working Parents in Taiwan

The purpose of this study was to explore the effectiveness of 2 positive career counseling modules—the strength-centered career counseling (SCC) module and the goal-oriented career counseling module—for working parents in Taiwan (23 men and 28 women). The study used an experimental design, and the instruments were the Personal Growth Initiative Scale, Job Satisfaction Inventory, and Career Self-Efficacy Scale. A within-subjects analysis of variance indicated that both modules were effective in personal growth initiative and career self-efficacy, and SCC particularly had continuous effects on both of them. Advanced versions for the 2 modules and implications for future practice are discussed.

Comparing Traditional and Distance Formats of a Psychiatric Rehabilitation Course

Purpose:The purpose of this study was to discover if an online course in psychiatric rehabilitation is as successful as a traditional on-campus course in terms of content delivery and learning outcomes.Method:A traditional on-campus (n= 25) and an online (n= 17) course were compared at pretest and posttest on a measure entitled “Psychiatric Vocational Rehabilitation Knowledge and Skills Inventory.” A 4 (Skill) × 3 (Time) within-subjects analysis of variance with repeated measures was used to assess changes in the skills of process, potential, partnership, and career advancement over time.Results:The results were that scores for both formats significantly increased from Time 1 to Time 2, but one format did not perform significantly better than another. The Psychiatric Vocational Rehabilitation Knowledge and Skills Inventory was found to be a reliable measure.Conclusion:The study underscores the value of a dedicated psychiatric rehabilitation course in rehabilitation graduate education.

BOLD Responses to Acupuncture on Each Side of ST36

Objectives : There has been some controversy about the modulatory effects on brain function during acupuncture on each side of the same acupoint. This study was designed to investigate and compare the blood oxygen level-dependent(BOLD) responses of acupuncture on each side of ST36. Methods : Fourteen healthy subjects were recruited for imaging and received acupuncture or placebo stimulations either on the left or on the right acupoint of ST36 in each scan. For the voxel-wise statistical analysis, one sample T-test and the within-subject analysis of variance(ANOVA) test were performed using SPM8 software. Results : This study showed that acupuncture on each side of ST36 showed different BOLD signal patterns. Higher BOLD responses after acupuncture stimulations at the left ST36 compared to the right were observed mainly in the parahippocampal gyrus(BA 28), dorsolateral prefrontal cortex(DLPFC, BA 44), thalamus, culmen and claustrum. We investigated the different neural responses between rest and activation periods of placebo and acupuncture stimulations on each side of ST36. Acupuncture at the right ST36 elicited activation mainly in the insula, supplementary motor area(SMA) and anterior cingulate cortex(ACC), while acupuncture at the left ST36 elicited activation mainly in the insula, primary somatosensory cortex(SI, BA 2) and DLPFC(BA 44). Conclusions : To our knowledge, this is the first reported functional MRI study directly comparing when needling at the right and at the left side of ST36. This study`s preliminary results proved to be evidence of acupuncture`s different effects when performed on opposite sides of an acupoint.

Establishing the Content Validity of Palpatory Examination for the Assessment of the Lumbar Spine Using Ultrasonography: A Pilot Study

Practitioners of manipulative medicine have long sought to prove the intra- and interexaminer reliability of palpatory examinations in assessing somatic dysfunction. However, decades of research have yet to achieve the level of reproducibility needed to satisfy evidence-based criteria. To examine the content validity of segmental motion evaluations using ultrasonographic measurements and to investigate the implication of these results for understanding the effects of an osteopathic manipulative treatment technique--high-velocity, low-amplitude (HVLA)--applied to somatic dysfunction in the lumbar spine. A repeated-measures design was used, with the ultrasonographer blinded to the findings for each participant. The study was divided into 2 phases: (1) palpatory and ultrasonographic examination with no treatment and (2) palpatory and ultrasonographic examination with HVLA treatment. During phase 1, measurements were taken of tissue depth corresponding to bony landmarks of the dysfunctional vertebrae. Dysfunction was identified by means of palpatory examination and captured in sequential (ie, test-retest) ultrasonographic images. Content validity of somatic dysfunction was addressed by comparing palpatory examination with ultrasonographic data. During phase 2, the same protocol for tissue depth measurements was applied to the pre- and posttreatment images for comparison. Twelve young, healthy, asymptomatic students with no contraindications to HVLA treatment were recruited at Kansas City University of Medicine and Biosciences. The test-retest reliability, as determined by a Pearson correlation coefficient, was 0.997. For all participants, objectively identified side of dysfunction correlated with palpatory evaluation of segmental motion. A within-subjects analysis of variance was performed on the raw data, corrected for lumbar lordosis, showing statistical significance for main effect for side of measurement (P<.001) and interaction of side and time (P<.001), and showed no statistically significant effect for time (P=.259). Ultrasonography is a reliable instrument for the assessment of somatic dysfunction of the lumbar spine. The data also establish the content validity of palpatory examinations. In addition, this study provides the first objective evidence, to our knowledge, of the effect of a thrusting manipulative treatment on dysfunctional lumbar vertebrae.

Longitudinal assessment of distress and quality of life in the early stages of breast cancer treatment

During breast cancer treatment, a decline in quality of life and the patient's psychological well-being is observed. The purpose of this study was to assess levels of quality of life and psychological distress during breast cancer treatment. Utilizing a longitudinal design, patients with breast cancer were assessed at three time-points during treatment. The within-subject analysis of variance was conducted to compare subscales of quality of life. Linear regression analyses were utilized to determine the contribution of psychological distress to the quality of life at each time assessment. Significant differences between the assessment times on the physical subscale (p < 0.001), socio-family (p < 0.01) and emotional well-being (p < 0.001) were showed. Specific domain-related breast cancer and psychological distress (p < 0.05) were significant during the assessment period. No difference was found on the total quality of life score within the three points of reference for treatment. The regression analysis revealed that after treatment, psychological distress showed a higher percentage of variance of the quality of life (62.6%) compared to other treatment time-points. Significant changes to the quality of life and psychological distress subscales are seen during breast cancer treatment. The degree to which psychological distress affected quality of life varied over the illness continuum. Health professionals should pay attention to the variability of the emotional support and care needs of patients with cancer at different times of treatment.

Auditory backup alarms: distance-at-first-detection via in-situ experimentation on alarm design and hearing protection effects

The purpose of this study was to assess normal hearing listeners' performance in detecting a stationary backup alarm signal and to quantify the linear distance at detection point. Detection distances for 12 participants with normal hearing were measured while they were fitted with 7 hearing protectors and while they were unoccluded (open ear). A standard (narrowband) backup alarm signal and a broadband (pulsed white noise) backup alarm signal from Brigade[1] were used. The method of limits, with distance as the physical measurement variable and threshold detection as the task, was employed to find at which distance the participant could first detect the backup alarms. A within-subject Analysis of Variance (ANOVA) revealed a significant main effect of the listening conditions on the detection distance in feet. Post hoc analyses indicated that the Bilsom L3HV conventional passive earmuff (at 1132.2 ft detection distance) was significantly poorer compared to all other HPDs and the open ear in detection distance achieved, and that there were no statistically-significant differences between the unoccluded ear (1652.3 ft), EB-15-Lo BlastPLGTM (1546.2 ft), EB-15-Hi BlastPLGTM (1543.4 ft), E-A-R/3M Combat ArmsTM earplug-nonlinear, level-dependent state (1507.8 ft), E-A-R/3M HiFiTM earplug (1497.7 ft), and Bilsom ImpactTM dichotic electronic earmuff (1567.2 ft). In addition, the E-A-R/3M Combat ArmsTM earplug-passive steady state resulted in significantly longer detection distances than only the open ear condition, at 1474.1 ft versus 1652.3 ft for the open ear. ANOVA also revealed a significant main effect of the backup alarm type on detection distance. The means were 1600.9 ft for the standard (narrowband) backup alarm signal, and a significantly closer 1379.4 ft was required for the Brigade broadband backup alarm signal. For on-ground workers, it is crucial to detect backup alarm signals as far away as possible rather than at close distances since this will provide them more time to react to approaching vehicles. The results of this study suggest that as the attenuation of the hearing protectors increases, precautions should be considered by safety professionals. This is because, as it was the case with the Bilsom passive earmuff and E-A-R/3M Combat ArmsTM earplug-passive steady state, high attenuation minimizes the detection distance and as a result on-foot workers will have less time to react to any approaching vehicle. The main effects of the type of backup alarm signal demonstrated a statistically-significant advantage of the standard backup alarm over the broadband backup alarm on detection distance in feet. The magnitude of the improvement produced by the standard backup alarm was 221.5 feet, a very large margin. For example, with a vehicle backing at 10 mph, the 221.5 ft decrease in detection distance with the Brigade alarm equates to the vehicle arriving 15 seconds sooner at the worker from the point at which its alarm was first heard.

Implications of controlled short-wavelength light exposure for sleep in older adults

BackgroundEnvironmental and physiological conditions make older adults more likely to lose synchronization to their local time and experience sleep disturbances. A regular, 24-hour light/dark cycle promotes synchronization. It is now well established that the circadian system is maximally sensitive to short-wavelength (blue) light. The purpose of the present study was to measure dose effectiveness (amounts and durations) of short-wavelength (blue) light for stimulating the circadian systems of older adults. We investigated the impact of six corneal irradiances (0.7 to 72 μW/cm2) of 470-nm light on nocturnal melatonin production. Nine participants, each over 50 years of age completed a within-subjects study. Each week, participants were exposed to one of the six irradiances of 470-nm light for 90 minutes.FindingsA two-factor (6 corneal irradiances × 10 exposure durations), within-subjects analysis of variance (ANOVA) was conducted using the melatonin suppression levels. The ANOVA revealed a significant main effect of corneal irradiance (F5, 30 = 9.131, p < 0.0001), a significant main effect of exposure duration (F9, 54 = 5.731, p < 0.0001), and a significant interaction between these two variables (F45,270 = 1.927, p < 0.001). Post hoc t-tests revealed that corneal irradiances as low as 2 μW/cm2 reliably suppressed melatonin after 90-minute exposure whereas 0.7 μW/cm2 did not.ConclusionsSleep disorders are common and a serious problem for millions of older adults. The present results showed that comfortable, precise and effective doses of light can be prescribed to older adults to reliably stimulate the circadian system that presumably would promote entrainment and, thus, regular sleep. Field studies on the impact of short-wavelength-light doses on sleep efficiency in older adults should be performed.

Near-Infrared Spectroscopy Measurement of Sacral Tissue Oxygen Saturation in Healthy Volunteers Immobilized on Rigid Spine Boards

Introduction. Immobilization of patients utilizing rigid spine boards (RSBs) is standard practice in the management of trauma patients. Pressure ulcers have been associated with prolonged immobilization, and the possibility exists that formation may begin when the patient is initially immobilized on the RSB. The effects may not be fully recognized because of limited research on the direct tissue effects of prolonged immobilization. Near-infrared spectroscopy is an emerging tool to measure peripheral tissue oxygen saturation (StO2). The purpose of this research was to study the effects of prolonged spinal immobilization on an RSB on sacral tissue oxygenation of healthy volunteers. Methods. This experimental study measured StO2 in healthy volunteers at baseline and again after 30 minutes of immobilization on an RSB at two sites: the sacral area (intervention) and 8–10 cm above the buttocks (control). Tissue oxygenation was measured with the InSpectra Tissue Oxygenation Monitor (Hutchinson Technology, Hutchinson, MN) by placing the probe at the measurement site and waiting for 15 seconds for equilibration prior to recording StO2. Data were analyzed utilizing mixed-model and within-subjects analysis of variance (ANOVA), chi-square, and t-tests. Results. Seventy-three participants were included in the analysis. A slight majority of participants were female (55%), the average age was 38 years, the average height was 170 cm, and the average weight was 82 kg. There was a significant increase in the StO2 percentage at the sacral (intervention) area following immobilization, p < 0.001, point biserial correlation (rpb) = 0.48. Significant changes in oxygenation were not noted at the control site. Conclusion. An increase in sacral tissue oxygenation following immobilization was a finding consistent with other research. This is likely a result of initial, rapid tissue reperfusion at the time of pressure release. Rapid reperfusion indicates that a period of previous hypoperfusion has occurred. This research indicates that there are detrimental effects of spine board immobilization in healthy volunteers, which suggests that pressure ulcer formation may begin prior to hospital admission with immobilization on an RSB.