Accountable care organizations (ACOs) and hospitals are facing additional requirements and financial rewards for improving population health. Therefore, ACOs and hospitals will need tools to understand the relationshi...Accountable care organizations (ACOs) and hospitals are facing additional requirements and financial rewards for improving population health. Therefore, ACOs and hospitals will need tools to understand the relationship between their patients and social determinants and health. We demonstrate the use of hot spotting for identifying geographical sources of high hospital costs and examining links between social determinants of health and these high-cost areas, known as hot spots. In 2012, using hospital data, we generated maps of inpatient costs from 2011 throughout New Haven and within an example neighborhood, Dixwell. We defined hot spots as addresses where costs were in the top 25%. We also overlaid data on concerns and assets in the community. Finally, we calculated the number of concerns and assets that fall within the 250 and 500 ft radii of the defined hot spots. We found that 34 addresses in Dixwell accounted for 70% of total costs for Dixwell. Hot spotting is a straightforward, approachable, and easily understood method for ACOs and hospitals to begin to address population health.展开更多
Background: Patellar tendinopathy(PT) or "jumper's knee" is generally found in active populations that perform jumping activities. Graded exposure of patellar tendon, stress through functional exercise h...Background: Patellar tendinopathy(PT) or "jumper's knee" is generally found in active populations that perform jumping activities. Graded exposure of patellar tendon, stress through functional exercise has been demonstrated to be effective for the treatment of PT. However, no studies have compared how anterior knee displacement variations during the commonly performed forward step lunge(FSL) affect patellar tendon stress.Methods:Twenty-five subjects(age: 22.69 ± 0.74 years; height: 169.39 ± 6.44 cm; mass: 61.55 ± 9.74 kg) performed 2 variations of an FSL with the anterior knee motion going in front of the toes(FSL-FT) and the knee remaining behind the toes(FSL-BT). Kinematic and kinetic data were used with an inverse-dynamics based static optimization technique to estimate individual muscle forces to determine patellar tendon stress during both lunge techniques. A repeated measures multivariate analysis was used to analyze these data.Results: The peak patellar tendon stress, stress impulse, quadriceps force, knee moment, knee flexion, and ankle dorsiflexion angle were significantly greater(p< 0.001) during the FSL-FT as compared to the FSL-BT. The peak patellar tendon stress rate did not differ between the FSL-FT and FSL-BT.Conclusion: The use of an FSL-FT as compared to an FSL-BT increased the load and stress on the patellar tendon. Because a graded exposure of patellar tendon loading with other closed kinetic chain exercises has proven to be effective in treating PT, consideration for the prescription of variations of the FSL and further clinical evaluation of this exercise is warranted in individuals with PT.展开更多
Purpose:Wearable devices are commonly used to measure physical activity.However,it remains unclear the effect of wearing these devices on health awareness.Our aim was to provide evidence related to wearing physical ac...Purpose:Wearable devices are commonly used to measure physical activity.However,it remains unclear the effect of wearing these devices on health awareness.Our aim was to provide evidence related to wearing physical activity trackers and health awareness.Methods:A quantitative comparison study design was used comparing participants who wore physical activity tracking devices(n=108)and those who did not(n=112).A paper-based Physical Health Knowledge survey designed for the purpose of this research was used for data collection in 2018.Results:A difference between participants who wore physical activity tracking devices and those that did not was identified in relation to activity levels and physical health awareness.Wearable devices are suggested as an opportunity for nurses to engage people in physical activity with the potential to improve their health awareness.Conclusions:Nurses are well placed in the healthcare landscape to work with patients who own an activity tracker device concerning increasing activity self-monitoring.This information the patient has from the device can also form the basis of health discussions between nurses and the people in their care.展开更多
AIM To investigate the acute effects of sinusoidal and stochastic resonance partial-body vibration in sitting position, including muscle activity, heart rate variability, balance and flexibility.METHODS Fifty healthy ...AIM To investigate the acute effects of sinusoidal and stochastic resonance partial-body vibration in sitting position, including muscle activity, heart rate variability, balance and flexibility.METHODS Fifty healthy participants were assigned randomly to two training conditions: A sinusoidal partial-body vibration(SIN, 8 Hz) or a stochastic resonance partial-body vibration(STOCH, 8 ± 2 Hz). For baseline assessment participants sat on the vibration platform without vibration. Both training conditions consisted of five series of a one-minute vibration training and a one-minutebreak between them. In this experimental study surface electromyography(EMG) of the erector spinae(ES), one of the back muscles, and heart rate variability(HRV) was measured at baseline and during training. Balance and flexibility were assessed at baseline and immediately after training. Balance was measured with the modified star excursion balance test(mS EBT) and flexibility was assessed through the modified fingertip-to-floor method(mF TF).RESULTS Paired sample t-test showed a significant increase in balance that was restricted to STOCH(t =-2.22, P = 0.018; SIN: t =-0.09, P = 0.466). An increase in flexibility was also restricted to STOCH(t = 2.65, P = 0.007; SIN: t = 1.41, P = 0.086). There was no significant change of muscle activity in the ES-EMG in STOCH or SIN conditions. In both training conditions, HRV decreased significantly, but remained in a low-load range(STOCH: t = 2.89, P = 0.004; SIN: t = 2.55, P = 0.009).CONCLUSION In sitting position, stochastic resonance partial-body vibration can improve balance and flexibility while cardiovascular load is low. STOCH can be a valuable training option to people who are unable to stand(e.g., people, who are temporarily wheelchair-bound).展开更多
The COVID-19 pandemic exposed critical vulnerabilities in global medical supply chains,resulting in widespread shortages of essential healthcare prod ucts.This study aims to optimize the resilience of medical supply c...The COVID-19 pandemic exposed critical vulnerabilities in global medical supply chains,resulting in widespread shortages of essential healthcare prod ucts.This study aims to optimize the resilience of medical supply chains against future pandemics by evaluating key mitigation strategies such as inventory buffering,multi-sourcing,and local manufacturing.Using an agent-based sim ulation model that incorporates realistic demand surges,supplier disruptions,and transportation delays,we quantify the impact of these strategies on supply chain performance metrics including fulfillment rate,lead time,and recovery speed.Our results demonstrate that integrating multiple resilience strategies significantly improves service levels and reduces recovery times compared to traditional supply chain configurations.The findings provide actionable in-sights for policymakers and healthcare organizations to strengthen prepared-ness and ensure reliable access to critical medical supplies in times of crisis.展开更多
Hepatocellular carcinoma(HCC)is the most prevalent primary malignancy in patients suffering from chronic liver diseases and cirrhosis.Recent attention has been paid to the involvement of the gut-liver axis(GLA)in HCC ...Hepatocellular carcinoma(HCC)is the most prevalent primary malignancy in patients suffering from chronic liver diseases and cirrhosis.Recent attention has been paid to the involvement of the gut-liver axis(GLA)in HCC pathogenesis.This axis results from a bidirectional,anatomical and functional relationship between the gastrointestinal system and the liver.Moreover,the complex network of interactions between the intestinal microbiome and the liver plays a crucial role in modulation of the HCC-tumor microenvironment,contributing to the pathogenesis of HCC by exposing the liver to pathogen-associated molecular patterns,such as bacterial lipopolysaccharides,DNA,peptidoglycans and flagellin.Indeed,the alteration of gut microflora may disturb the intestinal barrier,bringing several toll-like receptor ligands to the liver thus activating the inflammatory response.This review explores the new therapeutic opportunities that may arise from novel insights into the mechanisms by which microbiota immunomodulation,represented by probiotics,and prebiotics,affects HCC through the GLA.展开更多
Purpose This study examined the effects of tournament load on neuromuscular function,perceived wellness and coach rat-ings of performance across two 6-day netball tournaments.Methods Thirty-nine female youth netballer...Purpose This study examined the effects of tournament load on neuromuscular function,perceived wellness and coach rat-ings of performance across two 6-day netball tournaments.Methods Thirty-nine female youth netballers(age=14.6±0.5 years,stature=165.9±4.7 cm,body mass=56.5±7.2 kg)were categorised as HIGH(10-11 matches,n=20)or LOW(6 matches,n=19)tournament load.Match load,jump height,perceived wellness and coach ratings of performance were monitored daily.Results HIGH tournament load resulted in greater reductions in jump height on match-day 4(-8.3%,±5.6%)when compared to LOW.HIGH tournament load resulted in greater reductions in perceived soreness(-0.9,±1.1 AU)and overall wellness(-2.6,±2.3 AU)on match-day 3,and a greater reduction in perceived sleep(-0.9,±1.1 AU)on match-day 4.HIGH tournament load was negatively associated with sleep quality and coach ratings of performance(effect size correlation=-0.34 to-0.47)when compared to LOW.Conclusion Our results indicate that a higher tournament load resulted in greater increases in neuromuscular fatigue,reduced perceived wellness,and lower ratings of performance.Practitioners should consider pre-tournament preparation and monitoring strategies to minimise the physiological disturbances during an intensified tournament.展开更多
文摘Accountable care organizations (ACOs) and hospitals are facing additional requirements and financial rewards for improving population health. Therefore, ACOs and hospitals will need tools to understand the relationship between their patients and social determinants and health. We demonstrate the use of hot spotting for identifying geographical sources of high hospital costs and examining links between social determinants of health and these high-cost areas, known as hot spots. In 2012, using hospital data, we generated maps of inpatient costs from 2011 throughout New Haven and within an example neighborhood, Dixwell. We defined hot spots as addresses where costs were in the top 25%. We also overlaid data on concerns and assets in the community. Finally, we calculated the number of concerns and assets that fall within the 250 and 500 ft radii of the defined hot spots. We found that 34 addresses in Dixwell accounted for 70% of total costs for Dixwell. Hot spotting is a straightforward, approachable, and easily understood method for ACOs and hospitals to begin to address population health.
基金funding from a Graduate Student Research, Service, and Educational Leadership Grant at the University of Wisconsin-La Crosse
文摘Background: Patellar tendinopathy(PT) or "jumper's knee" is generally found in active populations that perform jumping activities. Graded exposure of patellar tendon, stress through functional exercise has been demonstrated to be effective for the treatment of PT. However, no studies have compared how anterior knee displacement variations during the commonly performed forward step lunge(FSL) affect patellar tendon stress.Methods:Twenty-five subjects(age: 22.69 ± 0.74 years; height: 169.39 ± 6.44 cm; mass: 61.55 ± 9.74 kg) performed 2 variations of an FSL with the anterior knee motion going in front of the toes(FSL-FT) and the knee remaining behind the toes(FSL-BT). Kinematic and kinetic data were used with an inverse-dynamics based static optimization technique to estimate individual muscle forces to determine patellar tendon stress during both lunge techniques. A repeated measures multivariate analysis was used to analyze these data.Results: The peak patellar tendon stress, stress impulse, quadriceps force, knee moment, knee flexion, and ankle dorsiflexion angle were significantly greater(p< 0.001) during the FSL-FT as compared to the FSL-BT. The peak patellar tendon stress rate did not differ between the FSL-FT and FSL-BT.Conclusion: The use of an FSL-FT as compared to an FSL-BT increased the load and stress on the patellar tendon. Because a graded exposure of patellar tendon loading with other closed kinetic chain exercises has proven to be effective in treating PT, consideration for the prescription of variations of the FSL and further clinical evaluation of this exercise is warranted in individuals with PT.
文摘Purpose:Wearable devices are commonly used to measure physical activity.However,it remains unclear the effect of wearing these devices on health awareness.Our aim was to provide evidence related to wearing physical activity trackers and health awareness.Methods:A quantitative comparison study design was used comparing participants who wore physical activity tracking devices(n=108)and those who did not(n=112).A paper-based Physical Health Knowledge survey designed for the purpose of this research was used for data collection in 2018.Results:A difference between participants who wore physical activity tracking devices and those that did not was identified in relation to activity levels and physical health awareness.Wearable devices are suggested as an opportunity for nurses to engage people in physical activity with the potential to improve their health awareness.Conclusions:Nurses are well placed in the healthcare landscape to work with patients who own an activity tracker device concerning increasing activity self-monitoring.This information the patient has from the device can also form the basis of health discussions between nurses and the people in their care.
文摘AIM To investigate the acute effects of sinusoidal and stochastic resonance partial-body vibration in sitting position, including muscle activity, heart rate variability, balance and flexibility.METHODS Fifty healthy participants were assigned randomly to two training conditions: A sinusoidal partial-body vibration(SIN, 8 Hz) or a stochastic resonance partial-body vibration(STOCH, 8 ± 2 Hz). For baseline assessment participants sat on the vibration platform without vibration. Both training conditions consisted of five series of a one-minute vibration training and a one-minutebreak between them. In this experimental study surface electromyography(EMG) of the erector spinae(ES), one of the back muscles, and heart rate variability(HRV) was measured at baseline and during training. Balance and flexibility were assessed at baseline and immediately after training. Balance was measured with the modified star excursion balance test(mS EBT) and flexibility was assessed through the modified fingertip-to-floor method(mF TF).RESULTS Paired sample t-test showed a significant increase in balance that was restricted to STOCH(t =-2.22, P = 0.018; SIN: t =-0.09, P = 0.466). An increase in flexibility was also restricted to STOCH(t = 2.65, P = 0.007; SIN: t = 1.41, P = 0.086). There was no significant change of muscle activity in the ES-EMG in STOCH or SIN conditions. In both training conditions, HRV decreased significantly, but remained in a low-load range(STOCH: t = 2.89, P = 0.004; SIN: t = 2.55, P = 0.009).CONCLUSION In sitting position, stochastic resonance partial-body vibration can improve balance and flexibility while cardiovascular load is low. STOCH can be a valuable training option to people who are unable to stand(e.g., people, who are temporarily wheelchair-bound).
文摘The COVID-19 pandemic exposed critical vulnerabilities in global medical supply chains,resulting in widespread shortages of essential healthcare prod ucts.This study aims to optimize the resilience of medical supply chains against future pandemics by evaluating key mitigation strategies such as inventory buffering,multi-sourcing,and local manufacturing.Using an agent-based sim ulation model that incorporates realistic demand surges,supplier disruptions,and transportation delays,we quantify the impact of these strategies on supply chain performance metrics including fulfillment rate,lead time,and recovery speed.Our results demonstrate that integrating multiple resilience strategies significantly improves service levels and reduces recovery times compared to traditional supply chain configurations.The findings provide actionable in-sights for policymakers and healthcare organizations to strengthen prepared-ness and ensure reliable access to critical medical supplies in times of crisis.
文摘Hepatocellular carcinoma(HCC)is the most prevalent primary malignancy in patients suffering from chronic liver diseases and cirrhosis.Recent attention has been paid to the involvement of the gut-liver axis(GLA)in HCC pathogenesis.This axis results from a bidirectional,anatomical and functional relationship between the gastrointestinal system and the liver.Moreover,the complex network of interactions between the intestinal microbiome and the liver plays a crucial role in modulation of the HCC-tumor microenvironment,contributing to the pathogenesis of HCC by exposing the liver to pathogen-associated molecular patterns,such as bacterial lipopolysaccharides,DNA,peptidoglycans and flagellin.Indeed,the alteration of gut microflora may disturb the intestinal barrier,bringing several toll-like receptor ligands to the liver thus activating the inflammatory response.This review explores the new therapeutic opportunities that may arise from novel insights into the mechanisms by which microbiota immunomodulation,represented by probiotics,and prebiotics,affects HCC through the GLA.
文摘Purpose This study examined the effects of tournament load on neuromuscular function,perceived wellness and coach rat-ings of performance across two 6-day netball tournaments.Methods Thirty-nine female youth netballers(age=14.6±0.5 years,stature=165.9±4.7 cm,body mass=56.5±7.2 kg)were categorised as HIGH(10-11 matches,n=20)or LOW(6 matches,n=19)tournament load.Match load,jump height,perceived wellness and coach ratings of performance were monitored daily.Results HIGH tournament load resulted in greater reductions in jump height on match-day 4(-8.3%,±5.6%)when compared to LOW.HIGH tournament load resulted in greater reductions in perceived soreness(-0.9,±1.1 AU)and overall wellness(-2.6,±2.3 AU)on match-day 3,and a greater reduction in perceived sleep(-0.9,±1.1 AU)on match-day 4.HIGH tournament load was negatively associated with sleep quality and coach ratings of performance(effect size correlation=-0.34 to-0.47)when compared to LOW.Conclusion Our results indicate that a higher tournament load resulted in greater increases in neuromuscular fatigue,reduced perceived wellness,and lower ratings of performance.Practitioners should consider pre-tournament preparation and monitoring strategies to minimise the physiological disturbances during an intensified tournament.
