1
|
Reddinger JL, Charness G, Levine D. Vaccination as personal public good provision. medRxiv 2024:2022.04.21.22274110. [PMID: 35923323 PMCID: PMC9347278 DOI: 10.1101/2022.04.21.22274110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Vaccination against infectious diseases has both private and public benefits. We study whether social preferences-concerns for the well-being of other people-are associated with one's decision regarding vaccination. We measure these social preferences for 549 online subjects with a public-good game and an altruism game. To the extent that one gets vaccinated out of concern for the health of others, contribution in the public-good game is analogous to an individual's decision to obtain vaccination, while our altruism game provides a different measure of altruism, equity, and efficiency concerns. We proxy vaccine demand with how quickly a representative individual voluntarily took the initial vaccination for COVID-19 (after the vaccine was widely available). We collect COVID-19 vaccination history separately from the games to avoid experimenter-demand effects. We find a strong result: Contribution in the public-good game is associated with greater demand to voluntarily receive a first dose, and thus also to vaccinate earlier. Compared to a subject who contributes nothing, one who contributes the maximum ($4) is 58% more likely to obtain a first dose voluntarily in the four-month period that we study (April through August 2021). In short, people who are more pro-social are more likely to take a voluntary COVID-19 vaccination. Behavior in our altruism game does not predict vaccination. We recommend further research on the use of pro-social preferences to help motivate individuals to vaccinate for other transmissible diseases, such as the flu and HPV.
Collapse
|
2
|
Kahn-Boesel O, Mitchell H, Li L, Zhu E, El-Jawahri A, Levine D, Ufere NN. Hospital-Level Care at Home for Patients with Cirrhosis. Dig Dis Sci 2024:10.1007/s10620-024-08361-5. [PMID: 38466464 DOI: 10.1007/s10620-024-08361-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/17/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Patients with cirrhosis have a 30-day readmission rate of over 30%. Novel care delivery models are needed to reduce healthcare costs and utilization associated with cirrhosis care. One such model is Home Hospital (HH), which provides inpatient-level care at home. Limited evidence currently exists supporting HH for cirrhosis patients. AIMS The aims of this study were to characterize patients with cirrhosis who received hospital-level care at home in a two-site clinical trial and to describe the care they received. Secondary aims included describing their outcomes, including adverse events, readmissions and mortality. METHODS We identified all patients with cirrhosis who enrolled in HH as part of a two-site clinical trial between 2017 and 2022. HH services include daily clinician visits, intravenous and oral medications, continuous vital sign monitoring, and telehealth specialist consultation. We collected sociodemographic data and analyzed HH stays, including interventions, outcomes, adverse events, and follow-up. RESULTS 22 patients with cirrhosis (45% Hispanic; 50% limited English proficiency, median MELD-Na 12) enrolled in HH during the study period. Interventions included lab chemistries (82%), intravenous medications (77%), specialist consultation (23%), and advanced diagnostics/procedures (23%). The median length of stay was 7 days (IQR 4-12); 186 bed-days were saved. Two patients (9%) experienced adverse events (AKI). No patients required escalation of care; 9% were readmitted within 30 days. CONCLUSIONS In this two-site study, HH was feasible for patients with cirrhosis, holding promise as a hepatology delivery model. Future randomized trials are needed to further evaluate the efficacy of HH for patients with cirrhosis.
Collapse
Affiliation(s)
| | - Henry Mitchell
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Lucinda Li
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, MA, USA
| | - Ennie Zhu
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, MA, USA
| | - Areej El-Jawahri
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - David Levine
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Nneka N Ufere
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, MA, USA.
- Liver Center, Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| |
Collapse
|
3
|
Whisenant KD, Foucaud M, Mariën T, Levine D, Richardson DW, Stefanovski D, Scherrer NM, Engiles JB, Ortved K. Dorsal-to-palmar branch neuroanastomosis in horses undergoing palmar digital neurectomy does not reduce neuroma formation or improve outcome. Vet Surg 2024. [PMID: 38361406 DOI: 10.1111/vsu.14075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/12/2023] [Accepted: 01/28/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Chronic foot pain, a common cause of forelimb lameness, can be treated by palmar digital neurectomy (PDN). Complications include neuroma formation and lameness recurrence. In humans, neuroanastomoses are performed to prevent neuroma formation. The aim of the study was to evaluate the outcome of horses undergoing dorsal-to-palmar branch neuroanastomosis following PDN. STUDY DESIGN Retrospective case series. ANIMALS Eighty-five horses with PDN and dorsal-to-palmar branch neuroanastomosis. METHODS Medical records for horses undergoing this procedure at two hospitals between 2015 and 2020 were reviewed. Palmar and dorsal nerve branches of the PDN were transected and end-to-end neuroanastomosis was performed by apposition of the perineurium. Follow-up was obtained from medical records and telephone interviews. Success was defined as resolution of lameness for at least one year. RESULTS Lameness resolved following surgery in 81/85 (95%) horses with 57/84 (68%) sound at one year. Postoperative complications occurred in 19/85 (22%) cases. The main limitations of the study were an incomplete data set, inaccurate owner recall, and variations in procedure. CONCLUSION Compared to previous studies, this technique resulted in similar numbers of horses sound immediately after surgery, a comparable rate of postoperative neuroma formation but a higher recurrence of lameness rate at 1 year postoperatively. CLINICAL SIGNIFICANCE End-to-end neuroanastomosis of the dorsal and palmar branches of the PDN does not reduce the rate of neuroma formation in horses. Long-term outcome was less favorable compared to previously reported PDN techniques.
Collapse
Affiliation(s)
- Katrijn D Whisenant
- Department of Clinical Studies, University of Pennsylvania, New Bolton Center, Kennett Square, Pennsylvania, USA
| | | | | | - David Levine
- Department of Clinical Studies, University of Pennsylvania, New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Dean W Richardson
- Department of Clinical Studies, University of Pennsylvania, New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Darko Stefanovski
- Department of Clinical Studies, University of Pennsylvania, New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Nicole M Scherrer
- Department of Clinical Studies, University of Pennsylvania, New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Julie B Engiles
- Department of Clinical Studies, University of Pennsylvania, New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Kyla Ortved
- Department of Clinical Studies, University of Pennsylvania, New Bolton Center, Kennett Square, Pennsylvania, USA
| |
Collapse
|
4
|
Achanta A, Phadke N, Wasfy JH, Levine D, Weiner RB. Home Hospital Heart Failure Admissions are an Opportunity to Optimize Guideline-Directed Medical Therapy. J Card Fail 2024; 30:115-116. [PMID: 37890656 DOI: 10.1016/j.cardfail.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/04/2023] [Accepted: 09/19/2023] [Indexed: 10/29/2023]
Affiliation(s)
- Aditya Achanta
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
| | - Neelam Phadke
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Allergy and Immunology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jason H Wasfy
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - David Levine
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA
| | - Rory B Weiner
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
5
|
Crow JA, Stauffer JW, Levine D, Dale RB, Borsa PA. Therapeutic Photobiomodulation Before Strenuous Exercise Attenuates Shoulder Muscle Fatigue. J Athl Train 2023:497270. [PMID: 38015822 DOI: 10.4085/1062-6050-0171.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
CONTEXT Photobiomodulation therapy (PBMT) applied as a preconditioning treatment before exercise has been shown to attenuate fatigue and improve skeletal muscle contractile function during high-intensity resistance exercise. Practical implications for preconditioning muscle with PBMT prior to fatiguing exercise include a safe and non-invasive means to enhance performance and reduce the risk of musculoskeletal injury. OBJECTIVE To examine the muscle fatigue attenuating effects of PBMT on performance of the shoulder external rotator muscle group when applied as a preconditioning treatment before high-intensity, high-volume resistance exercise. DESIGN Sham-controlled, cross-over design. SETTING Laboratory. PARTICIPANTS Twenty healthy men (n=8) and women (n=12) between the age of 18 and 30. INTERVENTION PBMT was administered using a near-infrared laser (λ=810/980nm, 1.8 W/cm2, treatment area = 80cm2-120 cm2) to the shoulder external rotator muscles at a radiant exposure of 10 J/cm2. Subjects performed 12 sets of isokinetic shoulder exercise. Each set consisted of 21 concentric contractions of internal and external rotation at 60°/s. The sets were subdivided into 3 blocks of exercise [Block 1: sets 1-4; Block 2: sets 5-8; Block 3: sets 9-12]. MAIN OUTCOME MEASURES normalized peak torque [Nm/kg], average peak torque [Nm], total work [Nm], and average power [W]. RESULTS During the last block of exercise (sets 9-12), all performance measures for the active PBMT condition were 6.2% to 10% greater than the sham PBMT values (p < 0.02 to 0.001). CONCLUSIONS PBMT attenuated fatigue and improved muscular performance of the shoulder external rotators in the latter stages of strenuous resistance exercise.
Collapse
Affiliation(s)
- Joshua A Crow
- Pain Research & Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - John W Stauffer
- Pain Research & Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - David Levine
- Department of Physical Therapy, College of Health, Education and Professional Studies, University of Tennessee, Chattanooga, TN, USA
| | - R Barry Dale
- Department of Physical Therapy, University of Tennessee Health Science Center, Memphis, TN
| | - Paul A Borsa
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| |
Collapse
|
6
|
Commodore-Mensah Y, Delva S, Ogungbe O, Smulcer LA, Rives S, Dennison Himmelfarb CR, Kim MT, Bone L, Levine D, Hill MN. A Systematic Review of the Hill-Bone Compliance to Blood Pressure Therapy Scale. Patient Prefer Adherence 2023; 17:2401-2420. [PMID: 37790863 PMCID: PMC10544210 DOI: 10.2147/ppa.s412198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 08/05/2023] [Indexed: 10/05/2023] Open
Abstract
Background Poor medication adherence hampers hypertension control and increases the risk of adverse health outcomes. Medication adherence can be measured with direct and indirect methods. The Hill-Bone Compliance to High Blood Pressure Therapy (HBCHBPT) Scale, one of the most popular adherence measures, indirectly assesses adherence to hypertension therapy in three behavioral domains: appointment keeping, diet and medication adherence. Aim To synthesize evidence on the use of the HBCHBPT Scale, including psychometric properties, utility in diverse patient populations, and directions for future clinical use and research. Methods We searched electronic databases, specifically CINAHL, PubMed, PsychInfo, Embase, and Web of Science. We included original studies that used the HBCHBPT Scale or its subscales to measure a health outcome, or methodological studies involving translations and validations of the scale. We extracted and synthesized data following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Results Fifty studies were included in this review, 44 on hypertension, two on diabetes, and others on other chronic conditions. The scale was successfully translated into numerous languages and used in descriptive and intervention studies. The scale demonstrated sound psychometric properties (Cronbach's α coefficient 0.75) and sensitivity to capture intervention effects when used to evaluate the effectiveness of high blood pressure adherence interventions. The medication-taking subscale of HBCHBPT performs best and is widely used in diverse contexts to assess medication adherence for chronic conditions. Conclusion The HBCHBPT Scale has high versatility globally and has been used in various settings by various healthcare worker cadres and researchers. The scale has several strengths, including high adherence phenotyping capabilities, contributing to the paradigm shift toward personalized health care.
Collapse
Affiliation(s)
- Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sabianca Delva
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| | - Oluwabunmi Ogungbe
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Sally Rives
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Cheryl R Dennison Himmelfarb
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloombery School of Public Health, Baltimore, MD, USA
| | - Miyong T Kim
- School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Lee Bone
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - David Levine
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Martha N Hill
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
7
|
Ward J, Raudsepp T, Levine D, Turner R. Ambiguous external genitalia in a 5-year-old intact miniature equid. J Am Vet Med Assoc 2023; 261:1391-1393. [PMID: 37290755 DOI: 10.2460/javma.23.03.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023]
Affiliation(s)
- Jenna Ward
- 1Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
| | - Terje Raudsepp
- 2Department of Integrative Biosciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - David Levine
- 1Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
| | - Regina Turner
- 1Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
| |
Collapse
|
8
|
Rosenbaum AJ, Marinescu AG, Levine D, Ellis SJ. Republication of "Cross-Sectional Assessment of Orthopedic Foot and Ankle Patient Knowledge". Foot Ankle Orthop 2023; 8:24730114231188095. [PMID: 37506106 PMCID: PMC10369091 DOI: 10.1177/24730114231188095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
Background Individuals with limited health literacy often struggle in effectively communicating with their physicians and may lack the skills needed to make informed health decisions. It is therefore important that providers have insight into patients' baseline medical knowledge, as this can help physicians customize their approach to, and conversations with, each patient. As such, this study evaluated the foot and ankle-specific knowledge of patients seeking care for various foot and ankle ailments. Methods An unvalidated survey developed by our study group was distributed to 206 patients, assessing their knowledge of foot and ankle anatomy, terminology, conditions, treatment, and perioperative issues. Performance was evaluated as a function of participants' demographic factors. Results Participants performed significantly worse on the conditions and treatment questions as compared to the anatomy, terminology, and perioperative considerations subsections. Significantly better performance correlated with education (≥college), visit type (preoperative evaluation), a current or previous health care occupation, and prior orthopedic surgeon evaluation. Conclusions Patients' knowledge of foot and ankle anatomy, terminology, conditions, treatment, and perioperative issues correlates with certain patient characteristics and demographics. With enhanced insight into the risk factors for limited knowledge, education campaigns can be designed to target those most in need.
Collapse
|
9
|
Durham Walker C, McCray GG, Wimes A, Levine D, Rivers D. Training Medical Students to Recognize, Understand, and Mitigate the Impact of Racism in a Service-Learning Course. Prev Chronic Dis 2023; 20:E41. [PMID: 37200501 DOI: 10.5888/pcd20.220367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
The Morehouse School of Medicine's Community Health Course (CHC) trains first-year medical students to work with people of racial and ethnic minorities and economically and medically disadvantaged communities. This service-learning course includes the diagnosis/assessment of the health of a community and the development, implementation, and evaluation of a plan to improve some aspect of the community's health. The CHC teaches about the impact of racism on the health of communities through lectures, educational games, and videos focused on social determinants of health, cultural competence, and effective community engagement. Students complete small group assessments, interventions, and service activities at assigned sites. This pedagogical approach integrates the Association of Medical Colleges' Diversity, Equity, and Inclusion competencies and engages many community partners. The course's strengths include a multidisciplinary faculty, a culturally and educationally diverse student body, and community partners with varied backgrounds and resources. Opportunities exist for collaborations with other degree programs to sustain and increase the impact of community interventions and link this community-based educational activity to clinical training years. Course evaluations, exams, and short essays assess students' awareness of racism and the extent to which unconscious bias affects students' completion and interpretation of community assessment data and their engagement with community partners.
Collapse
Affiliation(s)
- Carla Durham Walker
- Morehouse School of Medicine, Department of Community Health and Preventive Medicine, 720 Westview Drive, Atlanta, GA 30310-1495
| | | | | | | | | |
Collapse
|
10
|
Levine D, Noda K, Pham C, Zhou M, Sanchez P. Lack of Correlation Between Both Percent and Absolute Count Dd-CfDNA and Primary Graft Dysfunction. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
11
|
Xu Q, Roux A, Elrefaei M, Hitchman K, TAUPIN J, Gareau A, Lucas D, Bettinotti M, Marrari M, Narula T, Alvarez F, Iasella C, Sanchez P, Levine D, Zeevi A. Chronic Lung Allograft Dysfunction is Associated with an Increased Number of Autoantibodies. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
12
|
Levine D, Gimenez BS, Pham C, Jyothula S, Casas S, Garcia CB, Ruiz V, Peris MA, Masgoret CB, Roman A, Gomez S. Assessment of Dd-cfDNA Between Stable Single and Double Lung Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
13
|
Jyothula S, Hussain R, Patel M, Patel J, Pham C, Levine D. Donor Derived Cell Free DNA in Lung Transplant Recipients with COVID Based on Hospitalization. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
14
|
Goyal M, Haythornthwaite JA, Jain S, Peterlin BL, Mehrotra M, Levine D, Rosenberg JD, Minges M, Seminowicz DA, Ford DE. Intensive Mindfulness Meditation Reduces Frequency and Burden of Migraine: An Unblinded Single-Arm Trial. Mindfulness (N Y) 2023; 14:406-417. [PMID: 38282695 PMCID: PMC10810247 DOI: 10.1007/s12671-023-02073-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
Objectives Preventing migraine headaches and improving the quality of life for patients with migraine remains a challenge. We hypothesized intensive meditation training would reduce the disease burden of migraine. Method An unblinded trial was analyzed as a single cohort exposed to a silent 10-day Vipassana meditation retreat that included 100 hr of sitting meditation. Participants with chronic or episodic migraine were enrolled and followed for 1 year. The primary outcome was a change in mean monthly migraine days at 12 months from baseline. Secondary outcomes included headache frequency and intensity, acute medication use, work days missed, home meditation, sleep quality, general health, quality of life, migraine impact, positive and negative affect, perceived stress, mindfulness, and pain catastrophizing. Results Three hundred people were screened and 58 (19%) agreed to participate and enrolled in the intensive meditation training. Forty-six participants with chronic migraine (≥ 15 headaches/month of which ≥ 8 were migraines) and 12 with episodic migraine (< 15 and ≥ 4 migraines/month) attended and 45 (78%) completed the retreat. At 12 months, the average migraine frequency was reduced by 2.7 days (from 16.6 at baseline) per 28 days (95%CI - 4.3, - 1.3) and headaches by 3.4 (20.1 at baseline) per 28 days (- 4.9, - 1.9). Fifty percent responder rate was 29% for migraine. Acute medication use dropped by an average of 2.2 days (- 3.9, - 0.5) per 28 days, and participants reported 2.3 fewer days (- 4.0, - 0.5) on which they reduced their activity due to migraines. The most striking and promising effects were in several secondary outcomes, including migraine-specific quality of life, pain catastrophizing, and perceived stress. The significant improvements observed immediately following the intervention were sustained at 12 months follow-up. Conclusions Training in Vipassana meditation via a 10-day retreat may reduce the frequency and burden of migraine. Preregistration ClinicalTrials.gov: NCT00663585.
Collapse
Affiliation(s)
- Madhav Goyal
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
- Center for Primary Care, NorthBay Healthcare, Vacaville, CA, USA
| | | | - Sharat Jain
- Mid-Atlantic Vipassana Association, Claymont, DE, USA
| | - Barbara Lee Peterlin
- Neuroscience Institute, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Megha Mehrotra
- Department of Epidemiology and Biostatistics, Univ of California, San Francisco, USA
| | - David Levine
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jason D. Rosenberg
- Department of Neurology, Mid-Atantic Permanente Medical Group, MD, Halethorpe, USA
| | - Mary Minges
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
| | - David A. Seminowicz
- Department of Neural & Pain Sciences, School of Dentistry, Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, USA
| | - Daniel E. Ford
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| |
Collapse
|
15
|
|
16
|
Tudini F, Levine D, Healy M, Jordon M, Chui K. Evaluating the effects of two different kinesiology taping techniques on shoulder pain and function in patients with hypermobile Ehlers-Danlos syndrome. Front Pain Res (Lausanne) 2023; 4:1089748. [PMID: 36726531 PMCID: PMC9885497 DOI: 10.3389/fpain.2023.1089748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023]
Abstract
Background Ehlers-Danlos Syndrome (EDS) is a group of inherited connective tissue disorders which predominantly affects women and has a prevalence as high as 1 in 5,000 individuals. Hypermobile EDS (hEDS) is the most common subtype of EDS and is characterized by multi-joint pain, particularly in large joints such as the shoulder. Physical therapy is often utilized to address the pain, physical impairments, and functional loss in patients with EDS. Kinesiology Tape (KT) is an intervention commonly used by physical therapists for treating shoulder pain and dysfunction. Studies related to the effectiveness of KT in patients with shoulder pain is equivocal and there are a lack of studies specifically studying the effects of KT in an EDS population. Purpose The purpose of this study was to assess the efficacy and short-term effects of two different KT techniques on shoulder pain and function in individuals with hEDS and shoulder pain. Methods Participants were recruited from EDS support groups in the New England area of the United States; were diagnosed with hEDS by their physician; and had shoulder pain. Baseline demographic information was obtained for each participant followed by completion of 4 patient reported outcome (PRO) measures: the Upper Extremity Functional Index, QuickDASH (Disabilities of the Arm, Shoulder, & Hand), Shoulder Pain and Disability Index, and the Western Ontario Shoulder Instability Index. Current pain level, average pain over the past 24 h, and worst pain over the past 24 h were recorded using the numeric pain rating scale (NPRS). Subjects were randomly assigned to receive either an experimental shoulder KT procedure or a control shoulder taping. Immediately after taping, the NPRS was reassessed. Subjects then returned 48 h later to repeat the NPRS and PRO measures. Results There was no significant difference between the experimental and control tape groups for any outcome measure. There was a significant improvement from pre-taping to 48-hours post taping for each of the 4 PRO measures with large effect sizes (p < 0.001; ƞ p 2 = .517-.719). Likewise, average, and worst pain over the last 24 h significantly improved with large effect sizes over the same period (p = 0.005; ƞ p 2 = .225 and p < 0.001; ƞ p 2 = .382, respectively). Current NPRS levels significantly improved from pre-tape to immediately post-tape (p = .023, ƞ p 2 = .131) and was maintained through the 48-hour follow up, although no further improvement was seen. Conclusion KT is an inexpensive and relatively safe intervention that is easy to apply and can offer temporary improvements in pain and function for patients with EDS and shoulder pain.
Collapse
Affiliation(s)
- Frank Tudini
- Department of Physical Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, United States,Correspondence: Frank Tudini
| | - David Levine
- Department of Physical Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Michael Healy
- Healy Physical Therapy and Sports Medicine, East Providence, RI, United States
| | - Max Jordon
- Department of Physical Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Kevin Chui
- Department of Physical Therapy, Radford University, Roanoke, VA, United States
| |
Collapse
|
17
|
Jaffe MH, Levine D, Marcellin-Little DJ. Editorial: Sports medicine and physical rehabilitation, volume II. Front Vet Sci 2023; 10:1122309. [PMID: 37035807 PMCID: PMC10080089 DOI: 10.3389/fvets.2023.1122309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Affiliation(s)
- Michael H. Jaffe
- Department of Clinical Sciences, Mississippi State University, Starkville, MS, United States
| | - David Levine
- Department of Physical Therapy, University of Tennessee at Chattanooga, Chattanooga, TN, United States
- *Correspondence: David Levine
| | - Denis J. Marcellin-Little
- Department of Veterinary Surgical and Radiological Sciences, University of California, Davis, Davis, CA, United States
| |
Collapse
|
18
|
Gorbenko K, Franzosa E, Baim-Lance A, Schiller G, Wurtz H, Masse S, Levine D, Siu A. CONTENDING WITH UNCERTAINTY: IMPLEMENTING THE CMS ACUTE HOSPITAL CARE AT HOME WAIVER PROGRAM IN THE UNITED STATES. Innov Aging 2022. [PMCID: PMC9770143 DOI: 10.1093/geroni/igac059.994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
As Congress considers renewing the Acute Hospital Care At Home (AHCaH) waiver, which provides a full hospital payment for Hospital at Home (HaH) care, evaluating uncertainty around the future of HaH payment is critical. Our qualitative study explored HaH leaders’ experiences with implementing HaH (N=18, clinical/medical directors, operational and program managers) from 14 new and pre-existing programs across the U.S. We conducted semi-structured interviews with HaH programs diverse by size, urbanicity, and geography. We analyzed transcripts using a thematic approach. Participants across settings and regions wanted greater clarity about the waiver’s future. Lack of clarity affected staffing (nurses reluctant to take temporary jobs) and investment in establishing programs (building EMR components, changing workflows, creating inpatient processes in an outpatient setting). Programs adapted to uncertainty in multiple ways: 1) operating parallel waiver and non-waiver programs; 2) seeking to determine/ calculate the HaH value for their institution; 3) determining which patients would benefit most from HaH; and 4) seeking additional health system financing options beyond the CMS reimbursement (new programs) or relying on existing contracts with payers (existing programs). Implementing HaH is a complex and resource intensive process. Greater clarity from CMS regarding the waiver’s future state will encourage programs to invest the resources that they need to establish their programs long-term. Waiver extension/ permanence would also enable programs to develop and test measures of value, making rigorous evaluations possible to optimize different HaH components.
Collapse
Affiliation(s)
- Ksenia Gorbenko
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Emily Franzosa
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Abigail Baim-Lance
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | | | - Heather Wurtz
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Sybil Masse
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - David Levine
- Mass General Brigham, Boston, Massachusetts, United States
| | - Albert Siu
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| |
Collapse
|
19
|
Levine D, McDonald S, johnson A, Curtis N, Foster A, Smiddy E, Healy M. Sleep Disturbance and Common Interventions Used for Sleep Management in Individuals with Hypermobile Ehlers-Danlos Syndrome. Arch Phys Med Rehabil 2022. [DOI: 10.1016/j.apmr.2022.08.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
|
20
|
Kim J, Rajan L, Fuller R, O'Malley M, Levine D, Deland J, Ellis S, Demetracopoulos C. Mid-term functional outcomes following reoperation after total ankle arthroplasty: A retrospective cohort study. Foot Ankle Surg 2022; 28:1463-1467. [PMID: 36088242 DOI: 10.1016/j.fas.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/23/2022] [Accepted: 08/31/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite a significant reported rate of non-revision reoperation after total ankle arthroplasty (TAA), it is uncertain if these subsequent procedures have an impact on the longer term outcomes. This study aimed to compare minimum five-year functional outcomes of patients who had undergone reoperation after TAA to those who did not require reoperation. METHODS Seventy-six ankles (74 patients) who underwent TAA with the Salto Talaris fixed bearing system between 2007 and 2014 were allocated into two groups based on presence (n = 16) or absence of reoperation (n = 60). Reoperations included all secondary procedures after index TAA, excluding revision surgeries requiring removal or exchange of the original prosthesis. The foot and ankle outcome score (FAOS) at preoperative and minimum five-year follow-up was compared between the groups. Additionally, improvements in FAOS subscales were compared. Preoperative deformity, postoperative implant alignment, number of periprosthetic cysts, and subsidence between groups were compared using standard weightbearing radiographs. RESULTS The most common cause of reoperation was gutter impingement (n = 11), followed by stress fracture of the medial malleolus (n = 2), tarsal tunnel syndrome (n = 1), periprosthetic cyst (n = 1), and infection (n = 1). In comparison to the non-reoperation group, all FAOS subscales except for the Sports and Recreational Activities subscale were significantly lower in the reoperation group at final follow-up. The reoperation group exhibited significantly less improvement in the Pain, Symptoms, and Quality of Life subscales at final follow-up (p < 0.05). There were no statistical differences in the radiographic parameters between both groups. CONCLUSIONS Patients who underwent reoperation after TAA demonstrated inferior functional outcomes at mid-term follow-up. An emphasis should be placed on preventing possible causes of reoperations to achieve favorable patient outcomes. Additionally, if a reoperation is deemed necessary, a thorough evaluation and surgical correction of underlying causes should be achieved.
Collapse
Affiliation(s)
- Jaeyoung Kim
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Lavan Rajan
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Robert Fuller
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Martin O'Malley
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - David Levine
- Hospital for Special Surgery, 420 E 72nd St Ground Floor, New York, NY 10021, United States.
| | - Jonathan Deland
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Scott Ellis
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | | |
Collapse
|
21
|
Levine D, Poole C, Fell N, Kingrea C, Jeter K, Hostetler C, Kukta K. Sleep Evaluation and Interventions in Stroke Survivors: A Survey of Current Practice in Rehabilitation Professions. Arch Phys Med Rehabil 2022. [DOI: 10.1016/j.apmr.2022.08.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
|
22
|
Heath GW, Levine D. Physical Activity and Public Health among People with Disabilities: Research Gaps and Recommendations. Int J Environ Res Public Health 2022; 19:10436. [PMID: 36012074 PMCID: PMC9408065 DOI: 10.3390/ijerph191610436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/04/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
Physical activity has become an integral component of public health systems modeling the public health core functions of assessment, policy development, and assurance. However, people with disabilities have often not been included in public health efforts to assess, develop policies, or evaluate the impact of physical activity interventions to promote health and prevent disease among people with disabilities. Addressing the core function of assessment, current physical activity epidemiology, and surveillance among people with disabilities across the globe highlights the paucity of surveillance systems that include physical activity estimates among people with disabilities. The status of valid and reliable physical activity measures among people with condition-specific disabilities is explored, including self-report measures along with wearable devices, and deficiencies in measurement of physical activity. The core functions of policy development and assurance are described in the context of community-based intervention strategies to promote physical activity among people with disabilities. The identification of research gaps in health behavior change, policy, and environmental approaches to promoting physical activity among people with disabilities is explored, along with recommendations based on the principles of inclusive and engaged research partnerships between investigators and the members of the disability community.
Collapse
Affiliation(s)
- Gregory W. Heath
- Public Health Program, Department of Health and Human Performance, University of Tennessee, Chattanooga, TN 37403, USA
- University of Tennessee Health Science Center College of Medicine Chattanooga, Chattanooga, TN 37403, USA
| | - David Levine
- Department of Physical Therapy, The University of Tennessee, Chattanooga, TN 37403, USA
| |
Collapse
|
23
|
Reddinger JL, Levine D, Charness G. Can targeted messages reduce COVID-19 vaccination hesitancy? A randomized trial. Prev Med Rep 2022; 29:101903. [PMID: 35844628 PMCID: PMC9272666 DOI: 10.1016/j.pmedr.2022.101903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 07/06/2022] [Accepted: 07/06/2022] [Indexed: 12/05/2022] Open
Abstract
We find no evidence that tailoring public health communication regarding COVID-19 vaccination for broad demographic groups would increase its effectiveness. A post hoc analysis finds that a vaccine endorsement from Dr. Fauci reduces stated intent to vaccinate among conservatives. We recommend further research on communicators and endorsers, as well as incentives.
Background Widespread vaccination is certainly a critical element in successfully fighting the COVID-19 pandemic. We apply theories of social identity to design targeted messaging to reduce vaccine hesitancy among groups with low vaccine uptake, such as African Americans and political conservatives. Methods Participants. We conducted an online experiment from April 7 to 27, 2021, that oversampled Black, Latinx, conservative, and religious U.S. residents. We first solicited the vaccination status of over 10,000 individuals. Of the 4,609 individuals who reported being unvaccinated, 4,190 enrolled in our covariate-adaptive randomized trial. Interventions. We provided participants messages that presented the health risks of COVID-19 to oneself and others; they also received messages about the benefits of a COVID-19 vaccine and an endorsement by a celebrity. Messages were randomly tailored to each participant’s identities—Black, Latinx, conservative, religious, or being a parent. Outcomes. Respondents reported their intent to obtain the vaccine for oneself and, if a parent, for one’s child. Results We report results for the 2,621 unvaccinated respondents who passed an incentivized manipulation check. We find no support for the hypothesis that customized messages or endorsers reduce vaccine hesitancy among our segments. A post hoc analysis finds evidence that a vaccine endorsement from Dr. Fauci reduces stated intent to vaccinate among conservatives. Conclusions We find no evidence that tailoring public-health communication regarding COVID-19 vaccination for broad demographic groups would increase its effectiveness. We recommend further research on communicators and endorsers, as well as incentives.
Collapse
Affiliation(s)
- J Lucas Reddinger
- 1725 State St., 339C Wimberly Hall, La Crosse, WI 54601.,Department of Economics, University of California, Santa Barbara, 93106.,Menard Family Initiative, College of Business Administration, University of Wisconsin, La Crosse, 54601
| | - David Levine
- Haas School of Business, University of California, Berkeley, 94720
| | - Gary Charness
- Department of Economics, University of California, Santa Barbara, 93106
| |
Collapse
|
24
|
Poole CWW, Levine D, Fell NF, Kukta K, Hostetler C, Jeter K, Kingrea C. Sleep Management in Stroke Survivors: A Survey of Current Practice in OT. Am J Occup Ther 2022. [DOI: 10.5014/ajot.2022.76s1-po6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 03/31/2022
Stroke recovery, with its foundations in neuroplasticity, is affected by sleep. It is important for OT practitioners to actively evaluate sleep and facilitate sleep hygiene interventions with stroke survivors to optimize outcomes. This national survey examined sleep management knowledge, attitudes, and behaviors of OTs and OTAs working in stroke rehabilitation. Although 98% of respondents felt sleep assessment and intervention were important, they are not being regularly implemented.
Primary Author and Speaker: Cindy W. W. Poole
Additional Authors and Speakers: David Levine, Nancy F. Fell, Kloe Kukta, Christine Hostetler, Kendall Jeter, Cara Kingrea
Collapse
Affiliation(s)
- Cindy W. W. Poole
- University of Tennessee at Chattanooga, Chattanooga, Tennessee, United States
| | - David Levine
- Erlanger Health Care System, Chattanooga, Tennessee, United States
| | - Nancy F. Fell
- University of Tennessee at Chattanooga, Chattanooga, Tennessee, United States
| | | | | | | | | |
Collapse
|
25
|
Levine D, Spratt HG, Keates-Baleeiro JA, Brunton L, Gaylord W. Bacterial Contamination of Floors in a Hematology/Oncology Unit in a Children's Hospital. Am J Infect Control 2022. [DOI: 10.1016/j.ajic.2022.03.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
26
|
McDonald SS, Levine D. Commonly Used Statistics in Occupational Therapy Literature. Am J Occup Ther 2022. [DOI: 10.5014/ajot.2022.76s1-po93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 04/01/2022
This study determined which statistical methods are most commonly used in the occupational therapy (OT) literature by reviewing and categorizing all articles in 13 core OT journals from January 2018 - December 2018 (1,223 articles). The results of this study can help to better inform OT curricula as to which methods should be emphasized in teaching to prepare practitioners as evidence-based clinicians. These findings can also help inform clinicians seeking continuing education on statistics.
Primary Author and Speaker: Susan S. McDonald
Additional Authors and Speakers: David Levine
Collapse
Affiliation(s)
| | - David Levine
- Erlanger Health Care System, Chattanooga, Tennessee, United States
| |
Collapse
|
27
|
Work B, Levine D, Healy M. Short-Term Effects of Kinesiology Taping on Shoulder Pain and Function in Individuals With Hypermobile Ehlers-Danlos Syndrome. Am J Occup Ther 2022. [DOI: 10.5014/ajot.2022.76s1-po52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 04/01/2022
An estimated 85% of patients with hypermobile Ehlers-Danlos syndrome (hEDS) experience shoulder pain and impaired function. Kinesiology taping (KT) may be used by OT practitioners as an intervention to decrease shoulder pain and improve upper extremity function in individuals with hEDS. The purpose of this study was to investigate the short-term effects (0–48 hr) of KT on pain and function in individuals with hEDS and shoulder pain.
Primary Author and Speaker: Brittany Work
Additional Authors and Speakers: David Levine, Michael Healy
Collapse
Affiliation(s)
- Brittany Work
- University of Tennessee at Chattanooga, Chattanooga, Tennessee, United States
| | - David Levine
- Erlanger Health Care System, Chattanooga, Tennessee, United States
| | - Michael Healy
- Healy Physical Therapy, East Providence, Rhode Island, United States
| |
Collapse
|
28
|
Ursini T, Shaw K, Levine D, Richards J, Adair HS. Electromyography of the Multifidus Muscle in Horses Trotting During Therapeutic Exercises. Front Vet Sci 2022; 9:844776. [PMID: 35692292 PMCID: PMC9184818 DOI: 10.3389/fvets.2022.844776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Thoracolumbar pain has been identified in both human and equine patients. Rehabilitation and conditioning programs have focused specifically on improving trunk and abdominal muscle function (1–5). Equine exercise programs routinely incorporate ground poles and training devices for the similar goals of increasing spinal and core stability and strength (6–8). The multifidus muscle has been an area of focus due to atrophy associated with disease (9). To date, there have been no reports on the activity of the multifidus muscle in horses in relation to therapeutic exercises. Our objectives were to use electromyography to determine the average work performed and peak muscle activity of the multifidus in horses trotting, trotting over ground poles, trotting while wearing a resistance band-based training device and trotting while wearing the training device over ground poles. We hypothesized that ground poles and the training device would each increase average work performed and peak multifidus muscle activity. Right and left cranial thoracic locations showed significant increased muscle work and peak activation when horses were trotted over ground poles versus without. The peak activation was significantly greater in horses trotting over poles in both lumbar regions, but there was no significant change in peak activation in either location due to the training device. When the influence of the training device was investigated without ground poles, left caudal thoracic muscle work and peak activity, and right lumbar muscle work were significantly lower when using the training device, as compared to without. When the training device was combined with trotting over ground poles, both left and right caudal thoracic regions showed significantly lower muscle work and peak activity when the device was used. There was no significant difference between with and without the device in either left or right lumbar muscle work. In conclusion, implementing ground poles can be an effective strategy to increase the activation of the multifidus muscle, however, caution should be taken when incorporating the use of a resistance band training device as muscle work and peak activation were significantly reduced in most locations. Further study should be performed in regards to the training device to determine its effects on epaxial musculature.
Collapse
Affiliation(s)
- Tena Ursini
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Equine Performance and Rehabilitation Center, University of Tennessee, Knoxville, TN, United States
- *Correspondence: Tena Ursini
| | - Karen Shaw
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Equine Performance and Rehabilitation Center, University of Tennessee, Knoxville, TN, United States
| | - David Levine
- Department of Physical Therapy, University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Jim Richards
- Allied Health Research Unit, University of Central Lancashire, Lancashire, United Kingdom
| | - Henry Steve Adair
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Equine Performance and Rehabilitation Center, University of Tennessee, Knoxville, TN, United States
| |
Collapse
|
29
|
Ratsch BE, Levine D, Wakshlag J. Clinical Guide to Obesity and Nonherbal Nutraceuticals in Canine Orthopedic Conditions. Vet Clin North Am Small Anim Pract 2022; 52:939-958. [PMID: 35562213 DOI: 10.1016/j.cvsm.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The typical canine rehabilitation patient with orthopedic disease may differ in its nutritional needs, with the assumption that most patients will be on a complete and balanced commercial dog food that is not enriched with agents for ameliorating their condition. For a significant number of rehabilitation patients, obesity is a major issue where hypocaloric diet plans are often implemented and are covered extensively elsewhere (VCNA Small Animal Practice May 2021). The focus of this article will be implementation of physical activity or structured physical exercise protocols and how they might be used in combination with a typical hypocaloric diet plan, a diet low in calories. Considering the limited information regarding physical activity or structured exercise programs in dogs, a human comparative assessment of efficacy is fundamental as a baseline of information regarding typical interventions. In addition, many of these long-term rehabilitation cases typically exhibit osteoarthritis (OA) and as part of case management, there is a need to implement nutrient or nutraceutical intervention to either diminish the progression of OA or help with pain control measures, particularly for the nonsteroidal anti-inflammatory intolerant patient. Nutraceutical intervention comes in many forms from botanicals to nutritional enhancement; botanicals will be covered elsewhere in this issue. This overview of nutraceuticals will cover nonbotanical interventions including fish oil, glucosamine/chondroitin, avocado/soybean unsaponifiables, undenatured collagen, green lipped mussel, and egg shell membrane supplementation.
Collapse
Affiliation(s)
- Barbara Esteve Ratsch
- Department of Physical Medicine, Evidensia Sørlandet Animal Hospital, Krittveien 2, Hamresanden 4656, Norway.
| | - David Levine
- Department of Health, Education and Professional Studies, University of Tennessee, Chattanooga, TN 37403, USA; Department of Physical Therapy, The University of Tennessee at Chattanooga, 615 McCallie Avenue Department #3253, Chattanooga, TN 37403, USA
| | - Joseph Wakshlag
- Department of Clinical Sciences, Cornell University College of Veteinary Medicine, 930 Campus Road, CPC - 3-536, Ithaca, NY 14853, USA
| |
Collapse
|
30
|
Dycus DL, Levine D, Ratsch BE, Marcellin-Little DJ. Physical Rehabilitation for the Management of Canine Hip Dysplasia. Vet Clin North Am Small Anim Pract 2022; 52:719-747. [DOI: 10.1016/j.cvsm.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
31
|
Bavinger JC, Anthony CL, Lindeke-Myers AT, Lynch S, Xu LT, Barnett J, Levine D, Patel P, Shah R, Jain N, Rao P, Hendrick A, Cribbs BE, Yan J, Hubbard GB, Shantha JG, O'Keefe GD, Yeh S. Risk Factors for Retinal Detachment in Acute Retinal Necrosis. Ophthalmol Retina 2022; 6:478-483. [PMID: 35114414 DOI: 10.1016/j.oret.2022.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/13/2022] [Accepted: 01/24/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Retinal detachment (RD) is associated with poor visual outcome in patients with acute retinal necrosis (ARN). This research was undertaken to assess risk factors for RD in ARN. DESIGN Retrospective cohort study SUBJECTS: Patients diagnosed with ARN at a tertiary referral center from 2010-2020. METHODS Chart review was performed for all clinical and surgical encounters. Univariate and multivariate logistic analysis of demographic and clinical variables associated with RD was performed. Survival analysis with Kaplan-Meier estimates were performed to compare time to RD in HSV- and VZV-associated ARN. MAIN OUTCOME MEASURES Demographic information, clinical information including visual acuity, intraocular pressure (IOP), intraocular inflammation level, extent of retinitis, incidence and timing of retinal detachment, date of diagnosis, and treatments performed including intravitreal injections of antiviral medications. RESULTS Fifty-four eyes of 47 patients who were diagnosed with ARN were included with equal proportions of eyes (27, 50%) with VZV-ARN and HSV-ARN. Subjects with VZV-ARN were on average older, more likely to be male, and more likely to be immunosuppressed compared with subjects with HSV-ARN. Clinical characteristics were similar between eyes with VZV- and HSV-ARN, including initial visual acuity (VA), initial IOP, anterior segment inflammation, clock hours and posterior extent of retinitis. In univariate analysis of clinical and demographic variables associated with development of RD, initial VA (p = 0.0083) and greater clock hours of retinitis (p = 0.009) were significantly associated with RD. These two variables remained significant in multivariate logistic regression; worse VA at presentation had an odds ratio of 2.34 (95% CI: 1.01 - 5.44) (p = 0.042) and greater clock hours of retinitis had an odds ratio of 1.23 (95% CI: 1.02 - 1.47) (p = 0.025). Kaplan Meier survival analysis demonstrated no statistical difference in RD-free survival between HSV- and VZV-ARN. CONCLUSION Patients with VZV-ARN were more likely to be older, male, and immunosuppressed compared to HSV-ARN although no clear difference was observed in RD by viral etiology. Poor initial VA and clock-hours of retinitis were significantly associated with RD development and may be relevant for patient counseling and prognosis.
Collapse
Affiliation(s)
- J Clay Bavinger
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Casey L Anthony
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Stephanie Lynch
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Lucy T Xu
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Joshua Barnett
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - David Levine
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Purnima Patel
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Rachel Shah
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Nieraj Jain
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Prethy Rao
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Andrew Hendrick
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Blaine E Cribbs
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Jiong Yan
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - G Baker Hubbard
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Jessica G Shantha
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Ghazala D O'Keefe
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
| | - Steven Yeh
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska.
| |
Collapse
|
32
|
Watkins AR, Hopster K, Levine D, Hurcombe SD. Cervical Epidural Spinal Analgesia for Acute Management of Severe Unilateral Forelimb Lameness: Case Report. Front Vet Sci 2021; 8:749713. [PMID: 34805340 PMCID: PMC8599274 DOI: 10.3389/fvets.2021.749713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022] Open
Abstract
A 20-year-old Quarter Horse gelding was presented with severe right forelimb lameness (5/5 AAEP Lameness Scale) due to a tear of the superficial digital flexor muscle which was diagnosed via palpation of swelling and ultrasonography revealing major muscle fiber disruption and hematoma formation. When traditional systemic therapy (non-Steroidal anti-inflammatories) did not restore clinically acceptable comfort and the risk of supporting limb laminitis became a reasonable concern, a cervical epidural catheter was placed between the first and second cervical vertebrae in the standing, sedated patient using ultrasound guidance. The gelding was treated with epidural morphine (0.1 mg/kg every 24 h then decreased to 0.05 mg/kg every 12 h) and was pain-scored serially following treatment. Spinal analgesia was provided for 3 days. Pain scores significantly decreased following each treatment with morphine, and the gelding was successfully managed through the acutely painful period without any adverse effects associated with the C1-C2 epidural catheter placement technique, the epidural morphine, or contralateral limb laminitis. At the 2-month follow-up, the gelding was walking sound with no complications seen at the catheter insertion site. In this case, spinal analgesia using epidural morphine administered via a cervical epidural catheter was an effective and technically achievable option for pain management associated with severe forelimb muscle injury in a horse.
Collapse
Affiliation(s)
- Amanda R Watkins
- Department of Clinical Sciences, New Bolton Center, University of Pennsylvania, Kennett Square, PA, United States
| | - Klaus Hopster
- Department of Clinical Sciences, New Bolton Center, University of Pennsylvania, Kennett Square, PA, United States
| | - David Levine
- Department of Clinical Sciences, New Bolton Center, University of Pennsylvania, Kennett Square, PA, United States
| | - Samuel D Hurcombe
- Department of Clinical Sciences, New Bolton Center, University of Pennsylvania, Kennett Square, PA, United States
| |
Collapse
|
33
|
Keilman R, Harding S, Rowin M, Reade E, Klingborg P, Levine D, Spratt H. Investigations of Staphylococcal contamination on environmental surfaces of a neonatal intensive care unit of a children's hospital. Am J Infect Control 2021; 49:1450-1453. [PMID: 34029651 DOI: 10.1016/j.ajic.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022]
Abstract
Staphylococci species are known to cause healthcare-associated infections in neonatal intensive care (NICU) unit patients. Little is known about Staphylococcal contamination of NICU environments. Swabs from 25 of 46 (54%) surfaces sampled in a NICU had viable Staphylococcal contamination, with 11% contaminated by methicillin resistant Staphylococcus aureus [MRSA]. Floors by sinks and return air ducts in the NICU were the most contaminated (67% positive), possibly serving as reservoirs for Staphylococci.
Collapse
|
34
|
Levine D. Should we continue entrusting our health service to any single political party and the electoral cycle? BMJ 2021; 375:n2632. [PMID: 34725094 DOI: 10.1136/bmj.n2632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
35
|
Wagner Z, Zutshi R, Asiimwe JB, Levine D. The Cost-Effectiveness of Community Health Workers Delivering Free Diarrhea Treatment: Evidence from Uganda. Health Policy Plan 2021; 37:123-131. [PMID: 34698342 DOI: 10.1093/heapol/czab120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/02/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022] Open
Abstract
Community health workers (CHWs) are a vital part of the health infrastructure in Uganda and in many other low- and middle-income countries. While the need for CHWs is clear, it is less clear how they should dispense health products to maximize the health benefits to their community. In this study, we assess the cost-effectiveness of several competing CHW distribution strategies in the context of treatment for child diarrhea. We used data from a 4-armed cluster-randomized controlled trial to assess the cost-effectiveness of 1) free distribution of oral rehydration salts (ORS) via home deliveries prior to diarrhea onset (free delivery arm), 2) free distribution via vouchers where households retrieved the treatment from a central location (voucher arm), 3) a door-to-door sales model (home sales arm), and 4) a control arm where CHWs carried out their activities as normal. We assessed the cost-effectiveness from the implementor's perspective and a societal perspective, in terms of cost per case treated with ORS and cost per disability adjusted life-year (DALY) averted. Free delivery was the most effective strategy and the cheapest from a societal perspective. Although implementor costs were highest in this arm, cost savings comes from households using fewer resources to seek treatment outside the home (transport, doctor fees, and treatment costs). From the implementors' perspective, free delivery costs $2.19 per additional case treated and $56 per DALY averted relative to the control. Free delivery was also extremely cost-effective relative to home sales and vouchers but there was a large degree of uncertainty around the comparison with vouchers. Free distribution of ORS by CHWs prior to diarrhea onset is extremely cost-effective compared to other CHW distribution models. Implementers of CHW programs should consider free home delivery of ORS.
Collapse
Affiliation(s)
- Zachary Wagner
- Department of Economics, Sociology and Statistics, RAND Corporation, Santa Monica, CA, USA.,Pardee RAND Graduate School, Santa Monica, CA, USA
| | | | | | - David Levine
- Hass School Business, University of California, Berkeley, CA, USA
| |
Collapse
|
36
|
Levine D, Tudini F, Healy M, Dunlap A, Merritt M, Vaught E, Norman KD. The Short Term Effects of Kinesiology Taping on Shoulder Pain and Function in Patients with Ehlers-Danlos Syndrome. Arch Phys Med Rehabil 2021. [DOI: 10.1016/j.apmr.2021.07.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
37
|
Fell N, Levine D, Hellerstedt A, Meystrik G, Wilson B. Stroke Survivors' Self-Reported Participation in Meeting Strengthening Guidelines. Arch Phys Med Rehabil 2021. [DOI: 10.1016/j.apmr.2021.07.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
38
|
Levine D, Poole C, Hostetler C, Jeter K, Kingrea C, Kukta K, Fell N. The Association Between Sleep and Health-Related Quality of Life in Stroke Survivors. Arch Phys Med Rehabil 2021. [DOI: 10.1016/j.apmr.2021.07.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
39
|
Levine D, Work B, McDonald S, Harty N, Mabe C, Powell A, Sanford G. Occupational Therapy Interventions for Clients with Ehlers-Danlos Syndrome (EDS) in the Presence of Postural Orthostatic Tachycardia Syndrome (POTS). Occup Ther Health Care 2021; 36:253-270. [PMID: 34520307 DOI: 10.1080/07380577.2021.1975200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Postural orthostatic tachycardia syndrome (POTS) is often seen in clients with Ehlers-Danlos syndrome (EDS), primarily hypermobile EDS. Research has shown clients with EDS and POTS may experience limitations affecting not only their physical function, but also their social, emotional, and mental well-being. Using a client-centered approach, occupational therapy practitioners assess health, well-being, symptomatology (fatigue, muscle pain, dizziness, etc.), participation and engagement in occupation, and provide interventions to improve quality of life. This paper will address occupational therapy interventions to treat common symptomatology for clients with EDS in the presence of POTS, including environmental modifications, use of adaptive equipment and orthoses, exercise and fall prevention, energy conservation and pacing, sleep hygiene, and routine and habit development to promote optimal engagement in meaningful occupations.
Collapse
Affiliation(s)
- David Levine
- Department of Physical Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Brittany Work
- Department of Occupational Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Susan McDonald
- Department of Occupational Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Nicole Harty
- Department of Occupational Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Carolee Mabe
- Department of Occupational Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Alison Powell
- Department of Occupational Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Graceline Sanford
- Department of Occupational Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, USA
| |
Collapse
|
40
|
McDonald S, Levine D, Barnes H, Cornett A, Craig C, Langager S, Yeager L, Britt M. Effectiveness of Adaptive Silverware on Active Range of Motion in Individuals With Rheumatoid Arthritis. Am J Occup Ther 2021. [DOI: 10.5014/ajot.2021.75s2-rp387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
The purpose of this study was to quantify active range of motion (ROM) required for individuals with rheumatoid arthritis (RA) using built-up spoons with electrogoniometry. Statistical analysis provided quantitative evidence supporting our hypothesis that using a built-up handle requires less active ROM for grasp. Clinical implications suggest built-up handles may be used for people with other conditions with limited hand and wrist ROM, not just RA, increasing participation and independence in daily activiti
Primary Author and Speaker: Susan McDonald
Additional Authors and Speakers: David Levine, Hensley Barnes, Anna Cornett, Caroline Craig, Sally Langager, Lauren Yeager, and Michael Britt
Collapse
Affiliation(s)
- Susan McDonald
- University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | | | - Hensley Barnes
- University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Anna Cornett
- University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | | | - Sally Langager
- University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Lauren Yeager
- University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | | |
Collapse
|
41
|
Cavagna A, Chaikin PM, Levine D, Martiniani S, Puglisi A, Viale M. Vicsek model by time-interlaced compression: A dynamical computable information density. Phys Rev E 2021; 103:062141. [PMID: 34271646 DOI: 10.1103/physreve.103.062141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 05/13/2021] [Indexed: 11/07/2022]
Abstract
Collective behavior, both in real biological systems and in theoretical models, often displays a rich combination of different kinds of order. A clear-cut and unique definition of "phase" based on the standard concept of the order parameter may therefore be complicated, and made even trickier by the lack of thermodynamic equilibrium. Compression-based entropies have been proved useful in recent years in describing the different phases of out-of-equilibrium systems. Here, we investigate the performance of a compression-based entropy, namely, the computable information density, within the Vicsek model of collective motion. Our measure is defined through a coarse graining of the particle positions, in which the key role of velocities in the model only enters indirectly through the velocity-density coupling. We discover that such entropy is a valid tool in distinguishing the various noise regimes, including the crossover between an aligned and misaligned phase of the velocities, despite the fact that velocities are not explicitly used. Furthermore, we unveil the role of the time coordinate, through an encoding recipe, where space and time localities are both preserved on the same ground, and find that it enhances the signal, which may be particularly significant when working with partial and/or corrupted data, as is often the case in real biological experiments.
Collapse
Affiliation(s)
- A Cavagna
- Dipartimento di Fisica, Università La Sapienza, 00185 Rome, Italy.,Istituto dei Sistemi Complessi, Consiglio Nazionale delle Ricerche, 00185 Rome, Italy
| | - P M Chaikin
- Center for Soft Matter Research, Department of Physics, New York University, New York, New York 10003, USA
| | - D Levine
- Department of Physics, Technion-IIT, 32000 Haifa, Israel
| | - S Martiniani
- Department of Chemical Engineering & Materials Science, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - A Puglisi
- Dipartimento di Fisica, Università La Sapienza, 00185 Rome, Italy.,Istituto dei Sistemi Complessi, Consiglio Nazionale delle Ricerche, 00185 Rome, Italy
| | - M Viale
- Dipartimento di Fisica, Università La Sapienza, 00185 Rome, Italy.,Istituto dei Sistemi Complessi, Consiglio Nazionale delle Ricerche, 00185 Rome, Italy
| |
Collapse
|
42
|
Timofte I, Keller M, Varghese A, Levine D, Aryal S, Shah P, Vesselinov R, Ross D, Woodward R, Dale B, Terrin M, Iacono A, Agbor-Enoh S. Cell Free DNA Levels in Patients with Acute Rejection after Lung Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
43
|
Niv Y, Kuniavsky M, Bronshtein O, Goldschmidt N, Hanhart S, Levine D, Mahalla H. Quality Indicators for Prevention of Infection in the Surgical Site: The Israeli National Program for Quality Indicators Experience. Qual Manag Health Care 2021; 30:81-86. [PMID: 33783421 DOI: 10.1097/qmh.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The Israeli National Program for Quality Indicators (INPQ) sets as its primary goal to promote high-quality health care within selected core areas in the Israeli health system. Surgical site infection is one of the most common types of acquired infections. The INPQ supports 3 distinct indicators concerning suitable antibiotic treatment in colorectal surgery, cesarean sections, and surgery for femoral neck fractures. METHODS We measured the number of patients who received prophylactic antibiotics, beginning an hour before the first cut and stopping after 24 hours in 1 of the 3 operations, according to the International Classification of Diseases, Ninth Revision (ICD-9) codes. Goals for success have been established annually according to the results of the previous year. Data computed for each operation included socioeconomic status, dates of hospitalization and release, date of death, date of birth, gender, date of operation, time of beginning and end of the operation, and time of beginning and end of anesthesia. RESULTS Within 3 to 5 years, we achieved a significant increase in appropriate prophylactic antibiotic use from 78% to 85%, 78% to 95%, and 66% to 88% for colorectal surgery (n = 9404), cesarean sections (n = 141 362), and femoral joint operations (n = 30 728), respectively. The mortality rate was lower, 1.85% versus 0.55% in patients who received proper antibiotic therapy (odds ratio [OR] = 3.141; 95% confidence interval [CI], 1.829-5.394, P < .0001), 0.031% versus 0.006% (OR = 6.741; 95% CI, 1.879-21.187; P = .003), and 5.59% versus 4.51% (OR = 1.253; 95% CI, 1.091-1.439; P = .001), respectively. CONCLUSION Prophylactic antibiotic treatment is strongly recommended by medical guidelines. The experience of the INPQ supports this approach. We demonstrate a significant lower mortality rate in patients who have been properly treated.
Collapse
Affiliation(s)
- Yaron Niv
- The Israeli National Program for Quality Indicators, Ministry of Health, Jerusalem, Israel
| | | | | | | | | | | | | |
Collapse
|
44
|
Mutebi C, Ponor L, Cochrane A, Levine D, Jang M, Luikart H, Shah P, Mathew J, Brown A, Kong H, Berry G, Marboe C, Iacono A, Nathan S, Khush K, Orens J, Valantine H, Agbor-Enoh S. Impact of AMR Treatment: Responders vs Non-Responders Characteristics. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
45
|
Keller M, Mutebi C, Shah P, Levine D, Aryal S, Timofte I, Mathew J, Varghese A, Giner C, Ross D, Dale B, Woodward R, Agbor-Enoh S. Performance of Donor Derived Cell-Free DNA in Routine Clinical Care of Lung Transplant Recipients, a Multi-Center Study. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
46
|
Kennedy C, Budev M, Wille K, Lease E, Chandrashekaran S, Levine D, Nunley D, Chan K, Wilson M, Hayanga J, Shigemura N, Kumar A, Girgis R, Sharma N, Lyu D, Seghal S, Mattar A, Loor G. Multi-Center Validation of a Consensus-Based Scoring Guide for Evaluating Donor Lung Offers. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
47
|
Abstract
OBJECTIVE The aim of the study reported here was to determine the effect of cryotherapy on the caudal thigh muscles of dogs. We hypothesized that temperature changes would be greatest in superficial tissues and decrease with tissue depth. STUDY DESIGN Eight mixed-breed dogs (mean weight 21.2 kg, mean age 3.3 years) were studied. Temperature was measured at the skin surface and at depths of 1.0 and 3.0 cm below the skin using needle thermistor probes that were inserted beneath the site of cold pack application. Treatment consisted of a standard 1.0°C cold pack applied for 20 minutes. Temperature was recorded every minute for the 20 minute cold pack treatment, and for 80 minutes following treatment. RESULTS Cutaneous temperatures significantly decreased (p < 0.01), with rapid rewarming of the skin following cold pack removal. Tissue cooling was less profound with increasing tissue depths, but was still significant (p < 0.05). There was no significant difference in muscle temperature between haired and clipped limbs. CONCLUSION A single application of a cold pack to the caudal thigh muscles of dogs for 20 minutes resulted in significant temperature reduction at all tissue depths (p < 0.05). This decrease persisted for ∼60 minutes. The presence of hair did not have a significant effect on muscle cooling (p > 0.05).
Collapse
Affiliation(s)
- Krysta Janas
- Small Animal Clinical Sciences, University of Tennessee, Knoxville, Tennessee, United States
| | - Darryl Millis
- Small Animal Clinical Sciences, University of Tennessee, Knoxville, Tennessee, United States
| | - David Levine
- Department of Physical Therapy, University of Tennessee, Chattanooga, Tennessee, United States
| | - Melissa Keck
- Small Animal Clinical Sciences, University of Tennessee, Knoxville, Tennessee, United States
| |
Collapse
|
48
|
Hao X, Yim J, Freedman D, Siddiqui S, Levine D, Tritto M, Saffo GM, Isaac A, Mirkin G. PAS stain based histological classification and severity grading of toenail onychomycosis. Med Mycol 2021; 58:453-459. [PMID: 31309228 DOI: 10.1093/mmy/myz075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/06/2019] [Accepted: 06/11/2019] [Indexed: 11/13/2022] Open
Abstract
Onychomycosis is a common world-wide health issue. Accurate detection is essential for treatment. Multiple studies have shown that PAS-stain based histological visualization of fungal elements is superior to either direct microscopy with 20% potassium hydroxide, or fungal culture. However, PAS stain based histological classification and severity grading of onychomycosis are lacking in the literature. Here we reported a fungal detection rate of 47.87% based on an analysis of 13,805 toenails processed for H&E and PAS stains over a three year period. Based on the analysis of fungal density, distribution and infiltrating depth level in 858 PAS-positive toenails, we created a novel PAS stain based histological classification system to classify onychomycosis as occult onychomycosis (OO), focal or diffuse subungual onychomycosis (FSO or DSO), focal or diffuse plate onychomycosis (FPO or DPO), focal or diffuse subungual and plate onychomycosis (FSPO or DSPO) and superficial onychomycosis (SO). The severities of OO, FSO and FPO were graded as mild, DSO and DPO as moderate, FSPO and DSPO as severe infections, which revealed that more than 75% PAS positive toenails were severe infections. Evaluation of 97 paired toenails biopsied pre- and post-treatment from 47 patients demonstrated that the severity of infection was significantly reduced from severe to mild and moderate levels. These data indicate that the current histological classification evaluates not only the severity of the fungal infection but also the response to treatment. We further propose a guideline for treatment of onychomycosis based on the histological classification and severity.
Collapse
Affiliation(s)
- Xingpei Hao
- Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA
| | - Joon Yim
- Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA
| | - David Freedman
- Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA
| | - Sarwat Siddiqui
- Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA
| | - David Levine
- Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA
| | - Michael Tritto
- Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA
| | - Gina M Saffo
- Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA
| | - Adam Isaac
- Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA
| | - Gene Mirkin
- Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA
| |
Collapse
|
49
|
Colletti M, Levine D. Evaluation of a Function-Based Multidisciplinary Outpatient Program to Manage High-Impact Chronic Pain. Arch Phys Med Rehabil 2020. [DOI: 10.1016/j.apmr.2020.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
50
|
Abstract
BACKGROUND AND OBJECTIVE The purpose of this study was to evaluate the impact of using electrostatic precipitation to manage the surgical plume during low pressure laparoscopic gynecologic procedures. METHODS This was a prospective, blinded, randomized controlled study of women with a clinical indication for laparoscopic hysterectomy (n = 30) or myomectomy (n = 5). Patients were randomized to either use electrostatic precipitation (EP) during the procedure, or not (No EP, hysterectomy group only). RESULTS Low pressure surgery could be undertaken in 87% of hysterectomy cases (13/15) when using EP to manage the surgical plume, compared to only 53% (8/15) in the No EP group. Overall average rating of the visual field was excellent with EP vs fair for No EP. Average CO2 consumption was reduced by 29% when using EP (16.7L vs 23.5L, p = 0.152). The average number of procedural pauses to vent smoke was lower with EP than the No EP group (1.5 per case vs. 3.7 per case, p = 0.005). Average procedure duration for the EP vs No EP group was 40.5 min vs. 46.9 min (p = 0.987). There were no measurable differences between groups for body temperature, end-tidal CO2, and discharge pain scores. In myomectomy, all five cases could be performed at low pressure, with an excellent visual field rating. CONCLUSION Electrostatic precipitation enhances low pressure laparoscopic hysterectomy and myomectomy. This was achieved by minimizing interruptions to surgery and exchange of CO2; providing a clear visual field throughout the procedure; and eliminating surgical smoke at the site of origin.
Collapse
Affiliation(s)
- David Levine
- Department of Obstetrics and Gynecology, Mercy Hospital, 621 S. New Ballas Rd, St. Louis, Missouri
| | - Gregory F Petroski
- Biostatistics & Research Design Unit, University of Missouri - Columbia School of Medicine, 182C Galena Hall, Columbia, Missouri
| | - Tracy Haertling
- Mercy Research, 3231 S. National Ave., Ste 210, Springfield, Missouri
| | - Teresa Beaudoin
- Mercy Research, 615 S. New Ballas Rd, Ste 2010, St. Louis, Missouri
| |
Collapse
|