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Nursing Standard (Royal College of... Mar 2015The NHS runs on goodwill. Every day thousands of nurses, midwives and healthcare support workers work extra hours, skip breaks and go the extra mile to keep the health...
The NHS runs on goodwill. Every day thousands of nurses, midwives and healthcare support workers work extra hours, skip breaks and go the extra mile to keep the health service running. In return, you may receive a 'thank you' from your manager or expressions of gratitude from patients, but rarely will you see any extra in your pay packet.
Topics: Humans; Salaries and Fringe Benefits; State Medicine; United Kingdom
PubMed: 25804134
DOI: 10.7748/ns.29.30.3.s1 -
Clinical Journal of Sport Medicine :... Sep 2022To study hydration plans and understanding of exercise-associated hyponatremia (EAH) among current marathon runners.
OBJECTIVE
To study hydration plans and understanding of exercise-associated hyponatremia (EAH) among current marathon runners.
DESIGN
Cross-sectional study.
SETTING
Southern California 2018 summer marathon.
PARTICIPANTS
Two hundred ten marathon runners.
INTERVENTIONS
Survey administered 1 to 2 days before the race. Race times were obtained from public race website.
MAIN OUTCOME MEASURES
Planned frequency of hydration; awareness of, understanding of, and preventative strategies for dehydration and EAH; resources used to create hydration plans; drink preferences.
RESULTS
When the participants were split into 3 equal groups by racing speed, the slower tertile intended to drink at every mile/station (60%), whereas the faster tertile preferred to drink every other mile or less often (60%), although not statistically significant. Most runners (84%) claimed awareness of EAH, but only 32% could list a symptom of the condition. Both experienced marathoners and the faster tertile significantly had greater understanding of hyponatremia compared with first-time marathoners and the slower tertile, respectively. Less than 5% of marathoners offered "drink to thirst" as a prevention strategy for dehydration or EAH.
CONCLUSION
Slower runners plan to drink larger volumes compared with their faster counterparts. Both slower and first-time marathoners significantly lacked understanding of EAH. These groups have plans and knowledge that may put them at higher risk for developing EAH. Most marathon runners did not know of the guidelines to "drink to thirst," suggesting the 2015 EAH Consensus statement may not have had the desired impact.
Topics: Cross-Sectional Studies; Dehydration; Humans; Hyponatremia; Marathon Running; Running
PubMed: 34723866
DOI: 10.1097/JSM.0000000000000990 -
Journal of Thrombosis and Haemostasis :... Mar 2021F8 int1h inversions (Inv1) are detected in 1%-2% of severe hemophilia A (HA) patients. Long-range polymerase chain reaction (PCR) and inverse-shifting PCR have been used...
BACKGROUND
F8 int1h inversions (Inv1) are detected in 1%-2% of severe hemophilia A (HA) patients. Long-range polymerase chain reaction (PCR) and inverse-shifting PCR have been used to diagnose these inversions.
OBJECTIVES
To design and validate a sensitive and robust assay for detection of F8 Inv1 inversions.
METHODS
Archival DNA samples were investigated using mile-post assays and droplet digital PCR.
RESULTS
Milepost assays for Inv1 showing high specificities and sensitivities were designed and optimized. Analysis of four patients, two carrier mothers, and 40 healthy controls showed concordance with known mutation status with one exception. One patient had a duplication involving exons 2-22 of the F8 gene instead of an Inv1 mutation. DNA mixtures with different proportions of wild-type and Inv1 DNA correlated well with the observed relative linkage for both wild type and Inv1 assays and estimated the limit of detection of these assays to 2% of the rare chromosome.
CONCLUSIONS
The milepost strategy has several inherent control systems. The absolute counting of target molecules by both assays enables determination of template quantity, detection of copy number variants, and rare variants occurring in primer and probe annealing sites and estimation of DNA integrity through the observed linkage. The presented Inv1 milepost analysis offers sensitive and robust detection and quantification of the F8 int1h inversions and other rearrangements involving intron 1 in patients and their mothers.
Topics: Chromosome Inversion; Factor VIII; Hemophilia A; Humans; Introns; Mutation; Polymerase Chain Reaction
PubMed: 33345381
DOI: 10.1111/jth.15219 -
Sports Health 2021As mass participation events continue to increase in popularity, the need for medical care continues to increase. Our objective was to evaluate the course medical tent...
BACKGROUND
As mass participation events continue to increase in popularity, the need for medical care continues to increase. Our objective was to evaluate the course medical tent usage throughout the Bank of America Chicago Marathon course. Our second objective was to evaluate emergency medical services (EMS) utilization during the event.
HYPOTHESIS
We hypothesize that as the race progresses, medical tents will see more participants and EMS will have an increase in utilization.
LEVEL OF EVIDENCE
Level 4.
METHODS
This study was a retrospective analysis of data collected by the medical staff from 2015 to 2017. Documented patient encounters were analyzed from each course medical tent. Twenty medical tents were spaced roughly 1.2 miles apart depending on location and ease of EMS access to the medical tent location.
RESULTS
From 2015 to 2017, the course medical tents saw 2973 patients, with a 96.3% discharge rate. The data showed a linear increase of 5.69 patients seen per mile until mile 20 (linear regression < 0.01). After mile 20, the number of patients seen per mile was about the same. The data also showed an increase in EMS utilization every 5 miles as the race progressed ( = 0.04) and an increase in ratio of patients transported to the hospital compared with patients transferred to the main medical tents up to mile 20 ( = 0.02).
CONCLUSION
Course medical tents saw a statistically significant linear increase in patients per mile until mile 20. Total EMS utilization showed a statistically significant increase in usage as the race progressed and a statistically significant increase in ratio of transports to transfers as the race progressed until mile 20.
CLINICAL RELEVANCE
This study has the potential to influence medical tent and EMS placement for endurance events with increasing patient encounters and hospital transports as the mileage of the endurance event increases.
Topics: Adult; Chicago; Emergency Medical Services; Female; Humans; Male; Marathon Running; Mobile Health Units; Retrospective Studies
PubMed: 33535910
DOI: 10.1177/1941738120984149 -
Applied Optics Nov 2023Free-space optics (FSO) and visible light communication (VLC) are interesting solutions for last mile access due to their benefits over conventional wired and wireless...
Free-space optics (FSO) and visible light communication (VLC) are interesting solutions for last mile access due to their benefits over conventional wired and wireless communication systems, including easy installation, low latency, high bandwidth, and low cost. This study aims to present last mile access using hybrid FSO/VLC, addressing the shortcomings of each technology. A hybrid system might, for instance, use VLC to give last meter connectivity to specific buildings and FSO to provide high-bandwidth outdoor connectivity across vast distances. In this paper, three proposed scenarios are designed using Optisystem and Matlab software, employing pulse amplitude modulation with four levels (PAM-4). The first scenario involves designing the last mile of the FSO-VLC system. In contrast, the second uses wavelength division multiplexing (WDM) technology to increase the data transmission capacity by enabling multiple optical signals at various wavelengths. The last scenario entails using VLC systems and the non-orthogonal multiple access (NOMA) approach to accommodate several users simultaneously. The simulation results show that the proposed system can fulfill outdoor link distances of more than 10 km and indoor coverage of about 2 m with a bit-error rate (BER) of 1.5×10 for a 10 Gbps data rate. However, the proposed systems can achieve the same data rate with a reduced FSO distance under different turbulence and weather conditions.
PubMed: 38037945
DOI: 10.1364/AO.503272 -
Studies in Health Technology and... Aug 2022Issues of non-use of available health information technology (HIT) have been referred to as the 'last mile problem' impeding harnessing the full potential of HIT. We...
Issues of non-use of available health information technology (HIT) have been referred to as the 'last mile problem' impeding harnessing the full potential of HIT. We reflect upon which competencies are needed to address the last mile problem by ensuring a context-sensitive implementation. We argue that there is a need for context-sensitive digital integrators, who can navigate the realm where technological systems meet practice. This entails a situated, socio-technical, context-sensitive approach and competencies which are not easily addressed through formal training but require lifelong situated learning, as the field evolves continuously. Our ambition is to highlight the complexities of implementation and integration into local practice. This paper emphasizes the role of digital integrators in the hope of fostering further discussions on how to acknowledge and nourish these competencies in order to address and go beyond the last mile problem.
Topics: Medical Informatics; Technology
PubMed: 36073464
DOI: 10.3233/SHTI220915 -
Health Promotion Practice Jan 2020Retail settings are major channels for the tobacco industry to market commercial tobacco products. However, few studies have examined marketing strategies on Tribal...
Retail settings are major channels for the tobacco industry to market commercial tobacco products. However, few studies have examined marketing strategies on Tribal lands. The resulting evidence is important, especially given that American Indian/Alaska Native (AI/AN) youth and adults have the highest smoking prevalence of any racial/ethnic group in the United States. In this study, we examined cigarette, e-cigarette, and vape/vaporizer availability, advertising, and price-reducing promotions in retail settings on and within a 1-mile radius of Tribal lands in California. . Trained AI/AN community health representatives (n = 8) conducted store observations (n = 96) using a checklist adapted from the Standardized Tobacco Assessment for Retail Settings observation tool. Chi-square analyses were performed to look for potential differences in availability, exterior advertising, and price promotions for cigarettes, e-cigarettes, and vapes between stores. . All stores sold cigarettes and over 95% sold menthol cigarettes. Nearly 25% of stores on Tribal lands were located inside a casino, and 40.4% of stores on Tribal lands offered a Tribal member discount. Stores within a 1-mile radius of Tribal lands sold significantly (p < .01) more e-cigarettes (69.8%), including flavored e-cigarettes (53.4%), compared to stores on Tribal lands (37.7% and 28.3%, respectively). Price promotions for cigarettes were significantly (p < .01) more common in stores located within a 1-mile radius of Tribal lands (46.5%) than stores on Tribal lands (22.6%). . To our knowledge, this study is the first to use store observations to examine cigarette and e-cigarette availability, advertising, and price promotions in retail settings on and near California Tribal lands. We recommend future studies build on our initial efforts to take an AI/AN Tribal community-engaged approach in assessing and documenting tobacco marketing practices on and near Tribal lands. Tribal governments can consider tobacco policies to help reduce smoking disparities and advance health equity for their communities.
Topics: Advertising; California; Commerce; Electronic Nicotine Delivery Systems; Ethnicity; Humans; Indians, North American; Marketing; Prevalence; Tobacco Products; United States
PubMed: 31908191
DOI: 10.1177/1524839919883254 -
Clinical Journal of Sport Medicine :... Nov 2021Analyze the effect of sodium supplementation, hydration, and climate on dysnatremia in ultramarathon runners. (Observational Study)
Observational Study
OBJECTIVE
Analyze the effect of sodium supplementation, hydration, and climate on dysnatremia in ultramarathon runners.
DESIGN
Prospective observational study.
SETTING
The 2017 80 km (50 mile) stage of the 250 km (150 mile) 6-stage RacingThePlanet ultramarathon in 2017 Chilean, Patagonian, and 2018 Namibian, Mongolian, and Chilean deserts.
PARTICIPANTS
All race entrants who could understand English were invited to participate, with 266 runners enrolled, mean age of 43 years (± 9), 61 (36%) females, average weight 74 kg (± 12.5), and average race time 14.5 (± 4.1) hours. Post-race sodium collected on 174 (74%) and 164 (62%) participants with both the blood sample and post-race questionnaire.
INTERVENTION
Weight change and finish line serum sodium levels were gathered.
MAIN OUTCOME MEASURES
Incidence of exercise-associated hyponatremia (EAH; <135 mmol·L-1) and hypernatremia (>145 mmol·L-1) by sodium ingestion and climate.
RESULTS
Eleven (6.3%) runners developed EAH, and 30 (17.2%) developed hypernatremia. Those with EAH were 14 kg heavier at baseline, had significantly less training distances, and averaged 5 to 6 hours longer to cover 50 miles (80 km) than the other participants. Neither rate nor total ingested supplemental sodium was correlated with dysnatremia, without significant differences in drinking behaviors or type of supplement compared with normonatremic runners. Hypernatremic runners were more often dehydrated [8 (28%), -4.7 kg (± 9.8)] than EAH [4 (14%), -1.1 kg (± 3.8)] (P < 0.01), and EAH runners were more frequently overhydrated (6, 67%) than hypernatremia (1, 11%) (P < 0.01). In the 98 (56%) runners from hot races, there was EAH OR = 3.5 [95% confidence interval (CI), 0.9-25.9] and hypernatremia OR = 8.8 (95% CI, 2.9-39.5) compared with cold races.
CONCLUSIONS
This was the first study to show that hot race climates are an independent risk factor for EAH and hypernatremia. Sodium supplementation did not prevent EAH nor cause hypernatremia. Longer training distances, lower body mass, and avoidance of overhydration were shown to be the most important factors to prevent EAH and avoidance of dehydration to prevent hypernatremia.
Topics: Adult; Exercise; Female; Humans; Hyponatremia; Marathon Running; Running; Sodium
PubMed: 32097177
DOI: 10.1097/JSM.0000000000000832 -
Bridging the "last mile" gap between AI implementation and operation: "data awareness" that matters.Annals of Translational Medicine Apr 2020Interest in the application of machine learning (ML) techniques to medicine is growing fast and wide because of their ability to endow decision support systems with... (Review)
Review
Interest in the application of machine learning (ML) techniques to medicine is growing fast and wide because of their ability to endow decision support systems with so-called artificial intelligence, particularly in those medical disciplines that extensively rely on digital imaging. Nonetheless, achieving a pragmatic and ecological validation of medical AI systems in real-world settings is difficult, even when these systems exhibit very high accuracy in laboratory settings. This difficulty has been called the "last mile of implementation." In this review of the concept, we claim that this metaphorical mile presents two chasms: the hiatus of human trust and the hiatus of machine experience. The former hiatus encompasses all that can hinder the concrete use of AI at the point of care, including availability and usability issues, but also the contradictory phenomena of cognitive ergonomics, such as automation bias (overreliance on technology) and prejudice against the machine (clearly the opposite). The latter hiatus, on the other hand, relates to the production and availability of a sufficient amount of reliable and accurate clinical data that is suitable to be the "experience" with which a machine can be trained. In briefly reviewing the existing literature, we focus on this latter hiatus of the last mile, as it has been largely neglected by both ML developers and doctors. In doing so, we argue that efforts to cross this chasm require data governance practices and a focus on data work, including the practices of data awareness and data hygiene. To address the challenge of bridging the chasms in the last mile of medical AI implementation, we discuss the six main socio-technical challenges that must be overcome in order to build robust bridges and deploy potentially effective AI in real-world clinical settings.
PubMed: 32395545
DOI: 10.21037/atm.2020.03.63 -
International Journal of Sports... Aug 2022Training intensity distribution is important to training program design. The zones 1 to 2 boundary can be defined by the Talk Test and the rating of perceived exertion....
UNLABELLED
Training intensity distribution is important to training program design. The zones 1 to 2 boundary can be defined by the Talk Test and the rating of perceived exertion. The zones 2 to 3 boundary can be defined by respiratory gas exchange, maximal lactate steady state, or, more simply, by critical speed (CS). The upper boundary of zone 3 is potential defined by the velocity at maximum oxygen uptake (vVO2max), although no clear strategy has emerged to categorize this intensity. This is not normally definable outside the laboratory.
PURPOSE
This study predicts vVO2max from CS, determined from 1 (1.61 km) and 2 (3.22 km) citizen races in well-trained runners.
METHODS
A heterogeneous group of well-trained runners (N = 22) performed 1- and 2-mile races and were studied during submaximal and maximal treadmill running to measure oxygen uptake, allowing computation of vVO2max. This vVO2max was compared with CS.
RESULTS
vVO2max (4.82 [0.53] m·s-1) was strongly correlated with CS (4.37 [0.49] m·s-1; r = .84, standard error of estimate [SEE] = 0.132 m·s-1), 1-mile speed (5.09 [0.51] m·s-1; r = .84, SEE = 0.130 m·s-1), and 2-mile speed (4.68 [0.49] m·s-1; r = .86, SEE = 0.120 m·s-1).
CONCLUSIONS
CS, calculated from 2 citizen races (or even training time trials), can be used to make reasonable estimates of vVO2max, which can be used in the design of running training programs.
Topics: Exercise Test; Humans; Lactic Acid; Oxygen; Oxygen Consumption; Physical Endurance; Running
PubMed: 35661059
DOI: 10.1123/ijspp.2022-0018