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Annals of Internal Medicine Jun 2024Lesbian, gay, bisexual, transgender, queer, or other sexual and gender minorities (LGBTQ+) populations in the United States continue to experience disparities in health...
Lesbian, gay, bisexual, transgender, queer, or other sexual and gender minorities (LGBTQ+) populations in the United States continue to experience disparities in health and health care. Discrimination in both health care and society at large negatively affects LGBTQ+ health. Although progress has been made in addressing health disparities and reducing social inequality for these populations, new challenges have emerged. There is a pressing need for physicians and other health professionals to take a stance against discriminatory policies as renewed federal and state public policy efforts increasingly impose medically unnecessary restrictions on the provision of gender-affirming care. In this position paper, the American College of Physicians (ACP) reaffirms and updates much of its long-standing policy on LGBTQ+ health to strongly support access to evidence-based, clinically indicated gender-affirming care and oppose political efforts to interfere in the patient-physician relationship. Furthermore, ACP opposes institutional and legal restrictions on undergraduate, graduate, and continuing medical education and training on gender-affirming care and LGBTQ+ health issues. This paper also offers policy recommendations to protect the right of all people to participate in public life free from discrimination on the basis of their gender identity or sexual orientation and encourages the deployment of inclusive, nondiscriminatory, and evidence-based blood donation policies for members of LGBTQ+ communities. Underlying these beliefs is a reaffirmed commitment to promoting equitable access to quality care for all people regardless of their sexual orientation and gender identity.
PubMed: 38914001
DOI: 10.7326/M24-0636 -
Philosophical Transactions. Series A,... Jul 2024Elucidating the role of strange baryons (hyperons) in neutron stars requires detailed knowledge of hyperon-nucleon interactions in the light (u,d,s) quark sector. The...
Elucidating the role of strange baryons (hyperons) in neutron stars requires detailed knowledge of hyperon-nucleon interactions in the light (u,d,s) quark sector. The structure of the hyperons and their excitation spectra also directly impact, and are an input to, models of big-bang nucleosynthesis. The upcoming K-long Facility will provide a much-needed intense and clean neutral strange meson beam, from which hyperons can be produced at rates where hyperon structure, hyperon-nucleon interactions and higher-order interactions can be studied with a new level of accuracy and for hitherto unreachable measurements. The new facility has the potential to address long-standing questions surrounding the strange sector of the strong force and its relevance to the structure of atomic nuclei, neutron stars and the cosmos at large. This article is part of the theme issue 'The liminal position of Nuclear Physics: from hadrons to neutron stars'.
PubMed: 38910456
DOI: 10.1098/rsta.2023.0124 -
Journal of Orthopaedic Surgery (Hong... 2024To observe the activation strategies of the ankle muscles using surface electromyography (sEMG) during single-leg standing (SLS) and both-leg standing (BLS) on flat...
To observe the activation strategies of the ankle muscles using surface electromyography (sEMG) during single-leg standing (SLS) and both-leg standing (BLS) on flat ground (FG), soft mat (SM), and BOSU ball (BB) surfaces. Thirty healthy young adults participated in the study. The muscle activities of the tibialis anterior (TA) and gastrocnemius medial (GM) were measured on the three surfaces during SLS and BLS. Electromyographic evaluations of the TA and GM were recorded during maximum voluntary isometric contractions (MVIC). Muscle activation was evaluated using MVIC%, and muscle co-contraction was evaluated using the co-contraction index (CI). A statistically significant increase was observed in the MVIC% of the TA, GM, and CI on the three surfaces during SLS compared to BLS, except for the comparison of CI on BB between SLS and BLS (t = -1.35, = 0.19). The MVIC% of the TA and GM during SLS and BLS on BB was significantly increased in comparison with FG and SM. The CI during BLS on BB increased compared to FG (t = 3.19, < 0.01) and SM (t = 4.64, < 0.01). The CI during BLS on SM (t = -1.46, = 0.15) decreased when compared to FG but without statistical significance. SLS and unstable surfaces can induce greater muscle activation, and SLS can have a greater influence on ankle muscles.
Topics: Humans; Electromyography; Male; Muscle, Skeletal; Young Adult; Female; Standing Position; Adult; Ankle Joint; Isometric Contraction; Ankle; Postural Balance
PubMed: 38910029
DOI: 10.1177/10225536241258336 -
BMJ Open Jun 2024The primary aim of this study was to investigate the feasibility and acceptability of general practitioners (GPs) using sit-stand desks to facilitate standing during...
OBJECTIVES
The primary aim of this study was to investigate the feasibility and acceptability of general practitioners (GPs) using sit-stand desks to facilitate standing during consultations. A further aim was to examine the views of patients about GPs standing for their consultations.
DESIGN
A pre-post single-group experimental trial design.
SETTING
General practices in England, UK.
PARTICIPANTS
42 GPs (working a minimum of five clinical sessions per week) and 301 patients (aged ≥18 years).
INTERVENTIONS
The intervention consisted of each GP having a sit-stand desk (Opløft Sit-Stand Platform) installed in their consultation room for 4 working weeks. Sit-stand desks allow users to switch, in a few seconds, between a sitting and standing position and vice versa, by adjusting the height of the desk.
MAIN OUTCOME MEASURES
To test feasibility and acceptability, GPs reported their views about using sit-stand desks at work at baseline and follow-up. Sitting time and physical activity were also measured via accelerometer at baseline and follow-up. Patients who attended a consultation where their GP was standing were asked to complete an exit questionnaire about the perceived impact on the consultation.
RESULTS
Most GPs reported using their sit-stand desk daily (n=28, 75.7%). 16 GPs (44.4%) used their sit-stand desk during face-to-face consultations every day. Most GPs and patients did not view that GPs standing during face-to-face consultations impacted the doctor-patient relationship (GPs; 73.5%, patients; 83.7%). GPs' sitting time during work was 121 min per day lower (95% CI: -165 to -77.58) at follow-up compared with baseline.
CONCLUSIONS
Use of sit-stand desks is acceptable within general practice and may reduce sitting time in GPs. This may benefit GPs and help reduce sitting time in patients.
TRIAL REGISTRATION NUMBER
ISRCTN76982860.
Topics: Humans; Feasibility Studies; Male; Female; Middle Aged; Adult; General Practitioners; Standing Position; Sitting Position; Attitude of Health Personnel; England; Surveys and Questionnaires; Exercise; General Practice; Aged; Interior Design and Furnishings
PubMed: 38910005
DOI: 10.1136/bmjopen-2024-084085 -
The Journal of Biological Chemistry Jun 2024Nonribosomal peptide synthetases (NRPSs) are responsible for the production of important biologically active peptides. The large, multidomain NRPSs operate through an...
Nonribosomal peptide synthetases (NRPSs) are responsible for the production of important biologically active peptides. The large, multidomain NRPSs operate through an assembly line strategy in which the growing peptide is tethered to carrier domains that deliver the intermediates to neighboring catalytic domains. While most NRPS domains catalyze standard chemistry of amino acid activation, peptide bond formation and product release, some canonical NRPS catalytic domains promote unexpected chemistry. The paradigm monobactam antibiotic sulfazecin is produced through the activity of a terminal thioesterase domain of SulM, which catalyzes an unusual β-lactam forming reaction in which the nitrogen of the C-terminal N-sulfo-2,3-diaminopropionate residue attacks its thioester tether to release the monobactam product. We have determined the structure of the thioesterase domain as both a free-standing domain and a didomain complex with the upstream holo peptidyl-carrier domain. The position of variant lid helices results in an active site pocket that is quite constrained, a feature that is likely necessary to orient the substrate properly for β-lactam formation. Modeling of a sulfazecin tripeptide into the active site identifies a plausible binding mode identifying potential interactions for the sulfamate and the peptide backbone with Arg2849 and Asn2819, respectively. The overall structure is similar to the β-lactone forming thioesterase domain that is responsible for similar ring closure in the production of obafluorin. We further use these insights to enable bioinformatic analysis to identify additional, uncharacterized β-lactam-forming biosynthetic gene clusters by genome mining.
PubMed: 38908753
DOI: 10.1016/j.jbc.2024.107489 -
Medical Engineering & Physics Jul 2024The aim of this work is to investigate in-silico the biomechanical effects of a proximal fibular osteotomy (PFO) on a knee joint with different varus/valgus deformities...
The aim of this work is to investigate in-silico the biomechanical effects of a proximal fibular osteotomy (PFO) on a knee joint with different varus/valgus deformities on the progression of knee osteoarthritis (KOA). A finite element analysis (FEA) of a human lower extremity consisting of the femoral, tibial and fibular bones and the cartilage connecting them was designed. The FEA was performed in a static standing primitive position to determine the contact pressure (CP) distribution and the location of the center of pressure (CoP). The analysis examined the relationship between these factors and the degree of deformation of the hip-knee angle in the baseline condition. The results suggested that PFO could be a simple and effective surgical treatment for patients with associated genu varum. This work also reported that a possible CP homogenization and a CoP correction can be achieved for medial varus deformities after PFO. However, it reduced its effectiveness for tibial origin valgus misalignment and worsened in cases of femoral valgus misalignment.
Topics: Osteotomy; Humans; Biomechanical Phenomena; Knee Joint; Pressure; Finite Element Analysis; Computer Simulation; Fibula
PubMed: 38906579
DOI: 10.1016/j.medengphy.2024.104185 -
European Journal of Vascular and... Jun 2024Iliofemoral venous obstructive disease can result in significant, potentially debilitating symptoms that can negatively affect quality of life. Unlike arterial disease,...
OBJECTIVE
Iliofemoral venous obstructive disease can result in significant, potentially debilitating symptoms that can negatively affect quality of life. Unlike arterial disease, patients with deep venous disease have a significantly lower median age, therefore the need for long term stent patency becomes a matter of decades rather than years. Furthermore, iliofemoral lesions frequently require stent placement across the inguinal ligament. Such stents are subject to dynamic stress from leg movement and associated concerns for device fatigue, resulting in stent fracture. The aim of this study was to describe an in vitro 50 year stent fatigue test method designed to assess durability against dynamic stress induced device fracture.
METHODS
Through literature review, cadaver studies, and computer modelling, the most challenging loading was confirmed to be hip flexion across the inguinal ligament. This occurs when the patient adjusts between a seated and standing position. Sit to stand hip flexion at the inguinal ligament was effectively simulated on the bench in this in vitro experimental study.
RESULTS
When tested under challenge parameters, hip flexion was reliably found to cause fractures in non-venous nitinol stents. However, a dedicated self expanding nitinol venous stent, engineered for improved durability, underwent up to 50 years of simulated loading on the bench with 15% (3/20) of stents experiencing fractures at 50 years, compared with fractures in 35% (14/40) of non-venous stents tested to 1.4 years; no statistical testing was performed as durations do not match and the objective was to demonstrate the test method).
CONCLUSION
The presented fatigue test method is a suitable approach for evaluating the durability of stents intended for venous use. Venous stents demonstrated superior fatigue resistance compared with non-venous stents via in vitro hip flexion testing.
PubMed: 38906369
DOI: 10.1016/j.ejvs.2024.06.024 -
Gait & Posture Jun 2024Intrinsic foot muscles are known to support the medial longitudinal arch (MLA) and stabilize the foot, and they are activated with weight bearing and increased postural...
BACKGROUND
Intrinsic foot muscles are known to support the medial longitudinal arch (MLA) and stabilize the foot, and they are activated with weight bearing and increased postural demand. Various types of intrinsic foot muscle training have been reported, but one of the most useful of these, the short foot exercise, is challenging to perform effectively and requires practice, making it difficult to implement in ordinary clinical settings.
RESEARCH QUESTION
What are the differences in abductor hallucis longus (ABH) muscle activity and MLA angle during intrinsic foot muscle exercises that employ weight bearing and balancing conditions when they are performed with minimal practice?
METHODS
Sixteen healthy volunteers performed nine different intrinsic foot muscle exercises, practiced once or twice. The exercises consisted of toe curl, short foot without pushing, short foot with pushing and toe spread exercises in sitting and standing positions, and single leg swing in a standing position. Each exercise was performed three times for five seconds. The activities of the ABH muscles were measured using surface electromyographic (EMG) sensors and the MLA angles during the exercises were captured using an optical motion tracking system. The integrals of the ABH EMG signals were calculated.
RESULTS
Differences in the integral and maximum of the ABH EMG signal were found between the exercises (p < 0.001). Post-hoc pair-wise analysis revealed that the EMG activity was larger during the swing exercise than in exercises other than toe spread, both in sitting and standing positions, and short foot exercise with pushing while standing. The minimum MLA angle during each exercise was smaller for the toe spread exercise in a sitting position than other exercises (p < 0.023).
SIGNIFICANCE
A single leg swing exercise may be effective for self-exercise of intrinsic foot muscles, particularly when intensive supervised physiotherapy is not possible.
PubMed: 38905851
DOI: 10.1016/j.gaitpost.2024.06.008 -
International Journal of Occupational... Jun 2024Both physical and psychosocial risk factors contributing to musculoskeletal disorders occur in the professional nursing group, and previous literature suggested that...
OBJECTIVES
Both physical and psychosocial risk factors contributing to musculoskeletal disorders occur in the professional nursing group, and previous literature suggested that their interaction may increase the risk of musculoskeletal pain among nurses. The aim of the study was to examine perceived workload and stress as well as physical findings and musculoskeletal complaints in nurses.
MATERIAL AND METHODS
The participants consisted of 42 female nurses, age range 23-60 years. They marked on a pain drawing the site/sites that was/were painful at the moment of testing, its duration and intensity. Thereafter they were examined using the movement and respiration domains from the Global Physiotherapy Examination (GPE). Furthermore, a subjective workload measure was made using the paper version of the and stress was assessed using the .
RESULTS
Almost the entire study group declared that pain experienced in at least 1 location was chronic, i.e., had lasted ≥1 year (97%). The most frequent locations of pain were low back (22.4%) and cervical/head (21.6%) regions. In the GPE, most scores indicated restricted and reduced movement, with the subdomain flexibility having the highest deviation from the predefined standard. Furthermore, the results indicated hampered respiration, especially visible in standing position. Out of all workload scores, the highest was obtained for temporal demand. Perceived stress level was found to be moderate and significantly associated to chronic chest/ thoracic pain. Interestingly, the compression of thorax test positively correlated with mental (r = 0.42, p < 0.05) and physical demand (r = 0.35, p < 0.05), whereas the elbow drop test and temporal demand correlated negatively (r = -0.37, p < 0.05).
CONCLUSIONS
To sum up, the majority of nurses participating in this study had long-lasting pain and limited flexibility of the body and hampered respiration, which both may enhance intensity of experienced musculoskeletal pain. Int J Occup Med Environ Health. 2024;37(3).
PubMed: 38904294
DOI: 10.13075/ijomeh.1896.02389 -
Porto Biomedical Journal 2024We developed two methods for three-dimensional (3D) evaluation of spinal alignment in standing position by image matching between biplanar x-ray images and 3D vertebral...
We developed two methods for three-dimensional (3D) evaluation of spinal alignment in standing position by image matching between biplanar x-ray images and 3D vertebral models. One used a Slot-Scanning 3D x-ray Imager (sterEOS) to obtain biplanar x-ray images, and the other used a conventional x-ray system and a rotating table. The 3D vertebral model was constructed from the CT scan data. The spatial position of the vertebral model was determined by minimizing the contour difference between the projected image of the model and the biplanar x-ray images. Verification experiments were conducted using a torso phantom. The relative positions of the upper vertebrae to the lowest vertebrae of the cervical, thoracic, and lumbar vertebrae were evaluated. The mean, standard deviation, and mean square error of the relative position were less than 1° and 1 mm in all cases for sterEOS. The maximum mean squared errors of the conventional x-ray system and the rotating table were 0.7° and 0.4 mm for the cervical spine, 1.0° and 1.2 mm for the thoracic spine, and 1.1° and 1.2 mm for the lumbar spine. Therefore, both methods could be useful for evaluating the spinal alignment in standing position.
PubMed: 38903393
DOI: 10.1097/j.pbj.0000000000000256