Wetsuit Thermal Resistivity Measurements.

In recent years, attention to the realization and characterization of wetsuits for scuba diving and other sea sports or activities has increased. The research has aimed to establish reliable and standardized measurement methods to objectively assess wetsuit quality, particularly focusing on their mechanical and thermal properties. In this work, we describe and compare two different measurement methods for the characterization of neoprene wetsuit thermal resistivity. The first method follows the existing regulations in the field, while the second one, which we are originally proposing in this paper, offers an alternative yet accurate way based on a simplified experimental set-up and easier measurements. In both cases, the wetsuit sample under testing was shaped in the form of a cylindrical sleeve of proper dimensions and wrapped around a phantom containing water at a higher temperature and surrounded by water at a lower temperature. The wetsuit's cylindrical surface allows heat flow from the warmer water on the inside to the colder water on the outside through the wetsuit area. In the first case, a thermal steady state was achieved, with constant heat flow from the phantom to the exterior. This was obtained with a power balance between two homogenous quantities. Electrically supplied thermal heating within the phantom was used to balance the thermal energy naturally flowing through the wetsuit's surface. In this first case, a stable and fixed temperature difference was obtained between the inner and the outer surfaces of the wetsuit sample. In the second case, a thermal transient was analyzed during the cooling process of the phantom, and the thermal time constant was measured, providing the sample thermal resistance once the phantom thermal capacity was known. In both cases and methods, the heat flow and thermal resistance of other elements than the wetsuit must be evaluated and compensated for if they are not negligible. Finally, the thermal resistivity per unit area of the wetsuit material was obtained with the product of the wetsuit sample's thermal resistance and the wetsuit area. The measurements, conducted until now by immersing the phantom in a free surface tank, show that both methods-under stationary and under transient temperature conditions-were valid to assess the wetsuit's thermal resistivity. The stationary method somehow provided better accuracy while involving less well-known parameters but at the expense of a more complicated experimental set-up and additional energy consumption. The transitory method, on the other hand, is quite easy to implement and, after careful characterization of the phantom's parameters, it provided similar results to the stationary one. An uncertainty budget was evaluated for both methods, and they did provide highly compatible measurement results, with resistivity values of 0.104(9) m2·K/W (stationary method) and 0.095(9) K·m2/W (transient method) for the same wetsuit sample under testing, which is also consistent with the values in the literature. We finally propose that the novel method is a valid alternative for characterization of the thermal insulation properties of a scuba diving wetsuit.

Burnout and intent-to-leave in physical therapists: a preliminary analysis of factors under organizational control.

METHODS: Twelve hundred PTs were sent a survey packet including the 20-item Ethics Environment Questionnaire (EEQ) and additional items inquiring about contemporary practice factors. Returned packets (n = 340) were analyzed utilizing correlational and regression analyses to determine relationships between ethical environment, burnout, intent-to-leave, productivity standards, billing and coding requirements and ability to provide pro-bono services. RESULTS: There was a strong correlation between PTs' view of organizational ethics and burnout (Tb = -0.55), and a moderate correlation between organizational ethics and intent-to-leave (Tb = -0.43). There was also a strong relationship between burnout/intent-to-leave and practice factors such as productivity standards, billing/coding policy, and organizational provision of pro-bono services (p ≤ 0.01). Finally, there was a moderate correlation between PTs' view of organizational ethics and practice factors such as productivity standards (Tb = 0.46) and billing and coding policy (Tb = -0.45). CONCLUSIONS: Contemporary practice factors such as productivity standards and billing/coding practices are related PT's perception of ethical workplace environment and both are related to PT burnout and intent-to-leave. Factors identified in this study related to burnout are all under organizational control.

Superior Mesenteric Artery Syndrome: A Community Hospital Case Series.

Superior mesenteric artery syndrome is an obstruction of the small bowel between the aorta and the superior mesenteric artery. Patients with this disease are initially managed medically and those patients who fail medical treatment require surgery. A retrospective case series of thirteen patients diagnosed with SMAS at Flushing Hospital, Flushing, NY, from 2011 to 2020 was performed. Descriptive statistics were used to summarize the characteristics of the entire cohort, and comparative statistics were used to compare the patients who failed medical treatment and required surgery to those who were successfully managed medically. Nine patients were managed conservatively and four patients required operative intervention. BMI was significantly lower in patients requiring operation compared to those who were successfully managed medically. This retrospective community hospital case series adds to the literature on SMAS and provides evidence of BMI as a potential predictor of requiring surgery in SMAS.

Physical Therapists' Ethical Dilemmas in Treatment, Coding, and Billing for Rehabilitation Services in Skilled Nursing Facilities: A Mixed-Method Pilot Study.

OBJECTIVES: Reimbursement in skilled nursing facilities (SNFs) is driven by the number of minutes a patient receives rehabilitation. Physical therapists' (PTs) clinical decisions in evaluation and appropriate treatment of patients drive the dosing of rehabilitation services. Many times these 2 dynamics clash. The purpose of this study was to determine how PTs in SNFs viewed their ethical work environment, what primary issues drove their views, and what potential solutions were identified for the issues. DESIGN: This was a mixed-methods, cross-sectional survey study. SETTING AND PARTICIPANTS: An organizational ethics survey along with 2 open-ended questions were sent to a random sample of 1200 PTs in the state of Georgia; 340 surveys were returned, and the respondents were categorized into 9 typical PT work settings. Twenty eight participants (8.2%) reported they worked in SNFs. MEASURES: The Ethics Environment Questionnaire was the quantitative measurement tool used for the study. In addition, 2 open-ended questions were asked regarding ethical concerns and possible solutions to those concerns. RESULTS: Of the 9 workplace settings, therapists working in SNFs had the lowest perceptions of ethical work environment. They were also the only group that scored below the survey cut-off point for positive ethical work environment. Their primary concerns were overutilization issues, productivity standards, and billing and coding issues. The 2 primary themes regarding solutions were allowing PTs to be autonomous in their decision making and decreasing productivity standards. CONCLUSIONS/IMPLICATIONS: The current Medicare reimbursement system rewards quantity of rehabilitation over quality. PTs are trained to deliver quality care that is dosed appropriately, and this may conflict with organizational objectives. The primary implication in this study is that clinicians and administrators should engage more in open, honest dialogue on how to share responsibility and balance organizational goals with clinical ethics.

Physical therapists' perception of workplace ethics in an evolving health-care delivery environment: a cross-sectional survey.

Physical therapists are trained and obligated to deliver optimal health care and put patients first above all else. In the changing health-care environment, health-care organizations are grappling with controlling cost and increasing revenues. Moral distress may be created when physical therapists' desire to provide optimal care conflicts with their organization's goals to remain financially viable or profitable. Moral distress has been associated with low perception of ethical environment, professional burnout, and high turnover in organizations. This study identified groups who may be vulnerable to low perception of organizational ethical environment and identified self-reported strategies to remedy these perceptions. An ethics environment questionnaire was mailed to a random sample of 1200 physical therapists in Georgia. Respondents (n = 340) were analyzed by age, workplace setting, and position in organization. Therapists working in skilled nursing/assisted living environments scored the lowest on the questionnaire and voiced concerns regarding their ethical work environments. Owners and executives perceived their organizations to be more ethical than front-line clinicians. Respondent concerns included high productivity standards, aggressive coding/billing policies, decreased reimbursement, and increased insurance regulation. Possible solutions included more frequent communication between management and clinicians about ethics, greater professional autonomy, and increased training in business ethics and finance.

Effects of phonophoresis with gold nanoparticles on oxidative stress parameters in a traumatic muscle injury model.

The aim of this study was to evaluate the effects of therapeutic pulsed ultrasound with gold nanoparticles on oxidative stress parameters after traumatic muscle injury in Wistar rats. The animals were randomly divided into nine groups (n = 6 each): sham (uninjured muscle); muscle injury without treatment; muscle injury and treatment with dimethyl sulfoxide (15 mg/kg); muscle injury and treatment with gold nanoparticles (27 µg); muscle injury and treatment with dimethyl sulfoxide + gold nanoparticles (Plus); muscle injury and therapeutic pulsed ultrasound; muscle injury and therapeutic pulsed ultrasound + dimethyl sulfoxide; muscle injury and therapeutic pulsed ultrasound + gold nanoparticles; and muscle injury and therapeutic pulsed ultrasound + Plus. Gastrocnemius injury was induced by a single-impact blunt trauma. Therapeutic pulsed ultrasound (6-min application, frequency 1.0 MHz, intensity 0.8 W/cm(2)) was used 2, 12, 24, and 48 h after trauma. Mitochondrial superoxide generation, lipid peroxidation, and protein carbonylation, and the activities of superoxide dismutase, glutathione peroxidase, and catalase were evaluated. The increase in the superoxide production and TBARS and carbonyl levels observed in the control group after muscle damage were reduced in animals exposed to therapeutic pulsed ultrasound plus nanoparticles. Similarly, antioxidants enzymes showed a decreased activity with the same treatment. Our work suggest that therapeutic pulsed ultrasound + dimethyl sulfoxide + gold nanoparticles has beneficial effects on the muscle healing process by inducing a decrease in oxidative stress parameters and most likely decreasing the deleterious effects of the inflammatory response.

Routine versus selective abdominal computed tomography scan in the evaluation of right lower quadrant pain: a randomized controlled trial.

OBJECTIVES: To determine the role of abdominal computed tomography (CT) imaging in patients with right lower quadrant (RLQ) pain. The authors hypothesized that selective use of abdominal CT would reduce imaging without increasing the rates of negative appendectomy and perforated appendicitis. METHODS: A prospective randomized clinical trial was conducted in a community teaching emergency department. Adult patients with acute RLQ abdominal pain with suspected acute appendicitis were included. Patients were randomized to mandatory (all patients) or selective (based on clinical evaluation) abdominal CT imaging. The primary outcome was the negative appendectomy rate. RESULTS: A total of 152 patients were randomized to selective (n = 80) and mandatory (n = 72) intervention groups. The mean (+/-SD) age was 34.1 (+/-3.5) years, and 48% were female. CT imaging was performed in 54 of 80 patients (68%; 95% confidence interval [CI] = 56% to 78%) in the selective group and in 70 of 72 patients (97%; 95% CI = 90% to 100%) in the mandatory group. There was a trend to a decreased rate of negative appendectomy in the mandatory group (1/39 [2.6%]; 95% CI = 0.5% to 13.2%) as compared with the selective group (6/43 [13.9%]; 95% CI = 6.6% to 27.3%), with a difference in prevalence rates of 11.3% (95% CI = -3.5% to 26.3%). There was also a trend to a decreased perforated appendix rate in the mandatory group (4/39 [10.3%]) as compared with the selective group (7/38 [18.4%]), with a difference in prevalence rates of 8.2% (95% CI = -8.0% to 24.4%). CONCLUSIONS: In this small sample of adult patients with RLQ abdominal pain and suspected acute appendicitis, CT imaging was performed less frequently in the selective group and there was a trend with mandatory CT imaging to reduced rates of negative appendectomy and perforated appendices.

Objective quality of vision in presbyopic and non-presbyopic patients after pseudoaccommodative advanced surface ablation.

PURPOSE: To analyze the objective quality of vision at 6 months postoperatively after pseudoaccommodative (presbyopic) advanced surface ablation (PASA). METHODS: The study comprised 62 eyes of 35 patients with 6-month follow-up that underwent primary or secondary treatments using PASA. Pre- and postoperative results of distance and near uncorrected visual acuity (UCVA), spherical aberration (coefficient of the Z12 Zernike polynomial), and the asphericity (Q) index were reviewed. The corresponding wavefront maps (total, low, and high order aberrations) and the corresponding point spread function and modulation transfer function (MTF) were also calculated. RESULTS: Our results show that PASA improves distance and near mean UCVA, increases negative spherical aberration and negative asphericity index, and improves the corresponding MTF. CONCLUSIONS: Pseudoaccommodative advanced surface ablation is a promising approach for the surgical correction of presbyopia with distance refractive error (myopia and hyperopia with or without astigmatism). This PASA technique could theoretically be used in non-presbyopic patients with refractive error or post cataract patients with monofocal intraocular lenses. The increase in negative spherical aberration and asphericity/eccentricity index seems to increase the depth of focus of the eye, improving the near vision and compensating the age-related lens changes. Rather than creating a multifocal cornea, PASA appears to create an improved aspheric (prolate) ablation profile.

Whole eye wavefront aberrations in Mexican male subjects.

PURPOSE: To analyze the characteristics, incidence, and appearance of wavefront aberrations in undilated, normal, unoperated eyes. METHODS: Eighty-eight eyes of 44 healthy male Mexican subjects (mean age 25.32 years, range 18 to 36 yr) were divided into three groups based on uncorrected visual acuity of greater than or equal to 20/20, 20/30, or 20/40. UCVA measurements were obtained using an Acuity Max computer screen chart. Wavefront aberrations were measured with the Nidek OPD-Scan ARK 10000, Ver. 1.11b. All measurements were carried out at the same center by the same technician during a single session, following manufacturer instructions. Background illumination was 3 Lux. RESULTS: Wavefront aberration measurements for each group were statistically analyzed using StatView; an average eye was characterized and the resulting aberrations were simulated using MATLAB. We obtained wavefront aberration maps for the 20/20 undilated normal unoperated eyes for total, low, and high order aberration coefficients. Wavefront maps for right eyes were practically the same as those for left eyes. Higher aberrations did not contribute substantially to total wavefront analysis. CONCLUSIONS: Average aberrations of this "normal eye" will be used as criteria to decide the necessity of wavefront-guided ablation in our facilities. We will focus on the nearly zero average of high order aberrations in this normal whole eye as a reference to be matched.

Advanced surface ablation for presbyopia using the Nidek EC-5000 laser.

PURPOSE: To present 1 to 6-month follow-up results of laser in situ keratomileusis (LASIK) using multizone presbyopic advanced surface ablation (PASA) with a peripheral near zone. METHODS: LASIK was performed on 28 eyes of 17 patients (10 men and 7 women; mean age 49.8 years with a range of 37 to 62 years). Eyes had primary or enhancement treatments with the Nidek EC-5000 excimer laser. Three techniques were used: 1) total transepithelial ablation, 2) surface ablation for far vision ametropia correction, and 3) concentric peripheral near zone presbyopia correction (technique developed by Dr. A. Telandro with a modified nomogram by Dr. R. Cantú for surface ablation). One surgeon (RC) performed all surgery. RESULTS: We present the preoperative and postoperative measurements for far and near uncorrected visual acuity, total high order aberrations, spherical aberration (Z-12), asphericity Q index, eccentricity corneal shape factor, and total coma and trefoil aberrations. Increases occurred in negative spherical aberration, negative asphericity index, and positive eccentricity corneal shape factor. CONCLUSIONS: Advanced surface ablation for presbyopia with a concentric peripheral near zone is a promising approach for surgical correction of presbyopia and potentially could be used with any advanced surface ablation procedure. Increases in negative spherical aberration and asphericity/ eccentricity indices seemed to increase the depth of focus of the eye, improving the near vision.