Academic literature on the topic 'Action Observation Treatment'
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Journal articles on the topic "Action Observation Treatment"
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Buccino, Giovanni. "Action observation treatment: a novel tool in neurorehabilitation." Philosophical Transactions of the Royal Society B: Biological Sciences 369, no. 1644 (June 5, 2014): 20130185. http://dx.doi.org/10.1098/rstb.2013.0185.
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This review focuses on a novel rehabilitation approach known as action observation treatment (AOT). It is now a well-accepted notion in neurophysiology that the observation of actions performed by others activates in the perceiver the same neural structures responsible for the actual execution of those same actions. Areas endowed with this action observation–action execution matching mechanism are defined as the mirror neuron system. AOT exploits this neurophysiological mechanism for the recovery of motor impairment. During one typical session, patients observe a daily action and afterwards execute it in context. So far, this approach has been successfully applied in the rehabilitation of upper limb motor functions in chronic stroke patients, in motor recovery of Parkinson's disease patients, including those presenting with freezing of gait, and in children with cerebral palsy. Interestingly, this approach also improved lower limb motor functions in post-surgical orthopaedic patients. AOT is well grounded in basic neuroscience, thus representing a valid model of translational medicine in the field of neurorehabilitation. Moreover, the results concerning its effectiveness have been collected in randomized controlled studies, thus being an example of evidence-based clinical practice.
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KRASKOV, ALEXANDER. "The role of inhibition in action observation treatment." Developmental Medicine & Child Neurology 54, no. 9 (July 5, 2012): 778. http://dx.doi.org/10.1111/j.1469-8749.2012.04356.x.
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D’Innocenzo, Giorgia, Alexander V. Nowicky, and Daniel T. Bishop. "Dynamic task observation: A gaze-mediated complement to traditional action observation treatment?" Behavioural Brain Research 379 (February 2020): 112351. http://dx.doi.org/10.1016/j.bbr.2019.112351.
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Rossi, Fabio, Federica Savi, Andrea Prestia, Andrea Mongardi, Danilo Demarchi, and Giovanni Buccino. "Combining Action Observation Treatment with a Brain–Computer Interface System: Perspectives on Neurorehabilitation." Sensors 21, no. 24 (December 20, 2021): 8504. http://dx.doi.org/10.3390/s21248504.
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Action observation treatment (AOT) exploits a neurophysiological mechanism, matching an observed action on the neural substrates where that action is motorically represented. This mechanism is also known as mirror mechanism. In a typical AOT session, one can distinguish an observation phase and an execution phase. During the observation phase, the patient observes a daily action and soon after, during the execution phase, he/she is asked to perform the observed action at the best of his/her ability. Indeed, the execution phase may sometimes be difficult for those patients where motor impairment is severe. Although, in the current practice, the physiotherapist does not intervene on the quality of the execution phase, here, we propose a stimulation system based on neurophysiological parameters. This perspective article focuses on the possibility to combine AOT with a brain–computer interface system (BCI) that stimulates upper limb muscles, thus facilitating the execution of actions during a rehabilitation session. Combining a rehabilitation tool that is well-grounded in neurophysiology with a stimulation system, such as the one proposed, may improve the efficacy of AOT in the treatment of severe neurological patients, including stroke patients, Parkinson’s disease patients, and children with cerebral palsy.
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Palomo-Carrión, Rocío, Juan Carlos Zuil-Escobar, Myriam Cabrera-Guerra, Paloma Barreda-Martínez, and Carmen Belén Martínez-Cepa. "Mirror Therapy and Action Observation Therapy to Increase the Affected Upper Limb Functionality in Children with Hemiplegia: A Randomized Controlled Trial Protocol." International Journal of Environmental Research and Public Health 18, no. 3 (January 25, 2021): 1051. http://dx.doi.org/10.3390/ijerph18031051.
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The movements of the affected upper limb in infantile hemiplegia are slower and clumsy. This leads to a decrease in the use of the affected hand. The visual effect obtained using the mirror box and the observation of actions in another individual can activate the same structural neuronal cells responsible for the execution of these actions. This research will study the affected upper limb functionality in hemiplegia infantile from 6 to 12 years old after the application of two intervention protocols: observation action therapy and mirror therapy combined with observation action therapy. Children with a diagnose of congenital infantile hemiplegia will be recruited to participate in a randomized controlled trial with two intervention protocols during four weeks (1 h per/day; 5 sessions per/week): Mirror Therapy Action Observation (MTAO) or Action Observation Therapy (AOT). The study variables will be: spontaneous use, measured with the Assisting Hand Assessment (AHA); manual ability measured with the Jebsen Taylor Hand Function Test (JTHFT); surface electromyography of the flexors and extensors muscles of the wrist and grasp strength through a grip dynamometer. Four assessments will be performed: At baseline situation, at the end of treatment, 3 and 6 months after treatment (follow-up assessments). This study will study the effects of these therapies on the use of the affected upper limb in children with hemiplegia.
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Hsieh, Yu-Wei, Yu-Hsuan Lin, Jun-Ding Zhu, Ching-Yi Wu, Yun-Ping Lin, and Chih-Chi Chen. "Treatment Effects of Upper Limb Action Observation Therapy and Mirror Therapy on Rehabilitation Outcomes after Subacute Stroke: A Pilot Study." Behavioural Neurology 2020 (January 2, 2020): 1–9. http://dx.doi.org/10.1155/2020/6250524.
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Background. Action observation therapy and mirror therapy, two promising rehabilitation strategies, are aimed at enhancing the motor learning and functional improvement of stroke patients through different patterns of visual feedback and observation. Objective. This study investigated and compared the treatment effects of the action observation therapy, mirror therapy, and active control intervention on motor and functional outcomes of stroke patients. Methods. Twenty-one patients with subacute stroke were recruited in this study. All patients were randomly assigned to the action observation therapy, mirror therapy, or active control intervention for 3 weeks. Outcome measures were conducted at baseline, immediately after treatment, and at 3-month follow-up. The primary outcome was the Fugl-Meyer Assessment, and secondary outcomes included the Box and Block Test, Functional Independence Measure, and Stroke Impact Scale. Descriptive analyses and the number of patients whose change score achieved minimal clinically important difference were reported. Results. Both the action observation therapy and active control intervention showed similar improvements on the Fugl-Meyer Assessment, Box and Block Test, and Stroke Impact Scale. Moreover, the action observation therapy had a greater improvement on the Functional Independence Measure than the other 2 groups did. However, the mirror therapy group gained the least improvements on the outcomes. Conclusion. The preliminary results found that the patients in the action observation therapy and active control intervention groups had comparable benefits, suggesting that the 2 treatments might be used as an alternative to each other. A further large-scale study with at least 20 patients in each group to validate the study findings is needed. This trial is registered with NCT02871700.
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Hioka, Akemi, Yoshiteru Tada, Keiko Kitazato, Naoki Akazawa, Yasushi Takagi, and Shinji Nagahiro. "Action observation treatment improves gait ability in subacute to convalescent stroke patients." Journal of Clinical Neuroscience 75 (May 2020): 55–61. http://dx.doi.org/10.1016/j.jocn.2020.03.031.
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Toro, Christina del, and Megan Cuellar. "Action Observation Treatment for Verb Naming in Aphasia: Picture vs. Video Stimuli." Archives of Physical Medicine and Rehabilitation 100, no. 10 (October 2019): e39. http://dx.doi.org/10.1016/j.apmr.2019.08.098.
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Zabolotskiy, A. "Observation of the action of ichthyol in women's practice." Journal of obstetrics and women's diseases 7, no. 3 (September 6, 2020): 279–82. http://dx.doi.org/10.17816/jowd73279-282.
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The author used ichthyol in 278 cases, using it not only in gynecological cases, but for the treatment of this organism in general, guided by the following pharmacological data: being the double salts of ichthyosulfinic sodium sodium with ammonium, zinc, lithium and containing mainly sulfur, greedily combines with water, what is the effect of reduction and drying; and the ability to irritate tissues less than other drugs has already been proven Unn, They constrict blood vessels, absorb the liquid parts of inflammatory products, (bloodless tissues, and quickly destroy their swelling).
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Santamato, Andrea, Maurizio Ranieri, Nicoletta Cinone, Lucia Anna Stuppiello, Giovanni Valeno, Jula Laura De Sanctis, Francesca Fortunato, et al. "Postural and Balance Disorders in Patients with Parkinson’s Disease: A Prospective Open-Label Feasibility Study with Two Months of Action Observation Treatment." Parkinson's Disease 2015 (2015): 1–7. http://dx.doi.org/10.1155/2015/902738.
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Action observation treatment has been proposed as therapeutic option in rehabilitation of patients affected by Parkinson’s disease (PD) to improve freezing of gait episodes. The purpose of this prospective open-label feasibility study was to evaluate the impact of 8-week action observation training (video-therapy) for the treatment of postural instability and balance impairment in PD patients. Fifteen PD patients aged under 80 years with scores of 1 to 3 on the Hoehn and Yahr staging and without evidence of freezing of gait were recruited. They underwent 24 sessions of video-therapy training based on carefully watching video clips on motor tasks linked to balance, subsequently performing the same observed movements. No statistically significant differences were observed in the identified outcome measures with the Berg Balance Scale and the Activities-Specific Balance Confidence Scale after two months of follow-up. In the present study, a short course of action observation treatment seems to be not effective in reducing balance impairments and postural instability in patients affected by mild to moderate PD. Further studies with larger samples, longer follow-up period, and standardized protocols of action observation treatment are needed to investigate the effects of this rehabilitation technique in the management of postural and balance disorders of PD patients.
Dissertations / Theses on the topic "Action Observation Treatment"
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Molinaro, Anna. "INFLUENZA DELL’OSSERVAZIONE DEL MOVIMENTO SULL’APPRENDIMENTO MOTORIO NELLA RIABILITAZIONE DI SOGGETTI IN ETÀ EVOLUTIVA AFFETTI DA PARALISI CEREBRALE INFANTILE." Doctoral thesis, Università degli studi di Trieste, 2015. http://hdl.handle.net/10077/10853.
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2013/2014INTRODUZIONE: Sulla base delle evidenze del coinvolgimento del sistema dei Neuroni Mirror (MN) nei processi di apprendimento motorio, è stato ipotizzato un ruolo della terapia di osservazione delle azioni (Action Observation Treatment, AOT) nella riabilitazione di pazienti con Paralisi Cerebrale (PC). L’ipotesi è che l’AOT, già applicata con successo nei soggetti adulti per il recupero delle funzioni motorie dopo stroke o chirurgia ortopedica e nei soggetti affetti da morbo di Parkinson, in età evolutiva vada ad agire su un sistema di neuroni specchio ancora “intatto”, promuovendo l’apprendimento di abilità attraverso una modalità di scomposizione di attività complesse osservate in atti semplici, e nella loro ricomposizione in sequenze nuove. SCOPO DELLO STUDIO: Obiettivo principale dello studio è quello di dimostrare l’efficacia dell’Action Observation Treatment nel migliorare la performance motoria dell’arto superiore in una coorte di bambini affetti da Paralisi Cerebrale Infantile. MATERIALI E METODI: Studio randomizzato controllato, in cieco, multicentrico. I criteri di reclutamento e le procedure metodologiche sono state approvate dal Comitato Etico degli Spedali Civili di Brescia. I pazienti arruolati vengono assegnati in modo casuale al gruppo sperimentale o al gruppo di controllo per mezzo di un software dedicato. I criteri di inclusione sono: diagnosi di Paralisi Cerebrale Infantile; età compresa tra i 5 ed i 12 anni; QI verbale ≥ 70; integrità sistema visivo/uditivo; Modified Ashworth scale(MAS) ≤2; Manual Ability Classification System (MACS) <4. Ai bambini del gruppo sperimentale viene chiesto di osservare video-clip che mostrano azioni quotidiane appropriate all'età, e poi di imitarli. I bambini appartenenti al gruppo controllo sono invitati ad osservare video-clip senza contenuti motori e in seguito ad eseguire le stesse azioni presentate al gruppo sperimentale, dopo descrizione verbale standardizzta.. La valutazione dell'efficacia del trattamento viene eseguita utilizzando la scala Assisting Hand Assessment, la scala Melbourne e il questionario ABILHAND-Kids. I bambini sono valutati due volte prima dell'inizio del trattamento (a distanza di due settimane), alla fine del trattamento e dopo 8 settimane dal termine della terapia.. Allo scopo di confermare in modo indipendente la presenza di una influenza della visione delle azioni sul sistema dei MN, i soggetti partecipanti allo studio hanno effettuato pre- e post- trattamento un indagine di Risonanza Magnetica funzionale (fMRI) che prevede l’impiego di uno specifico paradigma di stimolazione corticale, appositamente disegnato per attivare il circuito dei neuroni mirror. Per la messa a punto di questo studio e per una preliminare valutazione delle aree di attivazione interessate dalla manipolazione, il protocollo fMRI è stato applicato a un gruppo di bambini sani, dimostrando l’esistenza di un circuito fronto-parietale, attivato durante compiti di manipolazione, anche nei soggetti in età pediatrica. L’utilizzo del DTI ha consentito di dimostrare, in maniera probabilistica, la presenza di fasci di connessione tra le aree somatosensoriali primarie e secondarie, il lobo parietale superiore ed inferiore, e la corteccia premotoria ventrale e dorsale. RISULTATI: I risultati presentati si riferiscono a un campione di 12 soggetti (F=7), con età media di 8 anni e 6 mesi; dopo randomizzazione, 6 pazienti sono stati assegnati al gruppo sperimentale e 6 al gruppo di controllo. Al momento attuale, tutti i 12 pazienti descritti hanno effettuato le valutazioni conclusive previste al termine del ciclo di terapia (T2), e 9 pazienti sono stati sottoposti alle valutazioni di follow-up a 8 settimane dalla fine del trattamento (T3). Pur non essendo possibile considerare i risultati conclusivi in considerazione della numerosità attuale del campione (50% dell’atteso), i dati ottenuti hanno consentito di mettere in luce una differenza tra gruppo sperimentale e gruppo di controllo. Confrontando i punteggi ottenuti dai soggetti al termine del trattamento (T2) con quelli ottenuti alle scale di valutazione ad inizio trattamento (T1) è possibile evidenziare nel gruppo sperimentale un miglioramento dei punteggi in entrambe le scale di valutazione dell’arto superiore, che risulta invece nettamente meno significativo nel gruppo di controllo. Questa differenza quantitativa evidenziabile tra il periodo pre- e post- trattamento confermerebbe l’efficacia dell’applicazione dell’ Action Observation Treatment. I diversi risultati ottenuti nel gruppo sperimentale e nei controlli non possono essere spiegati dall’attività motoria svolta durante la sessione di riabilitazione, poiché in entrambi i gruppi è stata programmata la stessa quantità di movimento, ma la spiegazione più plausibile di questi risultati è che l’osservazione dell’azione abbia portato ad un attivazione specifica a livello centrale delle strutture neurali normalmente attive durante l’esecuzione dell’azione. Inoltre, nella verifica del risultato a lungo termine dell’intervento terapeutico, il miglioramento del gruppo sperimentale si è mantenuto costante ed è incrementato nelle valutazioni di follow-up (T3), mentre il gruppo di controllo è rimasto invariato, suggerendo la possibilità di un meccanismo di miglioramento della riorganizzazione funzionale cerebrale nei pazienti sottoposti ad AOT. Considerando i risultati del solo gruppo sperimentale, in questi bambini è evidente come gli effetti ottenuti grazie all’applicazione dell’AOT siano più significativi in termini di promozione dell’utilizzo spontaneo dell’arto trattato, misurato dalla scala AHA, piuttosto che di miglioramento dei parametri cinematici rilevati dalla scala MUUL, ad indicare che, nei bambini, l'osservazione suscita una propensione a preservare la competenza nell’eseguire il compito, selezionando i movimenti che garantiscono il risultato, a prescindere dalla somiglianza cinematica con il modello osservato.Il protocollo di studio RM nei bambini con PCI ha permesso di dimostrare un coinvolgimento del medesimo circuito fronto-parietale evidenziato nei volontari sani, e un aumento della rappresentazione corticale delle aree coinvolte nella manipolazione a livello dell’emisfero lesionato. In particolare, il confronto delle acquisizioni fra gruppo di controllo e gruppo sperimentale ha mostrato per quest’ultimo un incremento statisticamente significativo di attivazioni nelle aree parietali, frontali precentrale e opercolare, corrispondenti alla localizzazione del sistema dei neuroni mirror. Limite del presente studio è sicuramente il piccolo numero di bambini attualmente arruolati, tuttavia l'omogeneità del campione, ottenuta con criteri di inclusione selettivi, garantisce una elevata affidabilità dei risultati ottenuti. Infine, i risultati forniscono informazioni indirette anche sulla ontogenesi del sistema dei neuroni specchio. Non è ancora stato chiarito se la presenza dei neuroni mirror sia innata o se si sviluppi in parallelo con l'esperienza motoria; i risultati attuali mostrano chiaramente che, almeno per l'età della scuola primaria, il network dei neuroni mirror può diventare il bersaglio di AOT e, quindi, indirettamente, suggeriscono la maturità del sistema a questa età. CONCLUSIONI: I risultati ottenuti nel presente studio, anche se non definitivi, forniscono la prova dell’efficacia dell’AOT nel migliorare l’utilizzo spontaneo dell’arto superiore in bambini con PCI.
XXVII Ciclo
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Ateba, ndongo Francis. "Traitement antirétroviral précoce des nourrissons infectés par le VIH-1 : évaluation de la réponse virologique à court et moyen termes dans un pays d’Afrique sub-saharienne (Cameroun) Could caregiver reporting adherence help detect virological failure in Cameroonian early treated HIV-infected infants Virological response to early combined antiretroviral therapy in HIV-infected infants: evaluation after 2 years of treatment in the PEDIACAM study, Cameroon Low Birth Weight in Perinatally HIV-Exposed Uninfected Infants: Observations in Urban Settings in Cameroon Feasibility of Routinely Offering Early Combined Antiretroviral Therapy to HIV-infected Infants in a Resource-limited Country: The ANRS-PediaCAM Study in Cameroon Different factors associated with loss to follow-up of infants born to HIV-infected or uninfected mothers: observations from the ANRS12140-PEDIACAM study in Cameroon Cytomegalovirus infection in HIV-infected versus non-infected infants and HIV disease progression in Cytomegalovirus infected versus non-infected infants early treated with cART in the ANRS 12140—Pediacam study in Cameroon." Thesis, Université Paris-Saclay (ComUE), 2017. http://www.theses.fr/2017SACLS322.
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Introduction : Depuis 2015, l’OMS recommande la mise sous traitement antirétroviral systématique de tous les enfants infectés par le VIH pour réduire la mortalité précoce liée au VIH chez les nourrissons en l’absence de traitement. Cependant, malgré la disponibilité des tests de dépistage et des médicaments antirétroviraux, l’initiation précoce de ces traitements reste un défi majeur dans les pays à ressources limitées. L’étude ANRS 12140-PEDIACAM est mise en place pour évaluer la faisabilité, l’efficacité et la tolérance en routine du traitement précoce des enfants infectés par le VIH au Cameroun. Objectifs : Les objectifs de cette thèse visaient à étudier la mortalité et la réponse virologique à deux et quatre ans après l’initiation précoce d’un traitement antirétroviral chez les nourrissons infectés par le VIH, et à identifier les facteurs associés à l’obtention et au maintien d’un succès virologique.Méthodes : Les analyses ont porté sur les 190 enfants infectés par le VIH traités avant l’âge de 1 an (médiane=4 mois), inclus dans les trois sites cliniques du Cameroun participant à la cohorte prospective ANRS PEDIACAM initiée en 2007. La première étude a évalué les performances d’un critère basé sur le nombre de doses manquées de traitement rapporté dans un questionnaire d’observance pour dépister un échec virologique chez les nourrissons. La seconde étude portait sur l’estimation de la fréquence et des facteurs associés à l’obtention d’un succès virologique et à la mortalité à deux ans du traitement, utilisant un modèle de survie à risque compétitif. La troisième concernait l’évolution de la réponse virologique entre 2 et 4 ans du traitement selon le statut virologique obtenu à deux ans.Résultats : Les performances du questionnaire d’observance administré à l’accompagnant du nourrisson s’avèrent limitées, avec une valeur prédictive positive trop faible pour dépister un échec virologique en l’absence de charge virale disponible. La mortalité reste élevée à un an du traitement précoce (18,0% [IC95% : 13,0 - 24,0]). Elle est de 3,3% [IC95% : 0,4 - 6,2] entre 2 et 4 ans de traitement. La probabilité d’atteindre au moins un succès virologique avant 2 ans de traitement est de 80% environ, mais celle d’obtenir une suppression virologique maintenue sur au moins 6 mois n’est que de 67% au seuil de 1000 copies/mL, et de 60% au seuil de 400 copies/mL. A 4 ans du traitement initial, la proportion de charge virale contrôlée (<400 copies/mL) est de 75,2% [68,3-82,1]) chez les 144 enfants toujours vivants et suivis, mais pour 12% la charge virale n’a pas été mesurée. Le seul facteur associé significativement au succès virologique dans les 2 ans du traitement initial est la bonne observance rapportée par l’accompagnant. Et seuls un succès virologique obtenu à 2 ans et l’initiation plus récente du traitement antirétroviral sont associés à un charge virale contrôlée à 4 ans.Conclusion : Même si l’intérêt du traitement précoce des nourrissons infectés par le VIH est démontré, le succès virologique à moyen et long terme passe par des stratégies favorisant l’administration quotidienne soutenue des médicaments et une surveillance régulière de la réponse virologique. L’évaluation de l’observance par questionnaire présente une trop faible performance pour dépister précocement un échec virologique. Il est urgent de donner un accès large à la mesure de la charge virale en routine dans les pays à ressources limitées pour dépister rapidement les échecs virologiques chez les enfants recevant un traitement antirétroviralIntroduction: Since 2015, the WHO recommends to start antiretroviral treatment promptly in all HIV-infected children in order to reduce HIV related mortality. Despite increasing availability of screening tests and antiretroviral drugs, early initiation of antiretroviral treatment (ART) remains challenging in resource-limited countries. The ANRS 12140-Pediacam study assesses feasibility, effectiveness and tolerability in routine practice of early treatment of HIV-infected children in Cameroon. Objectives: The objectives of this thesis are to study mortality and virologic response at 2 and 4 years of early initiation of ART in HIV-infected infants and identify factors associated with virologic success. Methods: The analysis concerned the 190 HIV-infected infants who have initiated ART no later than 1 year (median=4 months) and were enrolled in the 3 Cameroon clinical sites involved in the PEDIACAM prospective cohort study since 2007. The first study evaluated adherence criterium based on the number of missed doses as reported through an adherence questionnaire in oerder to detect virologic failure in infants. The second study concerned the evaluation of the frequency and the factors associated with virologic success and mortality at 2 years of ART initiation, using competing risk regression. The third study concerned the evolution of virologic response between 2 and 4 years of QRT initiation depending on virologic status achieved at 2 years of ART initiation. Results: The performances of adherence questionnaire administered to the infant's caregiver are limited; the positive predictive value is low for detecting virologic failure in the absence of viral load exam. The mortality is high at 1 year after early ART initiation (18.0% [95% CI: 13.0 – 24.0]). The mortality is 3.3% [95%CI: 0.4 – 6.2] between 2 and 4 years of ART initiation. The probability of achieving at least once virologic success within the first 2 years of ART is around 80.0% but the probability of maintaining virologic success for at least 6 months was 67% for threshold=1000 copies/mL and 60% for threshold=400 copies/mL. At 4 years of ART initiation, the proportion of virologic success (viral load<400 copies/mL) is 75.2% [68.3-82.1]) in the 144 children still alive among whom viral load exam was not performed. The only factor associated with virologic success at 2 years of ART initiation is good adherence as reported by the caregiver. Et seuls un succès virologique obtenu à 2 ans et l’initiation plus récente du traitement antirétroviral sont associés à un charge virale contrôlée à 4 ans.Conclusion: Although the interest of early ART in HIV-infected infants is demonstrated, the mid and long term virologic success pass through strategies enhancing supporting steady and daily administration of drugs and regular monitoring of virologic response. The steady evaluation of adherence as reported by questionnaire has a very low performance for early detecting virologic failure. It is urgent to widely get access to routine viral load exam in resource-limited countries for quickly detecting virologic failures in children receiving antiretroviral treatment
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Chen, Yu I., and 陳有毅. "Treatment effects of incorporating motor imagery into action observation therapy in patients with subacute stroke: A preliminary study." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/hkfuqz.
Full textBooks on the topic "Action Observation Treatment"
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Office, General Accounting. Drug control: Observations on elements of the federal drug control strategy : report to Congressional requesters. Washington, D.C: The Office, 1997.
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Participatory Research in Palliative Care: Actions and Reflections. Oxford University Press, Incorporated, 2012.
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Beaulieu, Pierre. Mechanisms of action of acetaminophen for pain treatment. Edited by Paul Farquhar-Smith, Pierre Beaulieu, and Sian Jagger. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198834359.003.0046.
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The landmark paper discussed in the chapter, published by 2008 by Mallet et al., reports on the mechanisms of action of acetaminophen for pain treatment. Acetaminophen, also known as paracetamol (N-acetyl-para-aminophenol), has analgesic and antipyretic properties and has superior tolerance, compared to non-steroidal anti-inflammatory drugs, making it appropriate for widespread use in patients. However, despite many years of use worldwide and numerous studies, acetaminophen’s mechanism of action is still uncertain. The article by Mallet et al. is a landmark paper because it reconciled many observations made at the time to propose a plausible mechanism of action of acetaminophen in pain treatment.
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Rosenberg, Dorothy Goldin. Action for prevention: Feminist practices in transformative learning in women's health and the environment (with a focus on breast cancer) : a case study of a participatory research circle. 1999.
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Clinical research on the efficacy of TENS. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199673278.003.0008.
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The acceptance of a treatment into mainstream medicine is influenced by a wide variety of factors. Traditionally, practitioners rely on information gleaned from their experience of using treatments on their patients although this can be misleading. Clinical research uses experiments to determine whether therapeutic effects of a treatment are attributed to its active ingredient by removing biases that confound clinical observation. This helps to determine whether treatments are efficacious. The purpose of this chapter is to overview evidence from clinical research on the efficacy of TENS for the management of pain by covering evidence-based practice, clinical research on acute pain including post-operative pain and labour pain, chronic musculoskeletal pain, including back pain and osteoarthritis, chronic neuropathic pain, including peripheral and central neuropathic pain, and cancer pain. It also discusses challenges in TENS research.
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Participatory Research In Palliative Care Actions And Reflections. Oxford University Press, 2013.
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Mowafak, Abdelghani. Botox analgesia for neuropathic pain. Edited by Paul Farquhar-Smith, Pierre Beaulieu, and Sian Jagger. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198834359.003.0072.
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The landmark paper discussed in this chapter is ‘Botulinum toxin type A induces direct analgesic effects in chronic neuropathic pain’, published by Ranoux et al. in 2008. The muscle-relaxant properties of botulinum toxin type A (BTX-A) have long been known and used therapeutically. However, BTX-A actions independent of those affecting neuromuscular function had previously only been alluded to, via the observation that BTX-A injections alleviated pain more than would have been expected through the treatment of muscle spasm alone. This paper was one of the first to specifically examine the efficacy of BTX-A in neuropathic pain and was a catalyst for further investigation into BTX-A as a novel analgesic.
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Steane, Andrew M. Relativity Made Relatively Easy Volume 2. Oxford University Press, 2021. http://dx.doi.org/10.1093/oso/9780192895646.001.0001.
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This is a textbook on general relativity and cosmology for a physics undergraduate or an entry-level graduate course. General relativity is the main subject; cosmology is also discussed in considerable detail (enough for a complete introductory course). Part 1 introduces concepts and deals with weak-field applications such as gravitation around ordinary stars, gravimagnetic effects and low-amplitude gravitational waves. The theory is derived in detail and the physical meaning explained. Sources, energy and detection of gravitational radiation are discussed. Part 2 develops the mathematics of differential geometry, along with physical applications, and discusses the exact treatment of curvature and the field equations. The electromagnetic field and fluid flow are treated, as well as geodesics, redshift, and so on. Part 3 then shows how the field equation is solved in standard cases such as Schwarzschild-Droste, Reissner-Nordstrom, Kerr, and internal stellar structure. Orbits and related phenomena are obtained. Black holes are described in detail, including horizons, wormholes, Penrose process and Hawking radiation. Part 4 covers cosmology, first in terms of metric, then dynamics, structure formation and observational methods. The meaning of cosmic expansion is explained at length. Recombination and last scattering are calculated, and the quantitative analysis of the CMB is sketched. Inflation is introduced briefly but quantitatively. Part 5 is a brief introduction to classical field theory, including spinors and the Dirac equation, proceeding as far as the Einstein-Hilbert action. Throughout the book the emphasis is on making the mathematics as clear as possible, and keeping in touch with physical observations.
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Cascorbi, Ingolf. Polymorphic cytochrome P450 2D6 as the responsible enzyme of activation. Edited by Paul Farquhar-Smith, Pierre Beaulieu, and Sian Jagger. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198834359.003.0079.
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The landmark paper discussed in this chapter is ‘Bioactivation of the narcotic drug codeine in human liver is mediated by the polymorphic monooxygenase catalyzing debrisoquine 4-hydroxylation (cytochrome P-450 dbl/bufI)’, published by Dayer et al. in 1988. Codeine is an old but frequently prescribed drug used for the treatment of mild-to-moderate pain. However, its use is nowadays restricted after observations of partly fatal respiratory repression in children. Codeine itself exhibits no analgesic effect, but is partly activated by O-demethylation to morphine by cytochrome P450 2D6 (CYP2D6). The identification of the polymorphic CYP2D6 as the enzyme responsible for activation was achieved by Dayer et al. in 1998 and was an important milestone contributing to the widely observed inter-individual differences of drug action and side effects of codeine. Translating the pharmacogenetics of codeine into clinical practice is currently underway in clinical trials, to identify ineffective analgesics and, in particular, avoid severe adverse events.
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Lheureux, Philippe, and Marc Van Nuffelen. Management of benzodiazepine poisoning. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0320.
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The wide use of benzodiazepines is associated with some inconveniences and are most frequently implicated in acute self-poisoning and accidental poisoning in children. Some of them are recognized as submission drugs, used to commit date rape or robbery. Prolonged use of a benzodiazepine leads to dependence, with a risk of developing a life-threatening withdrawal syndrome. Overdose has usually a good prognosis—most patients recover well with careful observation and prevention of complications, although care should be taken with elderly people, and patients with chronic obstructive pulmonary disease or liver dysfunction. Fast-acting agents and co-ingestion of other central nervous system depressants may be present greater risk. Early administration of activated charcoal in patients able to protect their airway is only needed if there are co-ingestants. Flumazenil may help confirm the diagnosis, improve alertness, and prevent the need for respiratory support in some patients, especially after accidental poisoning in children. Contraindications include patients on long-term treatment and/or dependent on benzodiazepines, or those who have simultaneously ingested proconvulsant or prodysrhythmic substances or at risk of increased intracranial pressure.
Book chapters on the topic "Action Observation Treatment"
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Bennett, Richard. "People's preferences in relation to animal welfare." In The economics of farm animal welfare: theory, evidence and policy, 75–97. Wallingford: CABI, 2020. http://dx.doi.org/10.1079/9781786392312.0075.
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Abstract People may have preferences in relation to products and services that they perceive to have animal welfare attributes. People may also have preferences in relation to different welfare states, standards and treatment of animals. Human empathy with animals is a potential source of utility (e.g. the pleasure from seeing animals playing) and disutility (e.g. the distress caused if we perceive an animal is suffering). We may derive satisfaction from moral preferences for how animals are treated regardless of this empathy. There are many animal-derived products for consumers to purchase in markets but little information on the welfare of the animals that produced them in order for consumers to make choices consistent with their animal welfare preferences. People's preferences can be ascertained by observations of their behaviour and the choices they make, and by asking people what their preferences are. Two research case studies are presented. There is a need for welfare advocacy on behalf of animals. This stewardship role must be informed by scientific evidence on animal sentience, preferences and welfare status. Government or an alternative body acting on behalf of society must take up the role to represent societal animal welfare preferences and act as custodians to protect the welfare of animals.
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Buccino, Giovanni, and Riccardo Dalla Volta. "The use of action observation treatment to restore motor function in patients with neurological disorders." In New Frontiers in Mirror Neurons Research, 366–79. Oxford University Press, 2015. http://dx.doi.org/10.1093/acprof:oso/9780199686155.003.0020.
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Zhao, Qing, Lingjing Jin, Lin Ma, Tingting Sun, and Mengdie Zhou. "Current Rehabilitation Therapies in Parkinson’s Disease." In Parkinson’s Disease - Animal Models, Current Therapies and Clinical Trials [Working Title]. IntechOpen, 2022. http://dx.doi.org/10.5772/intechopen.107237.
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Rehabilitation is one of the important non-pharmacological interventions for Parkinson’s disease (PD). At the time of diagnosis, an appropriate exercise regimen can be prescribed based on the patient’s symptoms. Rehabilitative therapies should be continued throughout the disease course. This chapter summarized the standard specifications and research progression on PD from perspectives of assessment and treatment of rehabilitation. The physical therapy, occupational therapy, speech-language therapy, and neuromodulation therapy are the focus of the introduction. Accurate and comprehensive functional assessment is the premise of rehabilitation plan. Various approaches are used individually or in combined targeted at one or more dysfunction. Although there is still no consensus about the optimal approach about intensity, the frequency of treatment sessions, and complexity, rehabilitation is proved to be able to induce short-term, but clinically important benefits, particularly for gait and balance. The rehabilitative program for PD should be targeted to practicing and learning specific activities in the core areas and be tailored to the individual patients’ characteristics. In addition to improving patient’s performance, environmental modification and alleviation of caregivers are also included in rehabilitation intervention. Innovative techniques have been recently proposed: virtual reality and exergaming, motor imagery and action observation, robot-assisted physiotherapy, and nonconventional therapies.
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Tong, Isaac, R. Jason Yong, and Beth B. Hogans. "Pain Emergencies and Complications of Pain Treatments." In Pain Care Essentials, edited by Yi Cai Isaac Tong, R. Jason Yong, and Beth B. Hogans, 221–40. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780199768912.003.0014.
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Chapter 13 reviews some common pain-associated emergencies and also discusses some complications of pain treatments that require immediate attention. Pain is a common occurrence in emergent illness, and some complications of pain treatments require emergent management. Chest pain is an excellent example of clinical decision-making following a process of organized, rapid pain assessment and then diagnostic and treatment reasoning based on the findings and observations of the clinical assessment. Providers assessing patients for acute chest pain elicit basic pain characteristics of region, quality, severity, and timing as well as usually associated factors and then pursue testing and treatment for elements in the differential diagnosis accordingly. The chapter illustrates this same process applied to conditions of acute abdominal, limb, headache, and spine emergencies. In the second part of the chapter, emergencies arising in the context of pain treatments are discussed, including overdose and withdrawal from opioids, benzodiazepines, and other pain-active medications as well as pump and device complications.
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Richard, Edo. "Trial designs, including observational to interventional." In Oxford Textbook of Neurologic and Neuropsychiatric Epidemiology, edited by Carol Brayne, Valery L. Feigin, Lenore J. Launer, and Giancarlo Logroscino, 57–64. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198749493.003.0007.
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Observational studies have taught us a lot about the origin of neurological and neuropsychiatric diseases. This chapter describes how we can translate this knowledge into action. Before engaging in a large RCT, several steps have to be taken. First, the potential for a treatment effect has to be compelling. The target population in the RCT has to resemble the population in which observational studies described an association. Second, the outcome of an RCT has to be chosen, and has to have clinical relevance or at least have the potential of clinical relevance in the future. Third, the right study design has to be decided on. Each research question will require a specific study design with accompanying sample size calculation. Lastly, specific ethical considerations have to be taken into account when designing and executing an intervention study. This chapter presents an overview of these issues.
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Ehrenreich-May, Jill, Sarah M. Kennedy, Jamie A. Sherman, Emily L. Bilek, Brian A. Buzzella, Shannon M. Bennett, and David H. Barlow. "UP-C Session 7: Problem Solving and Conflict Management." In Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents, 293–308. Oxford University Press, 2017. http://dx.doi.org/10.1093/med-psych/9780199340989.003.0017.
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Chapter 17 teaches “Problem Solving,” a strategy for generating and evaluating multiple solutions to a problem. Problem Solving skills can help children to manage situations where they feel “stuck” or unable to come to a good solution initially. This is an extension of “flexible thinking,” as children are encouraged to use their powers of observation and flexible thinking strategies to generate possible actions that they can take in difficult circumstances. These strategies are applied to emotional situations, including those in which there is a high degree of interpersonal conflict. The parent session continues to promote the goal of flexible thinking. Parents learn the steps of Problem Solving and how to support their child in using them.
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Kaltenboeck, Alexander, and Catherine Harmer. "Can Non-Pharmacological Antidepressant Treatments Influence the Processing of Affective Information?" In Cognitive Dimensions of Major Depressive Disorder, 257–68. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198810940.003.0020.
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Depressive disorders are commonly associated with abnormalities in affective cognition. When processing information with emotional content, the depressed brain typically exhibits mood-congruent negative biases; that is, an abnormal preference for negative relative to positive information. In turn, recent psychopharmacological research has revealed that antidepressant drug treatments have the ability to push affective information processing more towards a preferential processing of positive information. These observations have led to the postulation of a cognitive neuropsychological model of antidepressant treatment action. This model suggests that negative biases play an important causal (rather than just epiphenomenal) role in the development of depressed mood and efficacious antidepressant interventions exert their clinical effects by acutely counterbalancing these cognitive abnormalities. In this chapter, we extend the focus to non-pharmacological treatments for depression and ask whether they too can influence affective cognition, and, if so, what these effects look like. We highlight recent studies investigating how cognitive behavioural therapy, electroconvulsive therapy, transcranial direct current stimulation, and environmental therapeutics impact on affective information processing in patients with depression. We show that, for each of these treatments, at least some evidence exists that suggests an influence on affective cognition and that in some cases the observed effects are directly in line with the cognitive neuropsychological model. However, as will become clear, the currently available evidence is rather sparse and, in many regards, incomplete. We therefore conclude that—similar to antidepressant drugs—non-pharmacological treatments can also influence affective information processing in patients with depression. However, whether these changes can counterbalance negative biases, and whether they are causally involved in the clinical effects of the different treatments, remains to be elucidated by future research.
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Sathianathen, Niranjan. "Clinical Results of Long-Term Follow-Up of a Large, Active Surveillance Cohort With Localized Prostate Cancer." In 50 Studies Every Urologist Should Know, 25–30. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780190655341.003.0005.
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This chapter provides a summary of an important observational study of men with clinically localized, mostly favorable-risk prostate cancer who were followed with active surveillance, which consisted of periodic prostate-specific antigen testing and repeat biopsies. It found that local treatment with curative intent can be safely deferred long term in many patients as long as they are carefully monitored.
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Sverdlik, Steven. "Bentham’s Chapter XI." In Bentham's An Introduction to the Principles of Morals and Legislation, C11—C11P49. Oxford University Press, 2023. http://dx.doi.org/10.1093/oso/9780190089900.003.0012.
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Abstract The human dispositions that Bentham discusses in Chapter XI are enduring patterns of motivation. People tend to act from certain motives with some regularity, and these same motives can regularly restrain them as well. Here the restraining or “tutelary” role of motives becomes prominent. Bentham’s main subject is the inferences we can make from the evidence of an action to conclusions about the agent’s dispositions. His thinking about these inferences is explained, including his treatment of “standing tutelary motives” that tend to restrain a person from performing any mischievous act. Some observations are made about how judges now address the issue Bentham discusses, including their use of criminal records in sentencing.
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Nastenko, Ievgen Arnoldovich, Volodymyr Anatolevich Pavlov, Olena Konstantinovna Nosovets, Oleksandr Davydko, and Oleksander Pavlov. "Optimization Models for Calculation of Personalized Strategies." In Advances in Human Resources Management and Organizational Development, 305–23. IGI Global, 2020. http://dx.doi.org/10.4018/978-1-5225-8933-4.ch015.
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The chapter considers the problem of calculating the best individual strategy based on models obtained from observations of a given sample object's reaction to the applied control actions. In order to improve the calculation efficiency, the construction of the optimization problem with line dependence on the control variables is offered. To ensure the calculation adequacy, the object state models of optimal complexity, nonlinear with respect to the initial conditions and parameters, are considered. Examples of optimal personalized treatment strategies calculation are given. The proposed approach can be extended to other practical areas to solve the decision making, provided the development of adequate the object state models in the optimization field.
Conference papers on the topic "Action Observation Treatment"
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Logunov, Konstantin Valerievich, Sergei Anatolievich Antipov, and Andrey Borisovich Karpov. "Offshore Health Innovations." In Abu Dhabi International Petroleum Exhibition & Conference. SPE, 2021. http://dx.doi.org/10.2118/207945-ms.
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Objectives/Scope Analysis of 15 years results of remote occupational health care in oil and gas production industries. Methods, Procedures, Process Continuous observation, statistical analysis of morbidity, mortality, and treatment results in industrial personnel at different endpoints depending on the variability of care models. Cost-efficacy analysis of several occupational health interventions. Targeted polls of Customers. Dynamics of new Customers. Results, Observations, Conclusions The best practices which provide the maximum efficacy include risk assessment and risk management, action planning for emergencies, telemedicine, education, registry maintenance. Each of all these gave a 10-100-fold rise in Customer satisfaction, seriously improved medical statistics. Telemedicine implies both: the delivery of highly specialized diagnostic technologies directly to the industrial production site, where a GP or paramedic is present, and it implements the direct replacement of medics with gadgets at the patient's bedside. Education involves hands-on training for both industrial personnel at remote sites and for medical professionals who provide care. The 2020-21 COVID19 pandemic was a great real stress test for remote health models when systemic integrated management procedures played a pivotal role in ensuring smooth industry operation due to the high quality of back medical services. Novel/Additive Information Modern efficient models of medical care for remote industries are necessarily comprehensive, modular, adaptive, and rely on personnel health registers. Remote health practices gain a 5-15% rise in price every year, but it pays off in greater labor productivity and in improving the health of industry personnel.
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Tieghi, Lorenzo, Alessandro Corsini, Giovanni Delibra, and Francesco Aldo Tucci. "A Machine-Learnt Wall Function for Rotating Diffusers." In ASME Turbo Expo 2020: Turbomachinery Technical Conference and Exposition. American Society of Mechanical Engineers, 2020. http://dx.doi.org/10.1115/gt2020-15353.
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Abstract Data-driven tools and techniques have proved their effectiveness in many engineering applications. Machine-learning has gradually become a paradigm to explore innovative designs in turbomachinery. However, industrial Computational Fluid Dynamics (CFD) experts are still reluctant to embed similar approaches in standard practice and very few solutions have been proposed so far. The aim of the work is to prove that standard wall treatments can obtain serious benefits from machine-learning modelling. Turbomachinery flow modeling lives in a constant compromise between accuracy and the computational costs of numerical simulations. One of the key factors of process is defining a proper wall treatment. Many works point out how insufficient resolutions of boundary layers may lead to incorrect predictions of turbomachinery performances. Wall functions are universally exploited to replicate the physics of boundary layers where grid resolution does not suffice. Widespread wall functions were derived by the observation of a few canonical flows, further expressed as a simple polynomial of Reynolds number and turbulent kinetic energy. Despite their popularity, these functions are frequently applied in flows where the ground assumptions cease to be true, such as rotating passages or swirled flows. In these flows, the mathematical formulations of wall functions do not account for the distortion on the boundary layer due to the combined action of centrifugal and Coriolis forces. Here we will derive a wall function for rotating passages, through means of machine-learning. The algorithm is directly implemented in the N-S equations solver. Cross-validation results show that the machine-learnt wall treatment is able to effectively correct the turbulent kinetic energy field near the solid walls, without impairing the accuracy of the RANS turbulence model in any way.
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Chang, Hong, De Qiang Yi, Yang Lv, Ming Zhao, Peng Liang Cao, Lin Zhang, Rui Hou, et al. "Outside the Box: Innovative Application of Diversion as a Replacement for Bridge Plug." In SPE Middle East Oil & Gas Show and Conference. SPE, 2021. http://dx.doi.org/10.2118/204601-ms.
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Abstract Effective stage-to-stage isolation is typically accomplished by setting a bridge plug in a properly cemented casing between stages. This isolation plays a vital role in a horizontal well multistage fracturing completion. Failure of isolation not only impacts the well productivity but also wastes fracturing materials. The challenges isolation failure poses for stimulation effectiveness include both detection and remediation. First, there has been historically no reliable and cost-effective solution to detect stage-to-stage isolation onsite. One may only start to realize this problem when inconsistent production is observed. Second, existing remedial actions are seldom satisfying in case of an isolation failure. Most commonly, a new plug is set to replace the failed one. However, because the perforation clusters of an unstimulated stage may create irregularities in well inside diameter (ID) (e.g., casing deformation or burr), there is a risk that the plug will be damaged or become stuck when it passes the perforation area. Also, when the plug passes a perforation cluster, the perforations start to take in the pump-down fluid, which can increase the difficulty of the pump-down job. A novel remedial action uses high-frequency pressure monitoring (HFPM) and diversion to solve both challenges. The stage isolation integrity is evaluated in quasi-real time by analyzing the water hammer after the pump shutdown. In the case of a plug failure, large-particle fracture diversion materials and techniques can establish temporary wellbore isolation through a quick and simple delivery process. To close the cycle, the effect of the diversion can be evaluated by HFPM, which can reveal the fluid entry point of the treatment fluid after diversion. The technique was applied to two cases in Ordos basin in which wellbore isolation failure interrupted the operation. The problem identification, development of the solution workflow, and observation from treatment analysis are discussed. In both cases, the stage-to-stage isolation was recovered, and the drilled sand body was successfully stimulated without involving costly and time-consuming well intervention. The stimulation operation of the entire well was successfully resumed in a timely manner.
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Huayamave, Victor, Christopher Rose, Mohammed Zwawi, Eduardo Divo, Faissal Moslehy, Alain Kassab, and Charles Price. "Mechanics of Hip Dysplasia Reduction in Infants With the Pavlik Harness Using Patient-Specific Geometry." In ASME 2014 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2014. http://dx.doi.org/10.1115/imece2014-36603.
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A physics-based computational model of neonatal Developmental Dysplasia of the Hip (DDH) following treatment with the Pavlik Harness was developed to obtain muscle force contribution in order to elucidate biomechanical factors influencing the reduction of dislocated hips. Clinical observation indicates that reduction occurs in deep sleep and involves passive muscle action. Consequently, a set of five (5) adductor muscles, namely, the Adductor Brevis, Adductor Longus, Adductor Magnus, Pectineus, and Gracilis were identified as mediators of reduction using the Pavlik Harness. A Fung-type model was used to characterize the hyperelastic stress-strain muscle response. Four grades (1–4) of dislocation as specified by the International Hip Dysplasia Institute (IHDI) were considered. A three-dimensional model of the pelvis-femur-lower limb assembly of a representative 10 week-old female was generated based on CT scans of a 6-month and 14-year old female as well as the visible human project with the aid of anthropomorphic scaling of anatomical landmarks. The muscle model was calibrated to achieve equilibrium at 90° flexion and 80° abduction. The hip was computationally dislocated according to the grade under investigation, the femur was restrained to move in an envelope consistent with Pavlik Harness restraints, and the dynamic response under passive muscle action and under the effect of gravity was resolved using the ADAMS solver in Solidworks. Results of the current model with an anteversion angle of 50° show successful reduction IHDI Grades 1–3, while IHDI Grade 4 failed to reduce with the Pavlik Harness. These results are consistent with a previous study based on a simplified anatomically-consistent synthetic model and clinical reports of very low success of the Pavlik Harness for Grade 4. However, our model indicates that it is possible to achieve reduction of Grade 4 dislocation by hyperflexion. This finding is consistent with clinical procedures that utilize hyperflexion to help achieve reduction for patients with severe levels of DDH for whom the Pavlik Harness fails.
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"Prevalence of diabetes mellitus among medical students in Mutah university, Al- Karak, Jordan." In International Conference on Public Health and Humanitarian Action. International Federation of Medical Students' Associations - Jordan, 2022. http://dx.doi.org/10.56950/dpzr8628.
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Background: Diabetes mellitus is one of the major health problems in Middle East. There is no available data about its prevalance among our medical students .A lot of complications could be present due to such metabolic disorders . Objective: This study was conducted to determine the prevalence of diabetes mellitus among medical students at Mutah University in Al-Karak in Jordan, raising the awareness about its complication and to spot light problems encountered by student to get their proper support treatment. Method: : A total of 350 medical students were enrolled in in this observational study, (i.e., 67.5% females and 32.5% males) were investigated using a questionare designed for medical students from 1st up to 6th year. Statistical analysis was performed using SPSS version 25. Results: In the present data it was found that 68.9% consuming fast food. There is positive family history of D.M 46%. Sure diagnosis of DM proved to be 2.3% of participants, with 6.3% HbA1c (7-10gm %). Uncontrolled D.M treatment proved to be 35.3% and this could be due to financial problems 37.5% or unavailable drugs in the market 37.5% There is a history of hyperglycaemic coma proved to be 6.3% and hypoglycaemic coma 6.3% encountered among those affected. Conclusion: A lot of concern about medical students having diabetes mellitus should be implemented, as D.M complication is very serious including cardiovascular, nephrology and retinopathy complications. Also, we recommend that routine medical screening tests as fundus examination, fasting and post-prandial blood glucose assessment. Complete Urine analysis and glycosylated Hb should be done. Medical insurance services should cover all needed investigation and treatment for them. Keywords: diabetes mellitus, medical students, mutah school of medicine, Al-Karak, Jordan,
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Urzeala, Constanta, and Mihaela Vlaiculescu. "TELEMEDICINE AND PHYSICAL EXERCISE FOR THE CHILD WITH DIABETES." In eLSE 2016. Carol I National Defence University Publishing House, 2016. http://dx.doi.org/10.12753/2066-026x-16-241.
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This paper is a case study that highlights our concern for increasing the quality of life of the child with diabetes, using telemedicine devices. The central objective is to emphasize the efficiency of the Omnipod wireless insulin pump in the case of a child who, together with the diabetes care team, appropriately manages this metabolic disease and whose treatment also includes physical exercise. Our interest is oriented towards proving the effects derived from the practice of physical exercises on decreasing the amount of insulin administered during the days when the child participates in motor activities, through computerized monitoring. The research was conducted at the Bucharest DiabNutriMed Clinic of Diabetes, from September to November 2015. As research methods, we used: bibliographic study, observation, case study. Data were collected using the computerized DEXCOM Platinum G4 continuous glucose monitoring devices, the Omnipod wireless insulin pump and their related software programs, and the Diasend platform for downloading the data. We present the case of a child with diabetes who has been using a wireless insulin pump since June 2015. We mention that this child is included in the target group of the project sponsored by Vodafone, "Telemedicine and the insulin-dependent child", obtained by the DiabNutriMed Clinic,which aims to introduce advanced technology, with sensors for continuous glucose monitoring, 24hours a day, which eliminates the need for daily injections to measure the glucose levels. During our study, the child participated regularly in physical exercise programs, three times a week, outside the school schedule, practicing activities such as swimming and dynamic games. Information about the child's glucose level and its evolution trend was sent to a web platform and visualized in real time by the family and the diabetes physician, who provided guidance on treatment. According to the indications, the family could remotely administer insulin using the wireless insulin pump with remote control, while the child was carrying out educational and recreational activities uninterruptedly. It was found that, during the days of participation in motor activities, the amount of insulin decreased, its administration being even suspended when the child showed a tendency towards persistent hypoglycemia, which is impossible to achieve in the insulin therapy administered with an insulin pen, where, once administered, insulin cannot be stopped any more over its entire duration of action, 4 to 6 hours (for rapid insulin). Recording these beneficial effects of physical exercises on the child with diabetes entitles us to state that the Omnipod wireless insulin pump represents not only an instrument for insulin administration, but also a possibility of individualized management adaptable to the activities of the child from minute to minute, which allows him/her free access to various activities. In conclusion, we consider as efficient the use of telemedicine devices for the child with diabetes, because it facilitates a good control of this disease and brings more hope in his life.
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Zhang, Yi, Gao Li, Guangchun Leng, Keda Wang, Rui Wang, and Pingxian Li. "A Permeability Evolution Model of Double-Porosity Media with Consideration of Temperature and Pressure Variations." In Offshore Technology Conference Asia. OTC, 2022. http://dx.doi.org/10.4043/31646-ms.
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Abstract Reservoir heat treatment (RHT) can improve rock seepage capacity. Recently, it has been considered as a potential technology to enhance unconventional oil and gas recovery. This work presents a permeability evolution model to describe the thermal cracking effects of double-porosity media under temperature change and certain formation pressure. Moreover, to verify the accuracy of the model, a typical double-porosity media (tight sandstone) is selected as the sample, and the permeability of the sample is tested using a simulated formation heating device. Firstly, according to the observation results under SEM, 400°C is regarded as the transition temperature of porous and fractured media. The two-parameter exponential function and the improved "cubic law" are used to characterize the permeability of the pore part and the fracture part respectively. Secondly, rock is comprised of matrix grains and pore space. In the model hypothesis, the volume of the matrix grains is just a function of temperature, and the pore space is compressed or released under the action of effective stress, considering the difference of deformation between the matrix grains and the pore space, the Hooke's law based on engineering strain and natural strain is adopted for them respectively. Thirdly, the influence of temperature on crack spacing and opening is analyzed based on the energy principle and Weibull distribution. Finally, a permeability evolution model is established for the whole process of thermal expansion and cracking. The model describes two phases. In the first phase, the matrix grains expand under confining pressure, and at the same time accumulate thermal stress. In the second phase, after the thermal stress overcomes the confining pressure, the porosity recovers and cracks are gradually damaged and formed. The interaction between thermal stress and confining pressure is controlled by introducing a modulation factor. Due to the difference of component properties, the rock has obvious non-uniform thermal fracture phenomenon. Therefore, in this model, three parameters are introduced to ensure the robustness of the model: the contribution of deformation behavior of the matrix grains and pore space to crack opening, the influence of effective stress on crack opening, and the crack proportion of effective seepage. The results indicate that the model can describe the permeability evolution behavior of double-porosity media under certain confining pressure and temperature changes, it provides theoretical guidance for RHT to enhance oil and gas recovery.
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Fernández Varela, AM, LM Martínez Agulleiro, B. Salazar Laya, D. Núñez Arias, and I. Rodríguez Penín. "4CPS-138 An observational retrospective study on treatment adherence of long acting injectable antipsychotics." In 25th EAHP Congress, 25th–27th March 2020, Gothenburg, Sweden. British Medical Journal Publishing Group, 2020. http://dx.doi.org/10.1136/ejhpharm-2020-eahpconf.239.
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Kayo, Munehiro Michael, and Yoshiaki Ohkami. "Structural Modeling of the Human Musculoskeletal System for Clinical Treatment by Applying Joint-Connected Multibody Dynamics and System Approach." In ASME 2010 International Mechanical Engineering Congress and Exposition. ASMEDC, 2010. http://dx.doi.org/10.1115/imece2010-40065.
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The objective of this paper is to establish a concise structural model of the human musculoskeletal system (HMS) that can be used to clinically treat malfunctions or distortions of the human body. This model must be uncomplicated for therapists to identify the problematic areas of the human body with adequate visualization while maintaining a theoretical thoroughness in mechanics. To achieve this objective, a system theory approach called the Interpretive Structural Modeling (ISM) has been applied to bridge multi-body dynamics and clinical observations. From a mechanical engineering viewpoint, this HMS system can be treated as a collection of joint connected 15 rigid bodies in a topological tree configuration with 35 Degrees-of-Freedom (DOF). Alternatively, from a clinical viewpoint, the functioning of the joints is a major concern since most malfunctions or distortions take place around the joints. Based on 20 years of accumulated clinical observation data, we have discovered that all HMS movements can be constructed by a combination of 35 fundamental motion elements, all having a certain degree of interaction with each other. By applying the ISM for a matrix representation of the HMS system, we have obtained the following results: 1) The association between the rotation of the joints and the fundamental motion elements is represented by a square matrix of dimension N, where N is twice of the DOF 2) The determinant of this matrix, corresponding to the N-square matrix in SE terminology, gives an evaluation criteria in selecting the fundamental elements; 3) Application of the ISM reveals a distinction between an active motion element with intention versus an associated motion element that is induced by another motion element(s). In addition, the ISM yields a tiered structure of the fundamental motion elements according to the degree of activeness; and 4) most important, an overall investigation of the matrix characteristics gives a means to identify imbalances or distortions within the HMS. With the help of a motion diagram for the purpose of visualization, this research can eventually be applied to clinical observations whereby an automated identification of malfunctioning parts can be achieved with computer software. The above stated results will contribute to a holistic and non-invasive approach for medical care and rehabilitation.
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Brown, Erika, Marshall Pickarts, Jose Delgado-Linares, Hao Qin, Carolyn Koh, Sumil Thapa, Nakatsuka Matthew, and Vinod Veedu. "Scale-Up and Modeling Efforts Using an Omniphobic Surface Treatment for Mitigating Solids Deposition." In Offshore Technology Conference. OTC, 2022. http://dx.doi.org/10.4043/32059-ms.
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Abstract Gas hydrates, waxes and asphaltenes represent some of the most significant flow assurance challenges, especially in subsea lines, where treatment options can be limited. Currently, complete avoidance is the primary strategy for hydrate management, while chemical or mechanical flushing/pigging may be utilized for other solids. Each system must also be treated with individualized solutions, as there have been no proved one-size-fits-all technologies demonstrated to date. As an alternative to constant chemical injection or thermodynamic controls such as insulation or heating, a robust omniphobic surface treatment material has been developed which has been shown in previous studies to significantly reduce the adhesion of flow assurance solids, resulting in lower risk for deposition and plugging of gas hydrates, waxes, and asphaltenes. As part of a Department of Energy study, laboratory scale tests were performed on a variety of apparatuses ranging from micromechanical force (micron scale) to laboratory flow loop testing (meter scale). While the results from these tests have been promising, there can be some disconnects between lab-scale observations and field-scale testing. Several factors can result in discrepancies between small-scale bench-top studies and deployment-scale efforts. These include flow conditions (Reynolds number, flow regime), chemistry (synthetic vs. crude oils, gas composition, and additives), physical differences (pipeline material, size, and geometry), etc. This work will describe the actions taken to better understand the deployment and performance of a material such as this omniphobic surface treatment in field scenarios, and to build confidence for deployment in a production scenario. These efforts include modeling field production scenarios using models developed from lab observations, application of the material to field-scale equipment to better understand application challenges, and expanded survivability and longevity testing. Understanding the bridge between laboratory testing and full-scale deployment allows for better technique and risk mitigation for field scale testing.
Reports on the topic "Action Observation Treatment"
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Marold, Juliane, Ruth Wagner, Markus Schöbel, and Dietrich Manzey. Decision-making in groups under uncertainty. Fondation pour une culture de sécurité industrielle, February 2012. http://dx.doi.org/10.57071/361udm.
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The authors have studied daily decision-making processes in groups under uncertainty, with an exploratory field study in the medical domain. The work follows the tradition of naturalistic decision-making (NDM) research. It aims to understand how groups in this high reliability context conceptualize and internalize uncertainties, and how they handle them in order to achieve effective decision-making in their everyday activities. Analysis of the survey data shows that uncertainty is thought of in terms of issues and sources (as identified by previous research), but also (possibly a domain-specific observation) as a lack of personal knowledge or skill. Uncertainty is accompanied by emotions of fear and shame. It arises during the diagnostic process, the treatment process and the outcome of medical decision making. The most frequently cited sources of uncertainty are partly lacking information and inadequate understanding owing to instability of information. Descriptions of typical group decisions reveal that the individual himself is a source of uncertainty when a lack of knowledge, skills and expertise is perceived. The group can serve as a source of uncertainty if divergent opinions in the decision making group exist. Three different situations of group decisions are identified: Interdisciplinary regular meetings (e.g. tumor conferences), formal ward meetings and ad hoc consultations. In all healthcare units concerned by the study, only little use of structured decision making procedures and processes is reported. Strategies used to handle uncertainty include attempts to reduce uncertainty by collecting additional information, delaying action until more information is available or by soliciting advice from other physicians. The factors which ultimately determine group decisions are hierarchy (the opinion of more senior medical staff carries more weight than that of junior staff), patients’ interest and professional competence. Important attributes of poor group decisions are the absence of consensus and the use of hierarchy as the predominant decision criterion. On the other hand, decisions judged to be effective are marked by a sufficient information base, a positive discussion culture and consensus. The authors identify four possible obstacles to effective decision making: a steep hierarchy gradient, a poor discussion culture, a strong need for consensus, and insufficient structure and guidance of group decision making processes. A number of intervention techniques which have been shown in other industries to be effective in improving some of these obstacles are presented.
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Weiss, David, and Neil Olszewski. Manipulation of GA Levels and GA Signal Transduction in Anthers to Generate Male Sterility. United States Department of Agriculture, 2000. http://dx.doi.org/10.32747/2000.7580678.bard.
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The original objectives of the research were: i. To study the role of GA in anther development, ii. To manipulate GA and/or GA signal transduction levels in the anthers in order to generate male sterility. iii. To characterize the GA signal transduction repressor, SPY. Previous studies have suggested that gibberellins (GAs) are required for normal anther development. In this work, we studied the role of GA in the regulation of anther development in petunia. When plants were treated with the GA-biosynthesis inhibitor paclobutrazol, anther development was arrested. Microscopic analysis of these anthers revealed that paclobutrazol inhibits post-meiotic developmental processes. The treated anthers contained pollen grains but the connective tissue and tapetum cells were degenerated. The expression of the GA-induced gene, GIP, can be used in petunia as a molecular marker to: study GA responses. Analyses of GIP expression during anther development revealed that the gene is induced only after microsporogenesis. This observation further suggests a role for GA in the regulation of post-meiotic processes during petunia anther development. Spy acts as a negative regulator of gibberellin (GA) action in Arabidopsis. We cloned the petunia Spy homologue, PhSPY, and showed that it can complement the spy-3 mutation in Arabidopsis. Overexpression of Spy in transgenic petunia plants affected various GA-regulated processes, including seed germination, shoot elongation, flower initiation, flower development and the expression of a GA- induced gene, GIP. In addition, anther development was inhibited in the transgenic plants following microsporogenesis. The N-terminus of Spy contains tetratricopeptide repeats (TPR). TPR motifs participate in protein-protein interactions, suggesting that Spy is part of a multiprotein complex. To test this hypothesis, we over-expressed the SPY's TPR region without the catalytic domain in transgenic petunia and generated a dominant- negative Spy mutant. The transgenic seeds were able to germinate on paclobutrazol, suggesting an enhanced GA signal. Overexpression of PhSPY in wild type Arabidopsis did not affect plant stature, morphology or flowering time. Consistent with Spy being an O-GlcNAc transferase (OGT), Spy expressed in insect cells was shown to O-GlcNAc modify itself. Consistent with O-GlcNAc modification playing a role in GA signaling, spy mutants had a reduction in the GlcNAc modification of several proteins. After treatment of the GA deficient, gal mutant, with GA3 the GlcNAc modification of proteins of the same size as those affected in spy mutants exhibited a reduction in GlcNAcylation. GA-induced GlcNAcase may be responsible for this de-GlcNAcylation because, treatment of gal with GA rapidly induced an increase in GlcNAcase activity. Several Arabidopsis proteins that interact with the TPR domain of Spy were identified using yeast two-hybrids screens. One of these proteins was GIGANTEA (GI). Consistent with GI and Spy functioning as a complex in the plant the spy-4 was epistatic to gi. These experiments also demonstrated that, in addition to its role in GA signaling, Spy functions in the light signaling pathways controlling hypocotyl elongation and photoperiodic induction of flowering. A second Arabidopsis OGT, SECRET AGENT (SCA), was discovered. Like SPY, SCA O-GlcNAc modifies itself. Although sca mutants do not exhibit dramatic phenotypes, spy/sca double mutants exhibit male and female gamete and embryo lethality, indicating that Spy and SCA have overlapping functions. These results suggest that O-GlcNAc modification is an essential modification in plants that has a role in multiple signaling pathways.
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Leis, Sherry. Vegetation community monitoring trends in restored tallgrass prairie at Wilson’s Creek National Battlefield: 2008–2020. National Park Service, April 2022. http://dx.doi.org/10.36967/nrr-2293117.
Full textAbstract:
Plant community monitoring at Wilson’s Creek National Battlefield (NB) focused on the restored tallgrass prairie community. Six monitoring sites were visited four times and observations of plant species and ground cover were made. In addition to those observations, we included two environmental factors in this report—precipitation and recent fire history—to help understand the vegetation data status and trends. Precipitation data (standardized vegetation index) indicated drought conditions in 2012 and some dry periods in 2016. Although prairies are adapted to drought, we found that species richness at the site and community scales (alpha and gamma diversity) were reduced in dry years. Fire management also plays an important role in shaping the plant communities. Prescribed fire occurrence became less frequent through the monitoring period. Also, additional treatments, including herbicide and mowing, likely shaped the prairie community. Tree regeneration and nonnative plants in particular may have been affected by these techniques. The prairie plant community continues to be moderately diverse despite recent increases in tree seedlings and small saplings. Species richness varied over time and was correlated with precipitation; diversity indices (H′ and J′) were similar across monitored years. Species guilds (also known as functional groups) demonstrated differing patterns. Woody plants, long a concern at the park, were abundant and statistically similar across years. Many guilds were quite variable across the sites, but nonnative forbs declined, and nonnative grasses increased. Overstory trees and canopy cover, measured for the first time in 2020, have likely influenced the composition of one site. The composition of this site points to a shrubland-savanna community. Four of the sites tended towards shrubland rather than tallgrass prairie. The vegetation monitoring protocol experienced some changes between 2008 and 2020. A key difference was a shift from sampling twice during the field season to sampling only once in a monitoring year. An anticipated decline in species richness was observed in 2012 and 2016, but we were unable to isolate sample design as the cause. Additionally, we remedied inconsistencies in how tree regeneration was recorded by tallying seedlings and saplings in the field. Our quality assurance procedures indicated that our observer error from pseudoturnover was 20.2%, meeting our expectations. Cover class estimates agreed 73% of the time, with all disagreements within one cover class. Coordinating management actions to achieve plant community goals like structure and composition of tallgrass prairie will be critical to the survival of the prairie species at the park. Fire and nonnative plant treatments along with the reduction of woody cover including trees are needed to arrest the transition to savanna and woodland community types. Frequent prescribed fire is an integral process for this community and there is no equivalent substitute. Continued focus on management for the desired tallgrass prairie community will also provide needed habitat for imperiled pollinators such as the monarch butterfly. Best management practices for pollinators on federal lands specify that treatments (prescribed fire, mowing or haying) should not occur during the blooming season or when pollinator breeding, egg, larval or pupal stages are present.
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Chou, Roger, Jesse Wagner, Azrah Y. Ahmed, Benjamin J. Morasco, Devan Kansagara, Shelley Selph, Rebecca Holmes, and Rongwei Fu. Living Systematic Review on Cannabis and Other Plant-Based Treatments for iii Chronic Pain: 2022 Update. Agency for Healthcare Research and Quality (AHRQ), September 2022. http://dx.doi.org/10.23970/ahrqepccer250update2022.
Full textAbstract:
Objectives. To update the evidence on benefits and harms of cannabinoids and similar plant-based compounds to treat chronic pain using a living systematic review approach. Data sources. Ovid® MEDLINE®, PsycINFO®, Embase®, the Cochrane Library, and SCOPUS® databases; reference lists of included studies; and submissions received after Federal Register request were searched to April 4, 2022. Review methods. Using dual review, we screened search results for randomized controlled trials (RCTs) and observational studies of patients with chronic pain evaluating cannabis, kratom, and similar compounds with any comparison group and at least 1 month of treatment or followup. Dual review was used to abstract study data, assess study-level risk of bias, and rate the strength of evidence (SOE). Prioritized outcomes included pain, overall function, and adverse events. We grouped studies that assessed tetrahydrocannabinol (THC) and/or cannabidiol (CBD) based on their THC to CBD ratio and categorized them as comparable THC to CBD ratio, high-THC to CBD ratio, and low-THC to CBD ratio. We also grouped studies by whether the product was a whole-plant product (cannabis), cannabinoids extracted or purified from a whole plant, or a synthetic product. We conducted meta-analyses using the profile likelihood random effects model and assessed between-study heterogeneity using Cochran’s Q statistic chi square test and the I2 statistic. Magnitude of benefit was categorized as no effect or small, moderate, and large effects. Results. From 3,283 abstracts, 21 RCTs (N=1,905) and 8 observational studies (N=13,769) assessing different cannabinoids were included; none evaluated kratom. Studies were primarily short term, and 59 percent enrolled patients with neuropathic pain. Comparators were primarily placebo or usual care. The SOE was low unless otherwise noted. Compared with placebo, comparable THC to CBD ratio oral spray was associated with a small benefit in change in pain severity (7 RCTs, N=632, 0 to10 scale, mean difference [MD] −0.54, 95% confidence interval [CI] −0.95 to −0.19, I2=39%; SOE: moderate) and overall function (6 RCTs, N=616, 0 to 10 scale, MD −0.42, 95% CI −0.73 to −0.16, I2=32%). There was no effect on study withdrawals due to adverse events. There was a large increased risk of dizziness and sedation, and a moderate increased risk of nausea (dizziness: 6 RCTs, N=866, 31.0% vs. 8.0%, relative risk [RR] 3.57, 95% CI 2.42 to 5.60, I2=0%; sedation: 6 RCTs, N=866, 8.0% vs. 1.2%, RR 5.04, 95% CI 2.10 to 11.89, I2=0%; and nausea: 6 RCTs, N=866, 13% vs. 7.5%, RR 1.79, 95% CI 1.19 to 2.77, I2=0%). Synthetic products with high-THC to CBD ratios were associated with a moderate improvement in pain severity, a moderate increase in sedation, and a large increase in nausea (pain: 6 RCTs, N=390, 0 to 10 scale, MD −1.15, 95% CI −1.99 to −0.54, I2=48%; sedation: 3 RCTs, N=335, 19% vs. 10%, RR 1.73, 95% CI 1.03 to 4.63, I2=28%; nausea: 2 RCTs, N=302, 12.3% vs. 6.1%, RR 2.19, 95% CI 0.77 to 5.39; I²=0%). We also found moderate SOE for a large increased risk of dizziness (2 RCTs, 32% vs. 11%, RR 2.74, 95% CI 1.47 to 6.86, I2=40%). Extracted whole-plant products with high-THC to CBD ratios (oral) were associated with a large increased risk of study withdrawal due to adverse events (1 RCT, 13.9% vs. 5.7%, RR 3.12, 95% CI 1.54 to 6.33) and dizziness (1 RCT, 62.2% vs. 7.5%, RR 8.34, 95% CI 4.53 to 15.34); outcomes assessing benefit were not reported or insufficient. We observed a moderate improvement in pain severity when combining all studies of high-THC to CBD ratio (8 RCTs, N=684, MD −1.25, 95% CI −2.09 to −0.71, I2=58%; SOE: moderate). Evidence (including observational studies) on whole-plant cannabis, topical or oral CBD, low-THC to CBD, other cannabinoids, comparisons with active products or between cannabis-related products, and impact on use of opioids was insufficient to draw conclusions. Other important harms (psychosis, cannabis use disorder, and cognitive effects) were not reported. Conclusions. Low to moderate strength evidence suggests small to moderate improvements in pain (mostly neuropathic), and moderate to large increases in common adverse events (dizziness, sedation, nausea) with high- and comparable THC to CBD ratio extracted cannabinoids and synthetic products during short-term treatment (1 to 6 months); high-THC to CBD ratio products were also associated with increased risk of withdrawal due to adverse events. Evidence for whole-plant cannabis and other comparisons, outcomes, and plant-based compounds was unavailable or insufficient to draw conclusions. Small sample sizes, lack of evidence for moderate and long-term use and other key outcomes, such as other adverse events and impact on use of opioids during treatment, indicate that more research is needed.
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McDonagh, Marian S., Jesse Wagner, Azrah Y. Ahmed, Rongwei Fu, Benjamin Morasco, Devan Kansagara, and Roger Chou. Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain. Agency for Healthcare Research and Quality (AHRQ), October 2021. http://dx.doi.org/10.23970/ahrqepccer250.
Full textAbstract:
Objectives. To evaluate the evidence on benefits and harms of cannabinoids and similar plant-based compounds to treat chronic pain. Data sources. Ovid® MEDLINE®, PsycINFO®, Embase®, the Cochrane Library, and SCOPUS® databases, reference lists of included studies, submissions received after Federal Register request were searched to July 2021. Review methods. Using dual review, we screened search results for randomized controlled trials (RCTs) and observational studies of patients with chronic pain evaluating cannabis, kratom, and similar compounds with any comparison group and at least 1 month of treatment or followup. Dual review was used to abstract study data, assess study-level risk of bias, and rate the strength of evidence. Prioritized outcomes included pain, overall function, and adverse events. We grouped studies that assessed tetrahydrocannabinol (THC) and/or cannabidiol (CBD) based on their THC to CBD ratio and categorized them as high-THC to CBD ratio, comparable THC to CBD ratio, and low-THC to CBD ratio. We also grouped studies by whether the product was a whole-plant product (cannabis), cannabinoids extracted or purified from a whole plant, or synthetic. We conducted meta-analyses using the profile likelihood random effects model and assessed between-study heterogeneity using Cochran’s Q statistic chi square and the I2 test for inconsistency. Magnitude of benefit was categorized into no effect or small, moderate, and large effects. Results. From 2,850 abstracts, 20 RCTs (N=1,776) and 7 observational studies (N=13,095) assessing different cannabinoids were included; none of kratom. Studies were primarily short term, and 75 percent enrolled patients with a variety of neuropathic pain. Comparators were primarily placebo or usual care. The strength of evidence (SOE) was low, unless otherwise noted. Compared with placebo, comparable THC to CBD ratio oral spray was associated with a small benefit in change in pain severity (7 RCTs, N=632, 0 to10 scale, mean difference [MD] −0.54, 95% confidence interval [CI] −0.95 to −0.19, I2=28%; SOE: moderate) and overall function (6 RCTs, N=616, 0 to 10 scale, MD −0.42, 95% CI −0.73 to −0.16, I2=24%). There was no effect on study withdrawals due to adverse events. There was a large increased risk of dizziness and sedation and a moderate increased risk of nausea (dizziness: 6 RCTs, N=866, 30% vs. 8%, relative risk [RR] 3.57, 95% CI 2.42 to 5.60, I2=0%; sedation: 6 RCTs, N=866, 22% vs. 16%, RR 5.04, 95% CI 2.10 to 11.89, I2=0%; and nausea: 6 RCTs, N=866, 13% vs. 7.5%, RR 1.79, 95% CI 1.20 to 2.78, I2=0%). Synthetic products with high-THC to CBD ratios were associated with a moderate improvement in pain severity, a moderate increase in sedation, and a large increase in nausea (pain: 6 RCTs, N=390 to 10 scale, MD −1.15, 95% CI −1.99 to −0.54, I2=39%; sedation: 3 RCTs, N=335, 19% vs. 10%, RR 1.73, 95% CI 1.03 to 4.63, I2=0%; nausea: 2 RCTs, N=302, 12% vs. 6%, RR 2.19, 95% CI 0.77 to 5.39; I²=0%). We found moderate SOE for a large increased risk of dizziness (2 RCTs, 32% vs. 11%, RR 2.74, 95% CI 1.47 to 6.86, I2=0%). Extracted whole-plant products with high-THC to CBD ratios (oral) were associated with a large increased risk of study withdrawal due to adverse events (1 RCT, 13.9% vs. 5.7%, RR 3.12, 95% CI 1.54 to 6.33) and dizziness (1 RCT, 62.2% vs. 7.5%, RR 8.34, 95% CI 4.53 to 15.34). We observed a moderate improvement in pain severity when combining all studies of high-THC to CBD ratio (8 RCTs, N=684, MD −1.25, 95% CI −2.09 to −0.71, I2=50%; SOE: moderate). Evidence on whole-plant cannabis, topical CBD, low-THC to CBD, other cannabinoids, comparisons with active products, and impact on use of opioids was insufficient to draw conclusions. Other important harms (psychosis, cannabis use disorder, and cognitive effects) were not reported. Conclusions. Low to moderate strength evidence suggests small to moderate improvements in pain (mostly neuropathic), and moderate to large increases in common adverse events (dizziness, sedation, nausea) and study withdrawal due to adverse events with high- and comparable THC to CBD ratio extracted cannabinoids and synthetic products in short-term treatment (1 to 6 months). Evidence for whole-plant cannabis, and other comparisons, outcomes, and PBCs were unavailable or insufficient to draw conclusions. Small sample sizes, lack of evidence for moderate and long-term use and other key outcomes, such as other adverse events and impact on use of opioids during treatment, indicate that more research is needed.
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Chou, Roger, Azrah Y. Ahmed, Christina Bougatsos, Benjamin J. Morasco, Rebecca Holmes, Terran Gilbreath, and Rongwei Fu. Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain: 2022 Update—Surveillance Report 2. Agency for Healthcare Research and Quality (AHRQ), January 2023. http://dx.doi.org/10.23970/ahrqepccer250.2022updatesr2.
Full textAbstract:
Objectives. To update the evidence on benefits and harms of cannabinoids and similar plant-based compounds to treat chronic pain using a living systematic review approach. Data sources. Ovid® MEDLINE®, PsycINFO®, Embase®, the Cochrane Library, and SCOPUS® databases; reference lists of included studies; and submissions received after Federal Register request were searched to October 24, 2022. Review methods. Using dual review, we screened search results for randomized controlled trials (RCTs) and observational studies of patients with chronic pain evaluating cannabis, kratom, and similar compounds with any comparison group and at least 1 month of treatment or followup. Dual review was used to abstract study data, assess study-level risk of bias, and rate the strength of evidence (SOE). Prioritized outcomes included pain, overall function, and adverse events. We grouped studies that assessed tetrahydrocannabinol (THC) and/or cannabidiol (CBD) based on their THC to CBD ratio and categorized them as comparable THC to CBD ratio, high-THC to CBD ratio, and low-THC to CBD ratio. We also grouped studies by whether the product was a whole-plant product (cannabis), cannabinoids extracted or purified from a whole plant, or a synthetic product. We conducted meta-analyses using the profile likelihood random effects model and assessed between-study heterogeneity using Cochran’s Q statistic chi square test and the I2 statistic. Magnitude of benefit was categorized as no effect or small, moderate, and large effects. Results. From a total of 3,568 abstracts, 21 RCTs (N=1,905) and 9 observational studies (N=15,079) assessing different cannabinoids were included; none evaluated kratom. Studies were primarily short term, and 60 percent enrolled patients with neuropathic pain. Comparators were primarily placebo or usual care. The SOE was low unless otherwise noted. Compared with placebo, comparable THC to CBD ratio oral spray was associated with a small benefit in pain severity (7 RCTs, N=632, 0 to 10 scale, mean difference [MD] −0.54, 95% confidence interval [CI] −0.95 to −0.19, I2=39%; SOE: moderate) and overall function (6 RCTs, N=616, 0 to 10 scale, MD −0.42, 95% CI −0.73 to −0.16, I2=32%). There was no effect on study withdrawals due to adverse events. There was a large increased risk of dizziness and sedation, and a moderate increased risk of nausea (dizziness: 6 RCTs, N=866, 31.0% vs. 8.0%, relative risk [RR] 3.57, 95% CI 2.42 to 5.60, I2=0%; sedation: 6 RCTs, N=866, 8.0% vs. 1.2%, RR 5.04, 95% CI 2.10 to 11.89, I2=0%; and nausea: 6 RCTs, N=866, 13% vs. 7.5%, RR 1.79, 95% CI 1.19 to 2.77, I2=0%). Synthetic products with high-THC to CBD ratios were associated with a moderate improvement in pain severity, a moderate increase in sedation, and a large increase in nausea (pain: 6 RCTs, N=390, 0 to 10 scale, MD −1.15, 95% CI −1.99 to −0.54, I2=48%; sedation: 3 RCTs, N=335, 19% vs. 10%, RR 1.73, 95% CI 1.03 to 4.63, I2=28%; nausea: 2 RCTs, N=302, 12.3% vs. 6.1%, RR 2.19, 95% CI 0.77 to 5.39; I²=0%). We also found moderate SOE for a large increased risk of dizziness (2 RCTs, 32% vs. 11%, RR 2.74, 95% CI 1.47 to 6.86, I2=40%). Extracted whole-plant products with high-THC to CBD ratios (oral) were associated with a large increased risk of study withdrawal due to adverse events (1 RCT, 13.9% vs. 5.7%, RR 3.12, 95% CI 1.54 to 6.33) and dizziness (1 RCT, 62.2% vs. 7.5%, RR 8.34, 95% CI 4.53 to 15.34); outcomes assessing benefit were not reported or insufficient. We observed a moderate improvement in pain severity when combining all studies of high-THC to CBD ratio (8 RCTs, N=684, MD −1.25, 95% CI −2.09 to −0.71, I2=58%; SOE: moderate). Evidence (including observational studies) on whole-plant cannabis, topical or oral CBD, low-THC to CBD, other cannabinoids, comparisons with active products or between cannabis-related products, and impact on use of opioids was insufficient to draw conclusions. Other important harms (psychosis, cannabis use disorder, and cognitive effects) were not reported. Conclusions. Low to moderate strength evidence suggests small to moderate improvements in pain (mostly neuropathic), and moderate to large increases in common adverse events (dizziness, sedation, nausea) with high and comparable THC to CBD ratio extracted cannabinoids and synthetic products during short-term treatment (1 to 6 months); high-THC to CBD ratio products were also associated with increased risk of withdrawal due to adverse events. Evidence for whole-plant cannabis and other comparisons, outcomes, and plant-based compounds was unavailable or insufficient to draw conclusions. Small sample sizes, lack of evidence for moderate and long-term use and other key outcomes, such as other adverse events and impact on use of opioids during treatment, indicate that more research is needed.
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Poverenov, Elena, Tara McHugh, and Victor Rodov. Waste to Worth: Active antimicrobial and health-beneficial food coating from byproducts of mushroom industry. United States Department of Agriculture, January 2014. http://dx.doi.org/10.32747/2014.7600015.bard.
Full textAbstract:
Background. In this proposal we suggest developing a common solution for three seemingly unrelated acute problems: (1) improving sustainability of fast-growing mushroom industry producing worldwide millions of tons of underutilized leftovers; (2) alleviating the epidemic of vitamin D deficiency adversely affecting the public health in both countries and in other regions; (3) reducing spoilage of perishable fruit and vegetable products leading to food wastage. Based on our previous experience we propose utilizing appropriately processed mushroom byproducts as a source of two valuable bioactive materials: antimicrobial and wholesome polysaccharide chitosan and health-strengthening nutrient ergocalciferol⁽ᵛⁱᵗᵃᵐⁱⁿ ᴰ2⁾. ᴬᵈᵈⁱᵗⁱᵒⁿᵃˡ ᵇᵉⁿᵉᶠⁱᵗ ᵒᶠ ᵗʰᵉˢᵉ ᵐᵃᵗᵉʳⁱᵃˡˢ ⁱˢ ᵗʰᵉⁱʳ ᵒʳⁱᵍⁱⁿ ᶠʳᵒᵐ ⁿᵒⁿ⁻ᵃⁿⁱᵐᵃˡ ᶠᵒᵒᵈ⁻ᵍʳᵃᵈᵉ source. We proposed using chitosan and vitamin D as ingredients in active edible coatings on two model foods: highly perishable fresh-cut melon and less perishable health bars. Objectives and work program. The general aim of the project is improving storability, safety and health value of foods by developing and applying a novel active edible coating based on utilization of mushroom industry leftovers. The work plan includes the following tasks: (a) optimizing the UV-B treatment of mushroom leftover stalks to enrich them with vitamin D without compromising chitosan quality - Done; (b) developing effective extraction procedures to yield chitosan and vitamin D from the stalks - Done; (c) utilizing LbL approach to prepare fungal chitosan-based edible coatings with optimal properties - Done; (d) enrichment of the coating matrix with fungal vitamin D utilizing molecular encapsulation and nano-encapsulation approaches - Done, it was found that no encapsulation methods are needed to enrich chitosan matrix with vitamin D; (e) testing the performance of the coating for controlling spoilage of fresh cut melons - Done; (f) testing the performance of the coating for nutritional enhancement and quality preservation of heath bars - Done. Achievements. In this study numerous results were achieved. Mushroom waste, leftover stalks, was treated ʷⁱᵗʰ ᵁⱽ⁻ᴮ ˡⁱᵍʰᵗ ᵃⁿᵈ ᵗʳᵉᵃᵗᵐᵉⁿᵗ ⁱⁿᵈᵘᶜᵉˢ ᵃ ᵛᵉʳʸ ʰⁱᵍʰ ᵃᶜᶜᵘᵐᵘˡᵃᵗⁱᵒⁿ ᵒᶠ ᵛⁱᵗᵃᵐⁱⁿ ᴰ2, ᶠᵃʳ ᵉˣᶜᵉᵉᵈⁱⁿᵍ any other dietary vitamin D source. The straightforward vitamin D extraction procedure and ᵃ ˢⁱᵐᵖˡⁱᶠⁱᵉᵈ ᵃⁿᵃˡʸᵗⁱᶜᵃˡ ᵖʳᵒᵗᵒᶜᵒˡ ᶠᵒʳ ᵗⁱᵐᵉ⁻ᵉᶠᶠⁱᶜⁱᵉⁿᵗ ᵈᵉᵗᵉʳᵐⁱⁿᵃᵗⁱᵒⁿ ᵒᶠ ᵗʰᵉ ᵛⁱᵗᵃᵐⁱⁿ ᴰ2 ᶜᵒⁿᵗᵉⁿᵗ suitable for routine product quality control were developed. Concerning the fungal chitosan extraction, new freeze-thawing protocol was developed, tested on three different mushroom sources and compared to the classic protocol. The new protocol resulted in up to 2-fold increase in the obtained chitosan yield, up to 3-fold increase in its deacetylation degree, high whitening index and good antimicrobial activity. The fungal chitosan films enriched with Vitamin D were prepared and compared to the films based on animal origin chitosan demonstrating similar density, porosity and water vapor permeability. Layer-by-layer chitosan-alginate electrostatic deposition was used to coat fruit bars. The coatings helped to preserve the quality and increase the shelf-life of fruit bars, delaying degradation of ascorbic acid and antioxidant capacity loss as well as reducing bar softening. Microbiological analyses also showed a delay in yeast and fungal growth when compared with single layer coatings of fungal or animal chitosan or alginate. Edible coatings were also applied on fresh-cut melons and provided significant improvement of physiological quality (firmness, weight ˡᵒˢˢ⁾, ᵐⁱᶜʳᵒᵇⁱᵃˡ ˢᵃᶠᵉᵗʸ ⁽ᵇᵃᶜᵗᵉʳⁱᵃ, ᵐᵒˡᵈ, ʸᵉᵃˢᵗ⁾, ⁿᵒʳᵐᵃˡ ʳᵉˢᵖⁱʳᵃᵗⁱᵒⁿ ᵖʳᵒᶜᵉˢˢ ⁽Cᴼ2, ᴼ²⁾ ᵃⁿᵈ ᵈⁱᵈ not cause off-flavor (EtOH). It was also found that the performance of edible coating from fungal stalk leftovers does not concede to the chitosan coatings sourced from animal or good quality mushrooms. Implications. The proposal helped attaining triple benefit: valorization of mushroom industry byproducts; improving public health by fortification of food products with vitamin D from natural non-animal source; and reducing food wastage by using shelf- life-extending antimicrobial edible coatings. New observations with scientific impact were found. The program resulted in 5 research papers. Several effective and straightforward procedures that can be adopted by mushroom growers and food industries were developed. BARD Report - Project 4784
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Kwesiga, Victoria, Zita Ekeocha, Stephen Robert Byrn, and Kari L. Clase. Compliance to GMP guidelines for Herbal Manufacturers in East Africa: A Position Paper. Purdue University, November 2021. http://dx.doi.org/10.5703/1288284317428.
Full textAbstract:
With the global increase in the use of traditional and complementary remedies for the prevention and treatment of illness, the quality and safety of these medicines have become a significant concern for all regulatory authorities. Herbal medicines are the most commonly used form of traditional and complementary medicines in the world and the efficacy and safety of herbal medicines, like conventional medicines, largely depends on their quality from planting to harvesting, preprocessing and final processing. Due to the inherent complexity of herbal medicines, often containing an array of active compounds, the primary processing of herbal medicines has a direct influence on their quality. Quality concerns are the reason why the medicines regulatory agencies insist that manufacturers of medicines strictly follow Good Manufacturing Practices since it is an essential tool to prevent instances of contamination, mix-ups, deviations, failures and errors. However, a strict application of GMP requirements is expensive and would drive the prices of the manufactured products up. As a result, a maturity level grading of facilities is proposed as a way of justifying the costs incurred for manufacturers desiring to reach a broader market and investing in continuous improvement. 36 Good Manufacturing Practice (GMP) inspection reports of local herbal manufacturers conducted by National Drug Authority were analyzed to establish the type and extent of deficiencies to GMP requirements for local herbal manufacturers in Uganda. The different GMP chapters and related sub-parameters constituted the variables used for the analysis of conformity to requirements. The primary outcome variable was the conclusion regarding compliance or noncompliance of the inspected local herbal manufacturing facility. GMP parameters that were frequently defaulted by local herbal manufacturers and the corresponding frequencies were identified. The Pearson Chi-square test was applied independently on each category to find the association that existed between conformity and the questions in each category. Only 22% (8) of the 30 inspected facilities were found to comply with GMP requirements, as per National Drug Authority (NDA) guidelines; while the majority of the facilities, 28 (78%), were found not to comply. Of the facilities inspected, 25 were undergoing GMP inspection for the first time. A total of 1,236 deficiency observations were made in the 36 inspection reports reviewed for the study. The mean for all deficiencies was 34.3, and the standard deviation was 15.829. 91.5% of the facilities did not have mechanisms for a record of market complaints; 80.9% did not meet documentation requirements; 78.9% did not have quality control measures in place, and 65.7% did not meet stores requirements. By encouraging a culture of self/voluntary improvement through the introduction of listing of manufacturers based on a maturity level grading, the National Drug Authority will improve the Herbal Medicines sector as per the mandate of improving the herbal medicine industry. Also, increased sensitization of all relevant stakeholders regarding the requirements for GMP should be intensified.