Search

Survivors of critical illness, including those with COVID-19, are likely to experience post-intensive care syndrome (PICS). PICS involves a constellation of physical, cognitive, and mental health problems that can occur following hospitalization in an intensive care unit (ICU). This focused review describes the impact of PICS on an individual’s function, societal participation, and family. Specific evidence-based screening tools for in-home identification of the deficits associated with PICS are recommended. Recognition of PICS through early screening by home health care providers is crucial in order to assemble the physical rehabilitation, mental health, and community resources needed to mitigate the long-term effects of COVID-19 and other critical illnesses. This review concludes with further PICS resources for community-based providers to enhance their knowledge and expertise and to prepare them for caring for COVID-19 and other critical illness survivors.

Candida auris is an emerging drug-resistant yeast responsible for hospital outbreaks. This statement reviews the evidence regarding diagnosis, treatment and prevention of this organism and provides consensus recommendations for clinicians and microbiologists in Australia and New Zealand. C. auris has been isolated in over 30 countries (including Australia). Bloodstream infections are the most frequently reported infections. Infections have crude mortality of 30-60%. Acquisition is generally healthcare-associated and risks include underlying chronic disease, immunocompromise and presence of indwelling medical devices. C. auris may be misidentified by conventional phenotypic methods. Matrix-assisted laser desorption ionisation time-of-flight mass spectrometry or sequencing of the internal transcribed spacer regions and/or the D1/D2 regions of the 28S ribosomal DNA are therefore required for definitive laboratory identification. Antifungal drug resistance, particularly to fluconazole, is common, with variable resistance to amphotericin B and echinocandins. Echinocandins are currently recommended as first-line therapy for infection in adults and children ≥2 months of age. For neonates and infants

Background:Glycopyrrolate is often used as a premedication for anesthesia as it has anti-sialogogue and vagolytic effect. Patients undergoing laparoscopic gynecologic surgery have high-risk of Post-Operative Nausea and Vomiting (PONV).Objectives:This retrospective study investigates the effect of glycopyrrolate as a premedication for PONV in patients receiving fentanyl-based Intravenous (IV) Patient-Controlled Analgesia (PCA) after laparoscopic gynecological surgery.Methods:We reviewed the medical records of adult patients who received fentanyl-based IV-PCA after laparoscopic gynecological surgery at Chung-Ang University Hospital between January 1, 2010, and June 30, 2016. We classified patients into two groups on the basis of glycopyrrolate premedication: non-premedicated group (Group N; n = 316) and glycopyrrolate premedicated group (Group P; n = 434). The Propensity Score Matching Method (PSM) was used to select 157 subjects in Group N and P, on the basis of their covariates which were matched with a counterpart in the other group.Results:Prior to PSM, the necessities for rescue anti-emetics were lower on Postoperative Day (POD) 0 (58[18.4%]vs.45[10.4%],P= 0.002) and POD1 (60[19.0%]vs.59[13.6%],P= 0.046), and Visual Analogue Scale (VAS) of pain on POD 1 (2.86 ± 1.49vs.3.13 ± 1.53,P= 0.017) was higher in group P. After PSM, the Numerical Rating Scale (NRS) score for nausea (0.38 ± 0.75vs. 0.21 ± 0.62,P= 0.027) and rescue anti-emetics (27 [17.2%]vs. 15 [9.6%],P= 0.047) on POD 0 were both lower in the group P.Conclusion:In patients receiving fentanyl-based IV-PCA after laparoscopic gynecological surgery, the severity of nausea and necessity for rescue ant-emetic was lower in the glycopyrrolate premedication group.

Background and Purpose: The COVID-19 pandemic continues to grow, with 19% of total confirmed patients classified as severe or critical experiencing complications such as dyspnea, hypoxia, acute respiratory distress syndrome, or multiorgan failure These complications require rehabilitative care Considering the contagious nature of COVID-19 and the necessity to decrease the volume of health care professionals entering confirmed COVID-19 patient rooms and becoming a potential disease vector, can audiovisual technologies employed by telehealth and telerehabilitation help? Case Description: This case discusses the Baylor Scott and White Institute for Rehab (BSWIR) Physical Medicine and Rehabilitation (PMR) department COVID-19 acute care therapy team's creation of a telehealth strategy to provide early rehabilitative intervention without increasing the odds of disease transmission Outcomes: The COVID-19 therapy team created a simple process for identifying and triaging care for patients with possible or confirmed COVID-19 These patients were evaluated and treated by the dedicated team using telehealth strategies A structured risk-benefit analysis was used to determine when in-room care was indicated Discussion: Acute care physical therapy, occupational therapy, and speech-language pathology telehealth strategies can add value by mitigating COVID-19–related harm and influencing recovery, while not unnecessarily becoming additional disease vectors consuming personal protective equipment COVID-19 is not only an aggressive respiratory illness similar to acute respiratory distress syndrome but also highly contagious and a risk for health care providers Telehealth strategies allow therapists to intervene early, opening the possibility to maximize recovery and prevent harm or decompensation Telehealth strategies can be more prevention-focused while the patient is experiencing relatively good health with goals to maximize strength and endurance before the disease process evolves to critical illness As COVID-19 progresses, therapy can help mitigate potential complications associated with prolonged intensive care unit stay and ventilator management

Bilateral basal ganglia abnormalities on MRI are observed in a wide variety of childhood disorders. MRI pattern recognition can enable rationalization of investigations and also complement clinical and molecular findings, particularly confirming genomic findings and also enabling new gene discovery. A pattern recognition approach in children with bilateral basal ganglia abnormalities on brain MRI was undertaken in this international multicentre cohort study. Three hundred and five MRI scans belonging to 201 children with 34 different disorders were rated using a standard radiological scoring proforma. In addition, literature review on MRI patterns was undertaken in these 34 disorders and 59 additional disorders reported with bilateral basal ganglia MRI abnormalities. Cluster analysis on first MRI findings from the study cohort grouped them into four clusters: Cluster 1-T-weighted hyperintensities in the putamen; Cluster 2-T-weighted hyperintensities or increased MRI susceptibility in the globus pallidus; Cluster 3-T-weighted hyperintensities in the globus pallidus, brainstem and cerebellum with diffusion restriction; Cluster 4-T-weighted hyperintensities in the basal ganglia. The 34 diagnostic categories included in this study showed dominant clustering in one of the above four clusters. Inflammatory disorders grouped together in Cluster 1. Mitochondrial and other neurometabolic disorders were distributed across clusters 1, 2 and 3, according to lesions dominantly affecting the striatum (Cluster 1: glutaric aciduria type 1, propionic acidaemia, 3-methylglutaconic aciduria with deafness, encephalopathy and Leigh-like syndrome and thiamine responsive basal ganglia disease associated with SLC19A3), pallidum (Cluster 2: methylmalonic acidaemia, Kearns Sayre syndrome, pyruvate dehydrogenase complex deficiency and succinic semialdehyde dehydrogenase deficiency) or pallidum, brainstem and cerebellum (Cluster 3: vigabatrin toxicity, Krabbe disease). The Cluster 4 pattern was exemplified by distinct T-weighted hyperintensities in the basal ganglia and other brain regions in genetically determined hypermanganesemia due to SLC39A14 and SLC30A10. Within the clusters, distinctive basal ganglia MRI patterns were noted in acquired disorders such as cerebral palsy due to hypoxic ischaemic encephalopathy in full-term babies, kernicterus and vigabatrin toxicity and in rare genetic disorders such as 3-methylglutaconic aciduria with deafness, encephalopathy and Leigh-like syndrome, thiamine responsive basal ganglia disease, pantothenate kinase-associated neurodegeneration, TUBB4A and hypermanganesemia. Integrated findings from the study cohort and literature review were used to propose a diagnostic algorithm to approach bilateral basal ganglia abnormalities on MRI. After integrating clinical summaries and MRI findings from the literature review, we developed a prototypic decision-making electronic tool to be tested using further cohorts and clinical practice. Analysing a cohort of 201 children with bilateral basal ganglia MRI abnormalities in conjunction with a literature review, we propose a stepwise approach for 93 different disorders. Disorders cluster based on MRI changes in the putamen, globus pallidus alone or with brainstem and cerebellar changes and with T2W versus T1W hyperintensities in the basal ganglia

Background: With the increasingly serious energy and environmental crises and shortages of conventional energy such as coal and oil, humans have been focusing on new energy sources, especially the abundant wave energy resource. Previous researchers have made great contributions to the design of wave energy converters and have also applied for many patents. However, advanced comprehensive wave energy evaluation and application systems are still scarce, which results in the primitive state of wave energy evaluation. Methods: The goal of this work is to overview the status and prospects of the evaluation of global wave energy to find an effective method to evaluate wave energy resources. This study divides the wave energy evaluation into 4 historical periods according to the data source. The future focus for wave energy resource evaluation is also presented in this study. Results: The wave energy evaluation includes 4 periods: the observational wave data period, the satellite-derived wave data period, the hindcast (simulation wave data from a wave model) wave data period and the reanalysis wave data period. In future research, the focus of wave energy evaluation should include the swell energy, the climatic characteristics of the wave energy resource, the characteristics of marine environments, the mid-to-long-term prediction of wave energy, the short-term forecasting of wave energy, and the evaluation of resources at a particular site. Conclusion: A scientific evaluation framework and application system (software) is urgently needed to provide a basis for decisions for the development of wave power generation, desalination and other developments of wave energy and to promote the sustainable development of human society.

Background and Purpose Telehealth is defined as the delivery of health-related services and information via telecommunication technologies. The purposes of this case report are: (1) to describe the development, implementation, and evaluation of a telehealth approach for meeting physical therapist supervision requirements in a skilled nursing facility (SNF) in Washington and (2) to explore clinical and human factors of physical therapist practice in an SNF delivered via telehealth. Case Description In 2009, Infinity Rehab conducted a pilot program to determine whether telehealth could be used to meet physical therapist supervision requirements in an SNF. In 2011, language allowing telehealth physical therapy was approved by the Washington Board of Physical Therapy (Board). In 2014–2015, telehealth outcomes were evaluated in a 51-person sample at an Infinity Rehab SNF. Cost savings of telehealth implementation from 2011 to 2015 were estimated. Outcomes The Board deemed the telehealth pilot program a success and subsequently established telehealth practice language for physical therapy. Both human factors and clinical outcomes were required to implement a successful telehealth practice. Clinical outcomes and user satisfaction in telehealth and nontelehealth groups were equivalent. Cost savings were identified. Discussion Human factors, such as the need for provider education in appropriate bedside manner with a telehealth session, were identified. Since 2011, more than 1,000 telehealth physical therapy sessions were conducted at Infinity Rehab SNFs in Washington State. In the future, alternative payment models focused on valued-based clinical outcomes may facilitate wider telehealth adoption in physical therapy. Future research on efficacy and cost-effectiveness is needed to promote broader adoption of telehealth physical therapy in SNFs. This experience demonstrates that telehealth implementation in an SNF for the purpose of physical therapy re-evaluation is a feasible alternative to in-person encounters.

BACKGROUND AND PURPOSEMultimedia innovations including audio and video instructions are used in physical therapy education.1 Classroom technology in physical therapist (PT) educational programs has included multimedia use of CD ROM, student response systems, web 2.0 applications, and flipped class applications in PT educational programs.2'5 In addition, educational leaders in physical therapy emphasize the importance of delivering multimedia innovations into the modern classroom to effectively engage millennial learners.6,7 However, multimedia innovations come with inherent barriers and costs.5 Faculty in PT educational programs are challenged by lack of resources and time necessary to implement multimedia innovations in the classroom.8 Faculty may also be uncomfortable with new multimedia innovations and perceive its usage in the classroom as more disruptive than beneficial for learners. Most importantly, despite growing up with expansive technology, some student learners are not comfortable with use of new multimedia innovations in the classroom.5,9 Beyond the actual costs associated with physical hardware, software, and equipment, new multimedia innovations may require administrative fees and/or institutional licenses for users.5 One strategy to alleviate the potential costs and implementation barriers is to use free online media player 3 (mp3) media in order to reinforce classroom learning.Online mp3 media are audio files downloaded from the Internet ideally available to the general public for free and used in physical therapy.10 To date, online mp3 media to promote learning in PT education, including medical screening for patient referral content, have not been described.The literature provides examples of teaching strategies related to differential diagnosis and medical screening for patient referral in PT educational programs. Various educational programs have incorporated case vignettes and student/faculty role-playing to enhance classroom activities.11,12 These teaching methods improved students' written exam outcomes and student self-confidence in skills necessary for initiating a medical referral to a physician.11 Furthermore, learning experiences including actual callers with aches, pains, sprains, and strains may be advantageous to reinforce student medical screening for patient referral abilities in a written assignment. Jette et al,13 using a survey made up of 12 hypothetical case scenarios, noted that PTs with orthopedic specialty are better at making appropriate decisions for medical referrals. In fact, PTs with an orthopedic specialization were almost twice as likely to make correct decisions for critical medical and musculoskeletal conditions compared to PTs without orthopedic specialty. In a followup study using the same hypothetical case vignettes, PT students in their final year of curriculum demonstrated lower abilities to make the correct decisions regarding medical referral compared to practicing PTs with orthopedic specialization.12 This suggests that the experience gained from clinical practice is an important aspect of the reasoning process. For example, except orthopedists, PTs in the uniformed services demonstrated higher scores than medical students, physician interns, residents, active duty military physicians and specialists in management of musculoskeletal conditions.14 Physical therapists have been shown to have the requisite knowledge to provide direct access for patients with musculoskeletal conditions in the military and cost-effective care in orthopedic outpatient departments in the United Kingdom.14,15 In light of this evidence, it could be advantageous to connect PT students with experienced PTs in a "real world setting" to reinforce medical screening abilities and to aid in the reasoning process. The use of multimedia innovations, including online mp3 media, may provide this opportunity in the classroom. The purpose of this case report is to describe educational multimedia innovations used in the "Medical Screening for Patient Referral" course at the Mount Saint Mary's University (MSMU), Los Argeles Doctor of Physical Therapy (DPT) program. …

Background and Purpose: Stroke, predominantly a condition of older age, is a major cause of acquired disability in the global population and puts an increasing burden on health care resources. Clear evidence for the importance of intensity of therapy in optimizing functional outcomes is found in animal models, supported by neuroimaging and behavioral research, and strengthened by recent meta-Analyses from multiple clinical trials. However, providing intensive therapy using conventional treatment paradigms is expensive and sometimes not feasible because of social and environmental factors. This article addresses the need for cost-effective increased intensity of practice and suggests potential benefits of telehealth (TH) as an innovative model of care in physical therapy. Summary of Key Points: We provide an overview of TH and present evidence that a web-supported program, used in conjunction with constraint-induced therapy (CIT), can increase intensity and adherence to a rehabilitation regimen. The design and feasibility testing of this web-based program, "LifeCIT," is presented. We describe how wearable sensors can monitor activity and provide feedback to patients and therapists. The methodology for the development of a wearable device with embedded inertial and mechanomyographic sensors, algorithms to classify functional movement, and a graphical user interface to present meaningful data to patients to support a home exercise program is explained. Recommendations for Clinical Practice: We propose that wearable sensor technologies and TH programs have the potential to provide most-effective, intensive, home-based stroke rehabilitation.

Noroviruses account for over 90% of all viral gastroenteritis cases and ~50% of all outbreaks worldwide. Each year in Australia, there are an estimated 1.8 million cases. Casesmaybe sporadic or part of outbreaks, occurring in either the community or healthcare setting. Outbreaks are associated with significant morbidity and some mortality. They incur substantial costs and can be difficult to control in healthcare institutions or other closed settings. Multiple factors (related to virus biological properties, human immune responses or inadequate management modalities) make it a challenging pathogen to control. They include: multiple transmission routes, low infectious dose, environmental survival, spread and persistence, diagnostic difficulty, hand hygiene controversies, imperfect immunity and immune evasion, asymptomatic and prolonged shedding, lack of vaccine and lack of antiviral treatment. The purpose of this article is to promote a better understanding of these factors in order that health professionals may be better equipped to manage the problems posed by noroviruses. Until large-scale effective vaccination and specific treatments become available, the safeguarding of food and water supplies and the rigorous and timely application of outbreak management and infection control measures will remain the key to norovirus disease prevention and control.

Aims To describe long-term survival (beyond 200 days) following Staphylococcus aureus bacteraemia (SAB) and to determine if certain patient subgroups had poorer long-term survival outcomes. Methods A single-centre, retrospective, cohort study of all SAB cases at The Canberra Hospital, a tertiary referral centre, from January 1998 to December 2007 was performed. Clinical and demographic data were obtained from a pre-existing prospectively collected database. Patients were followed-up for a minimum of 9 months. Subsets within the cohort were analysed for differences in long-term survival. The main outcome measure was death from any cause. Results During the 3889-day study observation period, 439 patients had SAB and were followed for a total of 546 360 person-days. The overall median survival was 3169 days. The mortality rates were 9.6%, 17%, 24%, 29% and 32% at 7, 30, 90, 180 and 365 days respectively. Atotal of 188 (43%) patients died. Of the 188 deaths, 22%, 40%, 55%, 67% and 75% occurred within the first 7, 30, 90, 180 and 365 days respectively after their SAB episode. Initial analysis showed poorer long-term survival in those patients with older age, MRSA, with an unknown focus of infection, and who were not admitted under the Infectious Diseases team. However, on multivariate analysis, the only independent risk factors for poorer survival were older age, unknown focus of infection and not being admitted under the Infectious Diseases team. MRSA, sex, surgical vs non-surgical admitting team and an association with an intravascular device were not associated with poorer long-term survival. Conclusions High rates of death continue for many months after patients have an episode of SAB. Short-term follow-up studies (30 days or less) may miss large numbers of SAB-associated deaths. If accurate data on SAB associated mortality is needed, then follow-up of these patients will be needed for at least 90 days, ideally performed prospectively with a matched control group consisting of hospitalised patients without SAB.

Telehealth is defined as the delivery of health-related services and information via telecommunications technologies. According to the American Telemedicine Association (ATA), “telehealth” is a broad term used to describe the use of electronic communications to deliver clinical services as well as other types of health information.1 In rehabilitation, telehealth is defined by the American Physical Therapy Association (APTA) as the use of electronic communications to provide and deliver a host of health-related information and health care services, including, but not limited to, physical therapy–related information and services, over large and small distances.2 Telehealth may be used to provide health education and advice, communicate patient reminders, monitor clinical status, or deliver interventions. Other rehabilitation disciplines, such as occupational therapy and speech therapy, utilize the terms “telerehabilitation”3 and “telepractice”4 as terms to define telehealth in their respective disciplines. The Patient Protection and Affordable Care Act (Public Law 111–148) (PPACA),5 signed into law on March 23, 2010, addresses the use of telehealth as a means of delivering efficient and effective health care in the United States. The national health care reform6 presents a unique opportunity for physical therapists to become identified as clinicians eligible to provide telehealth physical therapy services. However, there are several barriers to overcome if telehealth as a means of health care delivery for physical therapist practice is to become a reality. The objectives of this health policy perspective article are: (1) to describe the development of the telehealth field from a rehabilitation perspective, thereby highlighting some of the potential applications by physical therapists; (2) to discuss current barriers to adoption of telehealth technology by physical therapists; and (3) to identify an overall strategy to achieve long-term adoption of telehealth practices for physical therapists. The earliest applications of telehealth used technology to monitor cardiac …

Background and Purpose. Physical therapists, particularly those involved in educating doctors of physical therapy (DPTs), are often confronted with the following question: What is the educational priority for entry-level students? To become socially responsible professionals? To become culturally competent providers? How is the physical therapy profession maintaining social responsibility and cultural competence as core values of the profession? The purpose of this study was to investigate whether existing measures of social responsibility and cultural competence capture a potential association between 2 groups of physical therapists with international experiences. The hypothesis was that physical therapists with multiple international experiences would demonstrate a positive relationship between social responsibility and the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised (IAPCC-R) survey tool. Therefore, potential partnership between educators and physical therapists with multiple international experiences could be possible with instructional technology in the classroom. Subjects. Purposive sampling consisted of 2 physical therapist groups, a "few international experiences" group (n = 32) and a "multiple international experiences" group (n = 23), retrieved from the American Physical Therapy Association's online member directory. Methods. Quantitative data, generated by using APTAs Professionalism in Physical Therapy: Core Values Self-Assessment and the IAPCC-R online survey, were collected. Results. Study outcomes indicated a statistically significant difference in IAPCCR total scores between the 2 groups. Social responsibility was moderately and positively correlated with IAPCC-R (r = .627, P = .001) for the multiple international experiences group. Discussion and Conclusion. The findings suggest that social responsibility and cultural competence may not be mutually exclusive. Physical therapists with multiple international experiences may help model social responsibility and cultural competence to physical therapist students. Overall, the process of social responsibility and cultural competence is seen as a life-long continuum that should be considered mainstream in the physical therapy profession. Key Words: Cultural competence, Professionalism, Social responsibility. BACKGROUND AND PURPOSE Physical therapists, particularly those involved in educating doctors of physical therapy (DPTs) must consider, "What is the educational priority for the entry-level student?" "Is it to be a culturally competent or socially responsible professional?" Purtilo,1 in her 31st Mary McMillan Lecture in 2000, noted that the task for future physical therapists will be to establish a "period of societal identity" as the moral foundation for a true professional partnering with the larger community of citizens and institutions. She added that cultural competence should be a non-negotiable skill subject to rigorous testing in the physical therapy profession.1 Hence, investigations should be implemented to explore how well the physical therapy profession is achieving Purtilo's challenge to achieve social responsibility and cultural competency as core components of the profession. The physical therapy profession has established a set of core values and a vision in the past decade. In 2002, the American Physical Therapy Association (APTA) identified 7 core values of the profession: accountability, altruism, compassion/caring, excellence, integrity, professional duty, and social responsibility.2 APTAs Board of Directors unanimously identified professionalism as the key to achieving Vision 20203 for the profession in 2003. To this end, social responsibility is defined as the promotion of a mutual trust between the physical therapy profession and the larger public that necessitates responding to societal needs for health and wellness. …

Background and Purpose. There are substantive issues to address in physical therapist education programs facing obstacles related to faculty funding for educational endeavors, identification of optimal pedagogies, and consideration of global and national health concerns. Educational technologies may serve as tools to expand the delivery of high-quality, efficient health care education to address current, evolving, and future needs of physical therapist students and the patients they will serve. The purpose of this case report is to describe the Versatile and Integrated System for Telerehabilitation (VISYTER) and its use for physical therapy telehealth consultation in an international setting, as well as its use to measure patient satisfaction and explore provider perspectives on the experience. Case Description. Three pediatric patients, 1 male and 2 females, with a mean age of 5 years (SD=3), and located in Mexico, participated in a telehealth session with academic and clinical faculty in the United States using the VISYTER telerehabilitation system. A patient satisfaction survey and user perspectives were collected and analyzed. Key themes were identified from semi-structured interviews with patients, family members, and health care providers. Outcomes. Patient satisfaction was high for utilizing the VISYTER telerehabilitation system. A key theme was that technology-assisted collaboration between the health care team members and patients may further education, research, and practice in Mexico and the United States. Discussion and Conclusion. Several challenges must be addressed when considering telehealth implementation internationally. Overall, the VISYTER telerehabilitation software, using lowbandwidth Internet connections (384 kbps) and aggressive compression with low resolution (320 x 240), allowed for a stable telehealth physical therapy consultation between Mexico to the United States. Key Words: International education, Telehealth, Telerehabilitation. BACKGROUND AND PURPOSE In 2009, the Pauline Cerasoli Lecturer Bella May1 envisioned physical therapist education programs in the year 2025, and identified drivers for future educational change in physical therapy. The original intent of May's lecture, as captured in the themes below, is as timely today as when it was first identified: Administrators and technology experts will be responsible for organization and implementation of activities as well as technological support and development. Physical therapy faculty members will be asked to set aside their roles as teachers and instead become designers of learning experiences, processes, and environments. Future learners' approach to learning will be plug and play>12> The themes from this Cerasoli Lectureto collaborate with technology experts in order to deliver effective pedagogy to future learners- are relevant today.1 With the United States facing double-digit college tuition hikes,2 universities must seek ways to effectively educate students in a cost-effective manner. Gwyer and Hack3 identified current challenges for physical therapist education programs, including faculty and academic leadership shortages, the funding of education endeavors in both academic and clinical settings, the identification of new pedagogies suited to a new generation of learners, and both global and national health concerns. The implementation of technologies in the classroom may have a positive impact on costs, the quality of education, the potential for collaborative and expanded research, and may enhance overall physical therapist practices locally and globally. Appropriate use of educational technology may help address the present challenges in physical therapist education programs by expanding the delivery of high-quality, cost-efficient education to address current, evolving, and future needs of physical therapist students and the patients they will serve. Telehealth is defined by the American Physical Therapy Association (APTA) as the use of electronic communications to provide and deliver a host of health-related information and health care services, including, but not limited to, physical therapy-related information and services over large and small distances. …

PurposeThe purpose of this paper is, first, to summarize six studies which analyze the key characteristics of different types of employees. Three types of employees found in workplaces all over the world are identified as “Necessities,” “Commoners,” and “Parasites” and, second, to combine the results of these studies in order to identify the key traits and behaviors that characterize each type of worker across a variety of social and cultural settings.Design/methodology/approachFor starters, three types of employees are defined. First, a person is a Necessity if s/he is irreplaceable and critical to the functioning of an organization. Second, a Commoner is a person of normal ability and talent who has no significant impact on organizational processes. Last, Parasites are detrimental freeloaders who damage the functioning of an organization. To identify the principal characteristics of these three types of workers, a group of researchers led by the first author conducted six studies in which they collected survey data from undergraduate and graduate business students in the USA, India, Korea, Chile, and Japan.FindingsThe authors note the points of commonality and difference across the data sets, and offer their thoughts on future research in the area. The perceptions of what characterizes really good workers (people of Necessity) and very bad workers (Parasites) appear to be the same in all five countries. The picture painted for the Commoner across all data sets, however, is not as clear‐cut.Originality/valueThe study described in this paper helps to explain both similarities and differences in employee characteristics between and among workers in different countries and cultures.

The concept of the Golden Mean, which has been accepted as a behavioral guideline of human beings for thousands of years, is briefly reviewed. Several empirical studies in the field of organizational behavior are summarized as evidence that the concept has practical management applications. Based on the Golden Mean concept and its management empirical evidence, the authors propose a model of “Reasoned Responses” and its practical application to the decision-making process.

The evolution of post-industrial society is resulting in a `knowledgeeconomy.’ The changes involve `knowledge workers' in contrast to `manualworkers' of the past industrial economy. The quantity and quality of knowledgeworkers will determine success in national borderless competition. Althoughthe United State's recent prosperity and near perfect employment rate areexemplary, the technology leading to this success has been developed andshared by traditional industrial powers, i.e., Japan and France, and mid-techpowers such as South Korea.This paper examines methods by which South Korea incorporates Americanapplications of the knowledge economy into its system. The interdisciplinaryapproach includes sociological, linguistic, educational, and ethical elements.Suggested methods include double loop sharing, knowledge management withelectronic support systems, professional journals, and professionalinternational conferences. This paper offers a brief history and synopsis ofcurrent developments in knowledge-based systems, and suggests South Korean andAmerican applications. Recommendations also include the emphasis on Englishas the primary language to improve Korean communication among government,industry, and academic entities.

This article presents a "new" theory of management for the new millennium: "new" not because singularly the ideas are recent, but because the combination of these older ideas collectively is novel. To some extent, this article represents the reestablishment of previously existing employment ethics that for various and sundry reasons lapsed into disuse in the past several decades. This article discusses employee relations ethics (ERE) in terms of an ERE credo and a set of assumptions. The modern millennium mission states that all organizations (public and private) should primarily be employee centered, not owner or administrator controlled, customer or client driven, or both.

Much is being written today about the changing nature of the American workforce. This article summarizes 10 of these changes: (a) global competition; (b) the changing skills of work; (c) the declining impact of unions; (d) the altered human composition of the workforce; (e) the effects of continuous improvement, downsizing, and reengineering; (f) the growing use of part-time employees; (g) the widening income gap; (h) lessened employer and employee loyalty and commitment; (i) early retirement programs; and (j) telecommunications and virtual employees. Rather than just identifying and documenting these trends, this article discusses the ethical implications of such movements. In this article, employee relations ethics is defined as "treating employees properly, with respect and dignity." The term employee relations ethics is used both individually and collectively to analyze the negative human results from a moral rather than an economic perspective. The age-old clash between bottom-line mentality (economi...

The crushing behaviour of a mild steel thin-walled rectangular tube under axial compression is investigated. The crushing process with only the compact mode is considered. The characteristic values of the crush load of a rectangular tube with an arbitrary aspect ratio of cross section are empirically obtained. In the empirical results, two different peak-values per period in the crush load-distance curve are considered where the peak values are obtained from an ideal model. The ideal model, recently proposed by the authors, is primarily based on accounting the ratio of outward length to half-wave fold length in the crushing process. The crush distance after the first perfect fold is formed and the general crush distance per fold are theoretically derived using the geometrical configuration of a crushing fold. The theoretical and empirical results are shown to agree. The crush load-distance curve is assumed to be the sum of a fourth power term and two cosine functions. The energy absorption capacity is the integral of this curve over the allowed crush distance. The number of crush folds is then easily calculated.

Telehealth is defined by the American Physical Therapy Association as the use of electronic communications to provide and deliver a host of health-related information and health-care services, including, but not limited to, physical therapy-related content and services over large and small distances. Telehealth encompasses a variety of health-care and health promotion activities, including, but not limited to, education, advice, reminders, interventions, and monitoring of interventions. Telerehabilitation is a form of telemedicine and involves the delivery of therapeutic rehabilitation interventions using telecommunication technologies. This chapter will discuss the current telerehabilitation literature related to physical therapy. In addition, novice telehealth PT practitioners will learn of telerehabilitation resources available from national and international professional associations. By looking at the current evidence and guidelines related to telerehabilitation, we hope to glean future opportunities for practice, research, and education for physical therapy practitioners.

Recently, there has been a growing trend among information technology (IT) organizations to form strategic alliances to increase competitive advantages in the marketplace. For an organization to exploit the benefits of alliances, human factors and IT factors must be among the basic components of any strategic plan (Kemeny & Yanowitz, 2000). Despite the obvious need to consider human and IT factors when developing a long-term plan, many strategic plans developed in the past that led to alliances have failed to consider human aspects. Examples of failure in the implementation of IT systems due to the lack of consideration of human factors have come to light in recent years, but a comprehensive study of the consideration of human factors in the development of strategic alliances resulting in a major IT system alignment for a firm, is still rare in IT literature.

Gortler vortices appear in boundary layer flow along the concave surfaces due to the imbalance between pressure and centrifugal force. Many practical engineering designs involve concave surfaces such as engine inlet. In hypersonic boundary layers, there exist higher harmonic boundary layer modes (second, third mode etc.) as well as the first mode. If the flow is associated with the concave surfaces, Gortler mode also exists. Finding the most dominant instability mode in boundary layer flows is one of the fundamental problems in fluid mechanics. Forcing disturbances initially enter the boundary layers and generate instability waves which is called receptivity. Receptivity to free stream disturbances introduces random disturbances into the boundary layers, and the most dominant instability mode develops. It helps to find the most dangerous instability wave in boundary layers. In this paper, receptivity of Gortler and other instability waves in hypersonic boundary layers are investigated using Direct Numerical Simulation (DNS). Forcing disturbances are introduced into the hypersonic boundary layers by receptivity to free stream disturbances and blowing and suction. Random disturbances introduced by freestream acoustic and vorticity waves and blowing and suction develops Gortler kinds instability waves inside hypersonic boundary layers in concave region.

In this paper, Gortler instability for hypersonic flow over a concave surface is investigated using two approaches: Linear Stability Theory(LST) and Direct Numerical Simulation(DNS). Initial forcing disturbances are obtained from the LST, and subsequent linear and nonlinear development is simulated using NavierStokes equations. We investigate linear and nonlinear growth of Gortler vortices in hypersonic boundary layers.

Starch-granule bound glucan synthetase was isolated from cotton leaves by a sucrose density technique. Starch granules were successively washed with 0.02 M Na-phosphate buffer containing 0.9% NaCl. The alkaline hydrolysate of washed materials and acid hydrolysate of protein-bound amylopectin were separated by use of Con A-Sepharose. Amylolytic hydrolysate of starch granules also was carried out with α-amylase and fractionated by chromatography on Sephadex G-25. Amylopectin was the only glucan glycosidically linked with proteins, in which glucan synthetase activity was identified. The amylose component was free from covalently bound proteins.

A procedure to compare N fertilizers based on comparing complete response curves simultaneously represented by a quadratic multifertilizer response model (MRM) is discussed. A modified version of the MRM, called fertilizer testing model (FTM), is used to test differences among response curves. The FTM describes the response curve to a fertilizer selected as a standard as well as the additional effect of test fertilizers over the response to the standard. In case of different response curves, an approximate test to decide whether the curves have equal limiting yield is introduced. Finally, a procedure to estimate the availability coefficient from quadratic response curves having equal limiting yield is derived. These procedures were employed to analyze six field experiments conducted over a period of 3 years in Korea using three varieties of rice (Oryza sativa L. ‘Tongil,’ ‘Jinheung,’ and ‘Milyang 23’) and three fertilizers (urea and two sulfur-coated ureas, or SCU) applied at four or five levels of N. Two out of six experiments showed a significant effect from SCU-A (25% release/7 days) beyond that of split-applied urea, whereas SCU-B (14% release/7 days) showed significant additional effects in three out of five experiments. However, in four of these six experiments, the limiting yield of the response curves of SCU was significantly higher than that of urea, precluding a valid estimation of the availability coefficient. Possibly, the proper combination of N dose and timed release of N from SCU in these experiments translated into grain yields unmatched by split applications of urea.

α-Amylase activity from phenolic-rich plant tissues is successfully determined with an amylopectin-azure substrate. This procedure, due to the substrate's specificity for α-amylase, overcomes the effects of the interfering substances firmly associated with enzyme preparations. The procedure is more sensitive than the assay for activity with iodine solution.

A simple sucrose density technique has been developed for starch granule isolation from leaves. With this procedure starch-granule-bound glucan synthetase (EC 2.4.1.21) was successfully isolated from phenolic-rich plant tissue. This enzyme is firmly bound to starch granules and free from soluble glucan synthetase. The enzyme specific activity is more than 100-fold higher than that prepared by the previously reported procedure.

Glandless cotton plants (Gossypium hirsutum L. cv. Coker 100) were subjected to the influence of high CO(2)-bicarbonate. The content of protein decreased with no accompanying increase in its degraded products. The decrease in protein was correlated with the low content of chlorophyll and also with the reduced activity of carbonic anhydrase. The initiation of these correlations coincided with the time when the control leaves contained the highest enzyme activity during leaf growth. The high concentration of bicarbonate directly restricted the rate of photophosphorylation and that of the Hill reaction in isolated chloroplasts. The amount of ATP in leaves treated in vivo also diminished. High CO(2) as bicarbonate, however, did not directly inhibit the activity of carbonic anhydrase in vitro.

Starch degradation enzymes and their products were determined from chloroplasts and leaves of cotton (Gossypium hirsutum L. cv Coker 100) exposed t

5-Lipoxygenase pathway-derived products of arachidonic acid released by human eosinophils activated in vitro have been measured by using radioimmunoassays specific for leukotriene B4 (LTB4) and for sulfidopeptide leukotrienes including leukotriene C4 (LTC4). Eosinophil-enriched leukocytes (mean, 85% eosinophils) from five hypereosinophilic donors activated with 5.0 microM ionophore A23187 for 15 min at 37 degrees C in the presence of 50 mM L-serine released 69 +/- 28 and 1.5 +/- 0.8 (mean +/- SEM) ng of LTC4 and LTB4, respectively, per 10(6) cells; ratios of LTC4 to LTB4 ranged from 16 to 149. Eosinophils stimulated with ionophore (2.5 microM) or phorbol myristate acetate (1 microgram per ml) metabolized exogenously added LTC4 to products that coeluted on reverse-phase high-performance liquid chromatography with synthetic S-diastereoisomeric LTC4 sulfoxides and 6-trans-LTB4 diastereoisomers, and this metabolic inactivation was inhibited by L-serine or catalase. Ionophore-activated eosinophils purified from three normal donors also preferentially generated LTC4 (38 +/- 3 ng per 10(6) cells) relative to LTB4 (6.0 +/- 3.1 ng per 10(6) cells), whereas neutrophils from the same donors released LTB4 (48 +/- 21 ng per 10(6) cells) in a greater than 7-fold excess to LTC4. The predominant production by human eosinophils of LTC4 with its potent smooth muscle spasmogenic and vasoactive properties may contribute to the pathobiology of allergic and other diseases associated with eosinophilia.

A low-activation energy (35 000 cal.) for thermal inactivation and a large Km value (11·10−3 moles) for substrate affinity were found from carbonic anhydrase of the cotton plant, which was reported to be heat-tolerant but low in the rate of CO2-fixation.

Q-Enzyme is responsible for branching during the biosynthesis of amylopectin, the major form of starch in leaves. Its activity, however, cannot be determined accurately in the presence of the degradative enzymes, α-amylase and R-enzyme (the debranching enzyme). Q-Enzyme activity was measured by incubating with amylose primer and measuring changes in absorbance of the glucan-I2 complex. Maximum interference by α-amylase occurred early because it attacked the amylose primer. Maximum interference by R-enzyme occurred later during the incubation period, because R-enzyme affected branched glucan which was formed at the later stage of incubation. Therefore, these enzymatic interferences occurred in sequence at two separate times and sites. Dialysis of Q-enzyme preparation against EDTA greatly decreased the activity of α-amylase, probably by removing calcium. Addition of calcium to the dialyzed enzyme preparation restored most of the amylase activity. R-Enzyme was removed from the reaction mixture by complexing it with alumina (r)-gel. The insoluble complex was then removed by centrifugation. Dialysis of the enzyme extract against EDTA, followed by treatment with alumina (r)-gel, effectively overcame interferences by α-amylase and R-enzyme, and permitted accurate measurement of Q-enzyme activity.

Samples of polystyrene and poly(methyl methacrylate) have been prepared by bulk polymerization under conditions previously investigated in the literature. The molecular weight distributions were determined for early-conversion samples by gel permeation chromatography, and the experimental distribution curves were compared with calculated curves based on kinetic data. The agreement between the experimental and calculated curves was such as to indicate the utility of gel permeation chromatography in the investigation of polymer reaction kinetics and mechanisms.

A method for fluoride determination has been developed in which a level of 0.0–2.5 μg fluoride was determined quantitatively from several milligram samples of biological material. This technique allows the drying, ashing, and diffusion of small samples without transfer. The SPADNS-zirconium lake is a sensitive and convenient color reagent. Recoveries of 96 to 102% were obtained.

Methods are described for the isolation and characterization of the nucleic acids of Oenothera organensis pollen. Alkaline hydrolysis, followed by paper chromatography served to characterize the ribonucleic acid. However, the low concentration of deoxyribonucleic acid and the large amounts of interfering polysaccharide material required application of special techniques and column chromatographic methods. In addition, a method is described for the isolation of “native” deoxyribonucleic acid from root tips of Zea mays and Oenothera .

In many previous studies developing barley embryos have been shown to be highly radiosensitive. With acute irradiations, many of the responses exhibited are dependent in great measure upon the specific embryonic stage irradiated. The present study was undertaken to determine to what extent nucleic acid metabolism in barley embryos might be altered following acute irradiation, and whether here, too, embryonic stage would play a decisive role. Embryos developing within the ovaries of the parent plants were irradiated with 450 r acute X-radiation at one of four specific stages: early proembryo, late proembryo, mid-differentiation, or late differentiation. Fractional analyses of the individual bases of DNA and RNA were carried out at embryonic “maturity”. Because of the presence of interfering substances within the embryos, modification of previously published methods was necessary, the procedures developed being described herein. The DNA of control embryos is of the A-T type with the ratio between guanine and cytosine being unity and that between adenine and thymine being only 0·68. The total nucleic acid content of irradiated embryos showed residual depressions of 30–36 per cent, most of this being due to an effect upon RNA which makes up about 85 per cent of the total nucleic acid at embryonic maturity. Overall depression of RNA amounted to as much as 39 per cent but with a maximum difference among irradiated groups of only 5 per cent. This low variability in RNA content indicates that neither difference in embryonic stage nor post-irradiation time are important factors. In contrast, DNA depression ranged from 7 to 33 per cent among irradiated groups, the degree of depression being inversely correlated with the embryonic stage irradiated. With the exception of the oldest embryo group, residual DNA depression was independent of post-irradiation time. Of the RNA bases, guanine and cytosine showed proportionately less alteration than adenine (which was the least radiosensitive) or uracil (which was the most labile). Changes in DNA base components were generally more complex with wide fluctuations in the amount of cytosine and guanine depression. Effects on adenine were less pronounced. Of the DNA bases, thymine was characteristically the most labile, being the only DNA base to be significantly depressed in all four irradiated groups and the only one to be so affected in two of the groups. Embryos irradiated early in proembryo development or late in differentiation showed greater degrees of residual DNA depression at embryonic maturity but with little alteration in DNA base ratios. Irradiation during late proembryo development, in contrast, produced little lasting effect on DNA content, but marked changes in DNA base ratios primarily because of a decrease in thymine. When compared with results from other studies the present data suggest that a relationship exists between alteration of DNA base ratios and the occurrence of organ abnormalities during embryonic development. Metabolic disturbance as an expression of intra- or inter-tissue incompatibility mediated through radiation-induced genetic heterogeneity is considered as a possible cause.

Investigation was made for the effect of fluoride on plant growth, acid soluble nucleotides, and RNA in germinating corn seedling roots. Fluoride suppresses root growth as measured by changes in fresh weight. Column chromatographic analyses demonstrated that fluoride modifies ratios of acid soluble nucleotide species. The relative amount of nucleotides is altered mainly due to triphosphate nucleotides of which ATP is most accumulated. Paper chromatographic analyses showed that fluoride induces changes of RNA structure. The RNA is characterized by lowered relative content of cytosine and by increased ratio of cytosine to guanine. Adenine is depressed significantly only in the root tissue treated by the highest fluoride concentration.

A study was made of the relationship between the level of r RNA and the rate of growth in pinto bean plants treated with 0·35 ppm ozone for 20–40 min. Cytoplasmic ribosomes and a fraction containing both cytoplasmic and chloroplast ribosomes were initially isolated from primary leaves. The r RNA components of 25S, 23S, and 16S were extracted from these fractions and analysed by sucrose density gradient. The levels of cytoplasmic r RNA components, 25S and 16S, are not significantly affected by ozone. In contrast, ozone specifically decreases the relative level of 23S of chloroplast r RNA, as the rate of growth is inhibited.