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The current descriptive qualitative study provides an in-depth understanding of the perspectives of certified nursing assistants (CNAs, N = 7) regarding delirium. Data were collected through interviews with seven CNAs working in a long-term care facility. Five themes emerged: Knowledge About Delirium, Caring for Residents With Delirium, Delirium Education, Psychological Burden, and Quality of Care. CNAs' care of residents with delirium was based on prior experiences and gut feelings, indicating a high need for delirium training. [Journal of Gerontological Nursing, 49(2), 43–51.], Delirium, a common geriatric syndrome, is defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (American Psychiatric Association [APA], 2022) as disturbances in attention, consciousness, [...]

Objective. The purpose of this study was to assess whether the superior cost-effectiveness of a personalized physical therapy approach (Coach2Move)--which was demonstrated in a previous trial compared with usual care physical therapy (UCP)--can be replicated in daily clinical practice. Methods. A multicenter, cluster-randomized, stepped wedge trial with 4 clusters consisting of 4 physical therapist practices in the Netherlands was used to compare a personalized physical therapy approach to elicit physical activity (Coach2Move) versus care as usual. Multilevel analyses for effectiveness were conducted for the amount of physical activity (Longitudinal Aging Study Amsterdam Physical Activity Questionnaire) and functional mobility (Timed "Up & Go" Test) at 3, 6 (primary outcome), and 12 months' follow-up. Secondary outcomes were level of frailty (Evaluative Frailty Index for Physical Activity), perceived effect (Global Perceived Effect and Patient-Specific Complaints Questionnaires), quality of life (Euro Quality of Life-5 Dimensions-5 Levels [EQ-5D-5L]), and health care expenditures. Results. The 292 community-dwelling older adults with mobility problems visiting physical therapists were included in either the Coach2Move (n = 112; mean [SD] age = 82 [5] years; 60% female) or UCP (n = 180; mean [SD] age = 81 (6) years; 62% female) section of the trial. At baseline, Coach2Move participants were less physically active compared with UCP participants (mean difference = -198; 95% CI = -90 to -306 active minutes). At 6 months, between-group mean differences [95% CI] favored Coach2Move participants on physical activity levels (297 [83 to 512] active minutes), functional mobility (-14.2 [-21 to -8]) seconds), and frailty levels (-5[-8 to -1] points). At 12 months, the physical activity levels of Coach2Move participants further increased, and frailty levels and secondary outcomes remained stable, whereas outcomes of UCP participants decreased. After the Coach2Move implementation strategy, physical therapists utilized significantly fewer treatment sessions compared with before the implementation (15 vs 22). Anticipated cost savings were not observed. Conclusion. This study replicated the results of an earlier trial and shows that Coach2Move leads to better mid- and long-term outcomes (physical activity, functional mobility, level of frailty) in fewer therapy sessions compared with UCF' Based on these and earlier findings, the implementation of Coach2Move in physical therapist practice is recommended. Impact. This article describes the implementation of the Coach2Move approach, a treatment strategy that has proven to be cost-effective in a previously conducted randomized controlled trial. Implementation of Coach2Move in a real-life setting allowed an evaluation of the effects in a clinically relevant population. Coach2Move has been shown to increase physical activity, improve functional mobility, and reduce frailty more effectively compared with UCP therapy and therefore has application for physical therapists working with older adults in daily clinical practice. Lay summary. Coach2Move is a new physical therapy approach for older adults. Implementation of Coach2Move in daily clinical practice can help people better outcomes over a longer period of time against similar costs compared with regular physical therapy. Keywords: Aged, Decision Making: Clinical, Evidence-Based Practice, Patient-Centered Care, Physical Therapists, Primary Health Care, Introduction Physical activity is beneficial to improve quality of life and to counter adverse effects of frailty and comorbidities in older adults. (1) However, adoption and maintenance of an active [...]

Objective. The purpose of this study was to critically appraise and summarize the evidence for reliability of muscle strength and muscle power assessment in patients with neuromuscular diseases (NMDs) using isokinetic dynamometry. Methods. PubMed, CINAHL, and Embase electronic databases were searched from inception to March 8, 2022. Studies designed to evaluate reliability of muscle strength and power measurements using isokinetic dynamometry were included in this review. First, the methodological quality of the studies was assessed according to the Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines. Next, the quality of measurement properties was determined. Finally, the methodological quality and quality of measurement properties of the studies were combined to obtain a best-evidence synthesis. Results. A best-evidence synthesis of reliability was performed in 11 studies including postpoliomyelitis syndrome (n = 5), hereditary motor and sensory neuropathy (n = 2), motor neuron diseases (n = 1), myotonic dystrophy (n = 1), and groups of pooled NMDs (n = 2). A best-evidence synthesis on measurement error could not be performed. Quality of evidence on reliability ranged from high in postpoliomyelitis syndrome to very low in hereditary motor and sensory neuropathy, motor neuron diseases, and groups of pooled NMDs. The most frequently used outcome measure was peak torque, which was reliable in all populations (intraclass correlation coefficient >0.7). Conclusion. The quality of evidence for reliability of isokinetic dynamometry was found to vary substantially among different NMDs. High quality of evidence has been obtained only in patients with postpoliomyelitis syndrome. Further research is needed in the majority of known NMDs to determine reliability and validity of isokinetic dynamometry. Impact. The ability of isokinetic dynamometers to capture clinically relevant changes in muscle strength and muscle power in NMDs remains unclear. Isokinetic dynamometry results in NMDs should be interpreted with caution. Keywords: Muscle Strength, Muscle Strength Dynamometer, Muscle Weakness, Neuromuscular Diseases, Reproducibility of Results, Introduction Neuromuscular disorders (NMDs) are a heterogeneous group of acquired and genetic diseases that may encompass all levels of dysfunction of the peripheral nervous system--that is, the anterior horn cells, [...]

Rashkovsky, Karine. An Improbable Life: My Father's Escape from Soviet Russia. Cherry Orchard. Sept. 2024.194p. ISBN 9798887195131. pap. $20. HIST Educator/artist/executive coach Rashkovsky's book, presented in her father's voice, follows [...]

According to a Deloitte study, 77 percent of manufacturers anticipate ongoing difficulties in attracting and retaining workers. Manufacturers are struggling to fill both entry-level and skilled positions. Experts estimate that [...]

Founded in 1947, HNI Corp. has grown into a premier manufacturer of office furniture, fireplaces and heating stoves. Since its inception, the company has focused on maximizing efficiency and providing [...]

BIOGRAPHY & MEMOIR Elmore, Phyllis Biffle. Quilt of Souls. Imagine. Nov. 2022.304p. ISBN 9781623545161. $24.99. MEMOIR At four years old, Elmore was uprooted from her home in Detroit and sent [...]

What's up, Nick? What are you up to? I just had dinner with my dad and I'm gonna get groceries, do some laundry, unpack and all that stuff. I'm just [...]

In this paper, we offer a new framework to measure cross-border supply chain fragmentation and its impact on the global trade elasticity. Firstly, we introduce the supply chain fragmentation ratio that sums the volume of imports by all countries that participate in a particular supply chain. We find that supply chain fragmentation slowed down after 2010 for most goods, but not for services. We demonstrate the importance of using trade and production data at constant prices in measuring fragmentation trends. Secondly, we quantify the impact of fragmentation on the elasticity of trade to world GDP, extending the framework of Bems et al. (Am Econ Rev Pap Proc 101 (3):308-312, 2011). We account for trade effects from fragmentation within supply chains as well as asymmetric shocks to final demand. We find that the declining pace of fragmentation accounted for more than a third of the decline in the global trade elasticity after 2010. JEL Classification F14 * F15 * F62, 1 Introduction How can we track cross-border supply chain fragmentation and its impact on the global trade elasticity? The contribution of this paper is twofold. We first introduce the supply [...]

As we sat in our Zodiac, watching the humpback whale's fluke disappear below the water, we heard a sharp popping sound behind us. I turned to see a small chunk [...]

IF SOMEONE said 'I used generative AI to help write this essay' only a year ago, it is a safe bet that many English language arts teachers would not understand [...]

'Everybody wants to feel as if they are a VIP; everyone wants to feel special,' said Kerry Ann Quallo Casserly, regional commercial director in Jamaica for Blue Diamond Resorts. She [...]

Objective. Dry needling is a treatment technique used by clinicians to relieve symptoms in patients with tension-type headache (TTH), cervicogenic headache (CGH), or migraine. This systematic review's main objective was to assess the effectiveness of dry needling on headache pain intensity and related disability in patients with TTH, CGH, or migraine. Methods. Medline/PubMed, Scopus, Embase, PEDro, Web of Science, Ovid, Allied and Complementary Medicine Database/EBSCO, Cochrane Central Register of Controlled Clinical Trials, Google Scholar, and trial registries were searched until April 1, 2020, along with reference lists of eligible studies and related reviews. Randomized clinical trials or observational studies that compared the effectiveness of dry needling with any other interventions were eligible for inclusion. Three reviewers independently selected studies, extracted data, and assessed risk of bias. Random-effects meta-analyses were performed to produce pooled-effect estimates (Morris [d.sub.ppc2]) and their respective CIs. Results. Of 2715 identified studies, 11 randomized clinical trials were eligible for qualitative synthesis and 9 for meta-analysis. Only 4 trials were of high quality. Very low-quality evidence suggested that dry needling is not statistically better than other interventions for improving headache pain intensity in the short term in patients with TTH (SMD -1.27, 95% CI = -3.56 to 1.03, n = 230), CGH (SMD -0.41, 95% CI = -4.69 to 3.87, n = 104), or mixed headache (TTH and migraine; SMD 0.03; 95% CI = -0.42 to 0.48, n = 90). Dry needling provided significantly greater improvement in related disability in the short term in patients with TTH (SMD -2.28, 95% CI = -2.66 to -1.91, n = 160) and CGH (SMD -0.72, 95% CI = -1.09 to -0.34, n = 144). The synthesis of results showed that dry needling could significantly improve headache frequency, health-related quality of life, trigger point tenderness, and cervical range of motion in TTH and CGH. Conclusions. Dry needling produces similar effects to other interventions for short-term headache pain relief, whereas dry needling seems to be better than other therapies for improvement in related disability in the short term. Impact. Although further high-methodological quality studies are warranted to provide a more robust conclusion, our systematic review suggested that for every 1 or 2 patients with TTH treated by dry needling, 1 patient will likely show decreased headache intensity (number needed to treat [NNT] = 2; large effect) and improved related disability (NNT = 1; very large effect). In CGH, for every 3 or 4 patients treated by dry needling, 1 patient will likely exhibit decreased headache intensity (NNT = 4; small effect) and improved related disability (NNT = 3; medium effect). Keywords: Cervicogenic Headache, Dry Needling, Meta-Analysis, Migraine, Systematic Review, Tension-Type Headache, Introduction Headache disorders are the third leading cause of disability among the world's adult population, (1) with a high economic burden for society, (2) affecting approximately 46% of the global [...]

Moorestown, NJ, Fire Department (MFD) Fire Police Capt. Peter Clifford, along with the Board of Fire Commissioners and members of the fire department, felt the pressure of declining membership in [...]

Background. Coach2Move is a personalized treatment strategy by physical therapists to elicit physical activity in community-dwelling older adults with mobility problems. Objective. The primary objective of this study is to assess the effectiveness and cost-effectiveness of the implementation of Coach2Move compared with regular care physical therapy in daily clinical practice. Design, Setting, Participants, and Intervention. A multicenter cluster-randomized stepped wedge trial is being implemented in 16 physical therapist practices (4 clusters of 4 practices in 4 steps) in the Netherlands. The study aims to include 400 older adults ([greater than or equal to]70 years) living independently with mobility problems and/or physically inactive lifestyles. The intervention group receives physical therapy conforming to the Coach2Move strategy; the usual care group receives typical physical therapist care. Measurements. Measurements are taken at baseline and 3, 6, and 12 months after the start of treatment. The primary outcomes for effectiveness are the amount of physical activity (LASA Physical Activity Questionnaire) and functional mobility (Timed Up and Go test). Trial success can be declared if at least 1 parameter improves while another does not deteriorate. Secondary outcomes are level of frailty (Evaluative Frailty Index for Physical Activity), perceived effect (Global Perceived Effect and Patient Specific Complaints questionnaire), quality of life (EQ-5D-5 L), and health care expenditures. Multilevel linear regression analyses are used to compare the outcomes between treatment groups according to an intention-to-treat approach. Alongside the trial, a mixed-methods process evaluation is performed to understand the outcomes, evaluate therapist fidelity to the strategy, and detect barriers and facilitators in implementation. Limitations. An important limitation of the study design is the inability to blind treating therapists to study allocation. Discussion. The trial provides insight into the effectiveness and cost-effectiveness of the Coach2Move strategy compared with usual care. The process evaluation provides insight into influencing factors related to outcomes and implementation., Physical activity has beneficial effects for older adults in the prevention and reduction of frailty and improvement of quality of life. (1) However, increasing physical activity is known to be [...]

Variation in healthcare delivery is necessary to some extent because of the need to tailor interventions to each patient's unique circumstances. But it also can reflect inefficiencies in care processes [...]

Background. Low back pain (LBP) is very common and is a main cause of limited activity and work absence. Patients with LBP may also report spinal morning stiffness; this symptom could be useful for identifying subgroups with signs and symptoms related to spinal osteoarthritis. Objective. This study investigated whether an association exists between reported spinal morning stiffness and radiographic evidence of lumbar disk degeneration (LDD) in people with LBP and a history of pain of the hip and/or knee. Design. This cross-sectional study used 8-year follow-up data from the Cohort Hip and Cohort Knee study. Methods. The association between spinal morning stiffness and radiographic LDD features was assessed with multivariable logistic regression models. Results. The presence of osteophytes was significantly associated with spinal morning stiffness (odds ratio [OR] = 2.1 [95% confidence interval [CI] = 1.3-3.2]) as was the presence of grade 2 or 3 disk space narrowing (OR = 2.0 [95% CI = 1.1-3.5]). There was also a significant association between morning stiffness persisting for > 30 minutes and grade 2 osteophytes (OR = 2.6 [95% CI = 1.1-6.2]) and grade 1 disk space narrowing (OR = 2.0 [95% CI = 1.1-3.6]). Furthermore, there was a significant association between moderate spinal morning stiffness and the presence of osteophytes (OR = 2.0 [95% CI = 1.2-3.2]). Both the presence of osteophytes and disk space narrowing were significantly associated with severe spinal morning stiffness (for osteophytes: OR = 2.0 [95% CI = 1.2-3.7]; for narrowing at L1-S1: OR = 1.8 [95% CI = 1.1-3.1]). Limitations. Only lumbar lateral radiographs were available for each participant, implying that the LDD features could have been underestimated. The quality of the radiographs was not consistent. Conclusions. This study showed an association between self-reported spinal morning stiffness and symptomatic LDD. When morning stiffness lasted > 30 minutes, there was a significant association with the features of LDD. The association was stronger when the severity of spinal morning stiffness increased., Low back pain (LBP) is a common medical problem, and 70% to 80% of adults report experiencing an episode of LBP during their lifetime. (1) Moreover, LBP is the most [...]

"Which is more extreme: despise or detest?" is the sort of question teachers will hear as students discuss vocabulary stepping stones. The strategy requires students to analyze nuances of words [...]

To The Holland Sentinel, July 2, 2023 So far this summer, Israeli settlers have attacked at least three Americans visiting their relatives in villages in the West Bank, Palestine. 'The [...]

Zhao Rong and Lothar Ledderose, editors. Buddhist Stone Sutras in China. Shaanxi Province. Volume 1: Jinchuanwan Cave, East Wall. Shaanxi Institute for the Preservation of Cultural Heritage. Heidelberger Akademie der [...]

In the near future, this scenario could become reality. Additive manufacturing (AM), also known as 3D printing, could enable future agile operating concepts. AM has the ability to significantly shorten [...]

Background. Evidence about the role of physical therapy in perioperative care pathways to improve postoperative outcomes is growing. However, it is unclear whether research findings have been translated into daily practice. Objective. The objectives of this study were to describe the current content and between-hospital variability of perioperative physical therapist management for patients undergoing colorectal, hepatic, or pancreatic resection in the Netherlands and to compare currently recommended state-of-the-art physical therapy with self-reported daily clinical physical therapist management. Design. This was a cross-sectional survey study. Methods. Hospital physical therapists were asked to complete an online survey about pre- and postoperative physical therapy at their hospital. To explore the variability of perioperative physical therapist management between hospitals, frequency variables were clustered to determine the level of uniformity. Latent class analysis was performed to identify clusters of hospitals with certain homogeneous characteristics on a 19-item dichotomous scale. Results. Of 82 eligible Dutch hospitals, 65 filled out the survey (79.3%). Preoperative physical therapy was performed in 34 hospitals (54.0%; 2/65 responding hospitals were excluded from the data analysis). Postoperative physical therapy was performed in all responding hospitals, focusing mainly on regaining independent physical functioning. Latent class analysis identified a 3-class model. Hospitals in classes I and II were more likely to provide preoperative physical therapist interventions than hospitals in class TIT. Limitations. The use of self-reported answers can lead to bias. Conclusions. There was a wide degree of variability between hospitals regarding pre- and postoperative clinical physical therapist practice for patients opting for major abdominal surgery. Three different classes of daily practice were identified. Further translation of key research findings into clinical physical therapist practice is advised, especially for hospitals in which the physical therapist is not involved preoperatively. Moreover, improving uniformity by developing up-to-date clinical guidelines is recommended., According to the World Health Organization, the number of people aged 65 and older is expected to increase to 1.5 billion by 2050, representing 16.0% of the world's population. (1) [...]

Luke Holden and Ben Conniff started a small chain of simple lobster shacks. Then they started thinking much bigger. Step into one of the 39 Luke's Lobster locations from New [...]

* A new wave of innovation disrupts our social and economic life as we have lived it in the 20th century. On the one hand, artificial intelligence (AI) has the [...]