"The Effects of Culture and Gender on Occupational Therapy Practice for Adults: From Palestinian Therapists' Perspective".

As the occupational therapy profession is rooted in Western ideals, it may encounter complexities in culturally traditional settings like Palestine, especially for adults. This study reveals the challenges faced by occupational therapists in Palestine. A phenomenological qualitative approach was used, interviewing six experienced female therapists using semi-structured interviews. Purposive sampling ensured a diverse participant selection. Thematic analysis revealed several key themes, such as the continuous adaptation to Western practices to fit the Palestinian context, the value of interdependence, and the unique life balance. Results show that cultural and gender norms significantly shape occupational therapy practices in Palestine. The discussion emphasizes the theoretical necessity for cultural sensitivity in occupational therapy, advocating alignment with local values and addressing resource limitations for effective service delivery.

Improving the Consent Process With an Informed Consent Video Prior to Outpatient Colonoscopy.

BACKGROUND AND AIMS: Informed consent should allow patients the appropriate time and conditions to make decisions about their care. However, consent is often obtained immediately prior to a colonoscopy. We conducted a quality improvement study to assess how a preprocedure consent video 2 days prior to an outpatient colonoscopy impacts patient satisfaction. METHODS: Patients undergoing outpatient colonoscopy at a large academic medical center opted in to a text messaging platform for procedural information. Our intervention was an informed consent video 2 days before the colonoscopy. Our primary outcome was a composite patient satisfaction score. Pre and postintervention scores were compared using ordinal or multinomial logistic models to calculate odds ratios (OR) or relative risk ratios and 95% confidence intervals (CI), adjusting for age and sex. RESULTS: 1109 and 1452 patients completed ≥1 survey question in the pre and postintervention phases, respectively. Overall patient satisfaction did not differ between groups [OR for a 1-point increment in satisfaction score between post- vs pre-intervention groups = 1.05; 95% CI: 0.90-1.22; P = .51]. Compared to preintervention, postintervention respondents were more likely to report higher satisfaction with time available to talk with their physician (OR of a 1-point increase in individual question response = 1.29; 95% CI: 1.09-1.54; P = .004). Compared to preintervention, more physicians in the postintervention phase rated satisfaction with consent process efficiency as "very satisfied" or "satisfied" (P < .001). CONCLUSION: An informed consent video prior to colonoscopy resulted in similar overall patient satisfaction. However, post-intervention, patients were more likely to report sufficient time to talk with their physician, and physicians reported higher satisfaction with consent efficiency.

Structural Performance of Ferrocement Panels under Low- and High-Velocity Impact Load.

The primary objective of this experimental study is to examine the response and energy absorption capacity of ferrocement panels exposed to low- and high-velocity impact loads. The panels are reinforced with two different types of mesh layers, namely, welded wire grid (WWG) and expanded wire grid (EWG), with varying percentages of steel fibers (SF). The ferrocement panel system is made up of cement mortar reinforced with 0-2% SF with an increment of 1% and wire grid layers arranged in three different layers 1, 2, and 3. A consistent water-cement ratio (w/c) of 0.4 is maintained during mortar preparation, and all panels are subjected to a 28-day curing process in water. The study utilized square-shaped ferrocement panels measuring 290 mm × 290 mm × 50 mm. The panels are exposed to repeated impact blows from a 2.5 kg falling mass dropped from a height of 0.80 m. The count of blows necessary to commence the first crack formation and the cause of ultimate failure are recorded for each panel. The study reports that an increase in SF content and the number of wire grid layers increased the number of blows needed for both the first crack and the ultimate failure. In the high-velocity impact test, 7.62 mm bullets are fired at the panels from a distance of 10 m with a striking velocity of 715 m/s. The study observed and analyzed the extent of spalling, scabbing, and perforation. The results showed that an increase in fiber content and the number of wire grid layers led to a decrease in the area of scabbing and spalling compared with the control specimens. It was also possible to see the mode of failure and crack pattern for impacts with low and high velocities.

Concurrent immune checkpoint inhibition and selective immunosuppressive therapy in patients with immune-related enterocolitis.

PURPOSE: Immune checkpoint inhibitor (ICI) therapy is often suspended because of immune-related enterocolitis (irEC). We examined the effect of resumption of ICIs with or without concurrent selective immunosuppressive therapy (SIT) on rates of symptom recurrence and survival outcomes. METHODS: This retrospective, multicenter study examined patients who were treated with ICI and developed irEC requiring SIT (infliximab or vedolizumab) for initial symptom control or to facilitate steroid tapering between May 2015 and June 2020. After symptom resolution, patients were restarted either on ICI alone or on concurrent ICI and SIT at the discretion of the treating physicians. The associations between irEC recurrence and treatment group were assessed via univariate analyses and multivariate logistic regression. Cox proportional hazards model was used for survival analysis. RESULTS: Of the 138 included patients who required SIT for initial irEC symptom control, 61 (44.2%) patients resumed ICI without concurrent SIT (control group) and 77 (55.8%) patients resumed ICI therapy with concurrent SIT: 33 with infliximab and 44 with vedolizumab. After symptom resolution, patients in the control group were more commonly restarted on a different ICI regimen (65.6%) compared with those receiving SIT (31.2%) (p<0.001). The total number of ICI doses administered after irEC resolution and ICI resumption was similar in both groups (four to five doses). Recurrence of severe colitis or diarrhea after ICI resumption was seen in 34.4% of controls compared with 20.8% of patients receiving concurrent SIT. Concurrent SIT was associated with reduced risk of severe irEC recurrence after ICI resumption in a multivariate logistic regression model (OR 0.34; 95% CI 0.13 to 0.92; p=0.034). There was no difference in survival outcomes between patients in the control group and patients concurrently treated with SIT. CONCLUSION: After resolution of irEC symptoms, reinitiation of ICI with concurrent SIT is safe, reduces severe irEC recurrence, and has no negative impact on survival outcomes.

Investigation of Alkali-Activated Slag-Based Composite Incorporating Dehydrated Cement Powder and Red Mud.

Recycled construction cementitious materials (RCCM) and red mud (RM) could be considered a type of discarded material with potential cementitious properties. Generally, landfilling and stacking are utilized to dispose of this type of solid waste, which can be detrimental to the environment and sustainability of the construction sector. Accordingly, a productive process for making eco-efficient alkali-activated slag-based samples with the inclusion of RCCM and red mud is studied in this paper. Dehydrated cement powder (DCP) is attained through the high-temperature treatment of RCCM, and red mud can be obtained from the alumina industry. Subsequently, DCP and RM are utilized as a partial substitute for granulated blast furnace slag (GBFS) in alkali-activated mixtures. Two different batches were designed; the first batch had only DCP at a dosage of 15%, 30%, 45%, and 60% as a partial substitute for GBFS, and the second batch had both DCP and RM at 15%, 30%, 45%, and 60% as a partial substitute for GBFS. Different strength and durability characteristics were assessed. The findings show that when both dehydrated cement powder and red mud are utilized in high quantities, the strength and durability of the specimens were enhanced, with compressive strength improving by 42.2% at 28 days. Such improvement was obtained when 7.5% each of DCP and RM were added. The results revealed that DCP and RM have a negative effect on workability, whilst they had a positive impact on the drying shrinkage as well as the mechanical strength. X-ray diffraction and micro-structural analysis showed that when the amount of DCP and RM is increased, a smaller number of reactive products forms, and the microstructure was denser than in the case of the samples made with DCP alone. It was also confirmed that when DCP and RM are used at optimized dosages, they can be a potential sustainable binder substitute; thus, valorizing wastes and inhibiting their negative environmental footprint.

At-home sleep monitoring using generic ear-EEG.

Introduction: A device comprising two generic earpieces with embedded dry electrodes for ear-centered electroencephalography (ear-EEG) was developed. The objective was to provide ear-EEG based sleep monitoring to a wide range of the population without tailoring the device to the individual. Methods: To validate the device ten healthy subjects were recruited for a 12-night sleep study. The study was divided into two parts; part A comprised two nights with both ear-EEG and polysomnography (PSG), and part B comprised 10 nights using only ear-EEG. In addition to the electrophysiological measurements, subjects filled out a questionnaire after each night of sleep. Results: The subjects reported that the ear-EEG system was easy to use, and that the comfort was better in part B. The performance of the system was validated by comparing automatic sleep scoring based on ear-EEG with PSG-based sleep scoring performed by a professional trained sleep scorer. Cohen's kappa was used to assess the agreement between the manual and automatic sleep scorings, and the study showed an average kappa value of 0.71. The majority of the 20 recordings from part A yielded a kappa value above 0.7. The study was compared to a companioned study conducted with individualized earpieces. To compare the sleep across the two studies and two parts, 7 different sleeps metrics were calculated based on the automatic sleep scorings. The ear-EEG nights were validated through linear mixed model analysis in which the effects of equipment (individualized vs. generic earpieces), part (PSG and ear-EEG vs. only ear-EEG) and subject were investigated. We found that the subject effect was significant for all computed sleep metrics. Furthermore, the equipment did not show any statistical significant effect on any of the sleep metrics. Discussion: These results corroborate that generic ear-EEG is a promising alternative to the gold standard PSG for sleep stage monitoring. This will allow sleep stage monitoring to be performed in a less obtrusive way and over longer periods of time, thereby enabling diagnosis and treatment of diseases with associated sleep disorders.

Experimental Analysis of Channel Steel Member under Tension Load with Damage in the Unconnected Legs.

Damage occurring to steel element structures is highly possible due to tearing ruptures, corrosion, or the adoption of sudden loads. The damage has a great effect on their capacity to bear load and the corresponding elongation, as well as the distribution of the stresses in the cross-section of the element. Therefore, in the present research, experimental tests were carried out on 15 specimens of channel steel elements with different damage ratios in the unconnected legs and at different locations along the element's length. Through the test, the load and the corresponding elongation values were obtained for the control and damaged specimens. From the study of the different variables, it was demonstrated that the damage location does not significantly affect the load capacity, with a maximum difference of 1.9%. With the presence of the damage in only one leg at a ratio of less than or equal to 40%, the prediction of the value of the loss in the load is within the safe limit. However, if this ratio increases, there is a defect in calculating the loss in the load as it is greater than the effect of the damage. If there is any damage in the two legs of the channel together, the prediction of the loss of load is within the safe limit, where the loss is less than the effect of the damage ratio. We propose a model that can predict the capacitance of the axial load of steel channel elements through identifying the ratio of damage in the unconnected leg.

Update on Immune Checkpoint Inhibitor Enterocolitis.

PURPOSE OF REVIEW: Immune checkpoint inhibitor (ICI) therapy revolutionized the treatment of multiple solid and hematologic malignancies. Yet, with it came profound inflammatory toxicities that mimic autoimmune diseases, termed immune-related adverse events (irAEs). Prominent among these is gastrointestinal inflammation, including a spectrum of gastritis, enteritis, and colitis. Here we synthesize an approach to immune checkpoint related enterocolitis (irEC) - including diagnostics and therapeutics - underpinned by new insights into the mechanism behind these phenomena. RECENT FINDINGS: This review presents updated insights on how to approach irEC, including novel approaches to selective immunosuppressive therapy, the role of fecal microbiota transplant, and the underlying cellular mechanisms of irEC. This review provides an update on irEC diagnosis and therapy, with considerations of new therapies and special patient populations. The field of gastrointestinal irAEs requires additional investigation, which will ultimately provide the tools required for patients to continue to receive life-saving ICI therapy.

Self-applied ear-EEG for sleep monitoring at home.

High quality sleep monitoring is done using EEG electrodes placed on the skin. This has traditionally required assistance by an expert when the equipment needed to mounted. However, this creates a limitation in how cheap and easy it can be to record sleep in the subject's own home. Here we present a data set of 120 home recordings of sleep, in which subjects use self-applied ear-EEG monitoring equipment. We compare this data set to a previously recorded data set with both ear-EEG and polysomnography, which was applied by an expert. Clinical relevance - On all tested metrics, self applied sleep recordings behaved the same as expert applied. This indicates that ear-EEG can reliably be used as a home sleep monitor, even when subjects apply the equipment themselves.

Effect of Polymers on Behavior of Ultra-High-Strength Concrete.

The development of ultra-high-performance concrete (UHPC) is still practically limited due to the scarcity of robust mixture designs and sustainable sources of local constituent materials. This study investigates the engineering characteristics of Styrene Butadiene Rubber (SBR) polymeric fiber-reinforced UHPC with partial substitution of cement at 0, 5 and 20 wt.% with latex polymer under steam and air curing techniques. The compressive and tensile strengths along with capillary water absorption and sulfate resistance were measured to evaluate the mechanical and durability properties. Scanning Electron Microscopy (SEM) was carried out to explore the microstructure development and hydration products in the designed mixtures under different curing regimes. The results indicated that the mixtures incorporating 20 wt.% SBR polymer achieved superior compressive strength at later ages. Additionally, the tensile strength of the polymeric UHPC without steel fibers and with 20% polymers was enhanced by 50%, which promotes the development of novel UHPC mixtures in which steel fibers could be partially replaced by polymer, while enhancing the tensile properties.

Systemic bevacizumab as salvage therapy for persistent severe bleeding and anemia in heyde syndrome following aortic valve replacement.

Heyde syndrome is characterized by the co-occurrence of aortic stenosis and bleeding gastrointestinal angiodysplasias, often with acquired von Willebrand syndrome. Current management for bleeding includes hematologic support with red cell transfusion and intravenous iron and correction of aortic stenosis with valve replacement. However, persistent Heyde syndrome after valve replacement occurs in a significant minority of cases, and there is no accepted therapy for these patients. Given that the pathophysiology of angiodysplasia formation in Heyde syndrome involves dysregulated angiogenesis, targeting angiogenesis may be an effective therapeutic option. We describe two cases of persistent Heyde syndrome with severe bleeding and anemia in patients following aortic valve replacement who were treated with systemic bevacizumab, a monoclonal antibody directed against vascular endothelial growth factor. In both cases, treatment was successful, with resolution of bleeding, liberation from hematologic support, and normalization of hemoglobin. In addition to responding to therapy, neither patient had treatment-related adverse events (and both had recurrent anemia upon treatment discontinuation, further evidence of the therapeutic impact of bevacizumab). Additional investigation into the use of systemic antiangiogenic therapy for treatment of Heyde syndrome is warranted.

Immune Checkpoint Inhibitor-Related Pulmonary Toxicity: A Comprehensive Review, Part II.

The development of immune checkpoint inhibitors (ICIs) has changed the treatment paradigm for cancer. The ICIs nivolumab, pembrolizumab, and cemiplimab target programmed cell death protein 1, and durvalumab, avelumab, and atezolizumab target programmed death ligand 1. Ipilimumab targets cytotoxic T lymphocyte-associated antigen-4. Used as monotherapy or in combination, they have shown remarkable efficacy in melanoma, lung cancer, and many other solid tumors, and indications continue to evolve. These checkpoint inhibitors are typically well tolerated; however, they may cause immune-mediated adverse effects, resulting in inflammation of any organ system. Pulmonary toxicity is vital to recognize, and it can be more challenging to diagnose in patients with lung cancer, given the nature of the disease course and treatment.

Arsenic toxicity manifesting as profuse watery diarrhea during induction therapy for acute promyelocytic leukemia.

Arsenic trioxide (ATO) is generally well tolerated for treatment of APL. We present a patient with severe watery diarrhea and pancreatitis thought to be due to ATO toxicity in the setting of obesity and acute kidney injury. Future studies evaluating ATO levels in patients experiencing toxicities may help guide dose modifications.

Availability, timeliness, documentation and quality of consultations among hospital departments: a prospective, comparative study.

BACKGROUND: Many in-patients require care from practitioners in various disciplines. Consultations most probably have significant implications for hospitalization outcomes. PURPOSE: To determine key aspects of consultations provided by various departments to formulate an optimal policy. METHODS: This study comprised two methods: first, a questionnaire was completed in 2019 by 127 physicians interns, residents and senior doctors) from the medical and surgical departments (64 from the surgical wards, 43 from the medical wards and 22 from the emergency room and General ICU) regarding the availability, timeliness and documentation rate of the consultations they received from different disciplines. The investigators rounded through the various departments that were included in the study and they accosted a sample of interns, residents and attending physicians, who were then asked to fill the questionnaire. Overall compliance of filling the questionnaire was 95%. Residents accounted for 72% of the filled questionnaires, seniors and interns accounted for 15 and 13% respectively. Second, a convenience sample of 300 electronic records of hospitalized patients (135 from the surgical wards, 129 from the Medical wards and 36 from the emergency room and General ICU) of actually carried out consultations was reviewed for validated indicators of quality for both the consultation request and response. We used a 5-point Likert scale, ranging from poor (1) to superb (5), to grade the measured parameters. RESULTS: The availability, timeliness and documentation rate for medical consultations were 4 ± 0.9, 4.1 ± 0.9 and 4.3 ± 0.9 respectively, as compared with surgical consultations 3.2 ± 1.1, 3.4 ± 1.2 and 3.6 ± 1.2 respectively (P < 0.001). The mean time (in hours) from the consultation request till documentation (of the requested consultation) by consultants in the medical and surgical departments was 3.9 ± 5.9 and 10.0 ± 15.6, respectively (P < 0.001). The quality of requests of consultations from the medical and surgical departments was 3.4 ± 1.1 and 2.8 ± 1.2, respectively (P < 0.001). Two different models of consultations are employed: while each medical department adopts several departments for medical consultations, each day's on-call surgeon provides all the hospital's surgical consultations. CONCLUSION: We detected significant differences in key aspects of consultations provided by the departments. The medical model of consultations, in which each medical department adopts several other wards to which it provides consulting services upon request, should probably be adopted as a major policy decision by hospitals directors to enhance inter-departmental consultations.

EEGs Vary Less Between Lab and Home Locations Than They Do Between People.

Given the rapid development of light weight EEG devices which we have witnessed the past decade, it is reasonable to ask to which extent neuroscience could now be taken outside the lab. In this study, we have designed an EEG paradigm well suited for deployment "in the wild." The paradigm is tested in repeated recordings on 20 subjects, on eight different occasions (4 in the laboratory, 4 in the subject's own home). By calculating the inter subject, intra subject and inter location variance, we find that the inter location variation for this paradigm is considerably less than the inter subject variation. We believe the paradigm is representative of a large group of other relevant paradigms. This means that given the positive results in this study, we find that if a research paradigm would benefit from being performed in less controlled environments, we expect limited problems in doing so.

A Comprehensive Systemic Literature Review of Pericardial Decompression Syndrome: Often Unrecognized and Potentially Fatal Syndrome.

BACKGROUND: Pericardial Decompression Syndrome (PDS) is defined as paradoxical hemodynamic deterioration and/or pulmonary edema, commonly associated with ventricular dysfunction. This phenomenon was first described by Vandyke in 1983. PDS is a rare but formidable complication of pericardiocentesis, which, if not managed appropriately, is fatal. PDS, as an entity, has discrete literature; this review is to understand its epidemiology, presentation, and management. METHODOLOGY: Medline, Science Direct and Google Scholar databases were utilized to do a systemic literature search. PRISMA protocol was employed. Abstracts, case reports, case series and clinical studies were identified from 1983 to 2019. A total of 6508 articles were reviewed, out of which, 210 were short-listed, and after removal of duplicates, 49 manuscripts were included in this review. For statistical analysis, patient data was tabulated in SPSS version 20. Cases were divided into two categories surgical and percutaneous groups. t-test was conducted for continuous variable and chi-square test was conducted for categorical data used for analysis. RESULTS: A total of 42 full-length case reports, 2 poster abstracts, 3 case series of 2 patients, 1 case series of 4 patients and 1 case series of 5 patients were included in the study. A total of 59 cases were included in this manuscript. Our data had 45.8% (n=27) males and 54.2% (n=32) females. The mean age of patients was 48.04 ± 17 years. Pericardiocentesis was performed in 52.5% (n=31) cases, and pericardiostomy was performed in 45.8% (n=27). The most common identifiable cause of pericardial effusion was found to be malignancy in 35.6% (n=21). Twenty-three 23 cases reported pre-procedural ejection fraction, which ranged from 20%-75% with a mean of 55.8 ± 14.6%, while 26 cases reported post-procedural ejection fraction which ranged from 10%-65% with a mean of 30% ± 15.1%. Data was further divided into two categories, namely, pericardiocentesis and pericardiostomy. The outcome as death was significant in the pericardiostomy arm with a p-value of < 0.00. The use of inotropic agents for the treatment of PDS was more common in needle pericardiocentesis with a p-value of 0.04. Lastly, the computed recovery time did not yield any significance with a p-value of 0.275. CONCLUSION: Pericardial decompression syndrome is a rare condition with high mortality. Operators performing pericardial drainage should be aware of this complication following drainage of cardiac tamponade, since early recognition and expeditious supportive care are the only therapeutic modalities available for adequate management of this complication.

Immune Checkpoint Inhibitor-Related Pulmonary Toxicity: Focus on Nivolumab.

The development of checkpoint inhibitors has changed the treatment paradigm for cancer. Checkpoint inhibitors nivolumab, pembrolizumab, and cemiplimab target programmed death-1 (PD-1), whereas durvalumab, avelumab, and atezolizumab target PD-ligand 1. Ipilimumab targets cytotoxic T lymphocyte-associated antigen 4. Used as monotherapy or in combination, these inhibitors have shown remarkable efficacy in melanoma, lung cancer, urothelial cancer, and many other solid tumors, and indications are continuing to evolve. Checkpoint inhibitors are well tolerated when compared with traditional chemotherapy. The major adverse effect profiles are idiosyncratic immune-mediated toxicities resulting from the abnormal activation of autoreactive T cells, which can lead to inflammation in any organ system. The most commonly affected organs are bowel, lung, skin, and endocrine. Pulmonary toxicity is important to recognize, and it can be more challenging to diagnose in lung cancer patients, given the nature of the disease course and treatment. This review article focuses on all of the pulmonary adverse effects of a single PD-1 inhibitor (nivolumab) that have been described in the literature. These complications include dyspnea, pneumonitis, pleural effusion, pulmonary sarcoidosis, pulmonary tuberculosis, acute fibrinous organizing pneumonia, organizing pneumonia, eosinophilic pneumonia, adult respiratory distress syndrome, and lung cavitation. Clinicians must be aware of these toxicities and mindful when prescribing these medications in patients with known lung dysfunction due to chronic lung diseases or lung cancer.

Predicting Sleep Classification Performance without Labels.

When generating automatic sleep reports with mobile sleep monitoring devices, it is crucial to have a good grasp of the reliability of the result. In this paper, we feed features derived from the output of a sleep scoring algorithm to a 'regression ensemble' to estimate the quality of the automatic sleep scoring. We compare this estimate to the actual quality, calculated using a manual scoring of a concurrent polysomnography recording. We find that it is generally possible to estimate the quality of a sleep scoring, but with some uncertainty ('root mean squared error' between estimated and true Cohen's kappa is 0.078). We expect that this method could be useful in situations with many scored nights from the same subject, where an overall picture of scoring quality is needed, but where uncertainty on single nights is less of an issue.

Muscle Activity Detection during Sleep by Ear-EEG.

Muscle activation during sleep is an important biomarker in the diagnosis of several sleep disorders and neurodegenerative diseases. Muscle activity is typically assessed manually based on the EMG channels from polysomnography recordings. Ear-EEG provides a mobile and comfortable alternative for sleep assessment. In this study, ear-EEG was used to automatically detect muscle activities during sleep. The study was based on a dataset comprising four full night recordings from 20 healthy subjects with concurrent polysomnography and ear-EEG. A binary label, active or relax, extracted from the chin EMG was assigned to selected 30 s epoch of the sleep recordings in order to train a classifier to predict muscle activation. We found that the ear-EEG based classifier detected muscle activity with an accuracy of 88% and a Cohen's kappa value of 0.71 relative to the labels derived from the chin EMG channels. The analysis also showed a significant difference in the distribution of muscle activity between REM and non-REM sleep.