DeKalb Medical Center

The territory’s isolation and integrity are recognized by jurists as criteria for determining the municipalities’ boundaries. Analyzing the geographic studies of the innercity territory morphology, territorial identity and the local communities development potential relationship, the authors come to conclusion that these criteria are not supplied with measurement methodology. As a result the studies are limited by extreme characteristics polygons. The article proposes a methodology for assessing of intracity territories’ isolation and integrity. Considering pedestrian links as the basis of intracity municipal communications, the authors develop a methodology based on the pedestrian graph, which makes more sensitive estimates comparing with transport methods. The indicators of isolation and integrity, as well as the integral indicator are calculated for the territorial units of St. Petersburg–administrative and municipal districts. The authors come to the conclusion that intracity district’s isolation and integrity are in a weak negative relationship with each other and are set by the urban settlement and development policy. According to the integral assessment, island administrative districts and peripheral municipal districts with the 1970s large quarter buildings demonstrate the greatest compliance with the isolation and integrity principles. The authors announce a study of the territory morphology influence on the local self-government development level based on the data presented in this article.

O objetivo foi avaliar, in vitro, a influência do condicionamentoem preparos confeccionados com ponta CVD e seus efeitos na microinfiltraçãomarginal de restaurações classe V. Vinte cavidades foram executadascom ponta CVD e distribuídas em dois grupos com 10 dentes: Grupo I -condicionado com ácido fosfórico 37%; Grupo II - ácido fosfórico 15%.Restauraram-se os espécimes com resina e, decorridas 24 horas, fez-sepolimento. Após termociclagem, impermeabilizaram-se os dentes, deixandoexpostas as restaurações e 1 mm ao redor. Os espécimes foram submetidosao Nitrato de Prata 50% por 8 horas, lavados, secos e seccionados nosentido vestíbulo-lingual. Através de lupa estereoscópica, três examinadoresclassificaram a microinfiltração, usando escores de 0 (ausência) até 3(microinfiltração em direção à polpa). O Teste de Kruskal-Wallis no nível de significância de 5% acusou diferença estatisticamente significanteentre os grupos. Concluiu-se que o Grupo I exibiu maior microinfiltraçãodo que o Grupo II.

Layered SmCrS2−xSexO (x = 0–2) solid solutions were synthesized which show typical antiferromagnetic orderings.

A UV photodetector based on LiCl-added FAPbCl3 nanorods exhibits bipolar photocurrent under 60 Hz 254 nm UV illumination. However, under 60 Hz 365 nm UV irradiation, LiCl:FAPbCl3 nanorods show monopolar photocurrent.

In this work, modified biomass ash (MA), obtained through the hydrothermal treatment technique with biomass ash (BA) and alkaline phosphate as raw materials, was used as a useful soil amendment to reduce the environmental risk of lead and was compared with raw ash. In order to confirm the composition changes from BA to MA, the materials before and after modification were characterized by using transmission electron microscopy (TEM), energy dispersive spectroscopy (EDS), Fourier transform infrared (FT-IR) spectroscopy, and X-ray diffraction (XRD). Subsequently, the suppression of the environmental risks of lead in the contaminated cropland soil by MA and BA was systematically investigated through pH evaluation, toxicity-extraction, and fractional analysis. The results show that needle-like hydroxyapatite nanoparticles were generated during the modification process of BA. After incubation with 5% BA and 5% MA for 60 days, the pH of soil samples increased from 5.46 to 7.20 and 6.83, respectively; the lead concentration by TCLP extraction decreased by about 52.6% and 95.2%, respectively. And the content of lead bound to RES increased from 36.28% to 49.09% and 59.58%, respectively. MA showed higher immobilization efficiency, better immobilization stability, and less disturbance to the soil pH than BA, and it can suppress the environmental risk of lead below the standard toxicity level. These results undoubtedly demonstrate that BA has great potential in the practical application of remediation of lead contaminated soil, and its modified product may become a useful amendment to suppress and/or eliminate the high environmental risk of lead by transforming industrial waste into useful nanomaterials for green environmental chemistry.

BackgroundRecent trends in the legalization of marijuana in many states are increasing the popularity of recreational marijuana use. Since current data on hospitalizations in marijuana users is sparse, we evaluated the primary reasons for admissions, procedures and associated healthcare burden in hospitalized recreational marijuana users.MethodsThe National Inpatient Sample (NIS) for the years 2010–2014 was queried for the hospitalizations with a history of recreational marijuana usage using applicable ICD-9 CM codes. Descriptive statistics were used to report frequency (N) and percentage (%). Discharge weights were applied to achieve national estimates. The predictors of in-hospital mortality in recreational marijuana users were assessed using a two-way hierarchical multivariate regression after adjusting for the confounders.Results We analyzed 465,959 (weighted n=2,317,343) hospitalizations with a history of recreational marijuana use. Among psychiatric disorders, most prominent primary discharge diagnoses were mood disorders (20.6%), schizophrenia/other psychotic disorders (10.6%), and substance/alcohol-related disorders (10.4%). Suicide and intentional self-inflicted injury (3.6%) was the leading cause of emergency admission. The most common non-psychiatric primary discharge diagnoses were diabetes mellitus with chronic complications (2.2%), acute myocardial infarction (AMI) (1.2%), nonspecific chest pain (1.1%), congestive cardiac failure (CHF) (1%), arrhythmia (0.8%), and hypertension (0.8%). Acute cerebrovascular diseases were noted in 1.1% and epilepsy in 1.8% of patients. Alcohol/drug rehabilitation and detoxification (6.9%) and psychiatric evaluation/therapy (3.9%) were the most evident psychiatric procedures whereas most frequent non-psychiatric procedures were diagnostic coronary arteriography (1%), percutaneous transluminal coronary angioplasty (0.7%), and echocardiogram (0.7%). Top independent predictors of in-hospital mortality were coagulopathy (OR 5.94), AMI (OR 4.59), pulmonary circulation disorder (OR 2.95), CHF (OR 2.02), renal failure (OR 1.91), coronary atherosclerosis (OR 1.34) and peripheral vascular disorder (OR 1.31). Major cardiovascular and cerebrovascular events also showed increasing trends among users.ConclusionWe established the most frequent psychiatric and non-psychiatric causes of admissions and procedures in recreational marijuana users, which may pose a significant healthcare burden and increase the odds of in-hospital mortality.

Purpose: Hypoglycemia is a common adverse event associated with insulin during treatment of hyperkalemia in hospitalized patients; however, limited data exist regarding hypoglycemia incidence and appropriate dosing strategies for treatment of patients in the emergency department. The study objective was to determine the incidence of hypoglycemia associated with insulin use during treatment of hyperkalemia among patients seen in the emergency department. Methods: This was an Institutional Review Board (IRB)-approved retrospective, chart-review study. All adult patients who received intravenous regular insulin as a result of an order from the emergency department hyperkalemia order set were eligible for inclusion. The main clinical outcomes were incidence of hypoglycemia (blood glucose <70 mg/dL) and severe hypoglycemia (blood glucose <40 mg/dL). Blood glucose was checked within 24 hours of insulin administration. Results: A total of 172 patients were included. The incidence of hypoglycemia was 19.8% (n = 34) and the incidence of severe hypoglycemia was 5.2% (n = 9). Hypoglycemic patients had a significantly lower median blood glucose at baseline compared to those who did not develop hypoglycemia (83.5 [72.0-112.0] mg/dL vs 123.0 [96.0-167.0] mg/dL, P < .0001); however, no difference was noted between groups in the average insulin dose administered (0.11 ± 0.04 units/kg vs 0.12 ± 0.05 units/kg, P = .6175). Conclusion: There is a concerning risk of hypoglycemia associated with insulin use during treatment of hyperkalemia in the emergency department. Standard insulin doses may not be appropriate in some cases like patients with lower baseline blood glucose. Further research is warranted to develop safer hyperkalemia treatment protocols that mitigate this high risk of hypoglycemia associated with insulin use.

ABSTRACTPurpose: The purpose of this study was to test the concurrent validity of using hydraulic dynamometers in comparison to the gold standard isokinetic dynamometers in measuring wrist and forearm strength. Materials and methods: Healthy adults between the ages of 18–65 participated, including 24 participants, 8 men and 16 women. The examiner used a handheld dynamometer, forearm/wrist dynamometer, and an isokinetic dynamometer to measure force/torque production in forearm rotation and wrist flexion/extension using a standardized protocol of two handle types for each motion. Sequence of testing was randomized. The data were analyzed using Pearson correlation coefficients and paired t-tests. Results: When matched for handle type, three of the four correlations between the strength measurements taken with the different dynamometers were moderate to high with Pearson product moment coefficients ranging from 0.72 to 0.96; the screwdriver handle demonstrated less than acceptable correlation (r = 0.45, 0.67 for wrist flexion and extension, respectively). There were significant differences in most of the force/torque values obtained by different handle types for wrist and forearm motions. Discussion and conclusions: Overall, the dynamometers demonstrated acceptable correlations supporting concurrent validity for measuring forearm and wrist strength, except with the screwdriver handle. However, different tools, positions, and handle interfaces provided different absolute values, therefore the tools cannot be used interchangeably. It is recommended that repeated measurements to monitor patient progress are taken with the same tool and handle type.

Experimental randomized crossover. The aim of the study was to determine whether sitting on a ball for 90 min/d instead of a chair has an effect on low back pain (LBP), low back disability, and/or core muscle endurance. LBP may result from prolonged sitting. It has been proposed that replacing chairs with stability balls can diminish LBP in those who sit for prolonged periods. Research on the topic is sparse and inconclusive. A total of 90 subjects (university students, staff, and faculty, ages 18-65, who sit ≥4 hr/d) were randomly assigned to the intervention or control group for the first part of the study. Baseline data were collected: Oswestry Disability Index, a numerical pain rating scale for LBP, and four core muscle endurance tests. For 8 weeks, the control group sat on their usual chair. The intervention group sat on stability balls 5 d/wk, increasing up to 90 min/d. Baseline measurements were repeated postintervention. After a washout period, subjects switched groups, and the procedures were repeated-70 completed participation in control group and 76 in intervention group. There were no statistically significant differences for pain or disability in either group (P > 0.05). Changes in isometric trunk flexion (P = 0.001), nondominant side plank (P = 0.008), and Sorensen (P = 0.006) endurance scores were significant within the intervention group but not the control group. Between-group comparisons revealed a significant difference for isometric trunk flexion (P = 0.005) and Sorensen endurance times (P = 0.010). Analysis also showed that ball-sitting did not prevent an increase in LBP over the 8-week period. Ball-sitting had no significant effects on LBP or associated disability, but did improve core endurance in the sagittal plane. Although ball-sitting may be useful as an adjunct treatment for LBP when core muscles are involved, clinicians should rely on other, evidence-based treatments for LBP.

81 Background: The Georgia Cancer Control Consortium’s Survivorship Working Group conducted a needs assessment to understand physical, psychological, practical, and spiritual needs of adult survivors. Results were used to assess survivors’ level of distress and how effectively their needs were being met. Methods: Cross-sectional online and paper-based surveys developed using NCCN and Commission on Cancer (CoC) guidelines. Surveys were distributed through survivorship programs of CoC hospitals (n = 40) and cancer organizations via email, social media and mail. 740 responses received September-December 2014. Results: Respondents were primarily female (78%) married (65%), college-educated (55%) and insured (97%). 83% were White,16% were African American and 3% were Hispanic. 36% of respondents were within 1 year of treatment; 45% were 1 - 5 years post treatment. Survivors reported positive experiences with provider communication. Responses of ‘often’ or ‘very often’ were: provider gave them a chance to ask questions (90.6%); provider involved them in healthcare decisions (84.7%), provider spent enough time with them (78.5%) and provider helped with feelings of uncertainty about health issues or treatment (75.7%). Physical and emotional needs were not as effectively met as spiritual or practical needs. A higher proportion of survivors reported moderate to extreme levels of emotional distress with: depression (32.7%), anxiety (32.1%), stress (30.2%), fear of recurrence (28.2%) and defining a “new normal” (25.9%). 81% of survivors found information and assistance online (56%), in print materials (41%) and from providers/cancer centers (41%). 37% received a survivorship care plan (SCP); 98% reported the SCP was helpful. Conclusions: Results demonstrate the need for providers in Georgia to be educated about and responsive to survivors’ unmet needs and levels of distress. Survivors report positive communication with providers but lower levels of having physical and emotional needs addressed. Survivors actively seek resources and benefit from SCPs. Providers can contribute to addressing needs and reducing distress by maintaining strong communication, guiding survivors to evidence-based resources and implementing SCPs.