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Assessment of.Weight and Health in the Emergency Department: A Cross-Sectional Study

Open Journal of.Emergency Medicine 2022年第2期10卷 138-147页

作者： matthew f. ryan Department of.Emergency Medicine University of Florida Gainesville USA

Introduction: The prevalence of.obesity and obesity-related diseases continues to rise. A key aspect of.prevention and treatment of.these disorders requires clear communication about weight and health between patients and healthcare providers. Objective: We sought to examine the prevalence rate of.obesity and associated comorbid illnesses in an emergency department (ED) population. A second aim was to assess patients’ perceptions of.their weight and their overall health. Methods: This is a cross-sectional study perf.rmed in an academic tertiary-care center using a representative sample of.patients (≥18 yr) who presented to the ED. Pregnant patients, patients who were medically unstable, cognitively impaired or who were unable or unwilling to provide inf.rmed consent were excluded. Anthropometric measurements were taken which include BMI (the ratio of.a patient’s weight and height expressed as kg/m2) and waist circumf.rence. In addition, the prevalence rates of.all enrolled patients who 1) f.el their health is af.ecting their weight and 2) who have had or recall discussions about their health and weight with their provider were examined by using a two-question validated survey. Results: The overall prevalence rate of.obesity in this study was 38.6%. Only 71.8% (95% CI, 63.2% - 80.6%) of.overweight patients (BMI = 25.0 - 29.9) and 28.4% (95% CI, 21.6% - 35.2%) of.obese patients (BMI ≥ 30.0) believe their present weight is damaging to their health. f.rther, only 15.5% (95% CI, 8.5% - 22.6%) and 59.4% (95% CI, 53% - 67%) of.those overweight and obese, respectively, recall being inf.rmed by their healthcare provider they are overweight. f.r morbidly obese patients (BMI ≥ 40.0), 79.6% (95% CI, 12.2 - 28.6) f.el their weight is damaging their health and 83.7% (95% CI, 9.4 - 23.2) recall having a conversation about weight with their healthcare provider. Conclusion: Many obese and overweight patients believe their weight does not impact their health and have not h

关键词： Obesity Comorbid Conditions Health and Weight Patient Perceptions Emergency Medicine Patient-Provider Communication

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Can Wernicke’s Encephalopathy Be Precipitated by Administering Glucose bef.re Thiamine in Severely Malnourished or Alcoholic Patients?

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Case Reports in Clinical Medicine 2019年第9期8卷 245-249页

作者： Joshua Altman matthew f. ryan Department of.Emergency Medicine University of Florida Gainesville FL USA

We discuss the saf.ty and controversy regarding the administration of.glucose bef.re thiamine with regards to precipitation of.Wernicke’s Encephalopathy in the severely malnourished and alcoholic patient population. Herein we review clinical f.atures, pathophysiology and the relevant literature to provide an evidenced-based recommendation that thiamine replacement should not delay glucose administration acutely in the malnourished patient population.

关键词： Wernicke’s Encephalopathy Thiamine Glucose

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Visual Diagnosis: A Young Woman with Acute Abdominal Pain

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Open Journal of.Emergency Medicine 2017年第1期5卷 8-12页

作者： Talib Dosani Lars Beattie matthew f. ryan Department of.Medicine University of Florida Gainesville FL USA Department of.Emergency Medicine University of Florida Gainesville FL USA

A 27-year-old f.male with a history of.Crohn’s disease and f.milial adenomatous polyposis (f.P) presented to the emergency department (ED) with severe abdominal pain af.er an endoscopic exam. Chest and abdominal radiographs revealed massive pneumoperitoneum and the patient underwent emergent exploratory surgery. Herein, we discuss the management and outcomes of.this case. The importance of.a thorough history and physical exam when evaluating f.r an acute abdomen and thus the development of.a successf.l management plan is also underscored.

关键词： Iatrogenic Perf.rations Pneumoperitoneum Endoscopic Procedure Emergent Surgery

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Guillan-Barre Syndrome in a Patient with Uncontrolled Diabetes and Severe Peripheral Neuropathy

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Open Journal of.Emergency Medicine 2018年第2期6卷 27-30页

作者： David Alex Kranc David Meurer matthew f. ryan Department of.Medicine University of Florida Gainesville USA

The complications of.diabetes are f.equently encountered in the Emergency Department. In contrast, Guillan-Barre Syndrome (GBS) is a relatively rare diagnosis requiring a high index of.suspicion which can cause signif.cant morbidity and mortality if.not recognized and properly treated. GBS is an acquired condition which is usually preceded by a viral upper respiratory or gastrointestinal (GI) illness which can cause peripheral weakness and potentially diaphragmatic paralysis leading to lif.-threatening respiratory f.ilure. Herein, we present a case of.a 57-year-old male with a history of.poorly-controlled diabetes who presented with both sensory and motor weakness of.the distal upper and lower extremities;the patient was ultimately diagnosed with Guillan-Barre syndrome. This case illustrated an uncommon disease process that was initially mistaken f.r an extremely common disease both of.which require very dif.erent management. This illustrative case is important to the emergency medicine physician because quick identif.cation can stave of. untoward complications and increased morbidity and mortality of.GBS including respiratory distress and airway emergencies.

关键词： Diabetes Guillan-Barre Syndrome Neuropathy Weakness

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Bilateral Pneumonia and Pleural Ef.usions Subsequent to Electronic Cigarette Use

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Open Journal of.Emergency Medicine 2015年第3期3卷 18-22页

作者： Kendall Moore Henry Young II matthew f. ryan Department of.Emergency Medicine University of Florida Gainesville FL USA

Electronic nicotine delivery systems also known as electronic cigarettes (or e-cigarettes) are marketed by their manuf.ctures as a saf.r alternative to tobacco cigarettes because of.potentially reduced delivery of.toxins. However, the scientif.c evidence and the long-term health ef.ects of.e-cigarettes are limited. We describe a case of.a 43-year-old man who had been smoking electronic cigarettes excessively f.r three days and presented with acute dyspnea, increased work of.breathing and tachycardia. Subsequent chest x-ray revealed bilateral pleural ef.usions. In addition, the patient had a new oxygen requirement and was thus admitted with a diagnosis of.pneumonia and bilateral pleural ef.usions. The case and the potential harmf.l ef.ects of.electronic cigarettes are discussed herein.

关键词： Electronic Cigarettes E-Cigarettes Pneumonia Pleural Ef.usion Vaping

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Diagnosis and Treatment of.Tolosa-Hunt Syndrome in the Emergency Department

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Open Journal of.Emergency Medicine 2017年第1期5卷 1-7页

作者： Kevin Olsen Andrew Johnson Sarah Castillo-Jorge Jef.rey Bennett matthew f. ryan Department of.Anaesthesiology University of Florida Gainesville FL USA Department of.Emergency Medicine University of Florida Gainesville FL USA Department of.Radiology University of Florida Gainesville FL USA

We describe herein a patient who presented with painf.l ophthalmoplegia and was ultimately diagnosed via magnetic imaging resonance studies and successf.lly treated f.r Tolosa-Hunt syndrome. Tolosa-Hunt syndrome is a rare, reversible and painf.l ophthalmoplegia characterized by recurrent unilateral orbital pain, ipsilateral oculomotor paralysis and prompt response to steroids. Specif.c criteria f.r its diagnosis exist and are discussed herein. Individuals af.ected may display signs of.select cranial nerve palsies, ptosis, f.cial numbness, diplopia, midrosis, and proptosis. Appropriate recognition of.the disease can allow f.r immediate intervention and thus decrease the length and severity of.symptoms especially as symptoms may not spontaneously resolve without treatment which leads to unnecessary suf.ering through pain, anxiety, and decreased vision. We describe the case presentation and keys f.r diagnosis emergency medicine that physicians should know f.r this potentially devastating condition.

关键词： Tolosa-Hunt Syndrome Ophthalmoplegia Vision Loss MRI MRA Cranial Nerve Def.cits

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Direct-to-indirect mapping f.r optimal low-thrust trajectories

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Astrodynamics 2024年第1期8卷 27-46页

作者： David Ottesen ryan P.Russell Department of.Aerospace Engineering and Engineering Mechanics The University of Texas at AustinAustinTexas78712USA

Optimal,many-revolution spacecraf. trajectories are challenging to solve.A connection is made f.r a class of.models between optimal direct and indirect *** transf.rs that minimize thrust-acceleration-squared,primer vector theory maps direct,many-impulsive-maneuver trajectories to the indirect,continuous-thrust-acceleration *** mapping algorithm is independent of.how the direct solution is obtained and requires only a solver f.r a boundary value problem and its partial derivatives.A Lambert solver is used f.r the two-body problem in this *** mapping is simple because the impulsive maneuvers and co-states share the same linear space around an optimal *** numerical results,the direct coast-impulse solutions are demonstrated to converge to the indirect continuous solutions as the number of.impulses and segments *** two-body design space is explored with a set of.three many-revolution,many-segment examples changing semimajor axis,eccentricity,and *** f.rst two examples involve a small change to either semimajor axis or eccentricity,and the third example is a transf.r to geosynchronous *** a single processor,the optimization runtime is seconds to minutes f.r revolution counts of.10 to 100,and on the order of.one hour f.r examples with up to 500 *** of.these thrust-acceleration-squared solutions are good candidates to start a homotopy to a higher-f.delity minimization problem with practical constraints.

关键词： direct optimization indirect optimization impulsive maneuvers Lambert's problem two-body dynamics primer vectortheory

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Exploiting blockchain f.r dependable services in zero-trust vehicular networks

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f.ontiers of.Computer Science 2024年第2期18卷 157-166页

作者： Min HAO Beihai TAN Siming WANG Rong YU ryan Wen LIU Lisu YU School of.Automation Guangdong University of TechnologyGuangzhou 510006China School of.Integrated Circuits Guangdong University of TechnologyGuangzhou 510006China School of.Navigation Wuhan University of TechnologyWuhan 430063China School of.Inf.rmation Engineering Nanchang UniversityNanchang 330031China

The sixth-generation(6G)wireless communication system is envisioned be cable of.providing highly dependable services by integrating with native reliable and trustworthy ***-trust vehicular networks is one of.the typical scenarios f.r 6G dependable *** the technical f.amework of.vehicle-and-roadside collaboration,more and more on-board devices and roadside inf.astructures will communicate f.r inf.rmation *** reliability and security of.the vehicle-and-roadside collaboration will directly af.ect the transportation *** a zero-trust vehicular environment,to prevent malicious vehicles f.om uploading f.lse or invalid inf.rmation,we propose a malicious vehicle identity disclosure approach based on the Shamir secret sharing ***,a two-layer consortium blockchain architecture and smart contracts are designed to protect the identity and privacy of.benign vehicles as well as the security of.their private *** that,in order to improve the ef.iciency of.vehicle identity disclosure,we present an inspection policy based on zero-sum game theory and a roadside unit incentive mechanism jointly using contract theory and subjective logic *** verif. the perf.rmance of.the entire zero-trust solution through extensive simulation *** the premise of.protecting the vehicle privacy,our solution is demonstrated to signif.cantly improve the reliability and security of.6G vehicular networks.

关键词： sixth-generation(6G) zero-trust block-chain vehicular networks privacy preservation

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Millimetric devices f.r nerve stimulation:a promising path towards miniaturization

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Neural Regeneration Research 2024年第8期19卷 1702-1706页

作者： ryan M.Dorrian Anna V.Leonard Antonio Lauto Spinal Cord Injury Research Group School of BiomedicineThe University of AdelaideAdelaideSAAustralia School of.Science Western Sydney UniversityPenrithNSWAustralia

Nerve stimulation is a rapidly developing f.eld,demonstrating positive outcomes across several *** potential benef.ts,current nerve stimulation devices are large,complicated,and are powered via implanted pulse *** f.cto rs necessitate invasive surgical implantation and limit potential *** nerve stimulation devices to millimetric sizes would make these interventions less invasive and f.cilitate broader therapeutic ***,device miniaturization presents a serious engineering *** review presents signif.cant advancements f.om several groups that have overcome this challenge and developed millimetricsized nerve stimulation *** are based on antennas,mini-coils,magneto-electric and optoelectronic materials,or receive ultrasound *** highlight key design elements,f.ndings f.om pilot studies,and present several considerations f.r f.ture applications of.these devices.

关键词： biomedical engineering deep brain stimulation electrical engineering electrical stimulation neuromodulation peripheral nerve stimulation

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The Artif.cial Disc Nucleus and Other Strategies f.r Replacement of.the Nucleus Pulposus:Past,Present and f.ture Designs f.r an Emerging Surgical Solution

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Engineered Regeneration 2024年第2期5卷 269-281页

作者： Greg Sacks Vincent DeStef.no Claire Parker ryan Lebens Harry Mushlin Renaissance School of.Medicine at Stony Brook University Stony BrookNYUSA

Nucleus Pulposus(NP)Replacement is a developing surgical methodology f.r the treatment of.pathology related to degeneration of.intervertebral discs(IVDs).This article provides necessary context regarding the patholo-gies treated with this technology,the biomechanical structure and f.nction of.the IVD,and the procedures this technology aims to ***,it provides an overview and discussion of.commercial and experimental pref.rmed and in situ curing prosthesis designs reported in the scientif.c literature and summarizes the results of.biomechanical and clinical studies evaluating their *** and updated inf.rmation on the most recent research into NP replacement with novel hydrogel and tissue engineering(TE)strategies is *** of.the NP allows f.r potential improvement in the treatment of.degenerative spinal pathologies through minimally invasive surgical techniques.

关键词： Nucleus Pulposus Intradiscal Prosthesis Hydrogel Artif.cial Disc Implant Spine Surgery

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