Prophylactic Bracing Has No Effect on Lower Extremity Alignment or Functional Performance.

PubMed

Hueber, Garrett A; Hall, Emily A; Sage, Brad W; Docherty, Carrie L

2017-07-01

Prophylactic ankle bracing is commonly used during physical activity. Understanding how bracing affects body mechanics is critically important when discussing both injury prevention and sport performance. The purpose is to determine if ankle bracing affects lower extremity mechanics during the Landing Error Scoring System test (LESS) and Sage Sway Index (SSI). Thirty physically active participants volunteered for this study. Participants completed the LESS and SSI in both a braced and unsupported conditions. Total errors were recorded for the LESS. Total errors and time (seconds) were recorded for the SSI. The Wilcoxon signed-rank test was utilized to evaluate any differences between the brace conditions for each dependent variable. A priori alpha level was set at p<0.05. The Wilcoxon signed-rank test yielded no significant difference between the braced and unsupported conditions for the LESS (Z=-0.35, p=0.72), SSI time (Z=-0.36, p=0.72), or SSI Errors (Z=-0.37, p=0.71). Ankle braces had no effect on subjective clinical assessments of lower extremity alignment or postural stability. Utilization of a prophylactic support at the ankle did not substantially alter the proximal components of the lower kinetic chain. © Georg Thieme Verlag KG Stuttgart · New York.

Mining temporal data sets: hypoplastic left heart syndrome case study

NASA Astrophysics Data System (ADS)

Kusiak, Andrew; Caldarone, Christopher A.; Kelleher, Michael D.; Lamb, Fred S.; Persoon, Thomas J.; Gan, Yuan; Burns, Alex

2003-03-01

Hypoplastic left heart syndrome (HLHS) affects infants and is uniformly fatal without surgery. Post-surgery mortality rates are highly variable and dependent on postoperative management. The high mortality after the first stage surgery usually occurs within the first few days after procedure. Typically, the deaths are attributed to the unstable balance between the pulmonary and systemic circulations. An experienced team of physicians, nurses, and therapists is required to successfully manage the infant. However, even the most experienced teams report significant mortality due to the extremely complex relationships among physiologic parameters in a given patient. A data acquisition system was developed for the simultaneous collection of 73 physiologic, laboratory, and nurse-assessed variables. Data records were created at intervals of 30 seconds. An expert-validated wellness score was computed for each data record. A training data set consisting of over 5000 data records from multiple patients was collected. Preliminary results demonstratd that the knowledge discovery approach was over 94.57% accurate in predicting the "wellness score" of an infant. The discovered knowledge can improve care of complex patients by development of an intelligent simulator that can be used to support decisions.

Intakes of Lutein, Zeaxanthin, and Other Carotenoids and Age-Related Macular Degeneration During 2 Decades of Prospective Follow-up.

PubMed

Wu, Juan; Cho, Eunyoung; Willett, Walter C; Sastry, Srinivas M; Schaumberg, Debra A

2015-12-01

Despite strong biological plausibility, evidence from epidemiologic studies and clinical trials on the relations between intakes of lutein and zeaxanthin and age-related macular degeneration (AMD) has been inconsistent. The roles of other carotenoids are less thoroughly investigated. To investigate the associations between intakes of carotenoids and AMD. Prospective cohort study, with cohorts from the Nurses' Health Study and the Health Professionals Follow-up Study in the United States. A total of 63,443 women and 38,603 men were followed up, from 1984 until May 31, 2010, in the Nurses' Health Study and from 1986 until January 31, 2010, in the Health Professionals Follow-up Study. All participants were aged 50 years or older and were free of diagnosed AMD, diabetes mellitus, cardiovascular disease, and cancer at baseline. Predicted plasma carotenoid scores were computed directly from food intake, assessed by repeated food frequency questionnaires at baseline and follow-up, using validated regression models to account for bioavailability and reporting validity of different foods, and associations between predicted plasma carotenoid scores and AMD were determined. We confirmed 1361 incident intermediate and 1118 advanced AMD cases (primarily neovascular AMD) with a visual acuity of 20/30 or worse by medical record review. Comparing extreme quintiles of predicted plasma lutein/zeaxanthin score, we found a risk reduction for advanced AMD of about 40% in both women and men (pooled relative risk comparing extreme quintiles = 0.59; 95% CI, 0.48-0.73; P for trend < .001). Predicted plasma carotenoid scores for other carotenoids, including β-cryptoxanthin, α-carotene, and β-carotene, were associated with a 25% to 35% lower risk of advanced AMD when comparing extreme quintiles. The relative risk comparing extreme quintiles for the predicted plasma total carotenoid index was 0.65 (95% CI, 0.53-0.80; P for trend < .001). We did not identify any associations of carotenoids, either as predicted plasma score or calculated intake, with intermediate AMD. Higher intake of bioavailable lutein/zeaxanthin is associated with a long-term reduced risk of advanced AMD. Given that some other carotenoids are also associated with a lower risk, a public health strategy aimed at increasing dietary consumption of a wide variety of fruits and vegetables rich in carotenoids may reduce the incidence of advanced AMD.

Soccer Injury Movement Screen (SIMS) Composite Score Is Not Associated With Injury Among Semi-Professional Soccer Players.

PubMed

McCunn, Robert; Fünten, Karen Aus der; Whalan, Matthew; Sampson, John A; Meyer, Tim

2018-05-08

Study Design Prospective cohort. Background The association between movement quality and injury is equivocal. No soccer-specific movement assessment has been prospectively investigated in relation to injury risk. Objectives To investigate the association between a soccer-specific movement quality assessment and injury risk among semi-professional soccer players. Methods Semi-professional soccer players (n=306) from 12 clubs completed the Soccer Injury Movement Screen (SIMS) during the pre-season period. Individual training/match exposure and non-contact time loss injuries were recorded prospectively for the entirety of the 2016 season. Relative risks (RR) were calculated, and presented with 90% confidence intervals (CI), for the SIMS composite and individual sub-test scores from generalized linear models with Poisson distribution offset for exposure. Results When considering non-contact time loss lower extremity injuries (primary level of analysis), there was a most likely trivial association with the SIMS composite score. Similarly, SIMS composite score demonstrated most likely to likely trivial associations to all injury categories included in the secondary level of analysis (non-contact time loss hip/groin, thigh, knee and ankle injuries). When considering hamstring strains and ankle sprains specifically (tertiary level of analysis) the SIMS composite score, again, demonstrated very likely trivial associations. A total of 262 non-contact time loss injuries were recorded. The overall (training and match exposure combined) incidence of non-contact time loss injury was 12/1000 hours. Conclusion The SIMS composite score demonstrated no association to any of the investigated categories of soccer-related injury. The SIMS composite score should not be used to group players into 'high' or 'low' risk groups. Level of Evidence Prognosis, level 4. J Orthop Sports Phys Ther, Epub 8 May 2018. doi:10.2519/jospt.2018.8037.

Intra-Operative Predictors of difficult cholecystectomy and Conversion to Open Cholecystectomy - A New Scoring System.

PubMed

Ahmed, Nauman; Hassan, Maaz Ul; Tahira, Maham; Samad, Abdul; Rana, Hamad Naeem

2018-01-01

To evaluate the intra-operative scoring system to predict difficult cholecystectomy and conversion to open surgery. This descriptive study was conducted from March 2016 to August, 2016 in the Department of Surgery, Shalimar Hospital. The study recruited 120 patients of either gender, age greater than 18 years and indicated for laparoscopic cholecystectomy (LC). Intra-operatively all patients were evaluated using the new scoring system. The scoring system included five aspects; appearance and adhesion of Gall Bladder (GB), distension or contracture degree of GB, ease in access, local or septic complications, and time required for cystic artery and duct identification. The scoring system ranges from 0 to 10, classified as score of <2 being considered easy, 2 to 4 moderate, 5-7 very difficult, and 8 to 10, extreme. Patient demographic data (i.e. age, gender), co-morbidities, intra-operative scores using the scoring system and conversion to open were recorded. The data was analysed using statistical analysis software SPSS (IBM). Among one hundred and twenty participants, sixty seven percent were females and the mean age (years) was 43.05 ± 14.16. Co-morbidities were present in twenty percent patients with eleven diagnosed with diabetes, six with hypertension and five with both hypertension and diabetes. The conversion rate to open surgery was 6.7%. The overall mean intra-operative scores were 3.52 ± 2.23; however significant difference was seen in mean operative score of converted to open and those not converted to open (8.00 ± 0.92 Vs. 3.20 V 1.92; p-value = 0.001). Among eight cases converted to open, three (37.5%) were in very difficult category while five (62.5%) were in extreme category. Moreover, age greater than 40 years and being diabetic were also the risk factors for conversion to open surgery. The new intra-operative scoring system is a valuable assessment tool to predict difficult laparoscopic cholecystectomy and conversion parameters to open surgery and its utility could improve patient's clinical outcome indicated for laparoscopic cholecystectomy.

Quantifying C-17 Aircrew Training Priorities

DTIC Science & Technology

2015-06-19

mentally process the situation. Skill-Probability-Risk (SPR) Score Once the data from the SS, SP, and SR has been calculated, an SPR Score can...discrepancies between the SPR Rank-Score and the Vol 1 Rank-Score. Figure 4.8 illustrates the differences in scores between the two processes . Ideally, the...tables. The extreme lower left and extreme upper right of the chart are areas of major discrepancy between the two processes and potentially provide the

Validity and reliability of Nintendo Wii Fit balance scores.

PubMed

Wikstrom, Erik A

2012-01-01

Interactive gaming systems have the potential to help rehabilitate patients with musculoskeletal conditions. The Nintendo Wii Balance Board, which is part of the Wii Fit game, could be an effective tool to monitor progress during rehabilitation because the board and game can provide objective measures of balance. However, the validity and reliability of Wii Fit balance scores remain unknown. To determine the concurrent validity of balance scores produced by the Wii Fit game and the intrasession and intersession reliability of Wii Fit balance scores. Descriptive laboratory study. Sports medicine research laboratory. Forty-five recreationally active participants (age = 27.0 ± 9.8 years, height = 170.9 ± 9.2 cm, mass = 72.4 ± 11.8 kg) with a heterogeneous history of lower extremity injury. Participants completed a single-limb-stance task on a force plate and the Star Excursion Balance Test (SEBT) during the first test session. Twelve Wii Fit balance activities were completed during 2 test sessions separated by 1 week. Postural sway in the anteroposterior (AP) and mediolateral (ML) directions and the AP, ML, and resultant center-of-pressure (COP) excursions were calculated from the single-limb stance. The normalized reach distance was recorded for the anterior, posteromedial, and posterolateral directions of the SEBT. Wii Fit balance scores that the game software generated also were recorded. All 96 of the calculated correlation coefficients among Wii Fit activity outcomes and established balance outcomes were interpreted as poor (r < 0.50). Intrasession reliability for Wii Fit balance activity scores ranged from good (intraclass correlation coefficient [ICC] = 0.80) to poor (ICC = 0.39), with 8 activities having poor intrasession reliability. Similarly, 11 of the 12 Wii Fit balance activity scores demonstrated poor intersession reliability, with scores ranging from fair (ICC = 0.74) to poor (ICC = 0.29). Wii Fit balance activity scores had poor concurrent validity relative to COP outcomes and SEBT reach distances. In addition, the included Wii Fit balance activity scores generally had poor intrasession and intersession reliability.

[Use of Ultrasound in the Follow-up of Professional Athletes Receiving Conservative Treatment of Patellar Tendon Enthesiopathy].

PubMed

Guo, Li-juan; Cui, Li-gang; Li, Yu-mei; Liao, Li-ping; Song, Lin

2015-10-01

To investigate the role of high-frequency ultrasound (HFUS) in evaluating in the effectiveness of conservative treatment for professional athletes with patellar tendon enthesiopathy. According to different treatment intensities, 24 professional athletes with patellar tendon enthesiopathy were randomly divided into painless group, slightly-painful group and extremely-painful group. Then changes of the HFUS findings [including ranges of two-dimensional diseases and blood conditions by Color Doppler Flow Imaging (CDFI)] of patellar tendon before and after the treatment were recorded. The results were also compared with conventional clinical treatment evaluations. After two courses of treatment,the percentage of athletes whose pain was resolved or disappeared was 37.5% in painless group, 87.5% in slightly-painful group, and 62.5% in extremely-painful group. The pain score was 4.50 ± 2.07, 4.88 ± 1.13, and 6.13 ± 1.55 in painless group,slightly-painful group,and extremely-painful group, respectively,before treatment and 4.88 ± 2.17, 3.00 ± 1.77,and 5.13 ± 2.36 after treatment. The average pain score remarkably decreased in the slightly-painful group and extremely-painful group,and such difference was statistically significant in the slightly-pain group (P<0.05). The effective rate (defined as thinner patellar,decreased hypoecho area and fewer blood distribution in the lesion) was 38%, 50%, and 62% in the painless group, slightly-painful group,and extremely-painful group, and the rates in the slightly-painful group and extremely-painful group were significantly higher than that in painless group (both P<0.05). HFUS can display the ultrasonographic changes of patellar tendon enthesiopathy after conservative treatments in an objective and quantitative manner. Compared with conventional clinical evaluations, it can more accurately reflect the disease recovery status.

Text mining approach to predict hospital admissions using early medical records from the emergency department.

PubMed

Lucini, Filipe R; S Fogliatto, Flavio; C da Silveira, Giovani J; L Neyeloff, Jeruza; Anzanello, Michel J; de S Kuchenbecker, Ricardo; D Schaan, Beatriz

2017-04-01

Emergency department (ED) overcrowding is a serious issue for hospitals. Early information on short-term inward bed demand from patients receiving care at the ED may reduce the overcrowding problem, and optimize the use of hospital resources. In this study, we use text mining methods to process data from early ED patient records using the SOAP framework, and predict future hospitalizations and discharges. We try different approaches for pre-processing of text records and to predict hospitalization. Sets-of-words are obtained via binary representation, term frequency, and term frequency-inverse document frequency. Unigrams, bigrams and trigrams are tested for feature formation. Feature selection is based on χ 2 and F-score metrics. In the prediction module, eight text mining methods are tested: Decision Tree, Random Forest, Extremely Randomized Tree, AdaBoost, Logistic Regression, Multinomial Naïve Bayes, Support Vector Machine (Kernel linear) and Nu-Support Vector Machine (Kernel linear). Prediction performance is evaluated by F1-scores. Precision and Recall values are also informed for all text mining methods tested. Nu-Support Vector Machine was the text mining method with the best overall performance. Its average F1-score in predicting hospitalization was 77.70%, with a standard deviation (SD) of 0.66%. The method could be used to manage daily routines in EDs such as capacity planning and resource allocation. Text mining could provide valuable information and facilitate decision-making by inward bed management teams. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

A web-based study of bipolarity and impulsivity in athletes engaging in extreme and high-risk sports.

PubMed

Dudek, Dominika; Siwek, Marcin; Jaeschke, Rafał; Drozdowicz, Katarzyna; Styczeń, Krzysztof; Arciszewska, Aleksandra; Chrobak, Adrian A; Rybakowski, Janusz K

2016-06-01

We hypothesised that men and women who engage in extreme or high-risk sports would score higher on standardised measures of bipolarity and impulsivity compared to age and gender matched controls. Four-hundred and eighty extreme or high-risk athletes (255 males and 225 females) and 235 age-matched control persons (107 males and 128 females) were enrolled into the web-based case-control study. The Mood Disorder Questionnaire (MDQ) and Barratt Impulsiveness Scale (BIS-11) were administered to screen for bipolarity and impulsive behaviours, respectively. Results indicated that extreme or high-risk athletes had significantly higher scores of bipolarity and impulsivity, and lower scores on cognitive complexity of the BIS-11, compared to controls. Further, there were positive correlations between the MDQ and BIS-11 scores. These results showed greater rates of bipolarity and impulsivity, in the extreme or high-risk athletes, suggesting these measures are sensitive to high-risk behaviours.

A pilot study of contralateral homonymous muscle activity simulated electrical stimulation in chronic hemiplegia.

PubMed

Osu, Rieko; Otaka, Yohei; Ushiba, Junichi; Sakata, Sachiko; Yamaguchi, Tomofumi; Fujiwara, Toshiyuki; Kondo, Kunitsugu; Liu, Meigen

2012-01-01

For the recovery of hemiparetic hand function, a therapy was developed called contralateral homonymous muscle activity stimulated electrical stimulation (CHASE), which combines electrical stimulation and bilateral movements, and its feasibility was studied in three chronic stroke patients with severe hand hemiparesis. Patients with a subcortical lesion were asked to extend their wrist and fingers bilaterally while an electromyogram (EMG) was recorded from the extensor carpi radialis (ECR) muscle in the unaffected hand. Electric stimulation was applied to the homonymous wrist and finger extensors of the affected side. The intensity of the electrical stimulation was computed based on the EMG and scaled so that the movements of the paretic hand looked similar to those of the unaffected side. The patients received 30-minutes of therapy per day for 2 weeks. Improvement in the active range of motion of wrist extension was observed for all patients. There was a decrease in the scores of modified Ashworth scale in the flexors. Fugl-Meyer assessment scores of motor function of the upper extremities improved in two of the patients. The results suggest a positive outcome can be obtained using the CHASE system for upper extremity rehabilitation of patients with severe hemiplegia.

Recovery of sensorimotor function and activities of daily living after cervical spinal cord injury: the influence of age.

PubMed

Wirz, Markus; Dietz, Volker

2015-02-01

This retrospective study was designed to examine the influence of age on the outcome of motor function and activities of daily living (ADLs) in patients with a cervical spinal cord injury (SCI). The study is based on the data registry of the European Multicenter Study of Spinal Cord Injury (EMSCI) study group. Initial upper-extremity motor score (UEMS) and its change over 5 months, as well as the initial Spinal Cord Independence Measure (SCIM) score, did not differ between younger adults (20-39 years) and elderly (60-79 years) patients. However, the change in SCIM score over 5 months was significantly greater in the younger patient group. Initial UEMS, SCIM, and ulnar compound motor action potentials (CMAP), reflecting peripheral nerve damage (motoneurons and roots), were significantly greater in incomplete, compared to complete, SCI, regardless of age group. The initial assessment of UEMS in combination with CMAP recordings allows an early prediction of ADLs outcomes in both younger adults and elderly subjects. The impaired translation of gain in motor score into increased ADL independence in elderly patients requires specifically tailored rehabilitation programs.

A Note on the Use of the Hiskey-Nebraska Test of Learning Aptitude with Deaf Children.

ERIC Educational Resources Information Center

Watson, Betty U.; Goldgar, David E.

1985-01-01

Comparing distribution of scores on the Hiskey-Nebraska Test of Learning Aptitude (H-NTLA) with those from the Wechsler Performance Scales for 71 hearing impaired Ss revealed a correlation of .85. However, the H-NTLA yielded more Ss with extreme scores. Findings stress the need for caution in interpreting extreme H-NTLA scores. (CL)

Peripheral neuropathy may increase the risk for asymptomatic otic barotrauma during hyperbaric oxygen therapy: research report.

PubMed

Mozdzanowski, Christopher; Perdrizet, George A

2014-01-01

Otic barotrauma (OBT) is an adverse event seen in patients receiving hyperbaric oxygen (HBO2) therapy. After encountering a case of painless tympanic perforation during HBO2 therapy of a diabetic patient with the diagnosis of neuropathic Wagner Grade III foot ulcer, we hypothesized that peripheral neuropathy of the lower extremity may be associated with an increased risk of asymptomatic OBT during HBO2 therapy. The medical records of all HBO2 patients during a one-year period of time were reviewed. Subjects were selected based on otoscopic documentation of OBT and divided into two groups based on the presence or absence of lower extremity peripheral neuropathy. Time to therapeutic compression, presence or absence of ear-related symptoms and modified Teed (mTeed) scores were compared between the two groups. A total of 38 patients with OBT, 18 neuropathic and 20 non-neuropathic, were identified. Asymptomatic OBT occurred more frequently in the neuropathic vs. non-neuropathic group (56% vs. 5%, p < 0.001). mTeed scores were significantly greater in the neuropathic vs. non-neuropathic group (mTeed 1, 30% vs. 61%; mTeed 2, 65% vs. 36%; mTeed 3, 4% vs. 3%; p = 0.032). Mean compression times were shorter in the neuropathic vs. non-neuropathic group (10. 5 +/- 1.8 vs. 14.4 +/- 3.3 minutes, p < 0.001). The presence of peripheral neuropathy of the lower extremity may be associated with a significantly greater incidence of asymptomatic otic barotrauma during HBO2 therapy.

Field Evaluation in Four NEEMO Divers of a Prototype In-suit Doppler Ultrasound Bubble Detector

NASA Technical Reports Server (NTRS)

Acock, K. E.; Gernhardt, M. L.; Conkin, J.; Powell, M. R.

2004-01-01

It is desirable to know if astronauts produce venous gas emboli (VGE) as a result of their exposure to 4.3 psia during space walks. The current prototype in-suit Doppler (ISD) ultrasound bubble detector provides an objective assessment of decompression stress by monitoring for VGE. The NOAA Aquarius habitat and NASA Extreme Environment Mission Operations (NEEMO) series of dives provided an opportunity to assess the ability of the prototype ISDs to record venous blood flow and possibly detect VGE in the pulmonary artery. From July 16 to 29,2003, four aquanauts (two males and two females) donned the ISD for a 4 hr automated recording session, following excursion dives (up to 6hrs and 29 MSW below storage depth) from air saturation at 17 MSW. Doppler recordings for 32 excursion dives were collected. The recordings consisted of approximately 150 digital wave files. Each wave file contained 24 sec of recording for each min. A 1 - 4 Doppler Quality Score (DQS) was assigned to each wave file in 17 of the 32 records evaluated to date. A DQS of 1 indicates a poor flow signal and a score of 4 indicates an optimum signal. Only 23% of all wave files had DQSs considered adequate to detect low grade VGE (Spencer I-II). The distribution of DQS in 2,356 wave files is as follows: DQS 1-56%, DQS 2-21%, DQS 3-18% and DQS 4-5%. Six of the 17 records had false positive VGE (Spencer I-IV) detected in one or more wave files per dive record. The false positive VGE recordings are attributable to air entrainment associated with drinking (verified by control tests), and this observation is important as astronauts drink water during space walks. The current ISD design provides quality recordings only over a narrow range of chest anatomy.

Operative management of partial-thickness tears of the proximal hamstring muscles in athletes.

PubMed

Bowman, Karl F; Cohen, Steven B; Bradley, James P

2013-06-01

Partial tears of the hamstring muscle origin represent a challenging clinical problem to the patient and orthopaedic surgeon. Although nonoperative treatment is frequently met with limited success, there is a paucity of data on the efficacy of surgical management for partial proximal hamstring tears in the active and athletic population. To evaluate the results of an anatomic repair for partial tears of the hamstring muscle origin in athletes. Case series; Level of evidence, 4. The records of 17 patients with partial tears of the proximal hamstring origin were reviewed after institutional review board approval was obtained. All patients were treated with open debridement and primary tendon repair after failure of at least 6 months of nonoperative therapy. Clinical and operative records, radiographs, and magnetic resonance images were reviewed for all patients. A patient-reported outcomes survey was completed by 14 patients that included the Lower Extremity Functional Score (LEFS), Marx activity rating scale, custom LEFS and Marx scales, and subjective patient satisfaction scores. Early and late postoperative complications were recorded. There were 3 male and 14 female patients; their average age was 43 years (range, 19-64 years) and average follow-up was 32 months (range, 12-51 months). There were 2 collegiate athletes (field hockey, track), 14 amateur athletes (distance running, waterskiing, tennis), and a professional bodybuilder. Postoperative LEFS was 73.3 ± 9.9 (range, 50-80) and custom LEFS was 66.7 ± 17.0 (range, 37-80) of a maximum 80 points. The most commonly reported difficulty was with prolonged sitting and explosive direction change while running. The average Marx score was 6.5 ± 5.3 (range, 0-16) of a maximum 16, correlating with a greater return to recreational running activities in this patient cohort than regular participation in pivoting or cutting sports. Marx custom scores were 20 of a maximum 20 in all patients, demonstrating no disability in the operative extremity with activities of daily living. No patient underwent a subsequent surgery. One patient was not satisfied with the result and reported persistent symptoms during competitive distance running. All patients were able to return to their preoperative level of activity after surgery. Anatomic surgical treatment of partial proximal hamstring avulsions can lead to satisfactory functional outcomes, a high rate of return to athletic activity, and low complication rate. This procedure should be reserved for patients who have failed an extended course of nonoperative treatment, and the proximity of the sciatic nerve mandates a careful assessment of the risk-benefit ratio before surgery is undertaken.

Football goal distributions and extremal statistics

NASA Astrophysics Data System (ADS)

Greenhough, J.; Birch, P. C.; Chapman, S. C.; Rowlands, G.

2002-12-01

We analyse the distributions of the number of goals scored by home teams, away teams, and the total scored in the match, in domestic football games from 169 countries between 1999 and 2001. The probability density functions (PDFs) of goals scored are too heavy-tailed to be fitted over their entire ranges by Poisson or negative binomial distributions which would be expected for uncorrelated processes. Log-normal distributions cannot include zero scores and here we find that the PDFs are consistent with those arising from extremal statistics. In addition, we show that it is sufficient to model English top division and FA Cup matches in the seasons of 1970/71-2000/01 on Poisson or negative binomial distributions, as reported in analyses of earlier seasons, and that these are not consistent with extremal statistics.

Phenotypic and genetic overlap between autistic traits at the extremes of the general population.

PubMed

Ronald, Angelica; Happé, Francesca; Price, Thomas S; Baron-Cohen, Simon; Plomin, Robert

2006-10-01

To investigate children selected from a community sample for showing extreme autistic-like traits and to assess the degree to which these individual traits--social impairments (SIs), communication impairments (CIs), and restricted repetitive behaviors and interests (RRBIs)--are caused by genes and environments, whether all of them are caused by the same genes and environments, and how often they occur together (as required by an autism diagnosis). The most extreme-scoring 5% were selected from 3,419 8-year-old pairs in the Twins Early Development Study assessed on the Childhood Asperger Syndrome Test. Phenotypic associations between extreme traits were compared with associations among the full-scale scores. Genetic associations between extreme traits were quantified using bivariate DeFries-Fulker extremes analysis. Phenotypic relationships between extreme SIs, CIs, and RRBIs were modest. There was a degree of genetic overlap between them, but also substantial genetic specificity. This first twin study assessing the links between extreme individual autistic-like traits (SIs, CIs, and RRBIs) found that all are highly heritable but show modest phenotypic and genetic overlap. This finding concurs with that of an earlier study from the same cohort that showed that a total autistic symptoms score at the extreme showed high heritability and that SIs, CIs, and RRBIs show weak links in the general population. This new finding has relevance for both clinical models and future molecular genetic studies.

Factors Influencing Obstacle Crossing Performance in Patients with Parkinson's Disease

PubMed Central

Liao, Ying-Yi; Yang, Yea-Ru; Wu, Yih-Ru; Wang, Ray-Yau

2014-01-01

Background Tripping over obstacles is the major cause of falls in community-dwelling patients with Parkinson's disease (PD). Understanding the factors associated with the obstacle crossing behavior may help to develop possible training programs for crossing performance. This study aimed to identify the relationships and important factors determining obstacle crossing performance in patients with PD. Methods Forty-two idiopathic patients with PD (Hoehn and Yahr stages I to III) participated in this study. Obstacle crossing performance was recorded by the Liberty system, a three-dimensional motion capture device. Maximal isometric strength of the lower extremity was measured by a handheld dynamometer. Dynamic balance and sensory integration ability were assessed using the Balance Master system. Movement velocity (MV), maximal excursion (ME), and directional control (DC) were obtained during the limits of stability test to quantify dynamic balance. The sum of sensory organization test (SOT) scores was used to quantify sensory organization ability. Results Both crossing stride length and stride velocity correlated significantly with lower extremity muscle strength, dynamic balance control (forward and sideward), and sum of SOT scores. From the regression model, forward DC and ankle dorsiflexor strength were identified as two major determinants for crossing performance (R2 = .37 to.41 for the crossing stride length, R2 = .43 to.44 for the crossing stride velocity). Conclusions Lower extremity muscle strength, dynamic balance control and sensory integration ability significantly influence obstacle crossing performance. We suggest an emphasis on muscle strengthening exercises (especially ankle dorsiflexors), balance training (especially forward DC), and sensory integration training to improve obstacle crossing performance in patients with PD. PMID:24454723

Characterization of Volitional Electromyographic Signals in the Lower Extremity After Motor Complete Spinal Cord Injury.

PubMed

Heald, Elizabeth; Hart, Ronald; Kilgore, Kevin; Peckham, P Hunter

2017-06-01

Previous studies have demonstrated the presence of intact axons across a spinal cord lesion, even in those clinically diagnosed with complete spinal cord injury (SCI). These axons may allow volitional motor signals to be transmitted through the injury, even in the absence of visible muscle contraction. To demonstrate the presence of volitional electromyographic (EMG) activity below the lesion in motor complete SCI and to characterize this activity to determine its value for potential use as a neuroprosthetic command source. Twenty-four subjects with complete (AIS A or B), chronic, cervical SCI were tested for the presence of volitional below-injury EMG activity. Surface electrodes recorded from 8 to 12 locations of each lower limb, while participants were asked to attempt specific movements of the lower extremity in response to visual and audio cues. EMG trials were ranked through visual inspection, and were scored using an amplitude threshold algorithm to identify channels of interest with volitional motor unit activity. Significant below-injury muscle activity was identified through visual inspection in 16 of 24 participants, and visual inspection rankings were well correlated to the algorithm scoring. The surface EMG protocol utilized here is relatively simple and noninvasive, ideal for a clinical screening tool. The majority of subjects tested were able to produce a volitional EMG signal below their injury level, and the algorithm developed allows automatic identification of signals of interest. The presence of this volitional activity in the lower extremity could provide an innovative new command signal source for implanted neuroprostheses or other assistive technology.

Validity of the Dictionary of Occupational Titles for Assessing Upper Extremity Work Demands

PubMed Central

Opsteegh, Lonneke; Soer, Remko; Reinders-Messelink, Heleen A.; Reneman, Michiel F.; van der Sluis, Corry K.

2010-01-01

Objectives The Dictionary of Occupational Titles (DOT) is used in vocational rehabilitation to guide decisions about the ability of a person with activity limitations to perform activities at work. The DOT has categorized physical work demands in five categories. The validity of this categorization is unknown. Aim of this study was to investigate whether the DOT could be used validly to guide decisions for patients with injuries to the upper extremities. Four hypotheses were tested. Methods A database including 701 healthy workers was used. All subjects filled out the Dutch Musculoskeletal Questionnaire, from which an Upper Extremity Work Demands score (UEWD) was derived. First, relation between the DOT-categories and UEWD-score was analysed using Spearman correlations. Second, variance of the UEWD-score in occupational groups was tested by visually inspecting boxplots and assessing kurtosis of the distribution. Third, it was investigated whether occupations classified in one DOT-category, could significantly differ on UEWD-scores. Fourth, it was investigated whether occupations in different DOT-categories could have similar UEWD-scores using Mann Whitney U-tests (MWU). Results Relation between the DOT-categories and the UEWD-score was weak (rsp = 0.40; p<.01). Overlap between categories was found. Kurtosis exceeded ±1.0 in 3 occupational groups, indicating large variance. UEWD-scores were significantly different within one DOT-category (MWU = 1.500; p<.001). UEWD scores between DOT-categories were not significantly different (MWU = 203.000; p = .49). Conclusion All four hypotheses could not be rejected. The DOT appears to be invalid for assessing upper extremity work demands. PMID:21151934

Temperature extremes: geographic patterns, recent changes, and implications for organismal vulnerabilities.

PubMed

Buckley, Lauren B; Huey, Raymond B

2016-12-01

Extreme temperatures can injure or kill organisms and can drive evolutionary patterns. Many indices of extremes have been proposed, but few attempts have been made to establish geographic patterns of extremes and to evaluate whether they align with geographic patterns in biological vulnerability and diversity. To examine these issues, we adopt the CLIMDEX indices of thermal extremes. We compute scores for each index on a geographic grid during a baseline period (1961-1990) and separately for the recent period (1991-2010). Heat extremes (temperatures above the 90th percentile during the baseline period) have become substantially more common during the recent period, particularly in the tropics. Importantly, the various indices show weak geographic concordance, implying that organisms in different regions will face different forms of thermal stress. The magnitude of recent shifts in indices is largely uncorrelated with baseline scores in those indices, suggesting that organisms are likely to face novel thermal stresses. Organismal tolerances correlate roughly with absolute metrics (mainly for cold), but poorly with metrics defined relative to local conditions. Regions with high extreme scores do not correlate closely with regions with high species diversity, human population density, or agricultural production. Even though frequency and intensity of extreme temperature events have - and are likely to have - major impacts on organisms, the impacts are likely to be geographically and taxonomically idiosyncratic and difficult to predict. © 2016 John Wiley & Sons Ltd.

Spatial Neglect Hinders Success of Inpatient Rehabilitation in Individuals With Traumatic Brain Injury: A Retrospective Study.

PubMed

Chen, Peii; Ward, Irene; Khan, Ummais; Liu, Yan; Hreha, Kimberly

2016-06-01

Background Current knowledge about spatial neglect and its impact on rehabilitation mostly originates from stroke studies. Objective To examine the impact of spatial neglect on rehabilitation outcome in individuals with traumatic brain injury (TBI). Methods The retrospective study included 156 consecutive patients with TBI (73 women; median age = 69.5 years; interquartile range = 50-81 years) at an inpatient rehabilitation facility (IRF). We examined whether the presence of spatial neglect affected the Functional Independence Measure (FIM) scores, length of stay, or discharge disposition. Based on the available medical records, we also explored whether spatial neglect was associated with tactile sensation or muscle strength asymmetry in the extremities and whether specific brain injuries or lesions predicted spatial neglect. Results In all, 30.1% (47 of 156) of the sample had spatial neglect. Sex, age, severity of TBI, or time postinjury did not differ between patients with and without spatial neglect. In comparison to patients without spatial neglect, patients with the disorder stayed in IRF 5 days longer, had lower FIM scores at discharge, improved slower in both Cognitive and Motor FIM scores, and might have less likelihood of return home. In addition, left-sided neglect was associated with asymmetric strength in the lower extremities, specifically left weaker than the right. Finally, brain injury-induced mass effect predicted left-sided neglect. Conclusions Spatial neglect is common following TBI, impedes rehabilitation progress in both motor and cognitive domains, and prolongs length of stay. Future research is needed for linking specific traumatic injuries and lesioned networks to spatial neglect and related impairment. © The Author(s) 2015.

Ingenol mebutate gel for actinic keratosis: the link between quality of life, treatment satisfaction, and clinical outcomes.

PubMed

Augustin, Matthias; Tu, John H; Knudsen, Kim Mark; Erntoft, Sandra; Larsson, Thomas; Hanke, C William

2015-05-01

Actinic keratosis therapy can elicit unsightly and painful local skin responses; assessment of treatment satisfaction and health-related quality of life (QoL) is important. Ingenol mebutate gel is a novel topical field therapy for actinic keratosis. Post-hoc analyses were performed based on patient-reported outcomes from phase-III trials (n = 1005) to assess the effects of ingenol mebutate on QoL and the relationship between both QoL and treatment satisfaction, and degree of lesion clearance. Patients received ingenol mebutate or vehicle for self-application to a 25-cm(2) contiguous area: 0.015% once daily for 3 consecutive days (face/scalp) or 0.05% once daily for 2 consecutive days (trunk/extremities). QoL (Skindex-16) and Treatment Satisfaction Questionnaire for Medication data were recorded. Significant, positive associations between Treatment Satisfaction Questionnaire for Medication score and degree of clearance were identified for patients in the face/scalp (effectiveness P < .0001 and global satisfaction P = .0002) and trunk/extremities (P < .0001 and P = .0014, respectively) groups. There was a significant association between Skindex-16 score and clearance for patients in the face/scalp group for change in symptoms (P = .0218), emotions (P = .0002), and overall Skindex-16 score (P = .0006) from baseline. Clinical trial population findings may not be generalizable to clinical practice. Ingenol mebutate significantly improved patients' QoL and treatment satisfaction. Improvements were associated with higher degrees of actinic keratosis lesion clearance. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Functional Outcomes of Persons Undergoing Dysvascular Lower Extremity Amputations

PubMed Central

Sauter, Carley N.; Pezzin, Liliana E.; Dillingham, Timothy R.

2012-01-01

Objective To examine the effect of post-acute rehabilitation setting on functional outcomes among patients undergoing major lower extremity dysvascular amputations. Design A population-based, prospective cohort study conducted in Maryland and Wisconsin. Data collected from medical records and patient interviews conducted during acute hospitalization following amputation and at six-month following the acute care discharge were analyzed using multivariate models and instrumental variable techniques. Results A total of 297 patients were analyzed based on post-acute care rehabilitation setting: acute inpatient rehabilitation (IRF), skilled nursing facility (SNF) or home. The majority (43.4%) received care in IRF, 32% in SNF, and 24.6% at home. On SF-36 subscales, significantly improved outcomes were observed for patients receiving post-acute care at an IRF relative to those cared for at a SNF in physical function (PF), role physical (RF) and physical component score (PCS). Patients receiving post-acute care in IRFs also experienced better RF and PCS outcomes compared to those discharged directly home. In addition, patients receiving post-acute care at an IRF were significantly more likely to score in the top quartile for general health in IRF compared to SNF or home, and less likely to score in the lowest quartile for PF, RF and PCS in IRF compared to SNF. Lower ADL impairment was observed in IRF compared to SNF. Conclusions Among this large and diverse cohort of patients undergoing major dysvascular lower limb amputations, receipt of interdisciplinary rehabilitation services at an IRF yielded improved functional outcomes six months after amputation relative to care received at SNFs or home. PMID:23291599

Oswestry Disability Index is a better indicator of lumbar motion than the Visual Analogue Scale.

PubMed

Ruiz, Ferrin K; Bohl, Daniel D; Webb, Matthew L; Russo, Glenn S; Grauer, Jonathan N

2014-09-01

Lumbar pathology is often associated with axial pain or neurologic complaints. It is often presumed that such pain is associated with decreased lumbar motion; however, this correlation is not well established. The utility of various outcome measures that are used in both research and clinical practice have been studied, but the connection with range of motion (ROM) has not been well documented. The current study was performed to assess objectively the postulated correlation of lumbar complaints (based on standardized outcome measures) with extremes of lumbar ROM and functional ROM (fROM) with activities of daily living (ADLs) as assessed with an electrogoniometer. This study was a clinical cohort study. Subjects slated to undergo a lumbar intervention (injection, decompression, and/or fusion) were enrolled voluntarily in the study. The two outcome measures used in the study were the Visual Analogue Scale (VAS) for axial extremity, lower extremity, and combined axial and lower extremity, as well as the Oswestry Disability Index (ODI). Pain and disability scores were assessed with the VAS score and ODI. A previously validated electrogoniometer was used to measure ROM (extremes of motion in three planes) and fROM (functional motion during 15 simulated activities of daily living). Pain and disability scores were analyzed for statistically significant association with the motion assessments using linear regression analyses. Twenty-eight men and 39 women were enrolled, with an average age of 55.6 years (range, 18-79 years). The ODI and VAS were associated positively (p<.001). Combined axial and lower extremity VAS scores were associated with lateral and rotational ROM (p<.05), but not with flexion/extension or any fROM. Similar findings were noted for separately analyzed axial and lower extremity VAS scores. On the other hand, the ODI correlated inversely with ROM in all planes, and fROM in at least one plane for 10 of 15 ADLs (p<.05). Extremes of lumbar motion and motions associated with ADLs are of increasing clinical interest. Although the ODI and VAS are associated with each other, the ODI appears to be a better predictor of these motion parameters than the VAS (axial extremity, lower extremity, or combined) and may be more useful in the clinical setting when considering functional movement parameters. Copyright © 2014 Elsevier Inc. All rights reserved.

An Innovative Multimedia Approach to Laboratory Safety

NASA Technical Reports Server (NTRS)

Anderson, M. B.; Constant, K. P.

1996-01-01

A new approach for teaching safe laboratory practices has been developed for materials science laboratories at Iowa State university. Students are required to complete a computerized safety tutorial and pass an exam before working in the laboratory. The safety tutorial includes sections on chemical, electrical, radiation, and high temperature safety. The tutorial makes use of a variety of interactions, including 'assembly' interactions where a student is asked to drag and drop items with the mouse (either labels or pictures) to an appropriate place on the screen (sometimes in a specific order). This is extremely useful for demonstrating safe lab practices and disaster scenarios. Built into the software is a record tracking scheme so that a professor can access a file that records which students have completed the tutorial and their scores on the exam. This paper will describe the development and assessment of the safety tutorials.

Are Outcomes of Extremely Preterm Infants Improving? Impact of Bayley Assessment on Outcomes

PubMed Central

Vohr, Betty R.; Stephens, Bonnie E.; Higgins, Rosemary D.; Bann, Carla M.; Hintz, Susan R.; Epi, MS; Das, Abhik; Newman, Jamie E.; Peralta-Carcelen, Myriam; Yolton, Kimberly; Dusick, Anna M.; Evans, Patricia W.; Goldstein, Ricki F.; Ehrenkranz, Richard A.; Pappas, Athina; Adams-Chapman, Ira; Wilson-Costello, Deanne E.; Bauer, Charles R.; Bodnar, Anna; Heyne, Roy J.; Vaucher, Yvonne E.; Dillard, Robert G.; Acarregui, Michael J.; McGowan, Elisabeth C.; Myers, Gary J.; Fuller, Janell

2013-01-01

Objectives To compare 18- to 22-month cognitive scores and neurodevelopmental impairment (NDI) in 2 time periods using the National Institute of Child Health and Human Development’s Neonatal Research Network assessment of extremely low birth weight infants with the Bayley Scales of Infant Development, Second Edition (Bayley II) in 2006–2007 (period 1) and using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley III), with separate cognitive and language scores, in 2008–2011 (period 2). Study design Scores were compared with bivariate analysis, and regression analyses were run to identify differences in NDI rates. Results Mean Bayley III cognitive scores were 11 points higher than mean Bayley II cognitive scores. The NDI rate was reduced by 70% (from 43% in period 1 to 13% in period 2; P < .0001). Multivariate analyses revealed that Bayley III contributed to a decreased risk of NDI by 5 definitions: cognitive score <70 and <85, cognitive or language score <70; cognitive or motor score <70, and cognitive, language, or motor score <70 (P < .001). Conclusion Whether the Bayley III is overestimating cognitive performance or whether it is a more valid assessment of emerging cognitive skills than the Bayley II is uncertain. Because the Bayley III identifies significantly fewer children with disability, it is recommended that all extremely low birth weight infants be offered early intervention services at the time of discharge from the neonatal intensive care unit, and that Bayley scores be interpreted with caution. PMID:22421261

Evaluation of Mangled Extremity Severity Score (MESS) as a predictor of lower limb amputation in children with trauma.

PubMed

Behdad, Saba; Rafiei, Mohammad Hadi; Taheri, Hadi; Behdad, Samin; Mohammadzadeh, Mahdi; Kiani, Gelare; Hosseinpour, Mehrdad

2012-12-01

Management of the severely injured lower limb in children remains a challenge despite advances in surgical techniques. Models that predict the risk of lower limb trauma patients are designed to provide an estimation of the probability of limb salvage. In this study, we validate Mangled Extremity Syndrome Index (Mangled Extremity Severity Score [MESS]) by measurement of its discrimination in children. From September 2009 to 2010, we collected the hospital records of all children who presented with lower extremity long bone open fractures. The inclusion criteria were I grade, II B, III C open fractures, severe injury to three of four organ systems, and severe injury to two of four organ systems with minor injury to two of four systems that require surgical interventions. Severity of limb injury was measured using MESS. Patients were followed up for 1 year. The discrimination of MESS model in differentiating of outcome in patients was assessed by calculating the area under the receiver operator characteristic plot. We evaluated 200 children referred consecutively to our center. The mean MESS in the amputation group was 7.5 ± 1.59 versus 6.4 ± 2.02 in the limb salvage group (p = 0.04). Amputation rate was 7.5% (n = 15). Percentages of skeletal/soft-tissue injury was different between groups (p = 0.0001). Children in the amputation group showed more tissue injury compared with limb salvage group. The best clinical discriminator power was calculated as MESS ≥ 6.5 (sensitivity = 73%, specificity = 54%). We assumed that patients with a high risk of amputation can be identified early, and specific measures can be implemented immediately by using MESS with threshold of 6.5. Georg Thieme Verlag KG Stuttgart · New York.

Prospective randomized comparison of scar appearances between cograft of acellular dermal matrix with autologous split-thickness skin and autologous split-thickness skin graft alone for full-thickness skin defects of the extremities.

PubMed

Yi, Ju Won; Kim, Jae Kwang

2015-03-01

The purpose of this study was to evaluate the clinical outcomes of cografting of acellular dermal matrix with autologous split-thickness skin and autologous split-thickness skin graft alone for full-thickness skin defects on the extremities. In this prospective randomized study, 19 consecutive patients with full-thickness skin defects on the extremities following trauma underwent grafting using either cograft of acellular dermal matrix with autologous split-thickness skin graft (nine patients, group A) or autologous split-thickness skin graft alone (10 patients, group B) from June of 2011 to December of 2012. The postoperative evaluations included observation of complications (including graft necrosis, graft detachment, or seroma formation) and Vancouver Scar Scale score. No statistically significant difference was found regarding complications, including graft necrosis, graft detachment, or seroma formation. At week 8, significantly lower Vancouver Scar Scale scores for vascularity, pliability, height, and total score were found in group A compared with group B. At week 12, lower scores for pliability and height and total scores were identified in group A compared with group B. For cases with traumatic full-thickness skin defects on the extremities, a statistically significant better result was achieved with cograft of acellular dermal matrix with autologous split-thickness skin graft than with autologous split-thickness skin graft alone in terms of Vancouver Scar Scale score. Therapeutic, II.

A short tapered stem reduces intraoperative complications in primary total hip arthroplasty.

PubMed

Molli, Ryan G; Lombardi, Adolph V; Berend, Keith R; Adams, Joanne B; Sneller, Michael A

2012-02-01

While short-stem design is not a new concept, interest has surged with increasing utilization of less invasive techniques. Short stems are easier to insert through small incisions. Reliable long-term results including functional improvement, pain relief, and implant survival have been reported with standard tapered stems, but will a short taper perform as well? We compared short, flat-wedge, tapered, broach-only femoral stems to standard-length, double-tapered, ream and broach femoral stems in terms of intraoperative complications, short-term survivorship, and pain and function scores. We retrospectively reviewed the records of 606 patients who had 658 THAs using a less invasive direct lateral approach from January 2006 to March 2008. Three hundred sixty patients (389 hips) had standard-length stems and 246 (269 hips) had short stems. Age averaged 63 years, and body mass index averaged 30.7 kg/m(2). We recorded complications and pain and function scores and computed short-term survival. Minimum followup was 0.8 months (mean, 29.2 months; range, 0.8-62.2 months). We observed a higher rate of intraoperative complications with the standard-length stems (3.1%; three trochanteric avulsions, nine femoral fractures) compared with the shorter stems (0.4%; one femoral fracture) and managed all complications with application of one or more cerclage cables. There were no differences in implant survival, Harris hip score, and Lower Extremity Activity Scale score between groups. Fewer intraoperative complications occurred with the short stems, attesting to the easier insertion of these devices. While longer followup is required, our early results suggest shortened stems can be used with low complication rates and do not compromise the survival and functional outcome of cementless THA. Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Validity and Reliability of Nintendo Wii Fit Balance Scores

PubMed Central

Wikstrom, Erik A.

2012-01-01

Context: Interactive gaming systems have the potential to help rehabilitate patients with musculoskeletal conditions. The Nintendo Wii Balance Board, which is part of the Wii Fit game, could be an effective tool to monitor progress during rehabilitation because the board and game can provide objective measures of balance. However, the validity and reliability of Wii Fit balance scores remain unknown. Objective: To determine the concurrent validity of balance scores produced by the Wii Fit game and the intrasession and intersession reliability of Wii Fit balance scores. Design: Descriptive laboratory study. Setting: Sports medicine research laboratory. Patients or Other Participants: Forty-five recreationally active participants (age  =  27.0 ± 9.8 years, height  =  170.9 ± 9.2 cm, mass  =  72.4 ± 11.8 kg) with a heterogeneous history of lower extremity injury. Intervention(s): Participants completed a single-limb–stance task on a force plate and the Star Excursion Balance Test (SEBT) during the first test session. Twelve Wii Fit balance activities were completed during 2 test sessions separated by 1 week. Main Outcome Measure(s): Postural sway in the anteroposterior (AP) and mediolateral (ML) directions and the AP, ML, and resultant center-of-pressure (COP) excursions were calculated from the single-limb stance. The normalized reach distance was recorded for the anterior, posteromedial, and posterolateral directions of the SEBT. Wii Fit balance scores that the game software generated also were recorded. Results: All 96 of the calculated correlation coefficients among Wii Fit activity outcomes and established balance outcomes were interpreted as poor (r < 0.50). Intrasession reliability for Wii Fit balance activity scores ranged from good (intraclass correlation coefficient [ICC]  =  0.80) to poor (ICC  =  0.39), with 8 activities having poor intrasession reliability. Similarly, 11 of the 12 Wii Fit balance activity scores demonstrated poor intersession reliability, with scores ranging from fair (ICC  =  0.74) to poor (ICC  =  0.29). Conclusions: Wii Fit balance activity scores had poor concurrent validity relative to COP outcomes and SEBT reach distances. In addition, the included Wii Fit balance activity scores generally had poor intrasession and intersession reliability. PMID:22892412

The General Movement Optimality Score – a detailed assessment of general movements during preterm and term age

PubMed Central

Einspieler, Christa; Marschik, Peter B.; Urlesberger, Berndt; Pansy, Jasmin; Scheuchenegger, Anna; Krieber, Magdalena; Yang, Hong; Kornacka, Maria K.; Rowinska, Edyta; Soloveichick, Marina; Ferrari, Fabrizio; Guzzetta, Andrea; Cioni, Giovanni; Bos, Arend F.

2018-01-01

Aim To explore the appropriateness of applying a detailed assessment of general movements (GMs) and characterise the relationship between global and detailed assessment. Method The analysis was based on 783 video-recordings of 233 infants (79 females) who had been videoed from 27 to 45 weeks postmenstrual age. Apart from assessing the global GM categories (normal, poor repertoire [PR], cramped-synchronised [CS] or chaotic GMs), we scored the amplitude, speed, spatial range, proximal and distal rotations, onset and offset, tremulous and cramped components of the upper and lower extremities. Applying the optimality concept, the maximum GM optimality score of 42 indicates the optimal performance. Results GM optimality scores differentiated between normal GMs (Median=39; P75=41, P25=37); PR GMs (Median=25; P75=29, P25=22), and CS GMs (Median=12; P75=14, P25=10; p<0.01). The optimality score for chaotic GMs (mainly occurring at late preterm age) was similar to those for CS GMs (Median=14; P75=17, P25=12). Short-lasting tremulous movements occurred from very preterm age to postterm age across all GM categories, including normal GMs. The detailed score at postterm age was slightly lower compared to the scores at preterm and term age for both normal (p=0.02) and PR GMs (p<0.01). Interpretation Further research might demonstrate that the GM optimality score provides a solid base for the prediction of improvement vs. deterioration within an individual GM trajectory. PMID:26365130

Using weather data to determine dry and wet periods relative to ethnographic records

NASA Astrophysics Data System (ADS)

Felzer, B. S.; Jiang, M.; Cheng, R.; Ember, C. R.

2017-12-01

Ethnographers record flood or drought events that affect a society's food supply and can be interpreted in terms of a society's ability to adapt to extreme events. Using daily weather station data from the Global Historical Climatology Network for wet events, and monthly gridded climatic data from the Climatic Research Unit for drought events, we determine if it is possible to relate these measured data to the ethnographic records. We explore several drought and wetness indices based on temperature and precipitation, as well as the Colwell method to determine the predictability, seasonality, and variability of these extreme indices. Initial results indicate that while it is possible to capture the events recorded in the ethnographic records, there are many more "false" captures of events that are not recorded in these records. Although extreme precipitation is a poor indicator of floods due to antecedent moisture conditions, even using streamflow for selected sites produces false captures. Relating drought indices to actual food supply as measured in crop yield only related to minimum crop yield in half the cases. Further mismatches between extreme precipitation and drought indices and ethnographic records may relate to the fact that only extreme events that affect food supply are recorded in the ethnographic records or that not all events are recorded by the ethnographers. We will present new results on how predictability measures relate to the ethnographic disasters. Despite the highlighted technical challenges, our results provide a historic perspective linking environmental stressors with socio-economic impacts, which in turn, will underpin the current efforts of risk assessment in a changing environment.

Reliability and Validity of a Japanese-language and Culturally Adapted Version of the Musculoskeletal Tumor Society Scoring System for the Lower Extremity.

PubMed

Iwata, Shintaro; Uehara, Kosuke; Ogura, Koichi; Akiyama, Toru; Shinoda, Yusuke; Yonemoto, Tsukasa; Kawai, Akira

2016-09-01

The Musculoskeletal Tumor Society (MSTS) scoring system is a widely used functional evaluation tool for patients treated for musculoskeletal tumors. Although the MSTS scoring system has been validated in English and Brazilian Portuguese, a Japanese version of the MSTS scoring system has not yet been validated. We sought to determine whether a Japanese-language translation of the MSTS scoring system for the lower extremity had (1) sufficient reliability and internal consistency, (2) adequate construct validity, and (3) reasonable criterion validity compared with the Toronto Extremity Salvage Score (TESS) and SF-36 using psychometric analysis. The Japanese version of the MSTS scoring system was developed using accepted guidelines, which included translation of the English version of the MSTS into Japanese by five native Japanese bilingual musculoskeletal oncology surgeons and integrated into one document. One hundred patients with a diagnosis of intermediate or malignant bone or soft tissue tumors located in the lower extremity and who had undergone tumor resection with or without reconstruction or amputation participated in this study. Reliability was evaluated by test-retest analysis, and internal consistency was established by Cronbach's alpha coefficient. Construct validity was evaluated using the principal factor analysis and Akaike information criterion network. Criterion validity was evaluated by comparing the MSTS scoring system with the TESS and SF-36. Test-retest analysis showed a high intraclass correlation coefficient (0.92; 95% CI, 0.88-0.95), indicating high reliability of the Japanese version of the MSTS scoring system, although a considerable ceiling effect was observed, with 23 patients (23%) given the maximum score. Cronbach's alpha coefficient was 0.87 (95% CI, 0.82-0.90), suggesting a high level of internal consistency. Factor analysis revealed that all items had high loading values and communalities; we identified a central role for the items "walking" and "gait" according to the Akaike information criterion network. The total MSTS score was correlated with that of the TESS (r = 0.81; 95% CI, 0.73-0.87; p < 0.001) and the physical component summary and physical functioning of the SF-36. The Japanese-language translation of the MSTS scoring system for the lower extremity has sufficient reliability and reasonable validity. Nevertheless, the observation of a ceiling effect suggests poor ability of this system to discriminate from among patients who have a high level of function.

The utility of the KJOC score in professional baseball in the United States.

PubMed

Franz, Justin O; McCulloch, Patrick C; Kneip, Chris J; Noble, Philip C; Lintner, David M

2013-09-01

The Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow questionnaire has been shown by previous studies to be more sensitive than other validated subjective measurement tools in the detection of upper extremity dysfunction in overhead-throwing athletes. The primary objective was to establish normative data for KJOC scores in professional baseball players in the United States. The secondary objectives were to evaluate the effect of player age, playing position, professional competition level, history of injury, history of surgery, and time point of administration on the KJOC score. Cross-sectional study; Level of evidence, 3. From 2011 to 2012, a total of 203 major league and minor league baseball players within the Houston Astros professional baseball organization completed the KJOC questionnaire. The questionnaire was administered at 3 time points: spring training 2011, end of season 2011, and spring training 2012. The KJOC scores were analyzed for significant differences based on player age, injury history, surgery history, fielding position, competition level, self-reported playing status, and time point of KJOC administration. The average KJOC score among healthy players with no history of injury was 97.1 for major league players and 96.8 for minor league players. The time point of administration did not significantly affect the final KJOC score (P = .224), and KJOC outcomes did not vary with player age (r = -0.012; P = .867). Significantly lower average KJOC scores were reported by players with a history of upper extremity injury (86.7; P < .001) and upper extremity surgery (75.4; P < .0001). The KJOC results did vary with playing position (P = .0313), with the lowest average scores being reported by pitchers (90.9) and infielders (91.3). This study establishes a quantitative baseline for the future evaluation of professional baseball players with the KJOC score. Age and time of administration had no significant effect on the outcome of the KJOC score. Missed practices or games within the previous year because of injury were the most significant demographic predictors of lower KJOC scores. The KJOC score was shown to be a sensitive measurement tool for detecting subtle changes in the upper extremity performance of the professional baseball population studied.

Association Between Brain-Derived Neurotrophic Factor Genotype and Upper Extremity Motor Outcome After Stroke.

PubMed

Chang, Won Hyuk; Park, Eunhee; Lee, Jungsoo; Lee, Ahee; Kim, Yun-Hee

2017-06-01

The identification of intrinsic factors for predicting upper extremity motor outcome could aid the design of individualized treatment plans in stroke rehabilitation. The aim of this study was to identify prognostic factors, including intrinsic genetic factors, for upper extremity motor outcome in patients with subacute stroke. A total of 97 patients with subacute stroke were enrolled. Upper limb motor impairment was scored according to the upper limb of Fugl-Meyer assessment score at 3 months after stroke. The prediction of upper extremity motor outcome at 3 months was modeled using various factors that could potentially influence this impairment, including patient characteristics, baseline upper extremity motor impairment, functional and structural integrity of the corticospinal tract, and brain-derived neurotrophic factor genotype. Multivariate ordinal logistic regression models were used to identify the significance of each factor. The independent predictors of motor outcome at 3 months were baseline upper extremity motor impairment, age, stroke type, and corticospinal tract functional integrity in all stroke patients. However, in the group with severe motor impairment at baseline (upper limb score of Fugl-Meyer assessment <25), the number of Met alleles in the brain-derived neurotrophic factor genotype was also an independent predictor of upper extremity motor outcome 3 months after stroke. Brain-derived neurotrophic factor genotype may be a potentially useful predictor of upper extremity motor outcome in patients with subacute stroke with severe baseline motor involvement. © 2017 American Heart Association, Inc.

Trends in Gender Differences in Academic Achievement from 1960 to 1994: An Analysis of Differences in Mean, Variance, and Extreme Scores.

ERIC Educational Resources Information Center

Nowell, Amy; Hedges, Larry V.

1998-01-01

Uses evidence from seven surveys of the U.S. 12th-grade population and the National Assessment of Educational Progress to show that gender differences in mean and variance in academic achievement are small from 1960 to 1994 but that differences in extreme scores are often substantial. (SLD)

[Growth in height of indigenous and non indigenous Chilean children].

PubMed

Bustos, Patricia; Weitzman, Mariana; Amigo, Hugo

2004-06-01

The aim of this study was to compare growth curves of stature in indigenous and non-indigenous children belonging to two levels of poverty and to establish the onset and evolution of the deficit. Children of indigenous and non-indigenous background living in communities of extreme and low poverty in Chile were studied and their height-for-age Z-score from birth until 6 year of age were compared. Mean weight at birth was within normal range, and no differences were found in ethnicity and levels of poverty. Length at birth was below the reference with the exception of the non indigenous newborn from counties of low poverty. Deficit in growth showed an early start, furthermore in indigenous children belonging to the extreme poverty, is from birth and progress through the 18 months. At 72 months the deficit reached -1.1 z scores in the indigenous of the extreme poverty versus -0.7 in the non indigenous group. Children from the low poverty had a Z-score of -0.4 z scores at 72 months without differences between ethnias. Indigenous of the extreme poverty had less accumulative growth while the indigenous of the low poverty areas growth satisfactory without differences with the non indigenous.

Australia's Unprecedented Future Temperature Extremes Under Paris Limits to Warming

NASA Astrophysics Data System (ADS)

Lewis, Sophie C.; King, Andrew D.; Mitchell, Daniel M.

2017-10-01

Record-breaking temperatures can detrimentally impact ecosystems, infrastructure, and human health. Previous studies show that climate change has influenced some observed extremes, which are expected to become more frequent under enhanced future warming. Understanding the magnitude, as a well as frequency, of such future extremes is critical for limiting detrimental impacts. We focus on temperature changes in Australian regions, including over a major coral reef-building area, and assess the potential magnitude of future extreme temperatures under Paris Agreement global warming targets (1.5°C and 2°C). Under these limits to global mean warming, we determine a set of projected high-magnitude unprecedented Australian temperature extremes. These include extremes unexpected based on observational temperatures, including current record-breaking events. For example, while the difference in global-average warming during the hottest Australian summer and the 2°C Paris target is 1.1°C, extremes of 2.4°C above the observed summer record are simulated. This example represents a more than doubling of the magnitude of extremes, compared with global mean change, and such temperatures are unexpected based on the observed record alone. Projected extremes do not necessarily scale linearly with mean global warming, and this effect demonstrates the significant potential benefits of limiting warming to 1.5°C, compared to 2°C or warmer.

A prospective study on MRI findings and prognostic factors in athletes with MTSS.

PubMed

Moen, M H; Schmikli, S L; Weir, A; Steeneken, V; Stapper, G; de Slegte, R; Tol, J L; Backx, F J G

2014-02-01

In medial tibial stress syndrome (MTSS) bone marrow and periosteal edema of the tibia on the magnetic resonance imaging (MRI) is frequently reported. The relationship between these MRI findings and recovery has not been previously studied. This prospective study describes MRI findings of 52 athletes with MTSS. Baseline characteristics were recorded and recovery was related to these parameters and MRI findings to examine for prognostic factors. Results showed that 43.5% of the symptomatic legs showed bone marrow or periosteal edema. Absence of periosteal and bone marrow edema on MRI was associated with longer recovery (P = 0.033 and P = 0.013). A clinical scoring system for sports activity (SARS score) was significantly higher in the presence of bone marrow edema (P = 0.027). When clinical scoring systems (SARS score and the Lower Extremity Functional Scale) were combined in a model, time to recovery could be predicted substantially (explaining 54% of variance, P = 0.006). In conclusion, in athletes with MTSS, bone marrow or periosteal edema is seen on MRI in 43,5% of the symptomatic legs. Furthermore, periosteal and bone marrow edema on MRI and clinical scoring systems are prognostic factors. Future studies should focus on MRI findings in symptomatic MTSS and compare these with a matched control group. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Comparative outcome of bomb explosion injuries versus high-powered gunshot injuries of the upper extremity in a civilian setting.

PubMed

Luria, Shai; Rivkin, Gurion; Avitzour, Malka; Liebergall, Meir; Mintz, Yoav; Mosheiff, Ram

2013-03-01

Explosion injuries to the upper extremity have specific clinical characteristics that differ from injuries due to other mechanisms. To evaluate the upper extremity injury pattern of attacks on civilian targets, comparing bomb explosion injuries to gunshot injuries and their functional recovery using standard outcome measures. Of 157 patients admitted to the hospital between 2000 and 2004, 72 (46%) sustained explosion injuries and 85 (54%) gunshot injuries. The trauma registry files were reviewed and the patients completed the DASH Questionnaire (Disabilities of Arm, Shoulder and Hand) and SF-12 (Short Form-12) after a minimum period of 1 year. Of the 157 patients, 72 (46%) had blast injuries and 85 (54%) had shooting injuries. The blast casualties had higher Injury Severity Scores (47% vs. 22% with a score of > 16, P = 0.02) and higher percent of patients treated in intensive care units (47% vs. 28%, P = 0.02). Although the Abbreviated Injury Scale score of the upper extremity injury was similar in the two groups, the blast casualties were found to have more bilateral and complex soft tissue injuries and were treated surgically more often. No difference was found in the SF-12 or DASH scores between the groups at follow up. The casualties with upper extremity blast injuries were more severely injured and sustained more bilateral and complex soft tissue injuries to the upper extremity. However, the rating of the local injury to the isolated limb is similar, as was the subjective functional recovery.

Effect of a Lower Extremity Preventive Training Program on Physical Performance Scores in Military Recruits.

PubMed

Peck, Karen Y; DiStefano, Lindsay J; Marshall, Stephen W; Padua, Darin A; Beutler, Anthony I; de la Motte, Sarah J; Frank, Barnett S; Martinez, Jessica C; Cameron, Kenneth L

2017-11-01

Peck, KY, DiStefano, LJ, Marshall, SW, Padua, DA, Beutler, AI, de la Motte, SJ, Frank, BS, Martinez, JC, and Cameron, KL. Effect of a lower extremity preventive training program on physical performance scores in military recruits. J Strength Cond Res 31(11): 3146-3157, 2017-Exercise-based preventive training programs are designed to improve movement patterns associated with lower extremity injury risk; however, the impact of these programs on general physical fitness has not been evaluated. The purpose of this study was to compare fitness scores between participants in a preventive training program and a control group. One thousand sixty-eight freshmen from a U.S. Service Academy were cluster-randomized into either the intervention or control group during 6 weeks of summer training. The intervention group performed a preventive training program, specifically the Dynamic Integrated Movement Enhancement (DIME), which is designed to improve lower extremity movement patterns. The control group performed the Army Preparation Drill (PD), a warm-up designed to prepare soldiers for training. Main outcome measures were the Army Physical Fitness Test (APFT) raw and scaled (for age and sex) scores. Independent t tests were used to assess between-group differences. Multivariable logistic regression models were used to control for the influence of confounding variables. Dynamic Integrated Movement Enhancement group participants completed the APFT 2-mile run 20 seconds faster compared with the PD group (p < 0.001), which corresponded with significantly higher scaled scores (p < 0.001). Army Physical Fitness Test push-up scores were significantly higher in the DIME group (p = 0.041), but there were no significant differences in APFT sit-up scores. The DIME group had significantly higher total APFT scores compared with the PD group (p < 0.001). Similar results were observed in multivariable models after controlling for sex and body mass index (BMI). Committing time to the implementation of a preventive training program does not appear to negatively affect fitness test scores.

400 years of summer hydroclimate from stable isotopes in Iberian trees

NASA Astrophysics Data System (ADS)

Andreu-Hayles, Laia; Ummenhofer, Caroline C.; Barriendos, Mariano; Schleser, Gerhard H.; Helle, Gerhard; Leuenberger, Markus; Gutierrez, Emilia; Cook, Edward R.

2017-04-01

Tree rings are natural archives that annually record distinct types of past climate variability depending on the parameters measured. Here, we use ring-width and stable isotopes in cellulose of trees from the northwestern Iberian Peninsula (IP) to understand regional summer hydroclimate over the last 400 years and the associated atmospheric patterns. Correlations between tree rings and climate data demonstrate that isotope signatures in the targeted Iberian pine forests are very sensitive to water availability during the summer period, and are mainly controlled by stomatal conductance. Non-linear methods based on extreme events analysis allow for capturing distinct seasonal climatic variability recorded by tree-ring parameters and asymmetric signals of the associated atmospheric features. Moreover, years with extreme high (low) values in the tree-ring records were characterised by coherent large-scale atmospheric circulation patterns with reduced (enhanced) moisture transport onto the northwestern IP. These analyses of extremes revealed that high/low proxy values do not necessarily correspond to mirror images in the atmospheric anomaly patterns, suggesting different drivers of these patterns and the corresponding signature recorded in the proxies. Regional hydroclimate features across the broader IP and western Europe during extreme wet/dry summers detected by the northwestern IP trees compare favourably to an independent multicentury sea level pressure and drought reconstruction for Europe. Historical records also validate our findings that attribute non-linear moisture signals recorded by extreme tree-ring values to distinct large-scale atmospheric patterns and allow for 400-yr reconstructions of the frequency of occurrence of extreme conditions in summer hydroclimate. We will discuss how the results for Lillo compare with other records.

The Relationship Between Early-Stage Knee Osteoarthritis and Lower-Extremity Alignment, Joint Laxity, and Subjective Scores of Pain, Stiffness, and Function.

PubMed

Hicks-Little, Charlie A; Peindl, Richard D; Hubbard-Turner, Tricia J; Cordova, Mitchell L

2016-08-01

Knee osteoarthritis (OA) is a debilitating disease that affects an estimated 27 million Americans. Changes in lower-extremity alignment and joint laxity have been found to redistribute the medial and/or lateral loads at the joint. However, the effect that changes in anteroposterior knee-joint laxity have on lower-extremity alignment and function in individuals with knee OA remains unclear. To examine anteroposterior knee-joint laxity, lower-extremity alignment, and subjective pain, stiffness, and function scores in individuals with early-stage knee OA and matched controls and to determine if a relationship exists among these measures. Case control. Sports-medicine research laboratory. 18 participants with knee OA and 18 healthy matched controls. Participants completed the Western Ontario McMaster (WOMAC) osteoarthritis questionnaire and were tested for total anteroposterior knee-joint laxity (A-P) and knee-joint alignment (ALIGN). WOMAC scores, A-P (mm), and ALIGN (°). A significant multivariate main effect for group (Wilks' Λ = 0.30, F7,26 = 8.58, P < .0001) was found. Knee-OA participants differed in WOMAC scores (P < .0001) but did not differ from healthy controls on ALIGN (P = .49) or total A-P (P = .66). No significant relationships were identified among main outcome measures. These data demonstrate that participants with early-stage knee OA had worse pain, stiffness, and functional outcome scores than the matched controls; however, ALIGN and A-P were no different. There was no association identified among participants' subjective scores, ALIGN, or A-P measures in this study.

Bone scan as a screening test for missed fractures in severely injured patients.

PubMed

Lee, K-J; Jung, K; Kim, J; Kwon, J

2014-12-01

In many cases, patients with severe blunt trauma have multiple fractures throughout the body. These fractures are not often detectable by history or physical examination, and their diagnosis can be delayed or even missed. Thus, screening test fractures of the whole body is required after initial management. We performed this study to evaluate the reliability of bone scans for detecting missed fractures in patients with multiple severe traumas and we analyzed the causes of missed fractures by using bone scan. A bone scan is useful as a screening test for fractures of the entire body of severe trauma patients who are passed the acute phase. We reviewed the electronic medical records of severe trauma patients who underwent a bone scan from September 2009 to December 2010. Demographic and medical data were compared and statistically analyzed to determine whether missed fractures were detected after bone scan in the two groups. A total of 382 patients who had an injury severity score [ISS] greater than 16 points with multiple traumas visited the emergency room. One hundred and thirty-one patients underwent bone scan and 81 patients were identified with missed fractures by bone scan. The most frequent location for missed fractures was the rib area (55 cases, 41.98%), followed by the extremities (42 cases, 32.06%). The missed fractures that required surgery or splint were most common in extremities (11 cases). In univariate analysis, higher ISS scores and mechanism of injury were related with the probability that missed fractures would be found with a bone scan. The ISS score was statistically significant in multivariate analysis. Bone scan is an effective method of detecting missed fractures among patients with multiple severe traumas. Level IV, retrospective study. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Climate Change: A New Metric to Measure Changes in the Frequency of Extreme Temperatures using Record Data

NASA Technical Reports Server (NTRS)

Munasinghe, L.; Jun, T.; Rind, D. H.

2012-01-01

Consensus on global warming is the result of multiple and varying lines of evidence, and one key ramification is the increase in frequency of extreme climate events including record high temperatures. Here we develop a metric- called "record equivalent draws" (RED)-based on record high (low) temperature observations, and show that changes in RED approximate changes in the likelihood of extreme high (low) temperatures. Since we also show that this metric is independent of the specifics of the underlying temperature distributions, RED estimates can be aggregated across different climates to provide a genuinely global assessment of climate change. Using data on monthly average temperatures across the global landmass we find that the frequency of extreme high temperatures increased 10-fold between the first three decades of the last century (1900-1929) and the most recent decade (1999-2008). A more disaggregated analysis shows that the increase in frequency of extreme high temperatures is greater in the tropics than in higher latitudes, a pattern that is not indicated by changes in mean temperature. Our RED estimates also suggest concurrent increases in the frequency of both extreme high and extreme low temperatures during 2002-2008, a period when we observe a plateauing of global mean temperature. Using daily extreme temperature observations, we find that the frequency of extreme high temperatures is greater in the daily minimum temperature time-series compared to the daily maximum temperature time-series. There is no such observable difference in the frequency of extreme low temperatures between the daily minimum and daily maximum.

Extreme deep white matter hyperintensity volumes are associated with African American race.

PubMed

Nyquist, Paul A; Bilgel, Murat S; Gottesman, Rebecca; Yanek, Lisa R; Moy, Taryn F; Becker, Lewis C; Cuzzocreo, Jennifer; Prince, Jerry; Yousem, David M; Becker, Diane M; Kral, Brian G; Vaidya, Dhananjay

2014-01-01

African Americans (AAs) have a higher prevalence of extreme ischemic white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) than do European Americans (EAs) based on the Cardiovascular Health Study (CHS) score. Ischemic white matter disease, limited to the deep white matter, may be biologically distinct from disease in other regions and may reflect a previously observed trend toward an increased risk of subcortical lacunar infarcts in AAs. We hypothesized that extreme deep WMH volume (DWMV) or periventricular volume (PV) may also have a higher prevalence in AAs. Thus, we studied extreme CHS scores and extreme DWMV and PV in a healthy population enriched for cardiovascular disease risk factors. We imaged the brains of 593 subjects who were first-degree relatives of probands with early onset coronary disease prior to 60 years of age. WMHs were manually delineated on 3-tesla cranial MRI by a trained radiology reader; the location and volume of lesions were characterized using automated software. DWMV and PV were measured directly with automated software, and the CHS score was determined by a neuroradiologist. Volumes were characterized as being in the upper 25% versus lower 75% of total lesion volume. Volumes in the upper versus the remaining quartiles were examined for AA versus EA race using multiple logistic regression (generalized estimating equations adjusted for family relatedness) and adjusted for major vascular disease risk factors including age ≥55 years versus <55, sex, current smoking, obesity, hypertension, diabetes and low-density lipoprotein >160 mg/dl. Participants were 58% women and 37% AAs, with a mean age of 51.5 ± 11.0 years (range, 29-74 years). AAs had significantly higher odds of having extreme DWMVs (odds ratio, OR, 1.8; 95% confidence interval, CI, 1.2-2.9; p = 0.0076) independently of age, sex, hypertension and all other risk factors. AAs also had significantly higher odds of having extreme CHS scores ≥3 (OR, 1.3; 95% CI, 1.1-3.6; p = 0.025). Extreme PV was not significantly associated with AA race (OR, 1.3; 95% CI, 0.81-2.1; p = 0.26). AAs from families with early-onset cardiovascular disease are more likely to have extreme DWMVs (a subclinical form of cerebrovascular disease) and an extreme CHS score, but not extreme PV, independently of age and other cardiovascular disease risk factors. These findings suggest that this AA population is at an increased risk for DWMV and may be at an increased risk for future subcortical stroke. Longitudinal studies are required to see if DWMV is predictive of symptomatic subcortical strokes in this population. © 2014 S. Karger AG, Basel.

Reliability of the Quality of Upper Extremity Skills Test for Children with Cerebral Palsy Aged 2 to 12 Years

ERIC Educational Resources Information Center

Thorley, Megan; Lannin, Natasha; Cusick, Anne; Novak, Iona; Boyd, Roslyn

2012-01-01

Aim: To investigate reliability of the Quality of Upper Extremity Skills Test (QUEST) scores for children with cerebral palsy (CP) aged 2-12 years. Method: Thirty-one QUESTs from 24 children with CP were rated once by two raters and twice by one rater. Internal consistency of total scores, inter- and intra-rater reliability findings for total,…

Effect of mirror therapy on upper extremity motor function in stroke patients: a randomized controlled trial.

PubMed

Gurbuz, Nigar; Afsar, Sevgi Ikbali; Ayaş, Sehri; Cosar, Sacide Nur Saracgil

2016-09-01

[Purpose] This study aimed to evaluate the effectiveness of mirror therapy combined with a conventional rehabilitation program on upper extremity motor and functional recovery in stroke patients. [Subjects and Methods] Thirty-one hemiplegic patients were included. The patients were randomly assigned to a mirror (n=16) or conventional group (n=15). The patients in both groups underwent conventional therapy for 4 weeks (60-120 minutes/day, 5 days/week). The mirror group received mirror therapy, consisting of periodic flexion and extension movements of the wrist and fingers on the non-paralyzed side. The patients in the conventional group performed the same exercises against the non-reflecting face of the mirror. The patients were evaluated at the beginning and end of the treatment by a blinded assessor using the Brunnstrom stage, Fugl-Meyer Assessment (FMA) upper extremity score, and the Functional Independence Measure (FIM) self-care score. [Results] There was an improvement in Brunnstrom stage and the FIM self-care score in both groups, but the post-treatment FMA score was significantly higher in the mirror therapy group than in the conventional treatment group. [Conclusion] Mirror therapy in addition to a conventional rehabilitation program was found to provide additional benefit in motor recovery of the upper extremity in stroke patients.

Effect of mirror therapy on upper extremity motor function in stroke patients: a randomized controlled trial

PubMed Central

Gurbuz, Nigar; Afsar, Sevgi Ikbali; Ayaş, Sehri; Cosar, Sacide Nur Saracgil

2016-01-01

[Purpose] This study aimed to evaluate the effectiveness of mirror therapy combined with a conventional rehabilitation program on upper extremity motor and functional recovery in stroke patients. [Subjects and Methods] Thirty-one hemiplegic patients were included. The patients were randomly assigned to a mirror (n=16) or conventional group (n=15). The patients in both groups underwent conventional therapy for 4 weeks (60–120 minutes/day, 5 days/week). The mirror group received mirror therapy, consisting of periodic flexion and extension movements of the wrist and fingers on the non-paralyzed side. The patients in the conventional group performed the same exercises against the non-reflecting face of the mirror. The patients were evaluated at the beginning and end of the treatment by a blinded assessor using the Brunnstrom stage, Fugl-Meyer Assessment (FMA) upper extremity score, and the Functional Independence Measure (FIM) self-care score. [Results] There was an improvement in Brunnstrom stage and the FIM self-care score in both groups, but the post-treatment FMA score was significantly higher in the mirror therapy group than in the conventional treatment group. [Conclusion] Mirror therapy in addition to a conventional rehabilitation program was found to provide additional benefit in motor recovery of the upper extremity in stroke patients. PMID:27799679

Motor and executive function at 6 years of age after extremely preterm birth.

PubMed

Marlow, Neil; Hennessy, Enid M; Bracewell, Melanie A; Wolke, Dieter

2007-10-01

Studies of very preterm infants have demonstrated impairments in multiple neurocognitive domains. We hypothesized that neuromotor and executive-function deficits may independently contribute to school failure. We studied children who were born at < or = 25 completed weeks' gestation in the United Kingdom and Ireland in 1995 at early school age. Children underwent standardized cognitive and neuromotor assessments, including the Kaufman Assessment Battery for Children and NEPSY, and a teacher-based assessment of academic achievement. Of 308 surviving children, 241 (78%) were assessed at a median age of 6 years 4 months. Compared with 160 term classmates, 180 extremely preterm children without cerebral palsy and attending mainstream school performed less well on 3 simple motor tasks: posting coins, heel walking, and 1-leg standing. They more frequently had non-right-hand preferences (28% vs 10%) and more associated/overflow movements during motor tasks. Standardized scores for visuospatial and sensorimotor function performance differed from classmates by 1.6 and 1.1 SDs of the classmates' scores, respectively. These differences attenuated but remained significant after controlling for overall cognitive scores. Cognitive, visuospatial scores, and motor scores explained 54% of the variance in teachers' ratings of performance in the whole set; in the extremely preterm group, additional variance was explained by attention-executive tasks and gender. Impairment of motor, visuospatial, and sensorimotor function, including planning, self-regulation, inhibition, and motor persistence, contributes excess morbidity over cognitive impairment in extremely preterm children and contributes independently to poor classroom performance at 6 years of age.

Disease activity, knee function, and walking ability in patients with rheumatoid arthritis 10 years after primary total knee arthroplasty.

PubMed

Nishikawa, Masataka; Owaki, Hajime; Takahi, Koichiro; Fuji, Takeshi

2014-04-01

To evaluate disease activity, knee function, and walking ability of patients with rheumatoid arthritis (RA) over 10 years after total knee arthroplasty (TKA). Four men and 26 women (mean age, 59.9 years) underwent 42 TKAs for RA with a mean duration of 151.3 months and were followed up for a mean of 142.3 months. Preoperatively, disease activity was assessed by C-reactive protein (CRP) level only, and the range of knee motion was recorded. At the final follow-up, tender joint count, swollen joint count, visual analogue scale of RA symptoms, and the Modified Health Assessment Questionnaire (MHAQ) score were assessed. Disease activity was evaluated using CRP, matrix metalloproteinase-3, and Disease Activity Score. Range of motion and Knee Society knee and function scores were also assessed. The use of methotrexate increased from 4 patients preoperatively to 20 patients at the final follow-up (p<0.001), and the mean dose increased from 3.9 to 6.3 mg/week (p<0.001). Among the 30 patients, the mean CRP level decreased from 2.63 mg/dl preoperatively to 0.61 mg/dl at the final follow-up (p<0.001). Disease activity was controlled. At the final follow-up, disease activity was in remission in 10 patients, low in 11, and moderate in 9. The mean Knee Society knee score was excellent (91.0), but the mean function score was poor (57.0) and diverse. Severe walking disability (function score, <40) was noted in 8 patients (11 TKAs). Knee and function scores did not correlate. Walking ability in patients with RA after TKA was generally poor. Poor function was associated with a history of spinal or lower extremity fracture surgery and the MHAQ score.

Cross-cultural adaptation and validation of the Korean Toronto Extremity Salvage Score for extremity sarcoma.

PubMed

Kim, Han-Soo; Yun, JiYeon; Kang, Seungcheol; Han, Ilkyu

2015-07-01

A Korean version of Toronto Extremity Salvage Score (TESS), a widely used disease-specific patient-reported questionnaire for assessing physical function of sarcoma patients, has not been developed. 1) to translate and cross-culturally adapt the TESS into Korean, and 2) to examine its comprehensibility, reliability and validity. TESS was translated into Korean, then translated back into English, and reviewed by a committee to develop the consensus version of the Korean TESS. The Korean TESS was administered to 126 patients to examine its comprehensibility, reliability, and validity. Comprehensibility was high, as the patients rated questions as "easy" or "very easy" in 96% for the TESS lower extremity (LE) and in 97% for the TESS upper extremity (UE). Test-retest reliability with intraclass coefficient (0.874 for LE and 0.979 for UE) and internal consistency with Cronbach's alpha (0.978 for LE and 0.989 for UE) were excellent. Korean TESS correlated with the MSTS score (r = 0.772 for LE and r = 0.635 for UE), and physical functioning domain of EORTC-CLQ C30 (r = 0.840 for LE and r = 0.630 for UE). Our study suggests that Korean version of the TESS is a comprehensible, reliable, and valid instrument to measure patient-reported functional outcome in patients with extremity sarcoma. © 2015 Wiley Periodicals, Inc.

Emergency department recidivism in adults older than 65 years treated for fractures.

PubMed

Southerland, Lauren T; Richardson, Daniel S; Caterino, Jeffrey M; Essenmacher, Alex C; Swor, Robert A

2014-09-01

Fractures in older adults are a commonly diagnosed injury in the emergency department (ED). We performed a retrospective medical record review to determine the rate of return to the same ED within 72 hours (returns) and the risk factors associated with returning. A retrospective medical record review of patients at least 65 years old discharged from a large, academic ED with a new diagnosis of upper extremity, lower extremity, or rib fractures was performed. Risk factors analyzed included demographic data, type of fracture, analgesic prescriptions, assistive devices provided, other concurrent injuries, and comorbidities (Charlson Comorbidity Index). Our primary outcome was return to the ED within 72 hours. Three hundred fifteen patients qualified. Most fractures were in the upper extremity (64% [95% confidence interval {CI}, 58%-69%]). Twenty patients (6.3% [95% CI, 3.9%-9.6%]) returned within 72 hours. Most returns (15/20, 75%) were for reasons associated with the fracture itself, such as cast problems and inadequate pain control. Only 3 (<1% of all patients) patients returned for cardiac etiologies. Patients with distal forearm fractures had higher return rates (10.7% vs 4.5%, P = .03), and most commonly returned for cast or splint problems. Age, sex, other injuries, assistive devices, and Charlson Comorbidity Index score (median, 1 [interquartile range, 1-2] for both groups) did not predict 72-hour returns. Older adults with distal forearm fractures may have more unscheduled health care usage in the first 3 days after fracture diagnosis than older adults with other fracture types. Overall, revisits for cardiac reasons or repeat falls were rare (<1%). Copyright © 2014 Elsevier Inc. All rights reserved.

Complete major amputation of the upper extremity: Early results and initial treatment algorithm.

PubMed

Märdian, Sven; Krapohl, Björn D; Roffeis, Jana; Disch, Alexander C; Schaser, Klaus-Dieter; Schwabe, Philipp

2015-03-01

Traumatic major amputations of the upper extremity are devastating injuries. These injuries have a profound impact on patient's quality of life and pose a burden on social economy. The aims of the current study were to report about the initial management of isolated traumatic major upper limb amputation from the time of admission to definitive soft tissue closure and to establish a distinct initial management algorithm. We recorded data concerning the initial management of the patient and the amputated body part in the emergency department (ED) (time from admission to the operation, Injury Severity Score [ISS], cold ischemia time from injury to ED, and total cold ischemia time). The duration, amount of surgical procedures, the time to definitive soft tissue coverage, and the choice of flap were part of the documentation. All intraoperative and postoperative complications were recorded. All patients were successfully replanted (time from injury to ED, 59 ± 4 minutes; ISS16; time from admission to operating room 57 ± 10 minutes; total cold ischemia time 203 ± 20 minutes; total number of procedures 7.3 ± 2.5); definitive soft tissue coverage could be achieved 23 ± 14 days after injury. Two thromboembolic complications occurred, which could be treated by embolectomy during revision surgery, and we saw one early infection, which could be successfully managed by serial debridements in our series. The management of complete major amputations of the upper extremity should be reserved for large trauma centers with enough resources concerning technical, structural, and personnel infrastructure to meet the demands of surgical reconstruction as well as the postoperative care. Following a distinct treatment algorithm is mandatory to increase the rate of successful major replantations, thus laying the foundation for promising secondary functional reconstructive efforts. Therapeutic study, level V.

Extreme event statistics in a drifting Markov chain

NASA Astrophysics Data System (ADS)

Kindermann, Farina; Hohmann, Michael; Lausch, Tobias; Mayer, Daniel; Schmidt, Felix; Widera, Artur

2017-07-01

We analyze extreme event statistics of experimentally realized Markov chains with various drifts. Our Markov chains are individual trajectories of a single atom diffusing in a one-dimensional periodic potential. Based on more than 500 individual atomic traces we verify the applicability of the Sparre Andersen theorem to our system despite the presence of a drift. We present detailed analysis of four different rare-event statistics for our system: the distributions of extreme values, of record values, of extreme value occurrence in the chain, and of the number of records in the chain. We observe that, for our data, the shape of the extreme event distributions is dominated by the underlying exponential distance distribution extracted from the atomic traces. Furthermore, we find that even small drifts influence the statistics of extreme events and record values, which is supported by numerical simulations, and we identify cases in which the drift can be determined without information about the underlying random variable distributions. Our results facilitate the use of extreme event statistics as a signal for small drifts in correlated trajectories.

Increasing your HCAHPS scores with Extreme Customer Service.

PubMed

Clouarte, Joe

2016-10-01

Providing great customer service is extremely critical in the healthcare setting, especially when it comes to HCAHBPS (Hospital Consumer Assessment of Health care Providers and Systems) scores, the author says. While there are several service training programs within healthcare, they often require six to eight minutes of interaction with patients or guests. This works well for clinical staff, he says, but when it comes to non-clinical staff, including security officers, many times they only have fifteen or thirty seconds to create positive patient or guest experience. In this article he describes Extreme Customer Service © a program he has developed to fill that customer gap for non-clinical staff.

400 Years of summer hydroclimate from stable isotopes in Iberian trees

NASA Astrophysics Data System (ADS)

Andreu-Hayles, Laia; Ummenhofer, Caroline C.; Barriendos, Mariano; Schleser, Gerhard H.; Helle, Gerhard; Leuenberger, Markus; Gutiérrez, Emilia; Cook, Edward R.

2017-07-01

Tree rings are natural archives that annually record distinct types of past climate variability depending on the parameters measured. Here, we use ring-width and stable isotopes in cellulose of trees from the northwestern Iberian Peninsula (IP) to understand regional summer hydroclimate over the last 400 years and the associated atmospheric patterns. Correlations between tree rings and climate data demonstrate that isotope signatures in the targeted Iberian pine forests are very sensitive to water availability during the summer period, and are mainly controlled by stomatal conductance. Non-linear methods based on extreme events analysis allow for capturing distinct seasonal climatic variability recorded by tree-ring parameters and asymmetric signals of the associated atmospheric features. Moreover, years with extreme high (low) values in the tree-ring records were characterised by coherent large-scale atmospheric circulation patterns with reduced (enhanced) moisture transport onto the northwestern IP. These analyses of extremes revealed that high/low proxy values do not necessarily correspond to mirror images in the atmospheric anomaly patterns, suggesting different drivers of these patterns and the corresponding signature recorded in the proxies. Regional hydroclimate features across the broader IP and western Europe during extreme wet/dry summers detected by the northwestern IP trees compare favourably to independent multicentury sea level pressure and drought reconstructions for Europe. Historical records also validate our findings that attribute non-linear moisture signals recorded by extreme tree-ring values to distinct large-scale atmospheric patterns and allow for 400-year reconstructions of the frequency of occurrence of extreme conditions in late spring and summer hydroclimate.

Cross-Cultural Adaptation, Translation, and Validation of the Toronto Extremity Salvage Score for Extremity Bone and Soft Tissue Tumor Patients in Netherlands.

PubMed

Willeumier, Julie J; van der Wal, C W P G; van der Wal, Robert J P; Dijkstra, P D S; Vliet Vlieland, Thea P M; van de Sande, Michiel A J

2017-01-01

The aim of this study was to translate and culturally adapt the Toronto Extremity Salvage Score (TESS) to Dutch and to validate the translated version. The TESS lower and upper extremity versions (LE and UE) were translated to Dutch according to international guidelines. The translated version was validated in 98 patients with surgically treated bone or soft tissue tumors of the LE or UE. To assess test-retest reliability, participants were asked to fill in a second questionnaire after one week. Construct validity was determined by computing Spearman rank correlations with the Short Form- (SF-) 36. The internal consistency (0.957 and 0.938 for LE and UE, resp.) and test-retest reliability (intraclass correlation coefficients 0.963 and 0.969 for LE and UE, resp.) were good for both questionnaires. The Dutch LE and UE TESS versions correlated most strongly with the SF-36 physical function dimension ( r = 0.737 for LE, 0.726 for UE) and the physical component summary score ( r = 0.811 and 0.797 for LE and UE). The Dutch TESS questionnaire for lower and upper extremities is a consistent, reliable, and valid instrument to measure patient-reported physical function in surgically treated patients with a soft tissue or bone tumor.

Short physical performance battery for middle-aged and older adult cardiovascular disease patients: implication for strength tests and lower extremity morphological evaluation.

PubMed

Yasuda, Tomohiro; Fukumura, Kazuya; Nakajima, Toshiaki

2017-04-01

[Purpose] To examine if the SPPB is higher with healthy subjects than outpatients, which was higher than inpatients and if the SPPB can be validated assessment tool for strength tests and lower extremity morphological evaluation in cardiovascular disease patients. [Subjects and Methods] Twenty-four middle aged and older adults with cardiovascular disease were recruited from inpatient and outpatient facilities and assigned to separate experimental groups. Twelve age-matched healthy volunteers were assigned to a control group. SPPB test was used to assess balance and functional motilities. The test outcomes were compared with level of care (inpatient vs. outpatient), physical characteristics, strength and lower extremity morphology. [Results] Total SPPB scores, strength tests (knee extensor muscle strength), and lower extremity morphological evaluation (muscle thickness of anterior and posterior mid-thigh and posterior lower-leg) were greater in healthy subjects and outpatients groups compared with inpatients. To predict total Short Physical Performance Battery scores, the predicted knee extension and anterior mid-thigh muscle thickness were calculated. [Conclusion] The SPPB is an effective tool as the strength tests and lower extremity morphological evaluation for middle-aged and older adult cardiovascular disease patients. Notably, high knee extensor muscle strength and quadriceps femoris muscle thickness are positively associated with high SPPB scores.

Outcomes After Dermal Allograft Reconstruction of Chronic or Subacute Pectoralis Major Tendon Ruptures.

PubMed

Neumann, Julie A; Klein, Christopher M; van Eck, Carola F; Rahmi, Hithem; Itamura, John M

2018-01-01

Avoiding delay in the surgical management of pectoralis major (PM) ruptures optimizes outcomes. However, this is not always possible, and when a tear becomes chronic or when a subacute tear has poor tissue quality, a graft can facilitate reconstruction. The primary aim was to evaluate the clinical outcomes of PM reconstruction with dermal allograft augmentation for chronic tears or for subacute tears with poor tissue quality. A second aim was to determine patient and surgical factors affecting outcome. Case series; Level of evidence, 4. Nineteen consecutive patients (19 PM ruptures) with a mean ± SD age of 39.1 ± 8.4 years were retrospectively reviewed at 26.4 ± 16.0 months following PM tendon reconstruction with dermal allograft. Surgery was performed at 19.2 ± 41.2 months after injury (median, 7.6 months; range, 1.1-185.4 months). Several outcome scores were recorded pre- and postoperatively, including Disabilities of the Arm, Shoulder, and Hand (DASH), as well as visual analog scale (VAS) (range, 0-10; 0 = no pain) and Single Assessment Numeric Evaluation (SANE). Range of motion, Constant score, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test score, and complications/reoperations were recorded postoperatively. Scores improved significantly for the DASH (preoperative, 34.9; postoperative, 8.0; P < .001) and VAS (preoperative, 5.0; postoperative, 1.5; P = .011). There was a trend toward improved SANE scores (preoperative, 15.0; postoperative, 80.0; P = .097), but the difference was not statistically significant, likely because of the small number of patients having preoperative SANE scores for review. Increased age was associated with higher VAS scores ( r = 0.628, P = .016) and less forward flexion ( r = -0.502, P = .048) and external rotation ( r = -0.654, P = .006). Patients with workers' compensation had lower scores for 3 measures: SANE (75.8 vs 88.4, P = .040), Constant (86.7 vs 93.4, P = .019), and ASES (81.9 vs 97.4, P = .016). Operating on the dominant extremity resulted in lower Constant scores (87.8 vs 95.4, P = .012). A 2-head tendon tear (107.5° vs 123.3°, P = .033) and the use of >1 graft (105.0° vs 121.3°, P = .040) resulted in decreased abduction. This was the first large series to observe patients with chronic or subacute PM tendon tears treated with dermal allograft reconstruction. PM tendon reconstruction with dermal allografts resulted in good objective and subjective patient-reported outcomes.

Item response theory scoring and the detection of curvilinear relationships.

PubMed

Carter, Nathan T; Dalal, Dev K; Guan, Li; LoPilato, Alexander C; Withrow, Scott A

2017-03-01

Psychologists are increasingly positing theories of behavior that suggest psychological constructs are curvilinearly related to outcomes. However, results from empirical tests for such curvilinear relations have been mixed. We propose that correctly identifying the response process underlying responses to measures is important for the accuracy of these tests. Indeed, past research has indicated that item responses to many self-report measures follow an ideal point response process-wherein respondents agree only to items that reflect their own standing on the measured variable-as opposed to a dominance process, wherein stronger agreement, regardless of item content, is always indicative of higher standing on the construct. We test whether item response theory (IRT) scoring appropriate for the underlying response process to self-report measures results in more accurate tests for curvilinearity. In 2 simulation studies, we show that, regardless of the underlying response process used to generate the data, using the traditional sum-score generally results in high Type 1 error rates or low power for detecting curvilinearity, depending on the distribution of item locations. With few exceptions, appropriate power and Type 1 error rates are achieved when dominance-based and ideal point-based IRT scoring are correctly used to score dominance and ideal point response data, respectively. We conclude that (a) researchers should be theory-guided when hypothesizing and testing for curvilinear relations; (b) correctly identifying whether responses follow an ideal point versus dominance process, particularly when items are not extreme is critical; and (c) IRT model-based scoring is crucial for accurate tests of curvilinearity. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Timing of rehabilitation in children with obstetric upper trunk brachial plexus palsy.

PubMed

Yilmaz, Volkan; Umay, Ebru; Tezel, Nihal; Gundogdu, Ibrahim

2018-06-01

The initiation timing of rehabilitation in children with obstetric brachial plexus palsy is controversial. The aim of the present study is to evaluate the effectiveness of rehabilitation timing to the functional outcomes of patients with obstetric upper trunk brachial plexus palsy. Twenty-nine patients, who did not previously received any rehabilitation programme but attended our outpatient clinic, were included for the study. The electrophysiological findings, obstetric characteristics, and demographic features of the patients were recorded. The range of motion (ROM) of shoulders, elbows, and wrists and the strength of the muscles associated with these joints were evaluated. Modified Mallet Scale (MMS) was used for functional evaluation. A 4-week rehabilitation programme was performed twice at 2-month intervals. Patients were divided into three groups according to their ages as follows: 1-3 years old (group 1), 3-5 years old (group 2), and 5-7 years old (group 3). The ROMs, muscle strengths, and MMS scores of the patients were all evaluated. Two out of 29 patients were female (6.9%) and 27 were male (93.1%). All 29 patients had right upper extremity palsy (100%). The MMS scores, ROMs, and muscle strength of the upper extremities had improved in all the groups following the standardized rehabilitation programme. A rehabilitation programme is the best choice of treatment before surgical procedures in patients with mild to moderate obstetric upper trunk brachial plexus palsy regardless of age and the initiation time.

Follow-up of extreme neonatal hyperbilirubinaemia in 5- to 10-year-old children: a Danish population-based study.

PubMed

Vandborg, Pernille Kure; Hansen, Bo Moelholm; Greisen, Gorm; Mathiasen, Rene; Kasper, Frederikke; Ebbesen, Finn

2015-04-01

To investigate whether infants with neonatal hyperbilirubinaemia but without intermediate or advanced bilirubin encephalopathy develop long-term sequelae, with impairment of motor development, executive function, or hearing. This nested double-cohort study included 167 exposed children (107 males, 60 females) born in Denmark 2000 to 2005 at gestational age ≥35 weeks with a total serum bilirubin ≥450 μmol/L (26.3mg/dL) and 163 age-, sex-, and gestational age-matched unexposed children (103 males, 60 females). The children were examined at a mean age of 7.7 years (SD 1.7y) using the Movement Assessment Battery for Children-Second Edition (MABC-2), pure tone audiometry, and the Behavioural Regulation Inventory of Executive Function (BRIEF) questionnaire. The follow-up rate was 70% of the eligible infants in the exposed group and 45% in the unexposed group. Mean difference was -0.2 (95% confidence interval [CI] -1.1 to 0.8) in adjusted standard score for MABC-2 and 0.3 (95% CI -2.9 to 3.5) in adjusted BRIEF executive composite standard score. No children had significant hearing impairment or a diagnosis of cerebral palsy, attention-deficit-hyperactive disorder, or autism spectrum disorder recorded in national registries. No evidence was found of an increased risk of deficits in motor development, executive function, or hearing in children with extreme hyperbilirubinaemia who did not have intermediate or advanced bilirubin encephalopathy. © 2014 Mac Keith Press.

Health related quality of life and return to work after minor extremity injuries: A longitudinal study comparing upper versus lower extremity injuries.

PubMed

Sluys, Kerstin Prignitz; Shults, Justine; Richmond, Therese S

2016-04-01

To investigate the impact on health related quality of life (HRQL) during the first year after minor extremity injury and to determine whether there is a difference in recovery patterns and return to work between upper extremity injuries (UEI) and lower extremity injuries (LEI). A total of 181 adults' age 18 years or older randomly selected from patients admitted to an emergency department with minor injuries were studied. HRQL was measured using the Functional Status Questionnaire (FSQ) at 1-2 weeks, 3, 6, and 12-months post-injury. Pre-injury FSQ scores were measured retrospectively at admission. A quasi-least square (QLS) model was constructed to examine differences of FSQ scores at each measuring point for UEI and LEI. Fractures of the knee/lower leg (25%) were the most frequently injured body area. Slips or falls (57%) and traffic-related events (22%) were the most common injury causes. The mean ISS was 4.2 (SD 0.86). Both groups had significant declines in the FSQ scores physical and social functioning at 1-2 weeks after injury. Patients with UEI made larger improvements in the first 3 months post-injury versus patients with LEI whose improvements extended over the first 6 months. None of the groups reached the pre-injury FSQ scores during the first post-injury year except in the subscale work performance where UEI exceeded the pre-injury scores. At 12 months post-injury, significant lower FSQ scores remained in the LEI group compared to the UEI group in intermediate activities of daily living (p=0.036, d 0.4) and work performance (p=0.004, d 0.7). The return to work at 3 months and 12 months were 76% and 88% for UEI and 58% and 77% for LEI. No significant differences were found between groups in the FSQ scale mental health and social interaction. LEI had the highest impact on HRQL and return to work during the first year which exceeded the consequences of UEI. These findings contribute to the information about the consequences of injury in order to give sufficient prognostic information to patients and different stakeholders. Future investigations should aim to investigate specific minor extremity injuries and identify factors that facilitate recovery and return to work. Copyright © 2016 Elsevier Ltd. All rights reserved.

Health related quality of life and return to work after minor extremity injuries: A longitudinal study comparing upper versus lower extremity injuries

PubMed Central

Sluys, Kerstin Prignitz; Shults, Justine; Richmond, Therese S.

2016-01-01

Purpose To investigate the impact on health related quality of life (HRQL) during the first year after minor extremity injury and to determine whether there is a difference in recovery patterns and return to work between upper extremity injuries (UEI) and lower extremity injuries (LEI). Method A total of 181 adults’ age 18 years or older randomly selected from patients admitted to an emergency department with minor injuries were studied. HRQL was measured using the Functional Status Questionnaire (FSQ) at 1–2 weeks, 3, 6, and 12-months post-injury. Pre-injury FSQ scores were measured retrospectively at admission. A quasi-least square (QLS) model was constructed to examine differences of FSQ scores at each measuring point for UEI and LEI. Results Fractures of the knee/lower leg (25%) were the most frequently injured body area. Slips or falls (57%) and traffic-related events (22%) were the most common injury causes. The mean ISS was 4.2 (SD 0.86). Both groups had significant declines in the FSQ scores physical and social functioning at 1–2 weeks after injury. Patients with UEI made larger improvements in the first 3 months post-injury versus patients with LEI whose improvements extended over the first 6 months. None of the groups reached the pre-injury FSQ scores during the first post-injury year except in the subscale work performance where UEI exceeded the pre-injury scores. At 12 months post-injury, significant lower FSQ scores remained in the LEI group compared to the UEI group in intermediate activities of daily living (p=0.036, d 0.4) and work performance (p=0.004, d 0.7). The return to work at 3 months and 12 months were 76% and 88% for UEI and 58% and 77% for LEI. No significant differences were found between groups in the FSQ scale mental health and social interaction. Conclusions LEI had the highest impact on HRQL and return to work during the first year which exceeded the consequences of UEI. These findings contribute to the information about the consequences of injury in order to give sufficient prognostic information to patients and different stakeholders. Future investigations should aim to investigate specific minor extremity injuries and identify factors that facilitate recovery and return to work. PMID:26965363

Fractures and dislocations of the hand in polytrauma patients: Incidence, injury pattern and functional outcome.

PubMed

Ferree, Steven; van der Vliet, Quirine M J; van Heijl, Mark; Houwert, Roderick M; Leenen, Luke P H; Hietbrink, Falco

2017-04-01

Injuries of the hand can cause significant functional impairment, diminished quality of life and delayed return to work. However, the incidence and functional outcome of hand injuries in polytrauma patients is currently unknown. The aim of this study was to determine the incidence, distribution and functional outcome of fractures and dislocation of the hand in polytrauma patients. A single centre retrospective cohort study was performed at a level 1 trauma centre. Polytrauma was defined as patients with an Injury Severity Score of 16 or higher. Fractures and dislocations to the hand were determined. All eligible polytrauma patients with hand injuries were included and a Quick Disability of Arm, Shoulder and Hand questionnaire (QDASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) were administered. Patients were contacted 1-6 years after trauma. In a cohort of 2046 polytrauma patients 72 patients (3.5%) suffered a hand injury. The functional outcome scores of 52 patients (72%) were obtained. The Metacarpal (48%) and carpal (33%) bones were the most frequently affected. The median QDASH score for all patients with hand injury was 17 (IQR 0-31) and the PRWHE 14 (IQR 0-41). Patients with a concomitant upper extremity injury (p=0.002 for PRWHE, p0.006 for QDASH) and those with higher ISS scores (p=0.034 for PRWHE, QDASH not significant) had worse functional outcome scores. As an example, of the 5 patients with the worst outcome scores 3 suffered an isolated phalangeal injury, all had concomitant upper extremity injury or neurological injuries (3 plexus injuries, 1 severe brain injury). The incidence of hand injuries in polytrauma patients is 3.5%, which is relatively low compared to a general trauma population. Metacarpal and carpal bones were most frequently affected. The functional extremity specific outcome scores are highly influenced by concomitant injuries (upper extremity injuries, neurological injuries and higher ISS). Copyright © 2017 Elsevier Ltd. All rights reserved.

Behavioural problems in children who weigh 1000 g or less at birth in four countries.

PubMed

Hille, E T; den Ouden, A L; Saigal, S; Wolke, D; Lambert, M; Whitaker, A; Pinto-Martin, J A; Hoult, L; Meyer, R; Feldman, J F; Verloove-Vanhorick, S P; Paneth, N

2001-05-26

The increased survival chances of extremely low-birthweight (ELBW) infants (weighing <1000 g at birth) has led to concern about their behavioural outcome in childhood. In reports from several countries with different assessments at various ages, investigators have noted a higher frequency of behavioural problems in such infants, but cross-cultural comparisons are lacking. Our aim was to compare behavioural problems in ELBW children of similar ages from four countries. We prospectively studied 408 ELBW children aged 8-10 years, whose parents completed the child behaviour checklist. The children came from the Netherlands, Germany, Canada, and USA. The checklist provides a total problem score consisting of eight narrow-band scales. Of these, two (aggressive and delinquent behaviour) give a broad-band externalising score, three (anxious, somatic, and withdrawn behaviour) give a broad-band internalising score, and three (social, thought, and attention problems) indicate difficulties fitting neither broad-band dimension. For each cohort we analysed scores in ELBW children and those in normal- birthweight controls (two cohorts) or national normative controls (two cohorts). Across countries, we assessed deviations of the ELBW children from normative or control groups. ELBW children had higher total problem scores than normative or control children, but this increase was only significant in European countries. Narrow-band scores were raised only for the social, thought, and attention difficulty scales, which were 0.5-1.2 SD higher in ELBW children than in others. Except for the increase in internalising scores recorded for one cohort, ELBW children did not differ from normative or control children on internalising or externalising scales. Despite cultural differences, types of behavioural problems seen in ELBW children were very similar in the four countries. This finding suggests that biological mechanisms contribute to behavioural problems of ELBW children.

Responsiveness to Change of Functional Limitation Reporting: Cross-sectional Study Using the Intermountain ROMS Scale in Outpatient Rehabilitation.

PubMed

Brennan, Gerard P; Hunter, Stephen J; Snow, Greg; Minick, Kate I

2017-12-01

The Centers for Medicare and Medicaid Services (CMS) require physical therapists document patients' functional limitations. The process is not standardized. 
A systematic approach to determine a patient's functional limitations and responsiveness to change is needed. The purpose of this study is to compare patient-reported outcomes (PROs) responsiveness to change using 7-level severity/complexity modifier scale proposed by Medicare to a derived scale implemented by Intermountain Healthcare's Rehabilitation Outcomes Management System (ROMS). This was a retrospective, observational cohort design. 165,183 PROs prior to July 1, 2013, were compared to 46,334 records from July 1, 2013, to December 31, 2015. Histograms and ribbon plots illustrate distribution and change of patients' scores. ROMS raw score ranges were calculated and compared to CMS' severity/complexity levels based on score percentage. Distribution of the population was compared based on the 2 methods. Sensitivity and specificity were compared for responsiveness to change based on minimal clinically important difference (MCID). Histograms demonstrated few patient scores placed in CMS scale levels at the extremes, whereas the majority of scores placed in 2 middle levels (CJ, CK). ROMS distributed scores more evenly across levels. Ribbon plots illustrated advantage of ROMS' using narrower score ranges. Greater chance for patients to change levels was observed with ROMS when an MCID was achieved. ROMS narrower scale levels resulted in greater sensitivity and good specificity. Geographic representation for the United States was limited. Without patients' global rating of change, a reference standard to gauge validation of improvement could not be provided. ROMS provides a standard approach to identify accurately functional limitation modifier levels and to detect improvement more accurately than a straight across transposition using the CMS scale. © 2017 American Physical Therapy Association

Extremely preterm birth affects boys more and socio-economic and neonatal variables pose sex-specific risks.

PubMed

Månsson, Johanna; Fellman, Vineta; Stjernqvist, Karin

2015-05-01

The early identification of at-risk extremely preterm (EPT) children could improve long-term outcomes. This study sought to investigate sex differences in developmental outcomes and to identify sex-specific predictors at two and a half years of age. We assessed 217 boys and 181 girls born before 27-week gestation using the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III), as a part of the Extremely Preterm Infants in Sweden Study. Sex-specific differences were calculated. Socio-economic, birth and neonatal factors were calculated separately for boys and girls using regression models. Girls scored significantly higher than boys on all Bayley-III indices. In both sexes, brain injury, long-term ventilator treatment and foreign-born mothers predicted lower scores. Receiving breast milk by hospital discharge predicted higher scores. Severe retinopathy of prematurity was the strongest predictor of cognitive and language deficits in boys. High parental education predicted higher cognitive and language scores in girls, whereas severe bronchopulmonary dysplasia was the strongest predictor of motor deficits. Extreme prematurity seems to affect boys more than girls. Socio-economic and neonatal factors confer similar risks or protections on both sexes, but some variables pose sex-specific risks. An awareness of risk factors may provide the basis for treatment and follow-up guidelines. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Drought as a Catalyst for Early Medieval European Subsistence Crises and Violence

NASA Astrophysics Data System (ADS)

Ludlow, Francis; Cook, Edward; Kostick, Conor; McCormick, Michael

2016-04-01

Tree-ring records provide one of most reliable means of reconstructing past climatic conditions, from longer-term multi-decadal fluctuations in temperature and precipitation to inter-annual variability, including years that experienced extreme weather. When combined with written records of past societal behaviour and the incidence of major societal stresses (e.g., famine, disease, and conflict), such records hold the potential to shed new light on historical interactions between climate and society. Recent years have seen the continued development of long dendroclimatic reconstructions, including, most recently the development of the Old World Drought Atlas (OWDA; Cook et al., 2015) which for the first time makes available a robust reconstruction of spring-summer hydroclimatic conditions and extremes for the greater European region, including the entirety of the Dark Ages. In this paper, we examine the association between hydroclimatic extremes identified in the OWDA and well-dated reports of severe drought in early medieval European annals and chronicles, and find a clear statistical correspondence, further confirming the accuracy of the OWDA and its importance as an independent record of hydroclimatic extremes, a resource that can now be drawn upon in both paleoclimatology and studies of climatic impacts on human society. We proceed to examine the association between hydroclimatic extremes identified in the OWDA and the incidence of a range of major societal stresses (scarcity and famine, epidemic disease, and mass human mortality) drawn from an exhaustive survey of early medieval European annals and chronicles. The outcome of this comparison firmly implicates drought as a significant driver of major societal stresses during early medieval times. Using a record of the violent killings of societal elites recorded on a continuous annual basis in medieval Irish monastic annals, we further examine the role of hydroclimatic extremes as triggers in medieval violence and conflict.

Examining global extreme sea level variations on the coast from in-situ and remote observations

NASA Astrophysics Data System (ADS)

Menendez, Melisa; Benkler, Anna S.

2017-04-01

The estimation of extreme water level values on the coast is a requirement for a wide range of engineering and coastal management applications. In addition, climate variations of extreme sea levels on the coastal area result from a complex interacting of oceanic, atmospheric and terrestrial processes across a wide range of spatial and temporal scales. In this study, variations of extreme sea level return values are investigated from two available sources of information: in-situ tide-gauge records and satellite altimetry data. Long time series of sea level from tide-gauge records are the most valuable observations since they directly measure water level in a specific coastal location. They have however a number of sources of in-homogeneities that may affect the climate description of extremes when this data source is used. Among others, the presence of gaps, historical time in-homogeneities and jumps in the mean sea level signal are factors that can provide uncertainty in the characterization of the extreme sea level behaviour. Moreover, long records from tide-gauges are sparse and there are many coastal areas worldwide without in-situ available information. On the other hand, with the accumulating altimeter records of several satellite missions from the 1990s, approaching 25 recorded years at the time of writing, it is becoming possible the analysis of extreme sea level events from this data source. Aside the well-known issue of altimeter measurements very close to the coast (mainly due to corruption by land, wet troposphere path delay errors and local tide effects on the coastal area), there are other aspects that have to be considered when sea surface height values estimated from satellite are going to be used in a statistical extreme model, such as the use of a multi-mission product to get long observed periods and the selection of the maxima sample, since altimeter observations do not provide values uniform in time and space. Here, we have compared the extreme values of 'still water level' and 'non-tidal-residual' of in-situ records from the GESLA2 dataset (Woodworth et al. 2016) against the novel coastal altimetry datasets (Cipollini et al. 2016). Seasonal patterns, inter-annual variability and long-term trends are analyzed. Then, a time-dependent extreme model (Menendez et al. 2009) is applied to characterize extreme sea level return values and their variability on the coastal area around the world.

Adherence evaluation of vented chest seals in a swine skin model.

PubMed

Arnaud, Françoise; Maudlin-Jeronimo, Eric; Higgins, Adam; Kheirabadi, Bijan; McCarron, Richard; Kennedy, Daniel; Housler, Greggory

2016-10-01

Perforation of the chest (open pneumothorax) with and without lung injury can cause air accumulation in the chest, positive intrapleural pressure and lead to tension pneumothorax if untreated. The performance of chest seals to prevent tension physiology depends partially on their ability to adhere to the skin and seal the chest wound. Novel non-occlusive vented chest seals were assessed for their adhesiveness on skin of live swine under normal and extreme environmental conditions to simulate austere battlefield conditions. Chest seals were applied on the back of the swine on skin that was soiled by various environmental contaminants to represent battlefield situations. A peeling (horizontal rim peeling) and detachment and breaching (vertical pulling) techniques were used to quantify the adhesive performance of vented chest seals. Among eight initially selected vented seals, five (Bolin, Russell, Fast breathe, Hyfin and SAM) were further down-selected based on their superior adherence scores at ambient temperatures. The adherence of these seals was then assessed after approximately 17h storage at extreme cold (-19.5°C) and hot (71.5°C) temperatures. Adherence scores for peeling (above 90%) and detachment scores (less than 25%) were comparable for four vented chest seals when tested at ambient temperature, except for the Bolin seal which had higher breaching. Under extreme storage temperatures, adherence peeling scores were comparable to those at ambient temperatures for four chest seals. Scores were significantly lower for the Bolin seal at extreme temperatures. This seal also had the highest detachment and breaching scores. In contrast, the Russell, Fast breathe, Hyfin and SAM seals showed similar ability to stay air tight without breaching after hot storage. No significant difference was found in skin adherence of the five vented chest seals at ambient temperature and the four seals (Russell, Fast breathe, Hyfin and SAM) maintained superior adherence even after exposure to extreme temperatures compared to the Bolin. To select the most effective product from the 5 selected vented chest seals, further functional evaluation of the valve of these chest seals on a chest wound with the potential for tension in the pneumothorax or hemopneumothorax is warranted. Copyright © 2016 Elsevier Ltd. All rights reserved.

The effect of extremity strength training on fibromyalgia symptoms and disease impact in an existing multidisciplinary treatment program.

PubMed

Kas, Tamara; Colby, Megan; Case, Maureen; Vaughn, Dan

2016-10-01

The purpose of this study was to examine the effect of upper and lower body extremity strengthening exercise in patients with Fibromyalgia (FM) within an existing multidisciplinary treatment program. Patients between the ages of 18-65 with the medical diagnosis of FM. Comparative study design. The control and experimental group received the same multidisciplinary treatment except that the experimental group performed upper and lower extremity strengthening exercises. The Fibromyalgia Impact Questionnaire (FIQ) was administered at evaluation and discharge from the program in order to measure change in quality of life (QOL). Statistically significant changes in FIQ scores were found for both groups. The addition of extremity strengthening in the experimental group produced an average 4 points greater reduction in FIQ score, however, these results are not considered statistically significant. This study appears to validate the success of a multidisciplinary approach in treating patients with FM, with the possibility for further benefit with the addition of extremity strengthening. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Observation on the clinical application effects of skin distractor on the treatment of scars].

PubMed

Gui, W L; Yang, E; Zhang, H S

2017-03-20

Objective: To explore clinical application effects of skin distractor on the treatment of scars and to observe effects of skin distractor with different pull speeds on different parts scars of human body. Methods: One hundred and four patients with scars, conforming to the study criteria, were hospitalized in our unit from January 2014 to June 2015. Patients were divided into 2 mm/d group and 4 mm/d group according to the random number table, with 52 patients in each group. After admission, skin distractors were pasted on scars in face and neck, trunk, and extremities of patients in 2 groups, with inner edges of pasteboards close to outside edges of longer sides of scars. Skin distractors in 2 mm/d group and 4 mm/d group were pulled to scars axis direction as speeds of 2 mm/d and 4 mm/d, respectively. Pull time equals values of pull speeds divided by width of scars. Scars were resected after finishing pulling. Immediately after scars resection, skin distractors were pasted again with inner edges of pasteboards close to outside edges of longer sides of incision and removed when stitches were taken out. Scars of patients were scored by Vancouver Scar Scale (VSS), and Patient and Observer Scar Assessment Scale (POSAS) was used to record scores of patient scar assessment scale (PSAS), observer scar assessment scale (OSAS) and overall scores of patients and observers of scars of patients before and one year after scars resection. Data were processed with χ (2) test, independent samples t test, paired samples t test, independent samples non-parametric rank-sum test and paired samples non-parametric rank-sum test. Results: (1) Scores of all scars of patients in 2 groups before scars resection were close (with t values from -1.384 to 0.622, P values above 0.05), obviously higher than those of one year post scars resection (with t values from 11.085 to 24.835, P values below 0.01). Scores of scars in face and neck, trunk and extremities in 2 groups before scars resection were close (with Z values from -1.651 to -0.035, t values from -1.549 to 0.219, P values above 0.05), significantly higher than those of one year post scar resection (with Z values from -2.992 to -2.555, t values from 8.739 to 19.076, P values below 0.01). (2) Scores of all scars of patients in 2 mm/d group of one year post scars resection were lower than those in 4 mm/d group (with t values from -2.583 to -2.018, P values below 0.05). PSAS scores of scars in face and neck and trunk in 2 mm/d group of one year post scars resection were lower than those in 4 mm/d group (with Z values respectively -2.385 and -2.198, P values below 0.05), other scores of scars in face and neck and trunk of patients in 2 groups of one year post scars resection were close (with Z values from -1.841 to -0.363, P values above 0.05). VSS scores, PSAS scores, OSAS scores, patients' overall scores, and observers' overall scores in 2 mm/d groups were (4.6±0.8), (28±4), (28±4), (4.7±0.7), (4.8±1.4) points, respectively, lower than those in 4 mm/d group[(5.2±0.8), (32±4), (31±6), (5.5±1.2), (5.5±1.0) points, respectively, with t values from -3.712 to -2.105, P <0.05 or P <0.01]. Conclusions: Skin distractor has better effects on the treatment of scars, and treatment effects of skin distractor in extremities pulled by 2 mm/d are better than those pulled by 4 mm/d.

Levomilnacipran Extended-Release Treatment in Patients With Major Depressive Disorder: Improvements in Functional Impairment Categories

PubMed Central

Gommoll, Carl P.; Chen, Changzheng; Greenberg, William M.; Ruth, Adam

2015-01-01

Objective: In this post hoc analysis, improvement in functional impairment in patients with major depressive disorder (MDD) treated with levomilnacipran extended release (ER) was evaluated by assessing shifts from more severe to less severe functional impairment categories on individual Sheehan Disability Scale (SDS) subscales. Method: SDS data were pooled from 5 phase II/III studies conducted between December 2006 and March 2012 of levomilnacipran ER versus placebo in adult patients with MDD (DSM-IV-TR criteria). Proportions of patients shifting from moderate-extreme baseline impairment (score ≥ 4) to mild-no impairment (score ≤ 3) at end of treatment were assessed for each SDS subscale. Proportions of patients shifting from marked-extreme (score ≥ 7) baseline impairment to moderate-no (score ≤ 6) or mild-no impairment (score ≤ 3) at end of treatment, and shifts in which patients worsened from moderate-no to marked-extreme impairment, were also evaluated. Results: A significantly higher proportion of patients treated with levomilnacipran ER than placebo-treated patients improved from more severe categories of functional impairment at baseline to less severe impairment categories across all SDS subscales: work/school, social life, and family life/home responsibilities (P < .01). Depending on the SDS subscale, 48%–55% of levomilnacipran ER–treated patients with moderate-extreme impairment at baseline improved to mild or no impairment, compared with no more than 40% of placebo patients on any subscale. Almost half (42%–47%) of levomilnacipran ER–treated patients versus only about one-third (29%–34%) of placebo patients improved from marked-extreme to mild or no impairment across functional domains. Conclusions: These results suggest that functional improvement was observed across the SDS functional domains. To our knowledge, this is the first such categorical analysis of functional improvement, as measured by the SDS, for an antidepressant. Trial Registration: ClinicalTrials.gov identifiers: NCT00969709, NCT01377194, NCT00969150, and NCT01034462 and EudraCT identifier: 2006–002404-34 PMID:26644957

A Comparison of Reliability Measures for Continuous and Discontinuous Recording Methods: Inflated Agreement Scores with Partial Interval Recording and Momentary Time Sampling for Duration Events

ERIC Educational Resources Information Center

Rapp, John T.; Carroll, Regina A.; Stangeland, Lindsay; Swanson, Greg; Higgins, William J.

2011-01-01

The authors evaluated the extent to which interobserver agreement (IOA) scores, using the block-by-block method for events scored with continuous duration recording (CDR), were higher when the data from the same sessions were converted to discontinuous methods. Sessions with IOA scores of 89% or less with CDR were rescored using 10-s partial…

Major hydrologic shifts in northwest Florida during the Holocene from a lacustrine sediment record

NASA Astrophysics Data System (ADS)

Rodysill, J. R.; Donnelly, J. P.

2011-12-01

Recent climate extremes have threatened water resource availability and destroyed homes and infrastructure along the heavily populated northern Gulf of Mexico coast. Water resources in Northwest Florida, in particular, suffer from declining aquifer levels and salt water intrusion despite the presence of extensive river and aquifer systems. Intensive water resource management has been necessary to meet water supply demands during recent droughts. Advanced preparedness for abrupt climate events requires the ability to anticipate when hydrologic extremes are likely to occur; however, the long-term history of hydrologic extremes is not well known, and the instrumental record is too short to resolve longer-term hydrologic variability. Reconstructing the pre-instrumental hydrologic history is essential to building our understanding of the timing of and the driving forces behind wet and dry extremes. Here we present a new record of paleohydrology in northwest Florida based upon variations in sediment lithology and geochemistry from Rattlesnake Lake. We see evidence for both brief and long-lived changes in the lake environment during the Holocene. We compare our record to published pollen-based reconstructions of paleohydrology to examine the spatial and temporal patterns of paleohydrologic extremes across the northern Gulf of Mexico region during the Holocene.

A pilot study to evaluate the role of the Spinal Cord Impairment Pressure Ulcer Monitoring Tool (SCI-PUMT) in clinical decisions for pressure ulcer treatment.

PubMed

Thomason, Susan S; Graves, Barbara Ann; Madaris, Linda

2014-12-01

The Spinal Cord Impairment Pressure Ulcer Monitoring Tool (SCI-PUMT) was designed to assess pressure ulcer (PrU) healing in the spinal cord impaired (SCI) population. The tool contains 7 variables: wound surface area, depth, edges, tunneling, undermining, exudate type, and necrotic tissue amount. A 2-phased, quantitative pilot study based on the Theory of Reasoned Action and Theory of Planned Behavior was conducted at a large SCI/Disorders Center in the Department of Veterans Affairs (VA). In the first phase of the study, a convenience sample of 5 physicians, 3 advanced practice registered nurses, and 3 certified wound care nurses (CWCN) was surveyed using a 2-part questionnaire to assess use of the SCI-PUMT instrument, its anticipated improvement in PrU assessment, and intent to use the SCI-PUMT in clinical practice. Attitudes, subjective norms, perceived behavioral controls, and barriers related to the intent to use the SCI-PUMT were evaluated using a 5-point Likert scale (range: 1= extremely likely, 5 = extremely unlikely). In the second phase of the study, the electronic health records (EHR) of 24 veterans (with 30 PrUs) who had at least 2 completed SCI-PUMT scores during a 4-week period were used to evaluate whether an association existed between magnitudes of change of total SCI-PUMT scores and ordered changes in PrU treatment. The overall mean score for intent to use SCI-PUMT was 1.80 (SD 0.75). The least favorable scores were for convenience and motivation to use the SCI-PUMT. Analysis of EHR data showed no significant difference in magnitudes of change in the SCI-PUMT score and changes in PrU treatment recommendations made by the CWCNs. The significance was not affected regardless of an increase or no change in the score (χ2 with 1 degree of freedom = 1.158, P = 0.282) or for a decrease in the score (χ2 with 1 degree of freedom = 0.5, P = 0.478). In this pilot study, the expressed intent to use the SCI-PUMT in making clinical decisions was generally positive but reservations remain. Additional research is being conducted to determine the barriers and facilitators to SCI-PUMT implementation. The SCI-PUMT was the first tool found to be valid, reliable, and sensitive to assess PrU healing in persons with SCI, and studies to examine the prospective validity of using this instrument on ulcer treatment decisions and outcomes are warranted.

Prognosis of West Nile virus associated acute flaccid paralysis: a case series.

PubMed

Johnstone, Jennie; Hanna, Steven E; Nicolle, Lindsay E; Drebot, Michael A; Neupane, Binod; Mahony, James B; Loeb, Mark B

2011-08-19

Little is known about the long-term health related quality of life outcomes in patients with West Nile virus associated acute flaccid paralysis. We describe the quality of life scores of seven patients with acute flaccid paralysis who presented to hospital between 2003 and 2006, and were followed for up to two years. Between 2003 and 2006, 157 symptomatic patients with West Nile virus were enrolled in a longitudinal cohort study of West Nile virus in Canada. Seven patients (4%) had acute flaccid paralysis. The first patient was a 55-year-old man who presented with left upper extremity weakness. The second patient was a 54-year-old man who presented with bilateral upper extremity weakness. The third patient was a 66-year-old woman who developed bilateral upper and lower extremity weakness. The fourth patient was a 67-year-old man who presented with right lower extremity weakness. The fifth patient was a 60-year-old woman who developed bilateral lower extremity weakness. The sixth patient was a 71-year-old man with a history of Parkinson's disease and acute onset bilateral lower extremity weakness. The seventh patient was a 52-year-old man who presented with right lower extremity weakness. All were Caucasian. Patients were followed for a mean of 1.1 years. At the end of follow-up the mean score on the Physical Component Summary of the Short-Form 36 scale had only slightly increased to 39. In contrast, mean score on the Mental Component Summary of the Short-Form 36 scale at the end of follow-up had normalized to 50. Despite the poor physical prognosis for patients with acute flaccid paralysis, the mental health outcomes are generally favorable.

Black breast cancer survivors experience greater upper extremity disability.

PubMed

Dean, Lorraine T; DeMichele, Angela; LeBlanc, Mously; Stephens-Shields, Alisa; Li, Susan Q; Colameco, Chris; Coursey, Morgan; Mao, Jun J

2015-11-01

Over one-third of breast cancer survivors experience upper extremity disability. Black women present with factors associated with greater upper extremity disability, including: increased body mass index (BMI), more advanced disease stage at diagnosis, and varying treatment type compared with Whites. No prior research has evaluated the relationship between race and upper extremity disability using validated tools and controlling for these factors. Data were drawn from a survey study among 610 women with stage I-III hormone receptor positive breast cancer. The disabilities of the arm, shoulder and hand (QuickDASH) is an 11-item self-administered questionnaire that has been validated for breast cancer survivors to assess global upper extremity function over the past 7 days. Linear regression and mediation analysis estimated the relationships between race, BMI and QuickDASH score, adjusting for demographics and treatment types. Black women (n = 98) had 7.3 points higher average QuickDASH scores than White (n = 512) women (p < 0.001). After adjusting for BMI, age, education, cancer treatment, months since diagnosis, and aromatase inhibitor status, Black women had an average 4-point (95 % confidence interval 0.18-8.01) higher QuickDASH score (p = 0.04) than White women. Mediation analysis suggested that BMI attenuated the association between race and disability by 40 %. Even several years post-treatment, Black breast cancer survivors had greater upper extremity disability, which was partially mediated by higher BMIs. Close monitoring of high BMI Black women may be an important step in reducing disparities in cancer survivorship. More research is needed on the relationship between race, BMI, and upper extremity disability.

In extremely preterm infants, do the Movement Assessment of Infants and the Alberta Infant Motor Scale predict 18-month outcomes using the Bayley-III?

PubMed

Lefebvre, Francine; Gagnon, Marie-Michèle; Luu, Thuy Mai; Lupien, Geneviève; Dorval, Véronique

2016-03-01

Extremely preterm infants are at high-risk for neurodevelopmental disabilities. The Movement Assessment of Infants (MAI) and the Alberta Infant Motor Scale (AIMS) have been designed to predict outcome with modest accuracy with the Bayley-I or Bayley-II. To examine and compare the predictive validity of the MAI and AIMS in determining neurodevelopmental outcome with the Bayley-III. Retrospective cohort study of 160 infants born at ≤ 28 weeks gestation. At their corrected age, infants underwent the MAI at 4 months, the AIMS at 4 and 10-12 months, and the Bayley-III and neurological examination at 18 months. Sensitivity and specificity were calculated. Infants had a mean gestation of 26.3 ± 1.4 weeks and birth weight of 906 ± 207 g. A high-risk score (≥ 14) for adverse outcome was obtained by 57% of infants on the MAI. On the AIMS, a high-risk score (<5th percentile) was obtained by 56% at 4 months and 30% at 10-12 months. At 18 months, infants with low-risk scores on either the MAI or AIMS had higher cognitive, language, and motor Bayley-III scores than those with high-risk scores. They were less likely to have severe neurodevelopmental impairment. To predict Bayley-III scores <70, sensitivity and specificity were 91% and 49%, respectively, for the MAI and 78% and 48%, respectively, for the AIMS. Extremely preterm infants with low-risk MAI at 4 months or AIMS scores at 4 or 10-12 months had better outcomes than those with high-risk scores. However, both tests lack specificity to predict individual neurodevelopmental status at 18 months. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

When is Chemical Similarity Significant? The Statistical Distribution of Chemical Similarity Scores and Its Extreme Values

PubMed Central

Baldi, Pierre

2010-01-01

As repositories of chemical molecules continue to expand and become more open, it becomes increasingly important to develop tools to search them efficiently and assess the statistical significance of chemical similarity scores. Here we develop a general framework for understanding, modeling, predicting, and approximating the distribution of chemical similarity scores and its extreme values in large databases. The framework can be applied to different chemical representations and similarity measures but is demonstrated here using the most common binary fingerprints with the Tanimoto similarity measure. After introducing several probabilistic models of fingerprints, including the Conditional Gaussian Uniform model, we show that the distribution of Tanimoto scores can be approximated by the distribution of the ratio of two correlated Normal random variables associated with the corresponding unions and intersections. This remains true also when the distribution of similarity scores is conditioned on the size of the query molecules in order to derive more fine-grained results and improve chemical retrieval. The corresponding extreme value distributions for the maximum scores are approximated by Weibull distributions. From these various distributions and their analytical forms, Z-scores, E-values, and p-values are derived to assess the significance of similarity scores. In addition, the framework allows one to predict also the value of standard chemical retrieval metrics, such as Sensitivity and Specificity at fixed thresholds, or ROC (Receiver Operating Characteristic) curves at multiple thresholds, and to detect outliers in the form of atypical molecules. Numerous and diverse experiments carried in part with large sets of molecules from the ChemDB show remarkable agreement between theory and empirical results. PMID:20540577

Long-Term Memory: A Natural Mechanism for the Clustering of Extreme Events and Anomalous Residual Times in Climate Records

NASA Astrophysics Data System (ADS)

Bunde, Armin; Eichner, Jan F.; Kantelhardt, Jan W.; Havlin, Shlomo

2005-01-01

We study the statistics of the return intervals between extreme events above a certain threshold in long-term persistent records. We find that the long-term memory leads (i)to a stretched exponential distribution of the return intervals, (ii)to a pronounced clustering of extreme events, and (iii)to an anomalous behavior of the mean residual time to the next event that depends on the history and increases with the elapsed time in a counterintuitive way. We present an analytical scaling approach and demonstrate that all these features can be seen in long climate records. The phenomena should also occur in heartbeat records, Internet traffic, and stock market volatility and have to be taken into account for an efficient risk evaluation.

Relation between the Disability of the Arm, Shoulder and Hand Score and Muscle Strength in Post-Cardiac Surgery Patients.

PubMed

Izawa, Kazuhiro P; Kasahara, Yusuke; Hiraki, Koji; Hirano, Yasuyuki; Watanabe, Satoshi

2017-11-27

Background: The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a valid and reliable patient-reported outcome measure. DASH can be assessed by self-reported upper extremity disability and symptoms. We aimed to examine the relationship between the physiological outcome of muscle strength and the DASH score after cardiac surgery. Methods: This cross-sectional study assessed 50 consecutive cardiac patients that were undergoing cardiac surgery. Physiological outcomes of handgrip strength and knee extensor muscle strength and the DASH score were measured at one month after cardiac surgery and were assessed. Results were analyzed using Spearman correlation coefficients. Results: The final analysis comprised 43 patients (men: 32, women: 11; age: 62.1 ± 9.1 years; body mass index: 22.1 ± 4.7 kg/m²; left ventricular ejection fraction: 53.5 ± 13.7%). Respective handgrip strength, knee extensor muscle strength, and DASH score were 27.4 ± 8.3 kgf, 1.6 ± 0.4 Nm/kg, and 13.3 ± 12.3, respectively. The DASH score correlated negatively with handgrip strength ( r = -0.38, p = 0.01) and with knee extensor muscle strength ( r = -0.32, p = 0.04). Conclusion: Physiological outcomes of both handgrip strength and knee extensor muscle strength correlated negatively with the DASH score. The DASH score appears to be a valuable tool with which to assess cardiac patients with poor physiological outcomes, particularly handgrip strength as a measure of upper extremity function, which is probably easier to follow over time than lower extremity function after patients complete cardiac rehabilitation.

Measurement Properties of the Lower Extremity Functional Scale: A Systematic Review.

PubMed

Mehta, Saurabh P; Fulton, Allison; Quach, Cedric; Thistle, Megan; Toledo, Cesar; Evans, Neil A

2016-03-01

Systematic review of measurement properties. Many primary studies have examined the measurement properties, such as reliability, validity, and sensitivity to change, of the Lower Extremity Functional Scale (LEFS) in different clinical populations. A systematic review summarizing these properties for the LEFS may provide an important resource. To locate and synthesize evidence on the measurement properties of the LEFS and to discuss the clinical implications of the evidence. A literature search was conducted in 4 databases (PubMed, MEDLINE, Embase, and CINAHL), using predefined search terms. Two reviewers performed a critical appraisal of the included studies using a standardized assessment form. A total of 27 studies were included in the review, of which 18 achieved a very good to excellent methodological quality level. The LEFS scores demonstrated excellent test-retest reliability (intraclass correlation coefficients ranging between 0.85 and 0.99) and demonstrated the expected relationships with measures assessing similar constructs (Pearson correlation coefficient values of greater than 0.7). The responsiveness of the LEFS scores was excellent, as suggested by consistently high effect sizes (greater than 0.8) in patients with different lower extremity conditions. Minimal detectable change at the 90% confidence level (MDC90) for the LEFS scores varied between 8.1 and 15.3 across different reassessment intervals in a wide range of patient populations. The pooled estimate of the MDC90 was 6 points and the minimal clinically important difference was 9 points in patients with lower extremity musculoskeletal conditions, which are indicative of true change and clinically meaningful change, respectively. The results of this review support the reliability, validity, and responsiveness of the LEFS scores for assessing functional impairment in a wide array of patient groups with lower extremity musculoskeletal conditions.

Effect of Lower Extremity Stretching Exercises on Balance in Geriatric Population.

PubMed

Reddy, Ravi Shankar; Alahmari, Khalid A

2016-07-01

The purpose of this study was to find "Effect of lower extremity stretching exercises on balance in the geriatric population. 60 subjects (30 male and 30 female) participated in the study. The subjects underwent 10 weeks of lower limb stretching exercise program. Pre and post 10 weeks stretching exercise program, the subjects were assessed for balance, using single limb stance time in seconds and berg balance score. These outcome measures were analyzed. Pre and post lower extremity stretching on balance was analyzed using paired t test. Of 60 subjects 50 subjects completed the stretching exercise program. Paired sample t test analysis showed a significant improvement in single limb stance time (eyes open and eyes closed) (p<0.001) and berg balance score (p<0.001). Lower extremity stretching exercises enhances balance in the geriatric population and thereby reduction in the number of falls.

Attenuation of Typical Sex Differences in 800 Adults with Autism vs. 3,900 Controls

PubMed Central

Baron-Cohen, Simon; Cassidy, Sarah; Auyeung, Bonnie; Allison, Carrie; Achoukhi, Maryam; Robertson, Sarah; Pohl, Alexa; Lai, Meng-Chuan

2014-01-01

Sex differences have been reported in autistic traits and systemizing (male advantage), and empathizing (female advantage) among typically developing individuals. In individuals with autism, these cognitive-behavioural profiles correspond to predictions from the “extreme male brain” (EMB) theory of autism (extreme scores on autistic traits and systemizing, below average on empathizing). Sex differences within autism, however, have been under-investigated. Here we show in 811 adults (454 females) with autism and 3,906 age-matched typical control adults (2,562 females) who completed the Empathy Quotient (EQ), the Systemizing Quotient-Revised (SQ-R), and the Autism Spectrum Quotient (AQ), that typical females on average scored higher on the EQ, typical males scored higher on the SQ-R and AQ, and both males and females with autism showed a shift toward the extreme of the “male profile” on these measures and in the distribution of “brain types” (the discrepancy between standardized EQ and SQ-R scores). Further, normative sex differences are attenuated but not abolished in adults with autism. The findings provide strong support for the EMB theory of autism, and highlight differences between males and females with autism. PMID:25029203

Generalized extreme gust wind speeds distributions

USGS Publications Warehouse

Cheng, E.; Yeung, C.

2002-01-01

Since summer 1996, the US wind engineers are using the extreme gust (or 3-s gust) as the basic wind speed to quantify the destruction of extreme winds. In order to better understand these destructive wind forces, it is important to know the appropriate representations of these extreme gust wind speeds. Therefore, the purpose of this study is to determine the most suitable extreme value distributions for the annual extreme gust wind speeds recorded in large selected areas. To achieve this objective, we are using the generalized Pareto distribution as the diagnostic tool for determining the types of extreme gust wind speed distributions. The three-parameter generalized extreme value distribution function is, thus, reduced to either Type I Gumbel, Type II Frechet or Type III reverse Weibull distribution function for the annual extreme gust wind speeds recorded at a specific site.With the considerations of the quality and homogeneity of gust wind data collected at more than 750 weather stations throughout the United States, annual extreme gust wind speeds at selected 143 stations in the contiguous United States were used in the study. ?? 2002 Elsevier Science Ltd. All rights reserved.

Relationship between diffusion tensor fractional anisotropy and long-term motor outcome in patients with hemiparesis after middle cerebral artery infarction.

PubMed

Koyama, Tetsuo; Marumoto, Kohei; Miyake, Hiroji; Domen, Kazuhisa

2014-10-01

Magnetic resonance diffusion tensor fractional anisotropy (DTI-FA) is often used to characterize neural damage after stroke. Here we assessed the relationship between DTI-FA and long-term motor outcome in patients after middle cerebral artery (MCA) infarction. Fractional anisotropy (FA) maps were generated from diffusion tensor brain images obtained from 16 patients 14-18 days postinfarction, and tract-based spatial statistics (TBSS) analysis was applied. Regions of interest were set within the right and left corticospinal tracts, and mean FA values were extracted from individual TBSS data. Hemiparesis motor outcome was evaluated according to Brunnstrom stage (BRS: 1-6, severe-normal) for separate shoulder/elbow/forearm, hand, and lower extremity functions, as well as the motor component score of the Functional Independence Measure (FIM-motor: 13-91, null-full) 5-7 months after onset. Ratios between FA values in the affected and unaffected hemispheres (rFA) were assessed by BRS and FIM-motor scores. rFA values were .636-.984 (median, .883) and BRS scores were 1-6 (median, 3) for shoulder/elbow/forearm, 2-6 (median, 3) for hand, and 3-6 (median, 5) for the lower extremities. FIM-motor scores were 51-90 (median, 75). Analysis revealed significant relationships between rFA and BRS data (correlation coefficient: .687 for shoulder/elbow/forearm, .579 for hand, and .623 for lower extremities) but no significance relationship between rFA and FIM-motor scores. The results suggest that DTI-FA is applicable for predicting the long-term outcome of extremity functions after MCA infarction. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

The effects of a multi-axis balance board intervention program in an elderly population.

PubMed

Dougherty, John; Kancel, Anne; Ramar, Cassandra; Meacham, Crystal; Derrington, Stephen

2011-01-01

Balance is a major issue facing the geriatric population. Nine participants from a local community center for seniors completed a five-week study to assess improvement in balance. Measures of balance, performance times, and scores on the Berg Balance Scale (BBS) and the Wii Fit Age (WFA) were recorded before and after the entire intervention. An analysis of variance (ANOVA) with repeated measures was used to assess change in BBS and WFA scores. An analysis of covariance with repeated measures was used to asses the impact of possible contributing factors of age, gender, BMI and total balance board training time over the five-week period. The analysis indicated that use of the Indo Balance Board three times a week for ten minutes can significantly improve balance and potentially decrease the risk of falls, as measured by the BBS. Age was the only factor that significantly influenced balance (p = .006). These improvements are postulated to be due to an increase in subjects' core and lower extremity muscle strength and improved proprioception; a result of balance board usage.

Upper extremity disorders in heavy industry workers in Greece.

PubMed

Tsouvaltzidou, Thomaella; Alexopoulos, Evangelos; Fragkakis, Ioannis; Jelastopulu, Eleni

2017-06-18

To investigate the disability due to musculoskeletal disorders of the upper extremities in heavy industry workers. The population under study consisted of 802 employees, both white- and blue-collar, working in a shipyard industry in Athens, Greece. Data were collected through the distribution of questionnaires and the recording of individual and job-related characteristics during the period 2006-2009. The questionnaires used were the Quick Disabilities of the Arm, Shoulder and Hand (QD) Outcome Measure, the Work Ability Index (WAI) and the Short-Form-36 (SF-36) Health Survey. The QD was divided into three parameters - movement restrictions in everyday activities, work and sports/music activities - and the SF-36 into two items, physical and emotional. Multiple linear regression analysis was performed by means of the SPSS v.22 for Windows Statistical Package. The answers given by the participants for the QD did not reveal great discomfort regarding the execution of manual tasks, with the majority of the participants scoring under 5%, meaning no disability. After conducting multiple linear regression, age revealed a positive association with the parameter of restrictions in everyday activities (b = 0.64, P = 0.000). Basic education showed a statistically significant association regarding restrictions during leisure activities, with b = 2.140 ( P = 0.029) for compulsory education graduates. WAI's final score displayed negative charging in the regression analysis of all three parameters, with b = -0.142 ( P = 0.0), b = -0.099 ( P = 0.055) and b = -0.376 ( P = 0.001) respectively, while the physical and emotional components of SF-36 associated with movement restrictions only in daily activities and work. The participants' specialty made no statistically significant associations with any of the three parameters of the QD. Increased musculoskeletal disorders of the upper extremity are associated with older age, lower basic education and physical and mental/emotional health and reduced working ability.

Predictors of outcome in acute traumatic central cord syndrome due to spinal stenosis.

PubMed

Aarabi, Bizhan; Alexander, Melvin; Mirvis, Stuart E; Shanmuganathan, Kathirkamanathan; Chesler, David; Maulucci, Christopher; Iguchi, Mark; Aresco, Carla; Blacklock, Tiffany

2011-01-01

the objective of this study was to elucidate the relationship between admission demographic data, validated injury severity measures on imaging studies, and clinical indicators on the American Spinal Injury Association (ASIA) motor score, Functional Independence Measure (FIM), manual dexterity, and dysesthetic pain at least 12 months after surgery for acute traumatic central cord syndrome (ATCCS) due to spinal stenosis. over a 100-month period (January 2000 to April 2008), of 211 patients treated for ATCCS, 59 cases were due to spinal stenosis, and these patients underwent surgical decompression. Five of these patients died, 2 were lost to follow-up, 10 were not eligible for the study, and the remaining 42 were followed for at least 12 months. in the cohort of 42 patients, mean age was 58.3 years, 83% of the patients were men, and 52.4% of the accidents were due to falls. Mean admission ASIA motor score was 63.8 (upper extremities score, 25.8 and lower extremities score, 39.8), the spinal cord was most frequently compressed at skeletal segments C3-4 and C4-5 (71%), mean midsagittal diameter at the point of maximum compression was 5.6 mm, maximum canal compromise (MCC) was 50.5%, maximum spinal cord compression was 16.5%, and length of parenchymal damage on T2-weighted MR imaging was 29.4 mm. Time after injury until surgery was within 24 hours in 9 patients, 24-48 hours in 10 patients, and more than 48 hours in 23 patients. At the 1-year follow-up, the mean ASIA motor score was 94.1 (upper extremities score, 45.7 and lower extremities score, 47.6), FIM was 111.1, manual dexterity was 64.4% of baseline, and pain level was 3.5. Stepwise regression analysis of 10 independent variables indicated significant relationships between ASIA motor score at follow-up and admission ASIA motor score (p = 0.003), MCC (p = 0.02), and midsagittal diameter (p = 0.02); FIM and admission ASIA motor score (p = 0.03), MCC (p = 0.02), and age (p = 0.02); manual dexterity and admission ASIA motor score (p = 0.0002) and length of parenchymal damage on T2-weighted MR imaging (p = 0.002); and pain level and age (p = 0.02) and length of parenchymal lesion on T2-weighted MR imaging (p = 0.04). the main indicators of long-term ASIA motor score, FIM, manual dexterity, and dysesthetic pain were admission ASIA motor score, midsagittal diameter, MCC, length of parenchymal damage on T2-weighted MR imaging, and age, but different domains of outcome were determined by different predictors.

Operational Definitions of Labor and Delivery Nursing Activities.

DTIC Science & Technology

1987-07-01

assess and record fetal heart rate. (S 2406 r) ZO!3 FETAL ELECTRODE INSERTION (RN): position patient, insert fetal electrode, secure monitor leads...to leg plate to patient’s lower extremity, connect, assess and record fetal heart rate. (S2405r) Z014 FETAL ELECTRODE INSERTION/INTRAUTERINE CATHETER...INSERTION, ASSIST: position patient for procedure, secure monitor Teads to patient’s lower extremity, assess and record fetal heart tones. Set up

Evaluation of Automated and Semi-Automated Scoring of Polysomnographic Recordings from a Clinical Trial Using Zolpidem in the Treatment of Insomnia

PubMed Central

Svetnik, Vladimir; Ma, Junshui; Soper, Keith A.; Doran, Scott; Renger, John J.; Deacon, Steve; Koblan, Ken S.

2007-01-01

Objective: To evaluate the performance of 2 automated systems, Morpheus and Somnolyzer24X7, with various levels of human review/editing, in scoring polysomnographic (PSG) recordings from a clinical trial using zolpidem in a model of transient insomnia. Methods: 164 all-night PSG recordings from 82 subjects collected during 2 nights of sleep, one under placebo and one under zolpidem (10 mg) treatment were used. For each recording, 6 different methods were used to provide sleep stage scores based on Rechtschaffen & Kales criteria: 1) full manual scoring, 2) automated scoring by Morpheus 3) automated scoring by Somnolyzer24X7, 4) automated scoring by Morpheus with full manual review, 5) automated scoring by Morpheus with partial manual review, 6) automated scoring by Somnolyzer24X7 with partial manual review. Ten traditional clinical efficacy measures of sleep initiation, maintenance, and architecture were calculated. Results: Pair-wise epoch-by-epoch agreements between fully automated and manual scores were in the range of intersite manual scoring agreements reported in the literature (70%-72%). Pair-wise epoch-by-epoch agreements between automated scores manually reviewed were higher (73%-76%). The direction and statistical significance of treatment effect sizes using traditional efficacy endpoints were essentially the same whichever method was used. As the degree of manual review increased, the magnitude of the effect size approached those estimated with fully manual scoring. Conclusion: Automated or semi-automated sleep PSG scoring offers valuable alternatives to costly, time consuming, and intrasite and intersite variable manual scoring, especially in large multicenter clinical trials. Reduction in scoring variability may also reduce the sample size of a clinical trial. Citation: Svetnik V; Ma J; Soper KA; Doran S; Renger JJ; Deacon S; Koblan KS. Evaluation of automated and semi-automated scoring of polysomnographic recordings from a clinical trial using zolpidem in the treatment of insomnia. SLEEP 2007;30(11):1562-1574. PMID:18041489

Healthful Dietary Patterns and the Risk of Hypertension Among Women With a History of Gestational Diabetes Mellitus: A Prospective Cohort Study.

PubMed

Li, Shanshan; Zhu, Yeyi; Chavarro, Jorge E; Bao, Wei; Tobias, Deirdre K; Ley, Sylvia H; Forman, John P; Liu, Aiyi; Mills, James; Bowers, Katherine; Strøm, Marin; Hansen, Susanne; Hu, Frank B; Zhang, Cuilin

2016-06-01

Women who developed gestational diabetes mellitus represent a high-risk population for hypertension later in life. The role of diet in the progression of hypertension among this susceptible population is unknown. We conducted a prospective cohort study of 3818 women with a history of gestational diabetes mellitus in the Nurses' Health Study II as part of the ongoing Diabetes & Women's Health Study. These women were followed-up from 1989 to 2011. Incident hypertension was identified through self-administered questionnaires that were validated previously by medical record review. Adherence scores for the alternative Healthy Eating Index 2010, the alternative Mediterranean diet, and the Dietary Approaches to Stop Hypertension were computed for each participant. Cox proportional hazard models were used to evaluate the associations between dietary scores and hypertension while adjusting for major risk factors for hypertension. We documented 1069 incident hypertension cases during a median of 18.5 years of follow-up. After adjustment for major risk factors for hypertension, including body mass index, alternative Healthy Eating Index 2010, alternative Mediterranean diet, and Dietary Approaches to Stop Hypertension scores were significantly inversely associated with the risk of hypertension; hazard ratio and 95% confidence interval comparing the extreme quartiles (highest versus lowest) were 0.76 (0.61-0.94; P for linear trend =0.03) for AHEI score, 0.72 (0.58-0.90; P for trend =0.01) for Dietary Approach to Stop Hypertension score, and 0.70 (0.56-0.88; P for trend =0.002) for alternative Mediterranean diet score. Adherence to a healthful dietary pattern was related to a lower subsequent risk of developing hypertension among women with a history of gestational diabetes mellitus. © 2016 American Heart Association, Inc.

Evaluation of Cardiovascular Risk Scores Applied to NASA's Astronant Corps

NASA Technical Reports Server (NTRS)

Jain, I.; Charvat, J. M.; VanBaalen, M.; Lee, L.; Wear, M. L.

2014-01-01

In an effort to improve cardiovascular disease (CVD) risk prediction, this analysis evaluates and compares the applicability of multiple CVD risk scores to the NASA Astronaut Corps which is extremely healthy at selection.

Are behaviour problems in extremely low-birthweight children related to their motor ability?

PubMed

Danks, Marcella; Cherry, Kate; Burns, Yvonne R; Gray, Peter H

2017-04-01

To investigate whether behaviour problems are independently related to mild motor impairment in 11-13-year-old children born preterm with extremely low birthweight (ELBW). The cross-sectional study included 48 (27 males) non-disabled, otherwise healthy ELBW children (<1000 g) and 55 (28 males) term-born peers. Parents reported behaviour using the Child Behaviour Checklist (CBCL). Children completed the Movement Assessment Battery for Children (Movement ABC). Extremely low birthweight children had poorer behaviour scores (CBCL Total Problem T score: mean difference = 5.89, 95% confidence interval = 10.29, 1.49, p = 0.009) and Movement ABC Total Motor Impairment Scores (ELBW group median = 17.5, IQR = 12.3; term-born group median = 7.5, IQR = 9, p < 0.01) than term-born peers. Behaviour was related to motor score (regression coefficient 2.16; 95% confidence interval 0.34, 3.97, p = 0.02) independent of gender, socio-economic factors or birthweight. Motor score had the strongest association with attention (ρ = 0.51; p < 0.01) and social behaviours (ρ = 0.50; p < 0.01). Behaviour problems of otherwise healthy 11- to 13-year-old ELBW children are not related to prematurity independent of their motor difficulties. Supporting improved motor competence in ELBW preteen children may support improved behaviour, particularly attention and social behaviours. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

A novel tool for continuous fracture aftercare - Clinical feasibility and first results of a new telemetric gait analysis insole.

PubMed

Braun, Benedikt J; Bushuven, Eva; Hell, Rebecca; Veith, Nils T; Buschbaum, Jan; Holstein, Joerg H; Pohlemann, Tim

2016-02-01

Weight bearing after lower extremity fractures still remains a highly controversial issue. Even in ankle fractures, the most common lower extremity injury no standard aftercare protocol has been established. Average non weight bearing times range from 0 to 7 weeks, with standardised, radiological healing controls at fixed time intervals. Recent literature calls for patient-adapted aftercare protocols based on individual fracture and load scenarios. We show the clinical feasibility and first results of a new, insole embedded gait analysis tool for continuous monitoring of gait, load and activity. Ten patients were monitored with a new, independent gait analysis insole for up to 3 months postoperatively. Strict 20 kg partial weight bearing was ordered for 6 weeks. Overall activity, load spectrum, ground reaction forces, clinical scoring and general health data were recorded and correlated. Statistical analysis with power analysis, t-test and Spearman correlation was performed. Only one patient completely adhered to the set weight bearing limit. Average time in minutes over the limit was 374 min. Based on the parameters load, activity, gait time over 20 kg weight bearing and maximum ground reaction force high and low performers were defined after 3 weeks. Significant difference in time to painless full weight bearing between high and low performers was shown. Correlation analysis revealed a significant correlation between weight bearing and clinical scoring as well as pain (American Orthopaedic Foot and Ankle Society (AOFAS) Score rs=0.74; Olerud-Molander Score rs=0.93; VAS pain rs=-0.95). Early, continuous gait analysis is able to define aftercare performers with significant differences in time to full painless weight bearing where clinical or radiographic controls could not. Patient compliance to standardised weight bearing limits and protocols is low. Highly individual rehabilitation patterns were seen in all patients. Aftercare protocols should be adjusted to real-time patient conditions, rather than fixed intervals and limits. With a real-time measuring device high performers could be identified and influenced towards optimal healing conditions early, while low performers are recognised and missing healing influences could be corrected according to patient condition. Copyright © 2015 Elsevier Ltd. All rights reserved.

Crossmodal and incremental perception of audiovisual cues to emotional speech.

PubMed

Barkhuysen, Pashiera; Krahmer, Emiel; Swerts, Marc

2010-01-01

In this article we report on two experiments about the perception of audiovisual cues to emotional speech. The article addresses two questions: 1) how do visual cues from a speaker's face to emotion relate to auditory cues, and (2) what is the recognition speed for various facial cues to emotion? Both experiments reported below are based on tests with video clips of emotional utterances collected via a variant of the well-known Velten method. More specifically, we recorded speakers who displayed positive or negative emotions, which were congruent or incongruent with the (emotional) lexical content of the uttered sentence. In order to test this, we conducted two experiments. The first experiment is a perception experiment in which Czech participants, who do not speak Dutch, rate the perceived emotional state of Dutch speakers in a bimodal (audiovisual) or a unimodal (audio- or vision-only) condition. It was found that incongruent emotional speech leads to significantly more extreme perceived emotion scores than congruent emotional speech, where the difference between congruent and incongruent emotional speech is larger for the negative than for the positive conditions. Interestingly, the largest overall differences between congruent and incongruent emotions were found for the audio-only condition, which suggests that posing an incongruent emotion has a particularly strong effect on the spoken realization of emotions. The second experiment uses a gating paradigm to test the recognition speed for various emotional expressions from a speaker's face. In this experiment participants were presented with the same clips as experiment I, but this time presented vision-only. The clips were shown in successive segments (gates) of increasing duration. Results show that participants are surprisingly accurate in their recognition of the various emotions, as they already reach high recognition scores in the first gate (after only 160 ms). Interestingly, the recognition scores raise faster for positive than negative conditions. Finally, the gating results suggest that incongruent emotions are perceived as more intense than congruent emotions, as the former get more extreme recognition scores than the latter, already after a short period of exposure.

Polygenic determinants in extremes of high-density lipoprotein cholesterol[S

PubMed Central

Dron, Jacqueline S.; Wang, Jian; Low-Kam, Cécile; Khetarpal, Sumeet A.; Robinson, John F.; McIntyre, Adam D.; Ban, Matthew R.; Cao, Henian; Rhainds, David; Dubé, Marie-Pierre; Rader, Daniel J.; Lettre, Guillaume; Tardif, Jean-Claude

2017-01-01

HDL cholesterol (HDL-C) remains a superior biochemical predictor of CVD risk, but its genetic basis is incompletely defined. In patients with extreme HDL-C concentrations, we concurrently evaluated the contributions of multiple large- and small-effect genetic variants. In a discovery cohort of 255 unrelated lipid clinic patients with extreme HDL-C levels, we used a targeted next-generation sequencing panel to evaluate rare variants in known HDL metabolism genes, simultaneously with common variants bundled into a polygenic trait score. Two additional cohorts were used for validation and included 1,746 individuals from the Montréal Heart Institute Biobank and 1,048 individuals from the University of Pennsylvania. Findings were consistent between cohorts: we found rare heterozygous large-effect variants in 18.7% and 10.9% of low- and high-HDL-C patients, respectively. We also found common variant accumulation, indicated by extreme polygenic trait scores, in an additional 12.8% and 19.3% of overall cases of low- and high-HDL-C extremes, respectively. Thus, the genetic basis of extreme HDL-C concentrations encountered clinically is frequently polygenic, with contributions from both rare large-effect and common small-effect variants. Multiple types of genetic variants should be considered as contributing factors in patients with extreme dyslipidemia. PMID:28870971

Polygenic determinants in extremes of high-density lipoprotein cholesterol.

PubMed

Dron, Jacqueline S; Wang, Jian; Low-Kam, Cécile; Khetarpal, Sumeet A; Robinson, John F; McIntyre, Adam D; Ban, Matthew R; Cao, Henian; Rhainds, David; Dubé, Marie-Pierre; Rader, Daniel J; Lettre, Guillaume; Tardif, Jean-Claude; Hegele, Robert A

2017-11-01

HDL cholesterol (HDL-C) remains a superior biochemical predictor of CVD risk, but its genetic basis is incompletely defined. In patients with extreme HDL-C concentrations, we concurrently evaluated the contributions of multiple large- and small-effect genetic variants. In a discovery cohort of 255 unrelated lipid clinic patients with extreme HDL-C levels, we used a targeted next-generation sequencing panel to evaluate rare variants in known HDL metabolism genes, simultaneously with common variants bundled into a polygenic trait score. Two additional cohorts were used for validation and included 1,746 individuals from the Montréal Heart Institute Biobank and 1,048 individuals from the University of Pennsylvania. Findings were consistent between cohorts: we found rare heterozygous large-effect variants in 18.7% and 10.9% of low- and high-HDL-C patients, respectively. We also found common variant accumulation, indicated by extreme polygenic trait scores, in an additional 12.8% and 19.3% of overall cases of low- and high-HDL-C extremes, respectively. Thus, the genetic basis of extreme HDL-C concentrations encountered clinically is frequently polygenic, with contributions from both rare large-effect and common small-effect variants. Multiple types of genetic variants should be considered as contributing factors in patients with extreme dyslipidemia. Copyright © 2017 by the American Society for Biochemistry and Molecular Biology, Inc.

Emergence of heat extremes attributable to anthropogenic influences

NASA Astrophysics Data System (ADS)

King, Andrew D.; Black, Mitchell T.; Min, Seung-Ki; Fischer, Erich M.; Mitchell, Daniel M.; Harrington, Luke J.; Perkins-Kirkpatrick, Sarah E.

2016-04-01

Climate scientists have demonstrated that a substantial fraction of the probability of numerous recent extreme events may be attributed to human-induced climate change. However, it is likely that for temperature extremes occurring over previous decades a fraction of their probability was attributable to anthropogenic influences. We identify the first record-breaking warm summers and years for which a discernible contribution can be attributed to human influence. We find a significant human contribution to the probability of record-breaking global temperature events as early as the 1930s. Since then, all the last 16 record-breaking hot years globally had an anthropogenic contribution to their probability of occurrence. Aerosol-induced cooling delays the timing of a significant human contribution to record-breaking events in some regions. Without human-induced climate change recent hot summers and years would be very unlikely to have occurred.

Clickers to the Rescue: Technology Integration Helps Boost Literacy Scores

ERIC Educational Resources Information Center

Moratelli, Katelyn; DeJarnette, Nancy K.

2014-01-01

Literacy assessment scores in an urban 5th grade classroom left much to be desired. In this diverse classroom population, typical urban distractions such as poverty, crime, English as a second language, and lack of parental support contribute to extremely low literacy scores. This classroom study examined the effects of implementing clickers, a…

Analysis of anthropogenic contributions to record high Australian summer rainfall (2010-2012) using CMIP5 simulations

NASA Astrophysics Data System (ADS)

Lewis, Sophie; Karoly, David

2013-04-01

Changes in extreme climate events pose significant challenges for both human and natural systems. Some climate extremes are likely to become "more frequent, more widespread and/or more intense during the 21st century" (Intergovernmental Panel on Climate Change, 2007) due to anthropogenic climate change. Particularly in Australia, El Niño-Southern Oscillation (ENSO) has a relationship to the relative frequency of temperature and precipitation extremes. In this study, we investigate the record high two-summer rainfall observed in Australia (2010-2011 and 2011-2012). This record rainfall occurred in association with a two year extended La Niña event and resulted in severe and extensive flooding. We examine simulated changes in seasonal-scale rainfall extremes in the Australian region in a suite of models participating in the Coupled Model Intercomparison Project Phase 5 (CMIP5). In particular, we utilise the novel CMIP5 detection and attribution historical experiments with various forcings (natural forcings only and greenhouse gas forcings only) to examine the impact of various anthropogenic forcings on seasonal-scale extreme rainfall across Australia. Using these standard detection and attribution experiments over the period of 1850 to 2005, we examine La Niña contributions to the 2-season record rainfall, as well as the longer-term climate change contribution to rainfall extremes. Was there an anthropogenic influence in the record high Australian summer rainfall over 2010 to 2012, and if so, how much influence? Intergovernmental Panel on Climate Change (2007), Climate Change 2007: The Physical Science Basis, Contribution of Working Group I to the Fourth Assessment Report on the Intergovernmental Panel on Climate Change, edited by S. Solomon et al., 996 pp., Cambridge Univ. Press, Cambridge, U. K.

Asymmetry of magnetic motor evoked potentials recorded in calf muscles of the dominant and non-dominant lower extremity.

PubMed

Olex-Zarychta, Dorota; Koprowski, Robert; Sobota, Grzegorz; Wróbel, Zygmunt

2009-08-07

The aim of the study was to determine the applicability of magnetic stimulation and magnetic motor evoked potentials (MEPs) in motor asymmetry studies by obtaining quantitative and qualitative measures of efferent activity during low intensity magnetic stimulation of the dominant and non-dominant lower extremities. Magnetic stimulation of the tibial nerve in the popliteal fossa was performed in 10 healthy male right-handed and right-footed young adults. Responses were recorded from the lateral head of the gastrocnemius muscles of the right and left lower extremities. Response characteristics (duration, onset latency, amplitude) were analyzed in relation to the functional dominance of the limbs and in relation to the direction of the current in the magnetic coil by use of the Wilcoxon pair sequence test. The CCW direction of coil current was related to reduced amplitudes of recorded MEPs. Greater amplitudes of evoked potentials were recorded in the non-dominant extremity, both in the CW and CCW coil current directions, with the statistical significance of this effect (p=0.005). No differences in duration of response were found in the CW current direction, while in CCW the time of the left-side response was prolonged (p=0.01). In the non-dominant extremity longer onset latencies were recorded in both current directions, but only for the CW direction the side asymmetries showed a statistical significance of p=0.005. In the dominant extremity the stimulation correlated with stronger paresthesias, especially using the CCW direction of coil current. The results indicate that low intensity magnetic stimulation may be useful in quantitative and qualitative research into the motor asymmetry.

Accuracy and Efficiency of Recording Pediatric Early Warning Scores Using an Electronic Physiological Surveillance System Compared With Traditional Paper-Based Documentation.

PubMed

Sefton, Gerri; Lane, Steven; Killen, Roger; Black, Stuart; Lyon, Max; Ampah, Pearl; Sproule, Cathryn; Loren-Gosling, Dominic; Richards, Caitlin; Spinty, Jean; Holloway, Colette; Davies, Coral; Wilson, April; Chean, Chung Shen; Carter, Bernie; Carrol, E D

2017-05-01

Pediatric Early Warning Scores are advocated to assist health professionals to identify early signs of serious illness or deterioration in hospitalized children. Scores are derived from the weighting applied to recorded vital signs and clinical observations reflecting deviation from a predetermined "norm." Higher aggregate scores trigger an escalation in care aimed at preventing critical deterioration. Process errors made while recording these data, including plotting or calculation errors, have the potential to impede the reliability of the score. To test this hypothesis, we conducted a controlled study of documentation using five clinical vignettes. We measured the accuracy of vital sign recording, score calculation, and time taken to complete documentation using a handheld electronic physiological surveillance system, VitalPAC Pediatric, compared with traditional paper-based charts. We explored the user acceptability of both methods using a Web-based survey. Twenty-three staff participated in the controlled study. The electronic physiological surveillance system improved the accuracy of vital sign recording, 98.5% versus 85.6%, P < .02, Pediatric Early Warning Score calculation, 94.6% versus 55.7%, P < .02, and saved time, 68 versus 98 seconds, compared with paper-based documentation, P < .002. Twenty-nine staff completed the Web-based survey. They perceived that the electronic physiological surveillance system offered safety benefits by reducing human error while providing instant visibility of recorded data to the entire clinical team.

Mechanisms of Short-Term Training-Induced Reaching Improvement in Severely Hemiparetic Stroke Patients: A TMS Study

PubMed Central

Harris-Love, Michelle L.; Morton, Susanne M.; Perez, Monica A.; Cohen, Leonardo G.

2011-01-01

Background The neurophysiological mechanisms underlying improved upper-extremity motor skills have been partially investigated in patients with good motor recovery but are poorly understood in more impaired individuals, the majority of stroke survivors. Objective The authors studied changes in primary motor cortex (M1) excitability (motor evoked potentials [MEPs], contralateral and ipsilateral silent periods [CSPs and ISPs] using transcranial magnetic stimulation [TMS]) associated with training-induced reaching improvement in stroke patients with severe arm paresis (n = 11; Upper-Extremity Fugl-Meyer score (F-M) = 27 ± 6). Methods All patients underwent a single session of reaching training focused on moving the affected hand from a resting site to a target placed at 80% of maximum forward reaching amplitude in response to a visual “GO” cue. Triceps contribute primarily as agonist and biceps primarily as antagonist to the trained forward reaching movement. Response times were recorded for each reaching movement. Results Preceding training (baseline), greater interhemispheric inhibition (measured by ISP) in the affected triceps muscle, reflecting inhibition from the nonlesioned to the lesioned M1, was observed in patients with lower F-M scores (more severe motor impairment). Training-induced improvements in reaching were greater in patients with slower response times at baseline. Increased MEP amplitudes and decreased ISPs and CSPs were observed in the affected triceps but not in the biceps muscle after training. Conclusion These results indicate that along with training-induced motor improvements, training-specific modulation of intrahemispheric and interhemispheric mechanisms occurs after reaching practice in chronic stroke patients with substantial arm impairment. PMID:21343522

Factors that impact expectations before total knee arthroplasty.

PubMed

Hepinstall, Matthew S; Rutledge, John R; Bornstein, Lindsey J; Mazumdar, Madhu; Westrich, Geoffrey H

2011-09-01

This study examined the effect of patient attributes on expectations before total knee arthroplasty (TKA). A total of 1943 patients completed an Expectations Survey before TKA. Demographics, surgical history, baseline Medical Outcomes Study Short Form 36 (SF-36) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Lower Extremity Activity Scale score were obtained. On univariate analysis, expectations (mean score, 77.6) correlated with SF-36 General Health, age, SF-36 Vitality, KOOS Quality-of-Life, and Lower Extremity Activity Scale. Living alone and history of joint arthroplasty were associated with significantly lower expectations, whereas male sex and white race were associated with higher expectations. On multivariate regression analysis, age, living situation, history of joint arthroplasty, SF-36 General Health, and KOOS Quality-of-Life remained significant predictors of expectations. Our results suggest that high, possibly unrealistic, expectations of TKA are common and should be moderated to maintain patient satisfaction. Copyright © 2011 Elsevier Inc. All rights reserved.

Trunk restraint to promote upper extremity recovery in stroke patients: a systematic review and meta-analysis.

PubMed

Wee, Seng Kwee; Hughes, Ann-Marie; Warner, Martin; Burridge, Jane H

2014-09-01

Many stroke patients exhibit excessive compensatory trunk movements during reaching. Compensatory movement behaviors may improve upper extremity function in the short-term but be detrimental to long-term recovery. To evaluate the evidence that trunk restraint limits compensatory trunk movement and/or promotes better upper extremity recovery in stroke patients. A search was conducted through electronic databases from January 1980 to June 2013. Only randomized controlled trials (RCTs) comparing upper extremity training with and without trunk restraint were selected for review. Three review authors independently assessed the methodological quality and extracted data from the studies. Meta-analysis was conducted when there was sufficient homogenous data. Six RCTs involving 187 chronic stroke patients were identified. Meta-analysis of key outcome measures showed that trunk restraint has a moderate statistically significant effect on improving Fugl-Meyer Upper Extremity (FMA-UE) score, active shoulder flexion, and reduction in trunk displacement during reaching. There was a small, nonsignificant effect of trunk restraint on upper extremity function. Trunk restraint has a moderate effect on reduction of upper extremity impairment in chronic stroke patients, in terms of FMA-UE score, increased shoulder flexion, and reduction in excessive trunk movement during reaching. There is insufficient evidence to demonstrate that trunk restraint improves upper extremity function and reaching trajectory smoothness and straightness in chronic stroke patients. Future research on stroke patients at different phases of recovery and with different levels of upper extremity impairment is recommended. © The Author(s) 2014.

Head-camera video recordings of trauma core competency procedures can evaluate surgical resident's technical performance as well as colocated evaluators.

PubMed

Mackenzie, Colin F; Pasley, Jason; Garofalo, Evan; Shackelford, Stacy; Chen, Hegang; Longinaker, Nyaradzo; Granite, Guinevere; Pugh, Kristy; Hagegeorge, George; Tisherman, Samuel A

2017-07-01

Unbiased evaluation of trauma core competency procedures is necessary to determine if residency and predeployment training courses are useful. We tested whether a previously validated individual procedure score (IPS) for individual procedure vascular exposure and fasciotomy (FAS) performance skills could discriminate training status by comparing IPS of evaluators colocated with surgeons to blind video evaluations. Performance of axillary artery (AA), brachial artery (BA), and femoral artery (FA) vascular exposures and lower extremity FAS on fresh cadavers by 40 PGY-2 to PGY-6 residents was video-recorded from head-mounted cameras. Two colocated trained evaluators assessed IPS before and after training. One surgeon in each pretraining tertile of IPS for each procedure was randomly identified for blind video review. The same 12 surgeons were video-recorded repeating the procedures less than 4 weeks after training. Five evaluators independently reviewed all 96 randomly arranged deidentified videos. Inter-rater reliability/consistency, intraclass correlation coefficients were compared by colocated versus video review of IPS, and errors. Study methodology and bias were judged by Medical Education Research Study Quality Instrument and the Quality Assessment of Diagnostic Accuracy Studies criteria. There were no differences (p ≥ 0.5) in IPS for AA, FA, FAS, whether evaluators were colocated or reviewed video recordings. Evaluator consistency was 0.29 (BA) - 0.77 (FA). Video and colocated evaluators were in total agreement (p = 1.0) for error recognition. Intraclass correlation coefficient was 0.73 to 0.92, dependent on procedure. Correlations video versus colocated evaluations were 0.5 to 0.9. Except for BA, blinded video evaluators discriminated (p < 0.002) whether procedures were performed before training versus after training. Study methodology by Medical Education Research Study Quality Instrument criteria scored 15.5/19, Quality Assessment of Diagnostic Accuracy Studies 2 showed low bias risk. Video evaluations of AA, FA, and FAS procedures with IPS are unbiased, valid, and have potential for formative assessments of competency. Prognostic study, level II.

Relation between the Disability of the Arm, Shoulder and Hand Score and Muscle Strength in Post-Cardiac Surgery Patients

PubMed Central

Kasahara, Yusuke; Hiraki, Koji; Hirano, Yasuyuki; Watanabe, Satoshi

2017-01-01

Background: The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a valid and reliable patient-reported outcome measure. DASH can be assessed by self-reported upper extremity disability and symptoms. We aimed to examine the relationship between the physiological outcome of muscle strength and the DASH score after cardiac surgery. Methods: This cross-sectional study assessed 50 consecutive cardiac patients that were undergoing cardiac surgery. Physiological outcomes of handgrip strength and knee extensor muscle strength and the DASH score were measured at one month after cardiac surgery and were assessed. Results were analyzed using Spearman correlation coefficients. Results: The final analysis comprised 43 patients (men: 32, women: 11; age: 62.1 ± 9.1 years; body mass index: 22.1 ± 4.7 kg/m2; left ventricular ejection fraction: 53.5 ± 13.7%). Respective handgrip strength, knee extensor muscle strength, and DASH score were 27.4 ± 8.3 kgf, 1.6 ± 0.4 Nm/kg, and 13.3 ± 12.3, respectively. The DASH score correlated negatively with handgrip strength (r = −0.38, p = 0.01) and with knee extensor muscle strength (r = −0.32, p = 0.04). Conclusion: Physiological outcomes of both handgrip strength and knee extensor muscle strength correlated negatively with the DASH score. The DASH score appears to be a valuable tool with which to assess cardiac patients with poor physiological outcomes, particularly handgrip strength as a measure of upper extremity function, which is probably easier to follow over time than lower extremity function after patients complete cardiac rehabilitation. PMID:29186880

Does rewording MRI reports improve patient understanding and emotional response to a clinical report?

PubMed

Bossen, Jeroen K J; Hageman, Michiel G J S; King, John D; Ring, David C

2013-11-01

Diagnostic MRI reports can be distressing for patients with limited health literacy. Humans tend to prepare for the worst particularly when we are in pain, and words like "tear" can make us feel damaged and in need of repair. Research on words used in provider-patient interactions have shown an affect on response to treatment and coping strategies, but the literature on this remains relatively sparse. The aim of this observational cross-sectional study is to determine whether rewording of MRI reports in understandable, more dispassionate language will result in better patient ratings of emotional response, satisfaction, usefulness, and understanding. Furthermore, we wanted to find out which type of report patients would choose to receive. One hundred patients visiting an orthopaedic hand and upper extremity outpatient office for reasons unrelated to the presented MRI report were enrolled. Four MRI reports, concerning upper extremity conditions, were reworded to an eighth-grade reading level and with the use of neutral descriptive words and the most optimistic interpretations based on current best evidence. After reading each report, emotional response was measured using the Self Assessment Manikin (SAM). Subjects also completed questions about satisfaction, usefulness, and understanding of the report. According to the results of the SAM questionnaire, the reworded MRI reports resulted in significantly higher pleasure and dominance scores and lower arousal scores. The mean satisfaction, usefulness, and understanding scores of the reworded report were significantly higher compared with the original reports. Seventy percent of the patients preferred the reworded reports over the original reports. Emotional response, satisfaction, usefulness, and understanding were all superior in MRI reports reworded for lower reading level and optimal emotional content and optimism. Given that patients increasingly have access to their medical records and diagnostic reports, attention to health literacy and psychologic aspects of the report may help optimize health and patient satisfaction.

Car surfing: an underreported mechanism of serious injury in children and adolescents.

PubMed

Geiger, J D; Newsted, J; Drongowski, R A; Lelli, J L

2001-01-01

Car surfing, in which participants stand on top of a moving vehicle as though it were a surfboard, has been reported as a cause of traumatic injury in only 5 cases in the literature. Over the last 8 years, however, the authors have treated 26 children, primarily adolescents, for injuries resulting from car surfing. This report describes the injuries and outcomes of this potentially underreported mechanism of injury. Medical records of 26 patients treated for car surfing injuries between 1991 and 1999 were reviewed. Demographics, hospital course, and type and severity of injuries were analyzed. Eighteen boys (69%) and 8 girls (31%) with an average age of 15.7+/-3.4 years (range, 6 to 22) have presented with injuries related to car surfing. All patients had fallen from the hood, roof, or trunk of a moving motor vehicle, the majority falling from the hood (n = 13; 50%). Injury severity was evaluated using the Injury Severity Scores (ISS; 12.4+/-6.5), Revised Trauma Score (RTS; 7.5+/- 1.1) and Glasgow Coma Score (GCS; 13.5+/-3.2). Injury severity was equivalent between boys and girls (P>.05). Central nervous system injuries predominated, with closed head injuries occurring in 22 (85%) and loss of consciousness in 10 (39%). Skull fractures occurred in 11 (42%) and intracranial bleeding in 9 (35%). Long-term cognitive rehabilitation was necessary in 22 (85%) patients. Three patients (12%) had spinal column fractures, with 2 (8%) suffering permanent paralysis. Two extremity (8%) and 3 (11.7%) pelvic fractures occurred. Most patients (73%) suffered significant skin and soft tissue injuries. Two patients (8%) presented with solid visceral injuries, and 1 child died. Car surfing is an extremely high-risk behavior in children and adolescents that leads to significant morbidity, long-term disability, and is potentially fatal. The incidence of car surfing may be greater than has been reported previously; therefore, prevention programs aimed at discouraging this high-risk behavior in children and adolescents should be considered.

A new therapeutic application of brain-machine interface (BMI) training followed by hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy for patients with severe hemiparetic stroke: A proof of concept study.

PubMed

Kawakami, Michiyuki; Fujiwara, Toshiyuki; Ushiba, Junichi; Nishimoto, Atsuko; Abe, Kaoru; Honaga, Kaoru; Nishimura, Atsuko; Mizuno, Katsuhiro; Kodama, Mitsuhiko; Masakado, Yoshihisa; Liu, Meigen

2016-09-21

Hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy improved paretic upper extremity motor function in patients with severe to moderate hemiparesis. We hypothesized that brain machine interface (BMI) training would be able to increase paretic finger muscle activity enough to apply HANDS therapy in patients with severe hemiparesis, whose finger extensor was absent. The aim of this study was to assess the efficacy of BMI training followed by HANDS therapy in patients with severe hemiparesis. Twenty-nine patients with chronic stroke who could not extend their paretic fingers were participated this study. We applied BMI training for 10 days at 40 min per day. The BMI detected the patients' motor imagery of paretic finger extension with event-related desynchronization (ERD) over the affected primary sensorimotor cortex, recorded with electroencephalography. Patients wore a motor-driven orthosis, which extended their paretic fingers and was triggered with ERD. When muscle activity in their paretic fingers was detected with surface electrodes after 10 days of BMI training, we applied HANDS therapy for the following 3 weeks. In HANDS therapy, participants received closed-loop, electromyogram-controlled, neuromuscular electrical stimulation (NMES) combined with a wrist-hand splint for 3 weeks at 8 hours a day. Before BMI training, after BMI training, after HANDS therapy and 3month after HANDS therapy, we assessed Fugl-Meyer Assessment upper extremity motor score (FMA) and the Motor Activity Log14-Amount of Use (MAL-AOU) score. After 10 days of BMI training, finger extensor activity had appeared in 21 patients. Eighteen of 21 patients then participated in 3 weeks of HANDS therapy. We found a statistically significant improvement in the FMA and the MAL-AOU scores after the BMI training, and further improvement was seen after the HANDS therapy. Combining BMI training with HANDS therapy could be an effective therapeutic strategy for severe UE paralysis after stroke.

Translation, reliability, and clinical utility of the Melbourne Assessment 2.

PubMed

Gerber, Corinna N; Plebani, Anael; Labruyère, Rob

2017-10-12

The aims were to (i) provide a German translation of the Melbourne Assessment 2 (MA2), a quantitative test to measure unilateral upper limb function in children with neurological disabilities and (ii) to evaluate its reliability and aspects of clinical utility. After its translation into German and approval of the back translation by the original authors, the MA2 was performed and videotaped twice with 30 children with neuromotor disorders. For each participant, two raters scored the video of the first test for inter-rater reliability. To determine test-retest reliability, one rater additionally scored the video of the second test while the other rater repeated the scoring of the first video to evaluate intra-rater reliability. Time needed for rater training, test administration, and scoring was recorded. The four subscale scores showed excellent intra-, inter-rater, and test-retest reliability with intraclass correlation coefficients of 0.90-1.00 (95%-confidence intervals 0.78-1.00). Score items revealed substantial to almost perfect intra-rater reliability (weighted kappa k w  = 0.66-1.00) for the more affected side. Score item inter-rater and test-retest reliability of the same extremity were, with one exception, moderate to almost perfect (k w  = 0.42-0.97; k w  = 0.40-0.89). Furthermore, the MA2 was feasible and acceptable for patients and clinicians. The MA2 showed excellent subscale and moderate to almost perfect score item reliability. Implications for Rehabilitation There is a lack of high-quality studies about psychometric properties of upper limb measurement tools in the neuropediatric population. The Melbourne Assessment 2 is a promising tool for reliable measurement of unilateral upper limb movement quality in the neuropediatric population. The Melbourne Assessment 2 is acceptable and practicable to therapists and patients for routine use in clinical care.

Space-time precipitation extremes for urban hydrology

NASA Astrophysics Data System (ADS)

Bardossy, A.; Pegram, G. G. S.

2017-12-01

Precipitation extremes are essential for hydrological design. In urban hydrology intensity duration frequency curves (IDFs) are estimated from observation records to design sewer systems. The conventional approaches seldom consider the areal extent of events. If they do so, duration-dependent area reduction factors (ARFs) are applied. In this contribution we investigate the influence of the size of the target urban area on the frequency of occurrence of extremes. We introduce two new concepts, (i) the maximum over an area and (ii) the sub-areal extremes. The properties of these are discussed. The space-time dependence of extremes strongly influences these statistics. The findings of this presentation show that the risk of urban flooding is routinely underestimated. We do this by sampling a long sequence of radar rainfall fields of 1 km resolution, not the usual limited information from gauge records at scattered point locations. The procedure we use is to generate 20 years of plausible 'radar' fields of 5 minute precipitation on a square frame of 128x128 one kilometer pixels and sample them in a regimented way. In this presentation we find that the traditional calculations are underestimating the extremes [by up to 30 % to 50 % depending on size and duration] and we show how we can revise them sensibly. The methodology we devise from simulated radar fields is checked against the records of a dense network of pluviometers covered by a radar in Baden-Württemberg, with a (regrettably) short 4-year record, as proof of concept.

Hemispheric preference and progressive-part or whole practice in beginning typewriting.

PubMed

Johns, L B

1989-04-01

This investigation explored the interaction of progressive-part versus whole methods of practice with hemispheric preference for processing information and the impact of each upon high school students' speed and accuracy in beginning typewriting. Zenhausern's Differential Hemispheric Activation Test was scored in such a way that it was possible to plot the scores along a continuum. Analysis of variance gave significant F ratios on 3 of the 4 testing days. The continuous scores were divided into five categories: middle, left moderates, right moderates, extreme rights, and extreme lefts. The moderate-left group speed was consistently the fastest group, and the extreme rights were consistently the slowest group. This difference was significant for all four testing days with the moderate-left mean speed varying between 4 to 6 words per minute faster each testing day. The extreme rights were consistently the most accurate, even though not statistically significantly so. There was no significant difference between method of practice and typewriting speed or between method of practice and typewriting accuracy; however, on all four testing days the mean gross speed of the whole practice learning group was 0.73 to 0.99 words per minute faster than the progressive-part group. A two-way analysis of variance indicated no interaction between method or practice and hemispheric preference.

The incidence of upper extremity injuries in endoscopy nurses working in the United States.

PubMed

Drysdale, Susan A

2013-01-01

Numerous studies have addressed musculoskeletal disorders in the international working population. The literature indicates that injuries exist at astounding rates with significant economic impact. Attempts have been made by government, private industry, and special interest groups to address the issues related to the occurrence and prevention of musculoskeletal injuries. Because of the limited research on the gastrointestinal (GI) endoscopy nursing sector, this descriptive, correlational study explored the incidence of upper extremity injuries in GI endoscopy nurses and technicians in the United States. A total of 215 subjects were included in the study. Findings show that upper extremity injuries exist among nurses working in GI endoscopy. Twenty-two percent of respondents missed work for upper extremity injuries. The findings also show that the severity of disability is related to the type of work done, type of assistive aids available at work, and whether or not ergonomic or physiotherapy assessments were provided at the place of employment. In reference to rate of injury and the availability of ergonomics and physiotherapy assessments, those who had ergonomic assessments available to them had scores on the Disabilities of the Arm, Shoulder, and Hand (DASH) inventory (indicating upper extremity disability) that were significantly lower (DASH score, 9.96) than those who did not have the assessments available (DASH score, 14.66). The results suggest that there are a significant number of subjects who are disabled to varying degrees and the majority of these are employed in full-time jobs.

Pre-Kidney Transplant Lower Extremity Impairment and Post-Kidney Transplant Mortality.

PubMed

Nastasi, A J; McAdams-DeMarco, M A; Schrack, J; Ying, H; Olorundare, I; Warsame, F; Mountford, A; Haugen, C E; González Fernández, M; Norman, S P; Segev, D L

2018-01-01

Prediction models for post-kidney transplantation mortality have had limited success (C-statistics ≤0.70). Adding objective measures of potentially modifiable factors may improve prediction and, consequently, kidney transplant (KT) survival through intervention. The Short Physical Performance Battery (SPPB) is an easily administered objective test of lower extremity function consisting of three parts (balance, walking speed, chair stands), each with scores of 0-4, for a composite score of 0-12, with higher scores indicating better function. SPPB performance and frailty (Fried frailty phenotype) were assessed at admission for KT in a prospective cohort of 719 KT recipients at Johns Hopkins Hospital (8/2009 to 6/2016) and University of Michigan (2/2013 to 12/2016). The independent associations between SPPB impairment (SPPB composite score ≤10) and composite score with post-KT mortality were tested using adjusted competing risks models treating graft failure as a competing risk. The 5-year posttransplantation mortality for impaired recipients was 20.6% compared to 4.5% for unimpaired recipients (p < 0.001). Impaired recipients had a 2.30-fold (adjusted hazard ratio [aHR] 2.30, 95% confidence interval [CI] 1.12-4.74, p = 0.02) increased risk of postkidney transplantation mortality compared to unimpaired recipients. Each one-point decrease in SPPB score was independently associated with a 1.19-fold (95% CI 1.09-1.30, p < 0.001) higher risk of post-KT mortality. SPPB-derived lower extremity function is a potentially highly useful and modifiable objective measure for pre-KT risk prediction. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

Early working memory as a racially and ethnically neutral measure of outcome in extremely preterm children at 18-22 months

PubMed Central

Lowe, Jean R.; Duncan, Andrea Freeman; Bann, Carla M.; Fuller, Janell; Hintz, Susan R.; Das, Abhik; Higgins, Rosemary D.; Watterberg, Kristi L.

2013-01-01

Background Difficulties with executive function has been found in preterm children, resulting in difficulties with learning and school performance. Aim This study evaluated the relationship of early working memory as measured by object permanence items to the cognitive and language scores on the Bayley Scales-III in a cohort of children born extremely preterm. Study Design Logistic regression models were conducted to compare object permanence scores derived from the Bayley Scales-III by race/ethnicity and maternal education, controlling for medical covariates. Subjects Extremely preterm toddlers (526), who were part of a Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network's multi-center study, were evaluated at 18-22 months corrected age. Outcome Measures Object permanence scores derived from the Bayley Developmental Scales were compared by race/ethnicity and maternal education, controlling for medical covariates. Results There were no significant differences in object permanence mastery and scores among the treatment groups after controlling for medical and social variables, including maternal education and race/ethnicity. Males and children with intraventricular hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia were less likely to demonstrate object permanence mastery and had lower object permanence scores. Children who attained object permanence mastery had significantly higher Bayley Scales-III cognitive and language scores after controlling for medical and socio-economic factors. Conclusions Our measure of object permanence is free of influence from race, ethnic and socio-economic factors. Adding this simple task to current clinical practice could help detect early executive function difficulties in young children. PMID:23993309

Early working memory as a racially and ethnically neutral measure of outcome in extremely preterm children at 18-22 months.

PubMed

Lowe, Jean R; Duncan, Andrea Freeman; Bann, Carla M; Fuller, Janell; Hintz, Susan R; Das, Abhik; Higgins, Rosemary D; Watterberg, Kristi L

2013-12-01

Difficulties with executive function have been found in preterm children, resulting in difficulties with learning and school performance. This study evaluated the relationship of early working memory as measured by object permanence items to the cognitive and language scores on the Bayley Scales-III in a cohort of children born extremely preterm. Logistic regression models were conducted to compare object permanence scores derived from the Bayley Scales-III by race/ethnicity and maternal education, controlling for medical covariates. Extremely preterm toddlers (526), who were part of a Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network's multi-center study, were evaluated at 18-22 months corrected age. Object permanence scores derived from the Bayley Developmental Scales were compared by race/ethnicity and maternal education, controlling for medical covariates. There were no significant differences in object permanence mastery and scores among the treatment groups after controlling for medical and social variables, including maternal education and race/ethnicity. Males and children with intraventricular hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia were less likely to demonstrate object permanence mastery and had lower object permanence scores. Children who attained object permanence mastery had significantly higher Bayley Scales-III cognitive and language scores after controlling for medical and socio-economic factors. Our measure of object permanence is free of influence from race, ethnic and socio-economic factors. Adding this simple task to current clinical practice could help detect early executive function difficulties in young children. Published by Elsevier Ireland Ltd.

Long-term records reveal decoupling of nitrogen and phosphorus cycles in a large, urban lake in response to an extreme rainfall event

NASA Astrophysics Data System (ADS)

Corman, J. R.; Loken, L. C.; Oliver, S. K.; Collins, S.; Butitta, V.; Stanley, E. H.

2017-12-01

Extreme events can play powerful roles in shifting ecosystem processes. In lakes, heavy rainfall can transport large amounts of particulates and dissolved nutrients into the water column and, potentially, alter biogeochemical cycling. However, the impacts of extreme rainfall events are often difficult to study due to a lack of long-term records. In this paper, we combine daily discharge records with long-term lake water quality information collected by the North Temperate Lakes Long-Term Ecological Research (NTL LTER) site to investigate the impacts of extreme events on nutrient cycling in lakes. We focus on Lake Mendota, an urban lake within the Yahara River Watershed in Madison, Wisconsin, USA, where nutrient data are available at least seasonally from 1995 - present. In June 2008, precipitation amounts in the Yahara watershed were 400% above normal values, triggering the largest discharge event on record for the 40 years of monitoring at the streamgage station; hence, we are able to compare water quality records before and after this event as a case study of how extreme rain events couple or decouple lake nutrient cycling. Following the extreme event, the lake-wide mass of nitrogen and phosphorus increased in the summer of 2008 by 35% and 21%, respectively, shifting lake stoichiometry by increasing N:P ratios (Figure 1). Nitrogen concentrations remained elevated longer than phosphorus, suggesting (1) that nitrogen inputs into the lake were sustained longer than phosphorus (i.e., a "smear" versus "pulse" loading of nitrogen versus phosphorus, respectively, in response to the extreme event) and/or (2) that in-lake biogeochemical processing was more efficient at removing phosphorus compared to nitrogen. While groundwater loading data are currently unavailable to test the former hypothesis, preliminary data from surficial nitrogen and phosphorus loading to Lake Mendota (available for 2011 - 2013) suggest that nitrogen removal efficiency is less than phosphorus, supporting the latter hypothesis. As climate change is expected to increase the frequency of extreme events, continued monitoring of lakes is needed to understand biogeochemical responses and when and how water quality threats may occur.

Upper Extremity Functional Status of Female Youth Softball Pitchers Using the Kerlan-Jobe Orthopaedic Clinic Questionnaire.

PubMed

Holtz, Kaila A; O'Connor, Russell J

2018-01-01

Softball is a popular sport with a high incidence of upper extremity injuries. The Kerlan-Jobe Orthopaedic Clinic (KJOC) questionnaire is a validated performance and functional assessment tool used in overhead athletes. Upper extremity pain patterns and baseline KJOC scores have not been reported for active female youth softball pitchers. The purpose of this study was to establish the prevalence of upper extremity pain and its effect in female youth softball pitchers over a competitive season. We hypothesized that participants who missed time due to injury in the past year would have lower KJOC scores. Cross-sectional study; Level of evidence, 3. Fifty-three female softball pitchers aged 12 to 18 years were recruited from softball clinics in Vancouver, British Columbia, Canada. All participants self-identified as a pitcher on a competitive travel team. Participants were administered the KJOC questionnaire before and during the playing season. Missed time due to injury in the past year, current pain patterns, and KJOC scores were primary outcomes. The mean (±SD) preseason KJOC score was 87.2 ± 10.6. In the preseason, 22.6% of pitchers reported playing with arm trouble, and 32.1% missed time due to injury in the past year. The mean KJOC score for pitchers reporting a previous injury (n = 17) was significantly lower compared with those without an injury (n = 36) (79.5 ± 13.8 vs 90.9 ± 6.2, respectively; P = .02). The posterior shoulder was the most commonly reported pain location. For the cohort completing the questionnaire both before and during the playing season (n = 35), mean KJOC scores did not change significantly over the playing season ( P = .64). Lower preseason KJOC scores were significantly related to the in-season injury risk ( P = .016). Pitchers with a preseason score of less than 90 had a 3.5 (95% CI, 1.1-11.2) times greater risk of reporting an in-season injury. Female youth softball pitchers have a high baseline functional status. However, 1 in 3 pitchers reported missed time due to injury in the previous year, and shoulder pain was more prevalent than elbow pain. The KJOC questionnaire can be used by coaches, researchers, and clinicians to identify youth softball pitchers at risk for injuries who may benefit from interventions.

The Youth Throwing Score: Validating Injury Assessment in Young Baseball Players.

PubMed

Ahmad, Christopher S; Padaki, Ajay S; Noticewala, Manish S; Makhni, Eric C; Popkin, Charles A

2017-02-01

Epidemic levels of shoulder and elbow injuries have been reported recently in youth and adolescent baseball players. Despite the concerning frequency of these injuries, no instrument has been validated to assess upper extremity injury in this patient population. Purpose/Hypothesis: The purpose of this study was to validate an upper extremity assessment tool specifically designed for young baseball players. We hypothesized that this tool will be both reliable and valid. Cohort study (diagnosis); Level of evidence, 2. The Youth Throwing Score (YTS) was constructed by an interdisciplinary team of providers and coaches as a tool to assess upper extremity injury in youth and adolescent baseball players (age range, 10-18 years). The psychometric properties of the test were then determined. A total of 223 players completed the final survey. The players' mean age was 14.3 ± 2.7 years. Pilot analysis showed that none of the 14 questions received a mean athlete importance rating less than 3 of 5, and the final survey read at a Flesch-Kincaid level of 4.1, which is appropriate for patients aged 9 years and older. The players self-assigned their injury status, resulting in a mean instrument score of 59.7 ± 8.4 for the 148 players "playing without pain," 42.0 ± 11.5 for the 60 players "playing with pain," and 40.4 ± 10.5 for the 15 players "not playing due to pain." Players playing without pain scored significantly higher than those playing with pain and those not playing due to pain ( P < .001). Psychometric analysis showed a test-retest intraclass correlation coefficient of 0.90 and a Cronbach alpha intra-item reliability coefficient of 0.93, indicating excellent reliability and internal consistency. Pearson correlation coefficients of 0.65, 0.62, and 0.31 were calculated between the YTS and the Pediatric Outcomes Data Collection Instrument sports/physical functioning module, the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow score, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, respectively. Injured players scored a mean of 9.4 points higher after treatment ( P < .001), and players who improved in their self-assigned pain categorization scored 16.5 points higher ( P < .001). The YTS is the first valid and reliable instrument for assessing young baseball players' upper extremity health.

Upper Extremity Functional Status of Female Youth Softball Pitchers Using the Kerlan-Jobe Orthopaedic Clinic Questionnaire

PubMed Central

Holtz, Kaila A.; O’Connor, Russell J.

2018-01-01

Background: Softball is a popular sport with a high incidence of upper extremity injuries. The Kerlan-Jobe Orthopaedic Clinic (KJOC) questionnaire is a validated performance and functional assessment tool used in overhead athletes. Upper extremity pain patterns and baseline KJOC scores have not been reported for active female youth softball pitchers. Purpose/Hypothesis: The purpose of this study was to establish the prevalence of upper extremity pain and its effect in female youth softball pitchers over a competitive season. We hypothesized that participants who missed time due to injury in the past year would have lower KJOC scores. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Fifty-three female softball pitchers aged 12 to 18 years were recruited from softball clinics in Vancouver, British Columbia, Canada. All participants self-identified as a pitcher on a competitive travel team. Participants were administered the KJOC questionnaire before and during the playing season. Missed time due to injury in the past year, current pain patterns, and KJOC scores were primary outcomes. Results: The mean (±SD) preseason KJOC score was 87.2 ± 10.6. In the preseason, 22.6% of pitchers reported playing with arm trouble, and 32.1% missed time due to injury in the past year. The mean KJOC score for pitchers reporting a previous injury (n = 17) was significantly lower compared with those without an injury (n = 36) (79.5 ± 13.8 vs 90.9 ± 6.2, respectively; P = .02). The posterior shoulder was the most commonly reported pain location. For the cohort completing the questionnaire both before and during the playing season (n = 35), mean KJOC scores did not change significantly over the playing season (P = .64). Lower preseason KJOC scores were significantly related to the in-season injury risk (P = .016). Pitchers with a preseason score of less than 90 had a 3.5 (95% CI, 1.1-11.2) times greater risk of reporting an in-season injury. Conclusion: Female youth softball pitchers have a high baseline functional status. However, 1 in 3 pitchers reported missed time due to injury in the previous year, and shoulder pain was more prevalent than elbow pain. The KJOC questionnaire can be used by coaches, researchers, and clinicians to identify youth softball pitchers at risk for injuries who may benefit from interventions. PMID:29349094

Validation of a Wireless, Self-Application, Ambulatory Electroencephalographic Sleep Monitoring Device in Healthy Volunteers.

PubMed

Finan, Patrick H; Richards, Jessica M; Gamaldo, Charlene E; Han, Dingfen; Leoutsakos, Jeannie Marie; Salas, Rachel; Irwin, Michael R; Smith, Michael T

2016-11-15

To evaluate the validity of an ambulatory electroencephalographic (EEG) monitor for the estimation of sleep continuity and architecture in healthy adults. Healthy, good sleeping participants (n = 14) were fit with both an ambulatory EEG monitor (Sleep Profiler) and a full polysomnography (PSG) montage. EEG recordings were gathered from both devices on the same night, during which sleep was permitted uninterrupted for eight hours. The study was set in an inpatient clinical research suite. PSG and Sleep Profiler records were scored by a neurologist board certified in sleep medicine, blinded to record identification. Agreement between the scored PSG record, the physician-scored Sleep Profiler record, and the Sleep Profiler record scored by an automatic algorithm was evaluated for each sleep stage, with the PSG record serving as the reference. Results indicated strong percent agreement across stages. Kappa was strongest for Stage N3 and REM. Specificity was high for all stages; sensitivity was low for Wake and Stage N1, and high for Stage N2, Stage N3, and REM. Agreement indices improved for the manually scored Sleep Profiler record relative to the autoscore record. Overall, the Sleep Profiler yields an EEG record with comparable sleep architecture estimates to PSG. Future studies should evaluate agreement between devices with a clinical sample that has greater periods of wake in order to better understand utility of this device for estimating sleep continuity indices, such as sleep onset latency and wake after sleep onset. © 2016 American Academy of Sleep Medicine

Reliability and Validity of the Musculoskeletal Tumor Society Scoring System for the Upper Extremity in Japanese Patients.

PubMed

Uehara, Kosuke; Ogura, Koichi; Akiyama, Toru; Shinoda, Yusuke; Iwata, Shintaro; Kobayashi, Eisuke; Tanzawa, Yoshikazu; Yonemoto, Tsukasa; Kawano, Hirotaka; Kawai, Akira

2017-09-01

The Musculoskeletal Tumor Society (MSTS) scoring system developed in 1993 is a widely used disease-specific evaluation tool for assessment of physical function in patients with musculoskeletal tumors; however, only a few studies have confirmed its reliability and validity. The aim of this study was to validate the MSTS scoring system for the upper extremity (MSTS-UE) in Japanese patients with musculoskeletal tumors for use by others in research. Does the MSTS-UE have: (1) sufficient reliability and internal consistency; (2) adequate construct validity; and (3) reasonable criterion validity in comparison to the Toronto Extremity Salvage Score (TESS) or SF-36? Reliability was performed using test-retest analysis, and internal consistency was evaluated with Cronbach's alpha coefficient. Construct validity was evaluated using a scree plot to confirm the construct number and the Akaike information criterion network. Criterion validity was evaluated by comparing the MSTS-UE with the TESS and SF-36. The test-retest reliability with intraclass correlation coefficient (0.95; 95% CI, 0.91-0.97) was excellent, and internal consistency with Cronbach's α (0.7; 95% CI, 0.53-0.81) was acceptable. There were no ceiling and floor effects. The Akaike Information Criterion network showed that lifting ability, pain, and dexterity played central roles among the components. The MSTS-UE showed substantial correlation with the TESS scoring scale (r = 0.75; p < 0.001) and fair correlation with the SF-36 physical component summary (r = 0.37; p = 0.007). Although the MSTS-UE showed slight correlation with the SF-36 mental component summary, the emotional acceptance component of the MSTS-UE showed fair correlation (r = 0.29; p = 0.039). We can conclude that the MSTS is not an adequate measure of general health-related quality of life; however, this system was designed mainly to be a simple measure of function in a single extremity. To evaluate the mental state of patients with musculoskeletal tumors in the upper extremity, further study is needed.

Management of complex regional pain syndrome type I in upper extremity-evaluation of continuous stellate ganglion block and continuous infraclavicular brachial plexus block: a pilot study.

PubMed

Toshniwal, Gokul; Sunder, Rani; Thomas, Ronald; Dureja, G P

2012-01-01

Interventional pain management techniques play an important role in the multidisciplinary approach to management of complex regional pain syndrome (CRPS). In this preliminary study we compared the efficacy of continuous stellate ganglion (CSG) block with that of continuous infraclavicular brachial plexus (CIBP) block in management of CRPS type I of upper extremity. Thirty-three patients with CRPS type I of upper extremity were randomly assigned to either CSG or CIBP group. Patients were treated for 1 week with continuous infusion of 0.125% bupivacaine at 2and 5mL/h, respectively. Catheter was removed at 1 week and patients were followed up for 4 weeks. The outcome was evaluated in terms of neuropathic pain scale score (NPSS), edema scores (Grades 0-2), and range of motion (ROM) of all upper extremity joints (Grades 0-2). CIBP group showed statistically significant improvement in NPSS compared with CSG group during the first 12 hours after the procedures (P value <0.05). After 12 hours, the NPSS was comparable between the groups. At 4 weeks, both groups showed clinically significant improvement in edema score and ROM of all upper extremity joints when compared with the baseline. This preliminary study suggests that CIBP block and CSG block may be feasible and effective interventional techniques for the management of CRPS type I of upper extremities. Hence, we recommend a larger well-randomized, well-controlled, clinical trial to confirm our findings and determine if any significant difference exists between the groups in terms of long-term pain relief and functional restoration. Wiley Periodicals, Inc.

Hydrometeorological extremes derived from taxation records for south-eastern Moravia, Czech Republic, 1751-1900 AD

NASA Astrophysics Data System (ADS)

Brázdil, R.; Chromá, K.; Valášek, H.; Dolák, L.

2012-03-01

Historical written records associated with tax relief at ten estates located in south-eastern Moravia (Czech Republic) are used for the study of hydrometeorological extremes and their impacts during the period 1751-1900 AD. At the time, the taxation system in Moravia allowed farmers to request tax relief if their crop yields had been negatively affected by hydrological and meteorological extremes. The documentation involved contains information about the type of extreme event and the date of its occurrence, while the impact on crops may often be derived. A total of 175 extreme events resulting in some kind of damage are documented for 1751-1900, with the highest concentration between 1811 and 1860 (74.9% of all events analysed). The nature of events leading to damage (of a possible 272 types) include hailstorm (25.7%), torrential rain (21.7%), flood (21.0%), followed by thunderstorm, flash flood, late frost and windstorm. The four most outstanding events, affecting the highest number of settlements, were thunderstorms with hailstorms (25 June 1825, 20 May 1847 and 29 June 1890) and flooding of the River Morava (mid-June 1847). Hydrometeorological extremes in the 1816-1855 period are compared with those occurring during the recent 1961-2000 period. The results obtained are inevitably influenced by uncertainties related to taxation records, such as their temporal and spatial incompleteness, the limits of the period of outside agricultural work (i.e. mainly May-August) and the purpose for which they were originally collected (primarily tax alleviation, i.e. information about hydrometeorological extremes was of secondary importance). Taxation records constitute an important source of data for historical climatology and historical hydrology and have a great potential for use in many European countries.

Hydrometeorological extremes and their impacts, as derived from taxation records for south-eastern Moravia, Czech Republic, AD 1751-1900

NASA Astrophysics Data System (ADS)

Brázdil, R.; Chromá, K.; Valášek, H.; Dolák, L.

2011-12-01

Historical written records associated with tax relief at ten estates located in south-eastern Moravia (Czech Republic) are used for the study of hydrometeorological extremes and their impacts during the period AD 1751-1900. At the time, the taxation system in Moravia allowed farmers to request tax relief if their crop yields had been negatively affected by hydrological and meteorological extremes. The documentation involved contains information about the type of extreme event and the date of its occurrence, while the impact on crops may often be derived. A total of 175 extreme events resulting in some kind of damage is documented for 1751-1900, with the highest concentration between 1811 and 1860 (74.9% of all events analysed). The nature of events leading to damage (of a possible 272 types) include hailstorm (25.7%), torrential rain (21.7%), and flood (21.0%), followed by thunderstorm, flash flood, late frost and windstorm. The four most outstanding events, affecting the highest number of settlements, were thunderstorms with hailstorms (25 June 1825, 20 May 1847 and 29 June 1890) and flooding of the River Morava (mid-June 1847). Hydrometeorological extremes in the 1816-1855 period are compared with those occurring during the recent 1961-2000 period. The results obtained are inevitably influenced by uncertainties related to taxation records, such as their temporal and spatial incompleteness, the limits of the period of outside agricultural work (i.e. mainly May-August) and the purpose for which they were originally collected (primarily tax alleviation, i.e. information about hydrometeorological extremes was of secondary importance). Taxation records constitute an important source of data for historical climatology and historical hydrology and have a great potential for use in many European countries.

Disability in the upper extremity and quality of life in hand-arm vibration syndrome.

PubMed

Poole, Kerry; Mason, Howard

2005-11-30

To investigate whether hand-arm vibration syndrome (HAVS) leads to disability in the upper extremity or deficit in quality of life (QoL) using validated questionnaire tools, and to establish whether these effects are related to the Stockholm Workshop Staging (SWS). This was a postal cross-sectional questionnaire study with a 50% response rate. Four hundred and forty-four males, who had been diagnosed and staged according to the SWS were sent the Disability in the Arm, Shoulder and Hand (DASH) and the SF-36v2 QoL questionnaires. HAVS cases had significantly greater DASH disability scores and reduced QoL physical and mental component scores compared to published normal values. Those HAVS cases with a presumptive diagnosis of Carpal Tunnel Syndrome(CTS) had even higher disability scores. There was a clear, linear relationship between both the DASH disability score and the physical component of the QoL and sensorineural SWS, but not with the vascular SWS. HAVS has a significant effect on an individual's perceived ability to perform everyday tasks involving the upper extremity, and their quality of life. Physical capability may be further compromised in those individuals who have a presumptive diagnosis of CTS. These findings may have important implications regarding management of the affected worker.

Development of the Korean Academy of Medical Sciences Guideline for Rating the Impairment in the Brain Injured and Brain Diseased Persons with Motor Dysfunction

PubMed Central

Baik, Jong Sam; Jang, Seong Ho; Park, Dong Sik

2009-01-01

To develop an objective and scientific method to evaluate the brain injured and brain diseased persons with motor dysfunction, American Medical Association's Guides to the Evaluation of Permanent Impairment was used as an exemplar. After the motor dysfunction due to brain injury or brain disease was confirmed, active range of motion and muscle strength of affected extremities were measured. Also, the total function of extremities was evaluated through the assessment of activities of daily living, fine coordination of hand, balance and gait. Then, the total score of manual muscle test and functional assessment of impaired upper and lower extremity were added, respectively. Spasticity of upper and lower extremity was used as minus factors. Patients with movement disorder such as Parkinson's disease were assessed based on the degree of dysfunction in response to medication. We develop a new rating system based on the concept of total score. PMID:19503680

Heat Vulnerability Index Mapping for Milwaukee and Wisconsin.

PubMed

Christenson, Megan; Geiger, Sarah Dee; Phillips, Jeffrey; Anderson, Ben; Losurdo, Giovanna; Anderson, Henry A

Extreme heat waves elevate the population's risk for heat-related morbidity and mortality, specifically for vulnerable groups such as older adults and young children. In this context, we developed 2 Heat Vulnerability Indices (HVIs), one for the state of Wisconsin and one for the Milwaukee metropolitan area. Through the creation of an HVI, state and local agencies will be able to use the indices as a planning tool for extreme heat events. Data used for the HVIs were grouped into 4 categories: (1) population density; (2) health factors; (3) demographic and socioeconomic factors; and (4) natural and built environment factors. These categories were mapped at the Census block group level. Unweighted z-score data were used to determine index scores, which were then mapped by quantiles ranging from "high" to "low" vulnerability. Statewide, Menominee County exhibited the highest vulnerability to extreme heat. Milwaukee HVI findings indicated high vulnerability in the city's inner core versus low vulnerability along the lakeshore. Visualization of vulnerability could help local public health agencies prepare for future extreme heat events.

Comparison of the severity of lower extremity arterial disease in smokers and patients with diabetes using a novel duplex Doppler scoring system.

PubMed

Hiremath, Rudresh; Gowda, Goutham; Ibrahim, Jebin; Reddy, Harish T; Chodiboina, Haritha; Shah, Rushit

2017-07-01

The aim of this study was to validate the diagnostic feasibility of a novel scoring system of peripheral arterial disease (PAD) in smokers and patients with diabetes depending on duplex Doppler sonographic features. Patients presenting with the symptomatology of PAD were divided into three groups: diabetes only, smoking only, and smokers with diabetes. The patients were clinically examined, a clinical severity score was obtained, and the subjects were categorized into the three extrapolated categories of mild, moderate, and severe. All 106 subjects also underwent a thorough duplex Doppler examination, and various aspects of PAD were assessed and tabulated. These components were used to create a novel duplex Doppler scoring system. Depending on the scores obtained, each individual was categorized as having mild, moderate, or severe illness. The Cohen kappa value was used to assess interobserver agreement between the two scoring systems. Interobserver agreement between the traditional Rutherford clinical scoring system and the newly invented duplex Doppler scoring system showed a kappa value of 0.83, indicating significant agreement between the two scoring systems (P<0.001). Duplex Doppler imaging is an effective screening investigation for lower extremity arterial disease, as it not only helps in its diagnosis, but also in the staging and grading of the disease, providing information that can be utilized for future management and treatment planning.

Accuracy and Efficiency of Recording Pediatric Early Warning Scores Using an Electronic Physiological Surveillance System Compared With Traditional Paper-Based Documentation

PubMed Central

Sefton, Gerri; Lane, Steven; Killen, Roger; Black, Stuart; Lyon, Max; Ampah, Pearl; Sproule, Cathryn; Loren-Gosling, Dominic; Richards, Caitlin; Spinty, Jean; Holloway, Colette; Davies, Coral; Wilson, April; Chean, Chung Shen; Carter, Bernie; Carrol, E.D.

2017-01-01

Pediatric Early Warning Scores are advocated to assist health professionals to identify early signs of serious illness or deterioration in hospitalized children. Scores are derived from the weighting applied to recorded vital signs and clinical observations reflecting deviation from a predetermined “norm.” Higher aggregate scores trigger an escalation in care aimed at preventing critical deterioration. Process errors made while recording these data, including plotting or calculation errors, have the potential to impede the reliability of the score. To test this hypothesis, we conducted a controlled study of documentation using five clinical vignettes. We measured the accuracy of vital sign recording, score calculation, and time taken to complete documentation using a handheld electronic physiological surveillance system, VitalPAC Pediatric, compared with traditional paper-based charts. We explored the user acceptability of both methods using a Web-based survey. Twenty-three staff participated in the controlled study. The electronic physiological surveillance system improved the accuracy of vital sign recording, 98.5% versus 85.6%, P < .02, Pediatric Early Warning Score calculation, 94.6% versus 55.7%, P < .02, and saved time, 68 versus 98 seconds, compared with paper-based documentation, P < .002. Twenty-nine staff completed the Web-based survey. They perceived that the electronic physiological surveillance system offered safety benefits by reducing human error while providing instant visibility of recorded data to the entire clinical team. PMID:27832032

Roy's Adaptation Model-Guided Education and Promoting the Adaptation of Veterans With Lower Extremities Amputation.

PubMed

Azarmi, Somayeh; Farsi, Zahra

2015-10-01

Any defect in extremities of the body can affect different life aspects. The purpose of this study was to investigate the effect of Roy's adaptation model-guided education on promoting the adaptation of veterans with lower extremities amputation. In a randomized clinical trial, 60 veterans with lower extremities amputation referring to Kowsar Orthotics and Prosthetics Center of veterans clinic in Tehran, Iran, were recruited with convenience method and were randomly assigned to intervention and control groups during 2013 - 2014. For data collection, Roy's adaptation model questionnaire was used. After completing the questionnaires in both groups, maladaptive behaviors were determined in the intervention group and an education program based on Roy's adaptation model was implemented. After two months, both groups completed the questionnaires again. Data was analyzed with SPSS software. Independent t-test showed statistically significant differences between the two groups in the post-test stage in terms of the total score of adaptation (P = 0.001) as well as physiologic (P = 0.0001) and role function modes (P = 0.004). The total score of adaptation (139.43 ± 5.45 to 127.54 ± 14.55, P = 0.006) as well as the scores of physiologic (60.26 ± 5.45 to 53.73 ± 7.79, P = 0.001) and role function (20.30 ± 2.42 to 18.13 ± 3.18, P = 0.01) modes in the intervention group significantly increased, whereas the scores of self-concept (42.10 ± 4.71 to 39.40 ± 5.67, P = 0.21) and interdependence (16.76 ± 2.22 to 16.30 ± 2.57, P = 0.44) modes in the two stages did not have a significant difference. Findings of this research indicated that the Roy's adaptation model-guided education promoted the adaptation level of physiologic and role function modes in veterans with lower extremities amputation. However, this intervention could not promote adaptation in self-concept and interdependence modes. More intervention is advised based on Roy's adaptation model for improving the adaptation of veterans with lower extremities.

Portable upper extremity robotics is as efficacious as upper extremity rehabilitative therapy: a randomized controlled pilot trial.

PubMed

Page, Stephen J; Hill, Valerie; White, Susan

2013-06-01

To compare the efficacy of a repetitive task-specific practice regimen integrating a portable, electromyography-controlled brace called the 'Myomo' versus usual care repetitive task-specific practice in subjects with chronic, moderate upper extremity impairment. Sixteen subjects (7 males; mean age 57.0 ± 11.02 years; mean time post stroke 75.0 ± 87.63 months; 5 left-sided strokes) exhibiting chronic, stable, moderate upper extremity impairment. Subjects were administered repetitive task-specific practice in which they participated in valued, functional tasks using their paretic upper extremities. Both groups were supervised by a therapist and were administered therapy targeting their paretic upper extremities that was 30 minutes in duration, occurring 3 days/week for eight weeks. One group participated in repetitive task-specific practice entirely while wearing the portable robotic, while the other performed the same activity regimen manually. The upper extremity Fugl-Meyer, Canadian Occupational Performance Measure and Stroke Impact Scale were administered on two occasions before intervention and once after intervention. After intervention, groups exhibited nearly identical Fugl-Meyer score increases of ≈2.1 points; the group using robotics exhibited larger score changes on all but one of the Canadian Occupational Performance Measure and Stroke Impact Scale subscales, including a 12.5-point increase on the Stroke Impact Scale recovery subscale. Findings suggest that therapist-supervised repetitive task-specific practice integrating robotics is as efficacious as manual practice in subjects with moderate upper extremity impairment.

Minimally important difference of the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q)

PubMed Central

2011-01-01

Background A previous study has documented the reliability and validity of the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) in exploring patient satisfaction with medicines for chronic health conditions in routine medical practice, but the minimally important difference (MID) of this tool is as yet unknown. The objective of this research was to estimate the MID for the SATMED-Q total score and six constituent domains. Methods The sample of patients (456 subjects, mean age 59 years, 53% male) used for testing psychometric properties was also used to assess MID. Item #14 of the Treatment Satisfaction Questionnaire for Medication (TSQM) was used as an anchor reference since it directly explores satisfaction with medicine on a 7-point ordinal scale (from extremely satisfied to extremely dissatisfied, with a neutral category). Patients were classified into four categories according to responses to this item (extremely satisfied/dissatisfied, very satisfied/dissatisfied, satisfied/dissatisfied, neither satisfied nor dissatisfied (neutral), and calculations were made for the total score and each domain of the SATMED-Q using standardised scores. The mean absolute differences in total score (and domains) between the neutral category and the satisfied/dissatisfied category were considered to be the MID. Effect sizes (ES) were also computed. Results The MID for the total score was 13.4 (ES = 0.91), while the domain values ranged from 10.3 (medical care domain, ES = 0.43) to 20.6 (impact on daily living, ES = 0.85). Mean differences in satisfaction (as measured by the total SATMED-Q score and domain scores) using the levels of satisfaction established by item #14 were significantly different, with F values ranging from 12.2 to 88.8 (p < 0.001 in all cases). Conclusion The SATMED-Q was demonstrated to be responsive to different levels of patient satisfaction with therapy in chronically ill subjects. The MID obtained was 13.4 points for the overall normalised scoring scale, and between 10.3 and 20.6 points for domains. PMID:22014277

The Correlation Between Recordable MEPs and Motor Function During Spinal Surgery for Resection of Thoracic Spinal Cord Tumor.

PubMed

Guo, LanJun; Li, Yan; Han, Ruquan; Gelb, Adrian W

2018-01-01

Motor evoked potentials (MEPs) are commonly used during surgery for spinal cord tumor resection. However, it can be difficult to record reliable MEPs from the muscles of the lower extremities during surgery in patients with preoperative weakness due to spinal cord compression. In this study, motor function of patients' lower extremities and their association with intraoperative MEP recording were compared. Patients undergoing thoracic spinal cord tumor resection were studied. Patients' motor function was checked immediately before the surgical procedure. MEP responses were recorded from the tibialis anterior and foot muscles, and the hand muscles were used as control. Electrical current with train of eight pulses, 200 to 500 V was delivered through 2 corkscrews placed at C3' and C4' sites. Anesthesia was maintained by total intravenous anesthesia using a combination of propofol and remifentanil after induction with intravenous propofol, remifentanil, and rocuronium. Rocuronium was not repeated. Bispectral Index was maintained between 40 to 50. From 178 lower limbs of 89 patients, myogenic MEPs could be recorded from 100% (105/105) of the patients with 5 of 5 motor strength in lower extremity; 90% (36/40) from the patients with 4/5 motor strength; only 25% (5/20) with 3/5; and 12.5% (1/8) with 2/5 motor strength; none (0/5) were able to be recorded if the motor strength was 1/5. The ability to record myogenic MEPs is closely associated with the patient's motor function. They are difficult to obtain if motor function is 3/5 motor strength in the lower extremity. They are almost impossible to record if motor function is worse than 3/5.

Symptom severity of patients with advanced cancer in palliative care unit: longitudinal assessments of symptoms improvement.

PubMed

Tai, Shu-Yu; Lee, Chung-Yin; Wu, Chien-Yi; Hsieh, Hui-Ya; Huang, Joh-Jong; Huang, Chia-Tsuan; Chien, Chen-Yu

2016-03-11

This study assessed the symptom severity of patients with advanced cancer in a palliative care unit and explored the factors associated with symptom improvement. This study was conducted in a palliative care unit in Taiwan between October 2004 and December 2009. Symptom intensity was measured by the "Symptom Reporting Form", and graded on a scale of 0 to 4 (0 = none, and 4 = extreme). These measures were assessed on the 1(st), 3(rd), 5(th), and 7(th) Day in the palliative care unit. The study data comprised routine clinical records and patients' demographic data. Generalized estimating equation (GEE) was used to assess the symptom improvement, and investigate the factors associated with the symptom reporting form scores. Among the 824 recruited patients with advanced cancer, pain (78.4%), anorexia (64.4%) and constipation (63.5%) were the most common and severe symptom. After controlling for other factors in the multivariate GEE model, the day of palliative care administration was a significant factor associated with all of the scales, except Days 7 on the dyspnoea and oedema scales and Day 5 on the anxiety scale. In addition, patients aged ≥ 65 years exhibited significantly lower scores on the pain, sleep disturbance, depression, and anxiety scales than did those aged < 65 years. Moreover, female patients exhibited higher scores on the vomiting, anorexia, oedema, depression, and anxiety scales than did male patients. Furthermore, patients with gastrointestinal tract cancer exhibited higher scores on the constipation, vomiting, anorexia, oedema, depression, and anxiety scales and lower scores on the dyspnoea scale than did those with lung cancer. Patients with breast cancer exhibited higher scores on the oedema scale and lower scores on the anxiety scale. Patients with genitourinary cancer exhibited higher scores on the vomiting and oedema scales and lower scores on the dyspnoea scale. Patients with head, neck, and oral cancer exhibited lower scores on the oedema scale alone. The symptom severity declined during the first week in the palliative care unit. In addition, differences in sex and primary cancer sites may contribute to varying degrees of symptom improvement.

Assessing functional mobility in survivors of lower-extremity sarcoma: reliability and validity of a new assessment tool.

PubMed

Marchese, Victoria G; Rai, Shesh N; Carlson, Claire A; Hinds, Pamela S; Spearing, Elena M; Zhang, Lijun; Callaway, Lulie; Neel, Michael D; Rao, Bhaskar N; Ginsberg, Jill P

2007-08-01

Reliability and validity of a new tool, Functional Mobility Assessment (FMA), were examined in patients with lower-extremity sarcoma. FMA requires the patients to physically perform the functional mobility measures, unlike patient self-report or clinician administered measures. A sample of 114 subjects participated, 20 healthy volunteers and 94 patients with lower-extremity sarcoma after amputation, limb-sparing, or rotationplasty surgery. Reliability of the FMA was examined by three raters testing 20 healthy volunteers and 23 subjects with lower-extremity sarcoma. Concurrent validity was examined using data from 94 subjects with lower-extremity sarcoma who completed the FMA, Musculoskeletal Tumor Society (MSTS), Short-Form 36 (SF-36v2), and Toronto Extremity Salvage Scale (TESS) scores. Construct validity was measured by the ability of the FMA to discriminate between subjects with and without functional mobility deficits. FMA demonstrated excellent reliability (ICC [2,1] >or=0.97). Moderate correlations were found between FMA and SF-36v2 (r = 0.60, P < 0.01), FMA and MSTS (r = 0.68, P < 0.01), and FMA and TESS (r = 0.62, P < 0.01). The patients with lower-extremity sarcoma scored lower on the FMA as compared to healthy controls (P < 0.01). The FMA is a reliable and valid functional outcome measure for patients with lower-extremity sarcoma. This study supports the ability of the FMA to discriminate between patients with varying functional abilities and supports the need to include measures of objective functional mobility in examination of patients with lower-extremity sarcoma.

Outcomes and Disability After Massive Proximal Upper Extremity Reconstruction in a Resource-Limited Setting.

PubMed

Giladi, Aviram M; Shanmugakrishnan, R Raja; Venkatramani, Hari; Raja Sekaran, S; Chung, Kevin C; Sabapathy, S Raja

2017-06-01

At Ganga Hospital in Coimbatore, India, a unique approach is applied to treat massive upper limb injuries. However, long-term outcomes of complex reconstruction performed in the resource-limited setting are not known. This hinders understanding of outcomes and disability from these injuries and prevents systematically addressing care delivery around upper extremity trauma in the developing world. This project aims to analyze the details of the unique Ganga Hospital reconstruction experience and use patient-reported outcome measures for the first time in this patient population to evaluate post-injury recovery and disability . Forty-six patients were evaluated 6 months or more after massive proximal upper extremity reconstruction at Ganga Hospital. Patients completed functional tests, Jebsen-Taylor test (JTT), and patient-reported outcomes (PROs)-Michigan Hand Questionnaire (MHQ), Disability of Arm, Shoulder, and Hand questionnaire (DASH), and Short-Form 36 (SF-36). Correlations between metrics were assessed with Pearson's correlation coefficients. Linear regression modeling evaluated associations between severity, reconstruction, and outcomes. MHQ and DASH results correlated with functional test performance, JTT performance, and SF-36 scores (Pearson's coefficients all ≥0.33, p ≤ 0.05). In this cohort, mean MHQ score was 79 ± 15 and mean DASH score was 13 ± 15, which are not significantly different than scores for long-term outcomes after other complex upper extremity procedures. The following factors predicted PROs and functional performance after reconstruction: extent of soft tissue reconstruction, multi-segmental ulna fractures, median nerve injury, and ability for patients to return to work and maintain their job after injury. Complex proximal upper extremity salvage can be performed in the resource-limited setting with excellent long-term functional and patient-reported outcomes. PRO questionnaires are useful for reporting outcomes that correlate to functional and sensory testing and may be used to assess post-traumatic disability.

Extreme Drought Events Revealed in Amazon Tree Ring Records

NASA Astrophysics Data System (ADS)

Jenkins, H. S.; Baker, P. A.; Guilderson, T. P.

2010-12-01

The Amazon basin is a center of deep atmospheric convection and thus acts as a major engine for global hydrologic circulation. Yet despite its significance, a full understanding of Amazon rainfall variability remains elusive due to a poor historical record of climate. Temperate tree rings have been used extensively to reconstruct climate over the last thousand years, however less attention has been given to the application of dendrochronology in tropical regions, in large part due to a lower frequency of tree species known to produce annual rings. Here we present a tree ring record of drought extremes from the Madre de Dios region of southeastern Peru over the last 190 years. We confirm that tree ring growth in species Cedrela odorata is annual and show it to be well correlated with wet season precipitation. This correlation is used to identify extreme dry (and wet) events that have occurred in the past. We focus on drought events identified in the record as drought frequency is expected to increase over the Amazon in a warming climate. The Cedrela chronology records historic Amazon droughts of the 20th century previously identified in the literature and extends the record of drought for this region to the year 1816. Our analysis shows that there has been an increase in the frequency of extreme drought (mean recurrence interval = 5-6 years) since the turn of the 20th century and both Atlantic and Pacific sea surface temperature (SST) forcing mechanisms are implicated.

Principles and Practices of Test Score Equating. Research Report. ETS RR-10-29

ERIC Educational Resources Information Center

Dorans, Neil J.; Moses, Tim P.; Eignor, Daniel R.

2010-01-01

Score equating is essential for any testing program that continually produces new editions of a test and for which the expectation is that scores from these editions have the same meaning over time. Particularly in testing programs that help make high-stakes decisions, it is extremely important that test equating be done carefully and accurately.…

Overcoming the Volatility in School-Level Gain Scores: A New Approach to Identifying Value Added with Cross-Sectional Data

ERIC Educational Resources Information Center

Kelly, Sean; Monczunski, Laura

2007-01-01

Traditionally, state accountability systems have measured school-level achievement gains using cross-sectional data, for example, by comparing scores of one year's eighth graders to scores of the next year's eighth graders. This approach produces extremely volatile estimates of value added from year to year. This volatility suggests that the…

A Risk Score for Predicting Multiple Sclerosis.

PubMed

Dobson, Ruth; Ramagopalan, Sreeram; Topping, Joanne; Smith, Paul; Solanky, Bhavana; Schmierer, Klaus; Chard, Declan; Giovannoni, Gavin

2016-01-01

Multiple sclerosis (MS) develops as a result of environmental influences on the genetically susceptible. Siblings of people with MS have an increased risk of both MS and demonstrating asymptomatic changes in keeping with MS. We set out to develop an MS risk score integrating both genetic and environmental risk factors. We used this score to identify siblings at extremes of MS risk and attempted to validate the score using brain MRI. 78 probands with MS, 121 of their unaffected siblings and 103 healthy controls were studied. Personal history was taken, and serological and genetic analysis using the illumina immunochip was performed. Odds ratios for MS associated with each risk factor were derived from existing literature, and the log values of the odds ratios from each of the risk factors were combined in an additive model to provide an overall score. Scores were initially calculated using log odds ratio from the HLA-DRB1*1501 allele only, secondly using data from all MS-associated SNPs identified in the 2011 GWAS. Subjects with extreme risk scores underwent validation studies. MRI was performed on selected individuals. There was a significant difference in the both risk scores between people with MS, their unaffected siblings and healthy controls (p<0.0005). Unaffected siblings had a risk score intermediate to people with MS and controls (p<0.0005). The best performing risk score generated an AUC of 0.82 (95%CI 0.75-0.88). The risk score demonstrates an AUC on the threshold for clinical utility. Our score enables the identification of a high-risk sibling group to inform pre-symptomatic longitudinal studies.

An Examination of Lower Extremity Function and its Correlates in Older African American and White Men.

PubMed

Clay, Olivio J; Thorpe, Roland J; Wilkinson, Larrell L; Plaisance, Eric P; Crowe, Michael; Sawyer, Patricia; Brown, Cynthia J

2015-08-07

Maintaining functional status and reducing/eliminating health disparities in late life are key priorities. Older African Americans have been found to have worse lower extremity functioning than Whites, but little is known about potential differences in correlates between African American and White men. The goal of this investigation was to examine measures that could explain this racial difference and to identify race-specific correlates of lower extremity function. Data were analyzed for a sample of community-dwelling men. Linear regression models examined demographics, medical conditions, health behaviors, and perceived discrimination and mental health as correlates of an objective measure of lower extremity function, the Short Physical Performance Battery (SPPB). Scores on the SPPB have a potential range of 0 to 12 with higher scores corresponding to better functioning. The mean age of all men was 74.9 years (SD=6.5), and the sample was 50% African American and 53% rural. African American men had scores on the SPPB that were significantly lower than White men after adjusting for age, rural residence, marital status, education, and income difficulty (P<.01). Racial differences in cognitive functioning accounted for approximately 41% of the race effect on physical function. Additional models stratified by race revealed a pattern of similar correlates of the SPPB among African American and White men. The results of this investigation can be helpful for researchers and clinicians to aid in identifying older men who are at-risk for poor lower extremity function and in planning targeted interventions to help reduce disparities.

Knee arthodesis using a modular customized intramedullary nail.

PubMed

Letartre, R; Combes, A; Autissier, G; Bonnevialle, N; Gougeon, F

2009-11-01

Arthrodesis of the knee, particularly in infectious situations, can be achieved using either an external fixator or an intramedullary device. The objective of this study is to report the clinical, functional, and radiographic outcomes of a continuous series of 19 cases of knee arthrodesis using a customized modular intramedullary nailing system. The modular intramedullary nail offers a satisfactory functional result while maintaining limb length, in spite of a nonunion risk, since acting like a true endoprosthesis. In our retrospective series of 19 patients, the main source of patients were infected total knee replacements. The nail was customized from assembling a dual surface-sanded titanium component (femoral and tibial). The Lequesne Algofunctional score and the WOMAC score were recorded, as well as the length discrepancy between the lower extremities. Arthrodesis consolidation and the nail's fit in the shaft were verified on anterior-posterior (AP) and lateral radiographs. Five complications were observed: one anterior cortical break, one excessive tibial rotation, two cases of delayed union, and one nail revision due to residual nail instability. The postoperative Lequesne Algofunctional score was 13/24 and the WOMAC score 57/100. The nonunion rate was 32%. From a functional point of view, the patients who did not achieve complete union and those who did had similar scores. The subjective results were not as good in patients who did not achieve final consolidation. Modular intramedullary nailing simplifies the technique, shortens the procedure, and reduces the amount of blood loss at surgery. Our nonunion rate was high, although the functional result did not seem compromised by such nonunion. The risk of long-term implant failure was not studied and requires longer follow-up studies. Level IV therapeutic study. 2009 Published by Elsevier Masson SAS.

Nintendo Wii assessment of Hoehn and Yahr score with Parkinson's disease tremor.

PubMed

Koçer, Abdulkadir; Oktay, Ayse Betul

2016-01-01

Diagnosis of Parkinson's Disease (PD) by analyzing the resting tremor were much studied by using different accelerometer based methods, however the quantitative assessment of Hoehn and Yahr Scale (HYS) score with a machine learning based system has not been previously addressed. In this study, we aimed to propose a system to automatically assess the HYS score of patients with PD. The system was evaluated and tested on a dataset containing 55 subjects where 35 of them were patients and 20 of them were healthy controls. The resting tremor data were gathered with the 3 axis accelerometer of the Nintendo Wii (Wiimote). The clinical disability of the PD was graded from 1 to 5 by the HYS and tremor was recorded twice from the more affected side in each patient and from the dominant extremity in each control for a 60 seconds period. The HYS scores were learned with Support Vector Machines (SVM) from the features of the tremor data. Thirty-two of the subjects with PD were classified correctly and 18 of the normal subjects were also classified correctly by our system. The system had average 0.89 accuracy rate (Range: 81-100% changing according to grading by HYS). We compared quantitative measurements of hand tremor in PD patients, with staging of PD based on accelerometer data gathered using the Wii sensor. Our results showed that the machine learning based system with simple features could be helpful for diagnosis of PD and estimate HYS score. We believed that this portable and easy-to-use Wii sensor measure might also be applicable in the continuous monitoring of the resting tremor with small modifications in routine clinical use.

Retrospective Analysis of an Ongoing Group-Based Modified Constraint-Induced Movement Therapy Program for Children with Acquired Brain Injury.

PubMed

Komar, Alyssa; Ashley, Kelsey; Hanna, Kelly; Lavallee, Julia; Woodhouse, Janet; Bernstein, Janet; Andres, Matthew; Reed, Nick

2016-01-01

A pretest-posttest retrospective design was used to evaluate the impact of a group-based modified constraint-induced movement therapy (mCIMT) program on upper extremity function and occupational performance. 20 children ages 3 to 18 years with hemiplegia following an acquired brain injury participated in a 2-week group mCIMT program. Upper extremity function was measured with the Assisting Hand Assessment (AHA) and subtests from the Quality of Upper Extremity Skills Test (QUEST). Occupational performance and satisfaction were assessed using the Canadian Occupational Performance Measure (COPM). Data were analyzed using a Wilcoxon signed-ranks test. Group-based analysis revealed upper extremity function and occupational performance attained statistically significant improvements from pre- to postintervention on all outcome measures (AHA: Z = -3.63, p = <.001; QUEST Grasps: Z = -3.10, p = .002; QUEST Dissociated Movement: Z = -2.51, p = .012; COPM Performance: Z = -3.64, p = <.001; COPM Satisfaction: Z = -3.64, p = <.001). Across individuals, clinically significant improvements were found in 65% of participants' AHA scores. 80% of COPM Performance scores and 70% of COPM Satisfaction scores demonstrated clinically significant improvements in at least one identified goal. This study is an initial step in evaluating and providing preliminary evidence supporting the effectiveness of a group-based mCIMT program for children with hemiplegia following an acquired brain injury.

Hydrometeorological extremes and their impacts derived from taxation records for south-eastern Moravia (Czech Republic) in the period 1751-1900

NASA Astrophysics Data System (ADS)

Chromá, K.; Brázdil, R.; Valášek, H.; Dolák, L.

2012-04-01

Hydrometeorological extremes always influenced human activities and caused great material damage or even loss of human lives. In the Czech Lands (recently the Czech Republic), systematic meteorological and hydrological observations started generally in the latter half of the 19th century. In order to create long-term series of hydrometeorological extremes, it is necessary to search for other sources of information for their study before 1850. In this study, written records associated with tax relief at ten estates located in south-eastern Moravia are used for the study of hydrometeorological extremes and their impacts during the period 1751-1900. The taxation system in Moravia allowed farmers to request tax relief if their crop yields had been negatively affected by hydrological and meteorological extremes. The documentation involved contains information about the type of extreme event and the date of its occurrence, and the impacts on crops may often be derived. A total of 175 extreme events resulting in some kind of damage is documented for 1751-1900, with the highest concentration between 1811 and 1860. The nature of events leading to damage (of a possible 272 types) include hailstorm (25.7%), torrential rain (21.7%), and flood (21.0%), followed by thunderstorm, flash flood, late frost and windstorm. The four most outstanding events, affecting the highest number of settlements, were thunderstorms with hailstorms (25 June 1825, 20 May 1847 and 29 June 1890) and flooding of the River Morava (mid-June 1847). Hydrometeorological extremes in the 1816-1855 period are compared with those occurring during the recent 1961-2000 period. The results obtained are inevitably influenced by uncertainties related to taxation records, such as their temporal and spatial incompleteness, the limits of the period of outside agricultural work (i.e. mainly May-August) and the purpose for which they were originally collected (primarily tax alleviation, i.e. information about hydrometeorological extremes was of secondary importance). Taxation records represent an important source of data for historical climatology and historical hydrology and have a great potential for use.

Extreme temperatures in Southeast Asia caused by El Niño and worsened by global warming

NASA Astrophysics Data System (ADS)

Thirumalai, Kaustubh; Dinezio, Pedro N.; Okumura, Yuko; Deser, Clara

2017-06-01

In April 2016, southeast Asia experienced surface air temperatures (SATs) that surpassed national records, exacerbated energy consumption, disrupted agriculture and caused severe human discomfort. Here we show using observations and an ensemble of global warming simulations the combined impact of the El Niño/Southern Oscillation (ENSO) phenomenon and long-term warming on regional SAT extremes. We find a robust relationship between ENSO and southeast Asian SATs wherein virtually all April extremes occur during El Niño years. We then quantify the relative contributions of long-term warming and the 2015-16 El Niño to the extreme April 2016 SATs. The results indicate that global warming increases the likelihood of record-breaking April extremes where we estimate that 29% of the 2016 anomaly was caused by warming and 49% by El Niño. These post-Niño Aprils can potentially be anticipated a few months in advance, and thus, help societies prepare for the projected continued increases in extremes.

Extreme temperatures in Southeast Asia caused by El Niño and worsened by global warming.

PubMed

Thirumalai, Kaustubh; DiNezio, Pedro N; Okumura, Yuko; Deser, Clara

2017-06-06

In April 2016, southeast Asia experienced surface air temperatures (SATs) that surpassed national records, exacerbated energy consumption, disrupted agriculture and caused severe human discomfort. Here we show using observations and an ensemble of global warming simulations the combined impact of the El Niño/Southern Oscillation (ENSO) phenomenon and long-term warming on regional SAT extremes. We find a robust relationship between ENSO and southeast Asian SATs wherein virtually all April extremes occur during El Niño years. We then quantify the relative contributions of long-term warming and the 2015-16 El Niño to the extreme April 2016 SATs. The results indicate that global warming increases the likelihood of record-breaking April extremes where we estimate that 29% of the 2016 anomaly was caused by warming and 49% by El Niño. These post-Niño Aprils can potentially be anticipated a few months in advance, and thus, help societies prepare for the projected continued increases in extremes.

From Drought to Flood: Biological Responses of Large River Salmonids and Emergent Management Challenges Under California's Extreme Hydroclimatic Variability

NASA Astrophysics Data System (ADS)

Anderson, C.

2017-12-01

California's hydroclimatic regime is characterized by extreme interannual variability including periodic, multi-year droughts and winter flooding sequences. Statewide, water years 2012-2016 were characterized by extreme drought followed by likely one of the wettest years on record in water year 2017. Similar drought-flood patterns have occurred multiple times both in the contemporary empirical record and reconstructed climate records. Both the extreme magnitude and rapid succession of these hydroclimatic periods pose difficult challenges for water managers and regulatory agencies responsible for providing instream flows to protect and recover threatened and endangered fish species. Principal among these riverine fish species are federally listed winter-run and spring-run Chinook salmon (Oncorhynchus tshawytscha), Central Valley steelhead (Oncorhynchus mykiss), and the pelagic species Delta smelt (Hypomesus transpacificus). Poor instream conditions from 2012-2016 resulted in extremely low abundance estimates and poor overall fish health, and while fish monitoring results from water year 2017 are too preliminary to draw substantive conclusions, early indicators show continued downward population trends despite the historically wet conditions. This poster evaluates California's hydroclimatic conditions over the past decade and quantifies resultant impacts of the 2012-2016 drought and the extremely wet 2017 water year to both adult escapement and juvenile production estimates in California's major inland salmon rivers over that same time span. We will also examine local, state, and federal regulatory actions both in response to the extreme hydroclimatic variability and in preparation for future drought-flood sequences.

Reliability and validity of the upper-extremity Motor Activity Log-14 for measuring real-world arm use.

PubMed

Uswatte, Gitendra; Taub, Edward; Morris, David; Vignolo, Mary; McCulloch, Karen

2005-11-01

In research on Constraint-Induced Movement (CI) therapy, a structured interview, the Motor Activity Log (MAL), is used to assess how stroke survivors use their more-impaired arm outside the laboratory. This article examines the psychometrics of the 14-item version of this instrument in 2 chronic stroke samples with mild-to-moderate upper-extremity hemiparesis. Participants (n=41) in the first study completed MALs before and after CI therapy or a placebo control procedure. In addition, caregivers independently completed a MAL on the participants. Participants (n=27) in the second study completed MALs and wore accelerometers that monitored their arm movements for 3 days outside the laboratory before and after an automated form of CI therapy. Validity of the participant MAL Quality of Movement (QOM) scale was supported. Correlations between pretreatment-to-posttreatment change scores on the participant QOM scale and caregiver MAL QOM scale, caregiver MAL amount of use (AOU) scale, and accelerometer recordings were 0.70, 0.73, and 0.91 (P<0.01), respectively. Internal consistency (alpha>0.81), test-retest reliability (r>0.91), stability, and responsiveness (ratio>3) of the participant QOM scale were also supported. The participant AOU and caregiver QOM and AOU scales were internally consistent, stable, and sensitive, but were not reliable. The participant MAL QOM scale can be used exclusively to reliably and validly measure real-world, upper-extremity rehabilitation outcome and functional status in chronic stroke patients with mild-to-moderate hemiparesis.

High-capacity high-speed recording

NASA Astrophysics Data System (ADS)

Jamberdino, A. A.

1981-06-01

Continuing advances in wideband communications and information handling are leading to extremely large volume digital data systems for which conventional data storage techniques are becoming inadequate. The paper presents an assessment of alternative recording technologies for the extremely wideband, high capacity storage and retrieval systems currently under development. Attention is given to longitudinal and rotary head high density magnetic recording, laser holography in human readable/machine readable devices and a wideband recorder, digital optical disks, and spot recording in microfiche formats. The electro-optical technologies considered are noted to be capable of providing data bandwidths up to 1000 megabits/sec and total data storage capacities in the 10 to the 11th to 10 to the 12th bit range, an order of magnitude improvement over conventional technologies.

GWOT Vascular Injury Study 2 Supplemental Project: Impact of Prophylactic Fasciotomy

DTIC Science & Technology

2016-10-01

total #) 15 10% 5 7% Overall Average 8.27 9.00 Overall Range 8-9 9-9 3 Mangled Extremity Severity Score: The most widely used lower - limb ...trauma, crush, blunt trauma, burns, and fractures . Each of these injuries places the wounded Service members at risk for developing acute extremity... lower extremity vascular injury will be used to determine fasciotomy rates, wound management, and iatrogenic complications. The impact of injury and

Confidence assignment for mass spectrometry based peptide identifications via the extreme value distribution.

PubMed

Alves, Gelio; Yu, Yi-Kuo

2016-09-01

There is a growing trend for biomedical researchers to extract evidence and draw conclusions from mass spectrometry based proteomics experiments, the cornerstone of which is peptide identification. Inaccurate assignments of peptide identification confidence thus may have far-reaching and adverse consequences. Although some peptide identification methods report accurate statistics, they have been limited to certain types of scoring function. The extreme value statistics based method, while more general in the scoring functions it allows, demands accurate parameter estimates and requires, at least in its original design, excessive computational resources. Improving the parameter estimate accuracy and reducing the computational cost for this method has two advantages: it provides another feasible route to accurate significance assessment, and it could provide reliable statistics for scoring functions yet to be developed. We have formulated and implemented an efficient algorithm for calculating the extreme value statistics for peptide identification applicable to various scoring functions, bypassing the need for searching large random databases. The source code, implemented in C ++ on a linux system, is available for download at ftp://ftp.ncbi.nlm.nih.gov/pub/qmbp/qmbp_ms/RAId/RAId_Linux_64Bit yyu@ncbi.nlm.nih.gov Supplementary data are available at Bioinformatics online. Published by Oxford University Press 2016. This work is written by US Government employees and is in the public domain in the US.

[A randomized controlled trial: acclimatization training on the prevention of motion sickness in hot-humid environment].

PubMed

Zhang, Lei; Mao, Jun-Feng; Wu, Xiao-Nong; Bao, Ying-Chun

2014-05-01

Incidence and severity of motion sickness (MS) in hot-humid environment are extremely high. We tried to know the effect of two-stage training for reducing incidence and severity of ms. Sixty male subjects were divided into experimental group and control group randomly. Subjects in experimental group received: (2) adaptation training including sitting, walking and running in hot lab. After adaptation confirmation based on subjective feeling, rectal temperature, heart rate, blood Pressure, sweat rates and sweat salt concentration, we tested both groups by Coriolis acceleration revolving chair test and recorded Graybiel's score and grading of severity to evaluate whether adaptation training was useful; (2) Anti-dizzy training 3m later of deacclimatization contained revolving chair training for 10 times. Then we did the same test as mentioned above to evaluate effect of anti-dizzy training. RESULST: Graybiel' s score and grading of severity had no difference between two groups through acclimatization training (P > 0.05). While they had difference through anti-dizzy training (P < 0.01). Adaptation training seems useless for reducing incidence and severity of MS in hot-humid environment, but anti-dizzy training is useful.

Genetic parameters for test day somatic cell score in Brazilian Holstein cattle.

PubMed

Costa, C N; Santos, G G; Cobuci, J A; Thompson, G; Carvalheira, J G V

2015-12-29

Selection for lower somatic cell count has been included in the breeding objectives of several countries in order to increase resistance to mastitis. Genetic parameters of somatic cell scores (SCS) were estimated from the first lactation test day records of Brazilian Holstein cows using random-regression models with Legendre polynomials (LP) of the order 3-5. Data consisted of 87,711 TD produced by 10,084 cows, sired by 619 bulls calved from 1993 to 2007. Heritability estimates varied from 0.06 to 0.14 and decreased from the beginning of the lactation up to 60 days in milk (DIM) and increased thereafter to the end of lactation. Genetic correlations between adjacent DIM were very high (>0.83) but decreased to negative values, obtained with LP of order four, between DIM in the extremes of lactation. Despite the favorable trend, genetic changes in SCS were not significant and did not differ among LP. There was little benefit of fitting an LP of an order >3 to model animal genetic and permanent environment effects for SCS. Estimates of variance components found in this study may be used for breeding value estimation for SCS and selection for mastitis resistance in Holstein cattle in Brazil.

Prevalence of iron deficiency without anaemia in inflammatory bowel disease and impact on health-related quality of life.

PubMed

González Alayón, Carlos; Pedrajas Crespo, Carolina; Marín Pedrosa, Sandra; Benítez, José Manuel; Iglesias Flores, Eva; Salgueiro Rodríguez, Isabel; Medina Medina, Rosario; García-Sánchez, Valle

2018-01-01

Iron deficiency without anaemia (IDWA) is commonly found in outpatients with inflammatory bowel disease (IBD) in an even higher proportion than anaemia. However, its true prevalence and possible impact on health-related quality of life (HRQoL) are unknown. The objectives of this study were: to establish the prevalence of IDWA, identify possible associated factors and measure their impact on HRQoL. 127 patients with IBD in an outpatient setting were consecutively included in an observational, descriptive, cross-sectional study. IDWA was defined as ferritin levels of <100 ng/ml with inflammatory activity or ≤30 ng/ml without it, with transferrin saturation of ≤16%, and with normal haemoglobin levels. HRQoL was assessed using two questionnaires: the IBDQ-9 for symptoms related to IBD and the FACIT-F to measure the presence of fatigue. Fatigue was considered extreme with a score of ≤30 points. The prevalence of IDWA was 37%. Variables associated with its occurrence were female gender (OR=2.9; p=.015) and the presence of inflammatory activity (OR=9.4; p=.001). Patients with IDWA presented HRQoL questionnaires with lower overall scores; decreases of 6.6 (p<.001) and 4.3 (p=.037) points in the IBDQ-9 and the FACIT-F were recorded, respectively. In addition, an increase of 29.4% in the presence of extreme fatigue was observed. The prevalence of IDWA is considerable in outpatients with IBD. IDWA is associated with female gender and inflammatory activity. It has a clear negative impact on HRQoL. A more active approach is needed to treat this complication. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Extreme Flood Events Over the Past 300 Years Recorded in the Sediments of a Mountain Lake in the Altay Mountains, Northwestern China

NASA Astrophysics Data System (ADS)

Wu, J.; Zhou, J.; Shen, B.; Zeng, H.

2017-12-01

Global climate change has the potential to accelerate the hydrological cycle, which may further enhance the temporal frequency of regional extreme floods. Climatic models predict that intra-annual rainfall variability will intensify, which will shift current rainfall regimes towards more extreme systems with lower precipitation frequencies, longer dry periods, and larger individual precipitation events worldwide. Understanding the temporal variations of extreme floods that occur in response to climate change is essential to anticipate the trends in flood magnitude and frequency in the context of global warming. However, currently available instrumental data are not long enough for capturing the most extreme events, thus the acquisition of long duration datasets for historical floods that extend beyond available instrumental records is clearly an important step in discerning trends in flood frequency and magnitude with respect to climate change. In this study, a reconstruction of paleofloods over the past 300 years was conducted through an analysis of grain sizes from the sediments of Kanas Lake in the Altay Mountains of northwestern China. Grain parameters and frequency distributions both demonstrate that two abrupt environment changes exist within the lake sedimentary sequence. Based on canonical discriminant analysis (CDA) and C-M pattern analysis, two flood events corresponding to ca. 1760 AD and ca. 1890 AD were identified, both of which occurred during warmer and wetter climate conditions according to tree-ring records. These two flood events are also evidenced by lake sedimentary records in the Altay and Tianshan areas. Furthermore, through a comparison with other records, the flood event in ca. 1760 AD seems to have occurred in both the arid central Asia and the Alps in Europe, and thus may have been associated with changes in the North Atlantic Oscillation (NAO) index.

Angiographic assessment of atherosclerotic load at the lower extremity in patients with diabetic foot and charcot neuro-arthropathy.

PubMed

Çildağ, Mehmet B; Ertuğrul, Bülent M; Köseoğlu, Ömer Fk; Çildağ, Songül; Armstrong, David G

2018-06-01

The aim of this study was to investigate atherosclerotic load at the lower extremity in patients with diabetic foot and charcot neuro-arthropathy and compare them with patients with diabetic foot without charcot neuro-arthropathy. This retrospective study consists of 78 patients with diabetic foot who had lower extremity angiography with antegrade approach. All patients were classified into two groups; neuro ischemic wounds with charcot neuro-arthropathy (30/78) and without charcot neuro-arthropathy (48/78).Atherosclerotic load at the side of diabetic foot was determined by using the Bollinger angiogram scoring method. Comparison of atherosclerotic load between the two groups was performed. The mean of total and infrapopliteal level angiogram scoring of all patients was 33.3 (standard deviation, sd:±17.2) and 29.3 (sd:±15.6), respectively. The mean of total and infrapopliteal level angiogram scoring of neuroischemic wounds with charcot neuro-arthropathy group was 18.1 (sd:±11.6) and 15.7 (sd:±10.4), respectively. The mean of total and infrapopliteal level angiogram scoring of neuroischemic wounds without charcot neuro-arthropathy group was 42.8 (sd:±12.7) and 37.7 (sd:±12.0), respectively. There was a statistically significant difference between the two groups of mean total and infrapopliteal angiogram scoring (p < 0.01). This angiographic study confirms that the atherosclerotic load in patients with diabetic foot and chronic charcot neuro-arthropathy is significantly less than in patients with neuroischemic diabetic foot wounds without chronic charcot neuro-arthropathy. Copyright © 2017. Published by Elsevier Taiwan LLC.

Muscle Strength and Changes in Physical Function in Women With Systemic Lupus Erythematosus.

PubMed

Andrews, James S; Trupin, Laura; Schmajuk, Gabriela; Barton, Jennifer; Margaretten, Mary; Yazdany, Jinoos; Yelin, Edward H; Katz, Patricia P

2015-08-01

Cross-sectional studies have observed that muscle weakness is associated with worse physical function among women with systemic lupus erythematosus (SLE). The present study examines whether reduced upper and lower extremity muscle strength predict declines in function over time among adult women with SLE. One hundred forty-six women from a longitudinal SLE cohort participated in the study. All measures were collected during in-person research visits approximately 2 years apart. Upper extremity muscle strength was assessed by grip strength. Lower extremity muscle strength was assessed by peak knee torque of extension and flexion. Physical function was assessed using the Short Physical Performance Battery (SPPB). Regression analyses modeled associations of baseline upper and lower extremity muscle strength with followup SPPB scores controlling for baseline SPPB, age, SLE duration, SLE disease activity (Systemic Lupus Activity Questionnaire), physical activity level, prednisone use, body composition, and depression. Secondary analyses tested whether associations of baseline muscle strength with followup in SPPB scores differed between intervals of varying baseline muscle strength. Lower extremity muscle strength strongly predicted changes over 2 years in physical function even when controlling for covariates. The association of reduced lower extremity muscle strength with reduced physical function in the future was greatest among the weakest women. Reduced lower extremity muscle strength predicted clinically significant declines in physical function, especially among the weakest women. Future studies should test whether therapies that promote preservation of lower extremity muscle strength may prevent declines in function among women with SLE. © 2015, American College of Rheumatology.

Portable Upper Extremity Robotics is as Efficacious as Upper Extremity Rehabilitative Therapy: A Randomized Controlled Pilot Trial

PubMed Central

Page, Stephen J.; Hill, Valerie; White, Susan

2013-01-01

Objective To compare the efficacy of a repetitive task specific practice regimen integrating a portable, electromyography-controlled brace called the “Myomo” versus usual care repetitive task specific practice in subjects with chronic, moderate upper extremity impairment. Subjects 16 subjects (7 males; mean age = 57.0 ± 11.02 years; mean time post stroke = 75.0 ± 87.63 months; 5 left-sided strokes) exhibiting chronic, stable, moderate upper extremity impairment. Interventions Subjects were administered repetitive task specific practice in which they participated in valued, functional tasks using their paretic upper extremities. Both groups were supervised by a therapist and were administered therapy targeting their paretic upper extremities that was 30-minutes in duration, occurring 3 days/week for 8 weeks. However, one group participated in repetitive task specific practice entirely while wearing the portable robotic while the other performed the same activity regimen manually.. Main Outcome Measures The upper extremity Fugl-Meyer, Canadian Occupational Performance measure and Stroke Impact Scale were administered on two occasions before intervention and once after intervention. Results After intervention, groups exhibited nearly-identical Fugl-Meyer score increases of ≈ 2.1 points; the group using robotics exhibited larger score changes on all but one of the Canadian occupational performance measure and Stroke Impact Scale subscales, including a 12.5-point increase on the Stroke Impact Scale recovery subscale. Conclusions Findings suggest that therapist-supervised repetitive task specific practice integrating robotics is as efficacious as manual in subjects with moderate upper extremity impairment. PMID:23147552

Score-Informed Musical Source Separation and Reconstruction

ERIC Educational Resources Information Center

Han, Yushen

2013-01-01

A systematic approach to retrieve individual parts in a monaural music recording with its score is introduced. We are interested in isolating the accompaniment part by removing the solo part from a recording of concerto music in which a solo instrument is accompanied by an orchestra. We require the music audio, the score, and optionally a sample…

DayRec: An Interface for Exploring United States Record-Maximum/Minimum Daily Temperatures

DOE Data Explorer

Kaiser, Dale [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

2015-01-01

Like politics, you might say that all climate is local. As researchers seek to help the public better understand climate and climate change, a sensible approach would include helping people know more about changes in their own backyards. High and low temperatures are something that all of us pay attention to each day; when they are extreme (flirting with or setting records) they generate tremendous interest, largely because of the potential for significant impacts on human health, the environment, and built infrastructure. Changes through time in record high and low temperatures (extremes) are also an important manifestation of climate change (Sect. 3.8 in Trenberth et al. 2007; Peterson et al. 2008; Peterson et al. 2012). Meehl et al. (2009) found that currently, about twice as many high temperature records are being set as low temperature records over the conterminous U.S. (lower 48 states) as a whole. As the climate warms further, this ratio is expected to multiply, mainly because when the whole temperature distribution for a location or region shifts, it changes the "tails" of the distribution (in the case of warming this means fewer extreme cold temperatures and more extreme hot temperatures; see Page 2, Figure ES.1 of Karl et al. 2008). The Meehl et al. (2009) findings were covered pretty well by the online media, but, as is the case for all types of scientifc studies, it's safe to say that most of the public are not aware of these basic findings, and they would benefit from additional ways to get climate extremes information for their own areas and assess it. One such way is the National Climatic Data Center's (NCDC) U.S. Records Look-Up page. But how do most people typically hear about their area's high and low temperature records? Likely via the evening news, when their local on-air meteorologist notes the high/low for the day at a nearby airport then gives the years when the all-time high and low for the date were set (perhaps not at that same airport). The year of the record is an interesting bit of information on its own but it doesn't do much to place things in context. What about the local history of record temperatures and how things may be changing? Here we present a daily temperature records data product that we hope will serve the scientist and non-scientist alike in exploring and analyzing high and low temperature records and trends at hundreds of locations across the U.S.

Quality-control of an hourly rainfall dataset and climatology of extremes for the UK.

PubMed

Blenkinsop, Stephen; Lewis, Elizabeth; Chan, Steven C; Fowler, Hayley J

2017-02-01

Sub-daily rainfall extremes may be associated with flash flooding, particularly in urban areas but, compared with extremes on daily timescales, have been relatively little studied in many regions. This paper describes a new, hourly rainfall dataset for the UK based on ∼1600 rain gauges from three different data sources. This includes tipping bucket rain gauge data from the UK Environment Agency (EA), which has been collected for operational purposes, principally flood forecasting. Significant problems in the use of such data for the analysis of extreme events include the recording of accumulated totals, high frequency bucket tips, rain gauge recording errors and the non-operation of gauges. Given the prospect of an intensification of short-duration rainfall in a warming climate, the identification of such errors is essential if sub-daily datasets are to be used to better understand extreme events. We therefore first describe a series of procedures developed to quality control this new dataset. We then analyse ∼380 gauges with near-complete hourly records for 1992-2011 and map the seasonal climatology of intense rainfall based on UK hourly extremes using annual maxima, n-largest events and fixed threshold approaches. We find that the highest frequencies and intensities of hourly extreme rainfall occur during summer when the usual orographically defined pattern of extreme rainfall is replaced by a weaker, north-south pattern. A strong diurnal cycle in hourly extremes, peaking in late afternoon to early evening, is also identified in summer and, for some areas, in spring. This likely reflects the different mechanisms that generate sub-daily rainfall, with convection dominating during summer. The resulting quality-controlled hourly rainfall dataset will provide considerable value in several contexts, including the development of standard, globally applicable quality-control procedures for sub-daily data, the validation of the new generation of very high-resolution climate models and improved understanding of the drivers of extreme rainfall.

Quality‐control of an hourly rainfall dataset and climatology of extremes for the UK

PubMed Central

Lewis, Elizabeth; Chan, Steven C.; Fowler, Hayley J.

2016-01-01

ABSTRACT Sub‐daily rainfall extremes may be associated with flash flooding, particularly in urban areas but, compared with extremes on daily timescales, have been relatively little studied in many regions. This paper describes a new, hourly rainfall dataset for the UK based on ∼1600 rain gauges from three different data sources. This includes tipping bucket rain gauge data from the UK Environment Agency (EA), which has been collected for operational purposes, principally flood forecasting. Significant problems in the use of such data for the analysis of extreme events include the recording of accumulated totals, high frequency bucket tips, rain gauge recording errors and the non‐operation of gauges. Given the prospect of an intensification of short‐duration rainfall in a warming climate, the identification of such errors is essential if sub‐daily datasets are to be used to better understand extreme events. We therefore first describe a series of procedures developed to quality control this new dataset. We then analyse ∼380 gauges with near‐complete hourly records for 1992–2011 and map the seasonal climatology of intense rainfall based on UK hourly extremes using annual maxima, n‐largest events and fixed threshold approaches. We find that the highest frequencies and intensities of hourly extreme rainfall occur during summer when the usual orographically defined pattern of extreme rainfall is replaced by a weaker, north–south pattern. A strong diurnal cycle in hourly extremes, peaking in late afternoon to early evening, is also identified in summer and, for some areas, in spring. This likely reflects the different mechanisms that generate sub‐daily rainfall, with convection dominating during summer. The resulting quality‐controlled hourly rainfall dataset will provide considerable value in several contexts, including the development of standard, globally applicable quality‐control procedures for sub‐daily data, the validation of the new generation of very high‐resolution climate models and improved understanding of the drivers of extreme rainfall. PMID:28239235

Leveraging routine clinical materials and mobile technology to assess CBT fidelity: the Innovative Methods to Assess Psychotherapy Practices (imAPP) study.

PubMed

Wiltsey Stirman, Shannon; Marques, Luana; Creed, Torrey A; Gutner, Cassidy A; DeRubeis, Robert; Barnett, Paul G; Kuhn, Eric; Suvak, Michael; Owen, Jason; Vogt, Dawne; Jo, Booil; Schoenwald, Sonja; Johnson, Clara; Mallard, Kera; Beristianos, Matthew; La Bash, Heidi

2018-05-22

Identifying scalable strategies for assessing fidelity is a key challenge in implementation science. However, for psychosocial interventions, the existing, reliable ways to test treatment fidelity quality are often labor intensive, and less burdensome strategies may not reflect actual clinical practice. Cognitive behavioral therapies (CBTs) provide clinicians with a set of effective core elements to help treat a multitude of disorders, which, evidence suggests, need to be delivered with fidelity to maximize potential client impact. The current "gold standard" for rating CBTs is rating recordings of therapy sessions, which is extremely time-consuming and requires a substantial amount of initial training. Although CBTs can vary based on the target disorder, one common element employed in most CBTs is the use of worksheets to identify specific behaviors and thoughts that affect a client's ability to recover. The present study will develop and evaluate an innovative new approach to rate CBT fidelity, by developing a universal CBT scoring system based on worksheets completed in therapy sessions. To develop a scoring system for CBT worksheets, we will compile common CBT elements from a variety of CBT worksheets for a range of psychiatric disorders and create adherence and competence measures. We will collect archival worksheets from past studies to test the scoring system and assess test-retest reliability. To evaluate whether CBT worksheet scoring accurately reflects clinician fidelity, we will recruit clinicians who are engaged in a CBT for depression, anxiety, and/or posttraumatic stress disorder. Clinicians and clients will transmit routine therapy materials produced in session (e.g., worksheets, clinical notes, session recordings) to the study team after each session. We will compare observer-rated fidelity, clinical notes, and fidelity-rated worksheets to identify the most effective and efficient method to assess clinician fidelity. Clients will also be randomly assigned to either complete the CBT worksheets on paper forms or on a mobile application (app) to learn if worksheet format influences clinician and client experience or differs in terms of reflecting fidelity. Scoring fidelity using CBT worksheets may allow clinics to test fidelity in a short and effective manner, enhancing continuous quality improvement in the workplace. Clinicians and clinics can use such data to improve clinician fidelity in real time, leading to improved patient outcomes. ClinicalTrials.gov NCT03479398 . Retrospectively registered March 20, 2018.

Relationship between upper extremity kinesthetic sense and writing performance by students with low vision.

PubMed

Aki, Esra; Atasavun, Songül; Kayihan, Holya

2008-06-01

Kinesthetic sense plays an important role in writing. Children with low vision lack sensory input from the environment given their loss of vision. This study assessed the effect of upper extremity kinesthetic sense on writing function in two groups, one of students with low vision (9 girls and 11 boys, 9.4 +/- 1.9 yr. of age) and one of sighted students (10 girls and 10 boys, 10.1 +/- 1.3 yr. of age). All participants were given the Kinesthesia Test and Jebsen Hand Function Test-Writing subtest. Students with low vision scored lower on kinesthetic perception and writing performance than sighted peers. The correlation between scores for writing performance and upper extremity kinesthetic sense in the two groups was significant (r = -.34). The probability of deficiencies in kinesthetic information in students with low vision must be remembered.

Evaluating the functional outcomes of ultrasound-guided botulinum toxin type A injections using the Euro-musculus approach for upper limb spasticity treatment in post-stroke patients; an observational study.

PubMed

Buyukavci, Raikan; Akturk, Semra; Ersoy, Yüksel

2018-02-07

Ultrasound-guided botulinum toxin type A injection is an effective treatment for spasticity. Euro-musculus spasticity approach is a new method for administering injections to the correct point of the correct muscle. The clinical outcomes of this practical approach is not yet available in the literature. The purpose of this study was to evaluate the effects on spasticity and the functional outcomes of ultrasound guided botulinum toxin type A injections via the Euro-musculus spasticity approach to treat upper limb spasticity in post-stroke patients. An observational study. Inpatient post-stroke patients. Twenty five post-stroke patients with post-stroke upper limb spasticity were recruited. The ultrasound-guided botulinum toxin type A injections were administered into the spastic target muscles using the Euro-musculus spasticity approach, and all of the patients were enrolled in rehabilitation programmes after the injections. This research included the innervation zone and injection site figures and ultrasound images of each muscle in the upper limb. The degree of spasticity was assessed via the Modified Ashworth Scale and the upper limb motor function via the Fugl Meyer Upper Extremity Scale at the baseline and 4 and 12 weeks after the botulinum toxin type A injection. Significant decreases in the Modified Ashworth Scale scores of the upper limb flexor muscle tone measured 4 and 12 weeks after the botulinum toxin type A injection were found when compared to the baseline scores (p<0.025). When compared with the baseline Fugl Meyer Upper Extremity subgroup scores, the sitting position, wrist and total scores at 4 and 12 weeks were significantly improved (p<0.025). However, only the Fugl Meyer Upper Extremity hand scores were significantly improved 12 weeks after the injection (p<0.025). Ultrasound-guided botulinum toxin type A injection via the Euro- musculus spasticity approach is a practical and effective method for administering injections to the correct point of the correct muscle. Ultrasound-guided botulinum toxin type A injections combined with rehabilitation programmes decrease spasticity and improve the upper extremity motor functions in stroke patients. This new approach for ultrasound- guided botulinum toxin type A injection is very practical and effective method for upper extremity spasticity.

Brief Report: Female-to-Male Transsexual People and Autistic Traits

ERIC Educational Resources Information Center

Jones, Rebecca M.; Wheelwright, Sally; Farrell, Krista; Martin, Emma; Green, Richard; Di Ceglie, Domenico; Baron-Cohen, Simon

2012-01-01

The "extreme male brain" theory suggests females with Autism Spectrum Conditions are hyper-masculinized in certain aspects of behavior. We predicted that females with Gender Identity Disorder (who are masculinized) would have elevated Autism Spectrum Quotient (AQ) scores. AQ scores from five groups were compared: (1) n = 61 transmen…

Detecting severe injuries of the upper body in multiple trauma patients.

PubMed

Horst, Klemens; Hildebrand, Frank; Kobbe, Philipp; Pfeifer, Roman; Lichte, Philipp; Andruszkow, Hagen; Lefering, Rolf; Pape, Hans Christoph

2015-12-01

The clavicle limits the upper thoracic cage and connects the body and upper extremities. The clavicle is easy to examine and is visible on standard emergency room radiographs. We hypothesized that clavicular fracture in polytrauma patients would indicate the presence of further injuries of the upper extremities, head, neck, and thorax. A population-based trauma registry was used. All patients were documented between 2002 and 2013. Inclusion criteria were age ≥16 y and injury severity score (ISS) ≥16. Patients were divided into two groups according to the presence or absence of a clavicular fracture (group C+ and group C-). Scoring was based on the abbreviated injury scale, ISS, and new injury severity score. Trauma mechanisms, demographics, and the posttraumatic clinical course were compared. In total, 4790 patients with clavicular fracture (C+) and 41,775 without (C-) were included; the mean ISS was 30 ± 11 (C+) versus 28 ± 12 (C-). Patients with clavicular fracture had a longer stay on the intensive care unit with 12 ± 14 versus 10 ± 13 d. Injuries to the thoracic wall, severe lung injuries as well as injuries to the cervical spine were significantly increased in C+ patients. Thoracic injuries as well as injuries of the shoulder girdle and/or arm showed an increased abbreviated injury scale in the C+ group. A clinically relevant coincidence of clavicular fractures with injuries of the chest and upper extremity was found. As clavicular fractures can be diagnosed easily, it might also help to reduce the incidence of missed injuries of the chest and upper extremity. Therefore, special attention should be paid on thoracic as well as upper extremity injures during the second and tertiary surveys in case of clavicular fractures. Copyright © 2015 Elsevier Inc. All rights reserved.

Predictive value of the DASH tool for predicting return to work of injured workers with musculoskeletal disorders of the upper extremity.

PubMed

Armijo-Olivo, Susan; Woodhouse, Linda J; Steenstra, Ivan A; Gross, Douglas P

2016-12-01

To determine whether the Disabilities of the Arm, Shoulder, and Hand (DASH) tool added to the predictive ability of established prognostic factors, including patient demographic and clinical outcomes, to predict return to work (RTW) in injured workers with musculoskeletal (MSK) disorders of the upper extremity. A retrospective cohort study using a population-based database from the Workers' Compensation Board of Alberta (WCB-Alberta) that focused on claimants with upper extremity injuries was used. Besides the DASH, potential predictors included demographic, occupational, clinical and health usage variables. Outcome was receipt of compensation benefits after 3 months. To identify RTW predictors, a purposeful logistic modelling strategy was used. A series of receiver operating curve analyses were performed to determine which model provided the best discriminative ability. The sample included 3036 claimants with upper extremity injuries. The final model for predicting RTW included the total DASH score in addition to other established predictors. The area under the curve for this model was 0.77, which is interpreted as fair discrimination. This model was statistically significantly different than the model of established predictors alone (p<0.001). When comparing the DASH total score versus DASH item 23, a non-significant difference was obtained between the models (p=0.34). The DASH tool together with other established predictors significantly helped predict RTW after 3 months in participants with upper extremity MSK disorders. An appealing result for clinicians and busy researchers is that DASH item 23 has equal predictive ability to the total DASH score. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Short-term effects of upper extremity circuit resistance training on muscle strength and functional independence in patients with paraplegia.

PubMed

Yildirim, Adem; Sürücü, Gülseren Dost; Karamercan, Ayşe; Gedik, Dilay Eken; Atci, Nermin; Dülgeroǧlu, Deniz; Özgirgin, Neşe

2016-11-21

A number of exercises to strengthen the upper extremities are recommended to increase functional independence and quality of life (QoL) in patients with paraplegia. Circuit resistance training (CRT) is a type of progressive resistive exercise performed repeatedly at fixed mechanical exercise stations. The aim of this study was to investigate the potential benefits of CRT for upper extremity muscle strength, functional independence, and QoL in patients with paraplegia. Twenty-six patients with paraplegia who were participating in a conventional rehabilitation program at a tertiary education and research hospital were enrolled in this study. The participants were randomly assigned to two groups. The exercise group participated in the CRT program, which consisted of repetitive exercises for the upper extremities performed at fixed mechanical stations 5 sessions per week for 6 weeks, in addition to conventional rehabilitation. Participants in the control group received only conventional rehabilitation over the same period. We compared the groups with respect to QoL, as well as isokinetic muscle test outcomes in the upper extremities, using the Functional Independence Measure (FIM) and Borg's scale. We observed significant increases in scores on the physical component of the FIM, Borg's scale, and QoL in both the exercise and control groups. Furthermore, the large majority of isokinetic values were significantly more improved in the exercise group compared to the control group. When post-treatment outcomes were compared between the groups, improvements in scores on the physical component of the FIM and in most isokinetic values were significantly greater in the exercise group. This study showed that CRT has positive effects on muscle strength in the upper extremities and the physical disability components of the FIM when added to conventional rehabilitation programs for paraplegic patients. However, we observed no significant improvement in QoL scores after adding CRT to a conventional treatment regime. Randomized trial (Level II).

The effects of Nintendo Wii(TM)-based balance and upper extremity training on activities of daily living and quality of life in patients with sub-acute stroke: a randomized controlled study.

PubMed

Şimşek, Tülay Tarsuslu; Çekok, Kübra

2016-12-01

The aim of this study was to investigate the effects of Nintendo Wii(TM)-based balance and upper extremity training on activities of daily living and quality of life in patients with subacute stroke. 42 adults with stroke (mean age (SD) = 58.04 (16.56) years and mean time since stroke (SD) = (55.2 ± 22.02 days (∼8 weeks)) were included in the study. Participants were enrolled from the rehabilitation department of a medical center (a single inpatient rehabilitation facility). Participants were randomly assigned to Nintendo Wii group (n = 20) or Bobath neurodevelopmental treatment (NDT) (n = 22). The treatments were applied for 10 weeks (45-60 minutes/day, 3 days/week) for both of two groups. Nintendo Wii group used five games selected from the Wii sports and Wii Fit packages for upper limb and balance training, respectively. The patients in Bobath NDT group were applied a therapy program included upper extremity activites, strength, balance gait and functional training. The functional independence in daily life activities and health-related quality of life was assessed with Functional Independence Measure (FIM) and Nottingham Health Profile (NHP), respectively. Participant's treatment satisfaction was recorded by using Visual Analogue Scale. A second evaluation (FIM and NHP) occurred after 10 weeks at the end of rehabilitative treatment (post-training). Treatment satisfaction was measured after 10 sessions. There were significant difference between FIM and NHP values in NDT and Nintendo Wii group (p < 0.05). However, a significant difference was not found between the groups with regard to FIM and NHP (p > 0.05). The patients in Nintendo Wii group were detected to be better satisfied from the therapy (p < 0.05). A significant difference was found between subparameters and total FIM score, all subparameters and total NHP score in both groups (p < 0.05). These findings suggested that the Nintendo Wii training was as effective as Bobath NDT on daily living functions and quality of life in subacute stroke patients.

Misclassification of OSA severity with automated scoring of home sleep recordings.

PubMed

Aurora, R Nisha; Swartz, Rachel; Punjabi, Naresh M

2015-03-01

The advent of home sleep testing has allowed for the development of an ambulatory care model for OSA that most health-care providers can easily deploy. Although automated algorithms that accompany home sleep monitors can identify and classify disordered breathing events, it is unclear whether manual scoring followed by expert review of home sleep recordings is of any value. Thus, this study examined the agreement between automated and manual scoring of home sleep recordings. Two type 3 monitors (ApneaLink Plus [ResMed] and Embletta [Embla Systems]) were examined in distinct study samples. Data from manual and automated scoring were available for 200 subjects. Two thresholds for oxygen desaturation (≥ 3% and ≥ 4%) were used to define disordered breathing events. Agreement between manual and automated scoring was examined using Pearson correlation coefficients and Bland-Altman analyses. Automated scoring consistently underscored disordered breathing events compared with manual scoring for both sleep monitors irrespective of whether a ≥ 3% or ≥ 4% oxygen desaturation threshold was used to define the apnea-hypopnea index (AHI). For the ApneaLink Plus monitor, Bland-Altman analyses revealed an average AHI difference between manual and automated scoring of 6.1 (95% CI, 4.9-7.3) and 4.6 (95% CI, 3.5-5.6) events/h for the ≥ 3% and ≥ 4% oxygen desaturation thresholds, respectively. Similarly for the Embletta monitor, the average difference between manual and automated scoring was 5.3 (95% CI, 3.2-7.3) and 8.4 (95% CI, 7.2-9.6) events/h, respectively. Although agreement between automated and manual scoring of home sleep recordings varies based on the device used, modest agreement was observed between the two approaches. However, manual review of home sleep test recordings can decrease the misclassification of OSA severity, particularly for those with mild disease. ClinicalTrials.gov; No.: NCT01503164; www.clinicaltrials.gov.

Misclassification of OSA Severity With Automated Scoring of Home Sleep Recordings

PubMed Central

Aurora, R. Nisha; Swartz, Rachel

2015-01-01

BACKGROUND: The advent of home sleep testing has allowed for the development of an ambulatory care model for OSA that most health-care providers can easily deploy. Although automated algorithms that accompany home sleep monitors can identify and classify disordered breathing events, it is unclear whether manual scoring followed by expert review of home sleep recordings is of any value. Thus, this study examined the agreement between automated and manual scoring of home sleep recordings. METHODS: Two type 3 monitors (ApneaLink Plus [ResMed] and Embletta [Embla Systems]) were examined in distinct study samples. Data from manual and automated scoring were available for 200 subjects. Two thresholds for oxygen desaturation (≥ 3% and ≥ 4%) were used to define disordered breathing events. Agreement between manual and automated scoring was examined using Pearson correlation coefficients and Bland-Altman analyses. RESULTS: Automated scoring consistently underscored disordered breathing events compared with manual scoring for both sleep monitors irrespective of whether a ≥ 3% or ≥ 4% oxygen desaturation threshold was used to define the apnea-hypopnea index (AHI). For the ApneaLink Plus monitor, Bland-Altman analyses revealed an average AHI difference between manual and automated scoring of 6.1 (95% CI, 4.9-7.3) and 4.6 (95% CI, 3.5-5.6) events/h for the ≥ 3% and ≥ 4% oxygen desaturation thresholds, respectively. Similarly for the Embletta monitor, the average difference between manual and automated scoring was 5.3 (95% CI, 3.2-7.3) and 8.4 (95% CI, 7.2-9.6) events/h, respectively. CONCLUSIONS: Although agreement between automated and manual scoring of home sleep recordings varies based on the device used, modest agreement was observed between the two approaches. However, manual review of home sleep test recordings can decrease the misclassification of OSA severity, particularly for those with mild disease. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01503164; www.clinicaltrials.gov PMID:25411804

Reliability and Validity of 3 Methods of Assessing Orthopedic Resident Skill in Shoulder Surgery.

PubMed

Bernard, Johnathan A; Dattilo, Jonathan R; Srikumaran, Uma; Zikria, Bashir A; Jain, Amit; LaPorte, Dawn M

Traditional measures for evaluating resident surgical technical skills (e.g., case logs) assess operative volume but not level of surgical proficiency. Our goal was to compare the reliability and validity of 3 tools for measuring surgical skill among orthopedic residents when performing 3 open surgical approaches to the shoulder. A total of 23 residents at different stages of their surgical training were tested for technical skill pertaining to 3 shoulder surgical approaches using the following measures: Objective Structured Assessment of Technical Skills (OSATS) checklists, the Global Rating Scale (GRS), and a final pass/fail assessment determined by 3 upper extremity surgeons. Adverse events were recorded. The Cronbach α coefficient was used to assess reliability of the OSATS checklists and GRS scores. Interrater reliability was calculated with intraclass correlation coefficients. Correlations among OSATS checklist scores, GRS scores, and pass/fail assessment were calculated with Spearman ρ. Validity of OSATS checklists was determined using analysis of variance with postgraduate year (PGY) as a between-subjects factor. Significance was set at p < 0.05 for all tests. Criterion validity was shown between the OSATS checklists and GRS for the 3 open shoulder approaches. Checklist scores showed superior interrater reliability compared with GRS and subjective pass/fail measurements. GRS scores were positively correlated across training years. The incidence of adverse events was significantly higher among PGY-1 and PGY-2 residents compared with more experienced residents. OSATS checklists are a valid and reliable assessment of technical skills across 3 surgical shoulder approaches. However, checklist scores do not measure quality of technique. Documenting adverse events is necessary to assess quality of technique and ultimate pass/fail status. Multiple methods of assessing surgical skill should be considered when evaluating orthopedic resident surgical performance. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Interobserver Variability in Injury Severity Scoring After Combat Trauma: Different Perspectives, Different Values?

PubMed

Smith, Iain M; Naumann, David N; Guyver, Paul; Bishop, Jonathan; Davies, Simon; Lundy, Jonathan B; Bowley, Douglas M

2015-01-01

Anatomic measures of injury burden provide key information for studies of prehospital and in-hospital trauma care. The military version of the Abbreviated Injury Scale [AIS(M)] is used to score injuries in deployed military hospitals. Estimates of total trauma burden are derived from this. These scores are used for categorization of patients, assessment of care quality, and research studies. Scoring is normally performed retrospectively from chart review. We compared data recorded in the UK Joint Theatre Trauma Registry (JTTR) and scores calculated independently at the time of surgery by the operating surgeons to assess the concordance between surgeons and trauma nurse coordinators in assigning injury severity scores. Trauma casualties treated at a deployed Role 3 hospital were assigned AIS(M) scores by surgeons between 24 September 2012 and 16 October 2012. JTTR records from the same period were retrieved. The AIS(M), Injury Severity Score (ISS), and New Injury Severity Score (NISS) were compared between datasets. Among 32 matched casualties, 214 injuries were recorded in the JTTR, whereas surgeons noted 212. Percentage agreement for number of injuries was 19%. Surgeons scored 75 injuries as "serious" or greater compared with 68 in the JTTR. Percentage agreement for the maximum AIS(M), ISS, and NISS assigned to cases was 66%, 34%, and 28%, respectively, although the distributions of scores were not statistically different (median ISS: surgeons: 20 [interquartile range (IQR), 9-28] versus JTTR: 17.5 [IQR, 9-31.5], p = .7; median NISS: surgeons: 27 [IQR, 12-42] versus JTTR: 25.5 [IQR, 11.5-41], p = .7). There are discrepancies in the recording of AIS(M) between surgeons directly involved in the care of trauma casualties and trauma nurse coordinators working by retrospective chart review. Increased accuracy might be achieved by actively collaborating in this process. 2015.

Feasibility of task-specific brain-machine interface training for upper-extremity paralysis in patients with chronic hemiparetic stroke.

PubMed

Nishimoto, Atsuko; Kawakami, Michiyuki; Fujiwara, Toshiyuki; Hiramoto, Miho; Honaga, Kaoru; Abe, Kaoru; Mizuno, Katsuhiro; Ushiba, Junichi; Liu, Meigen

2018-01-10

Brain-machine interface training was developed for upper-extremity rehabilitation for patients with severe hemiparesis. Its clinical application, however, has been limited because of its lack of feasibility in real-world rehabilitation settings. We developed a new compact task-specific brain-machine interface system that enables task-specific training, including reach-and-grasp tasks, and studied its clinical feasibility and effectiveness for upper-extremity motor paralysis in patients with stroke. Prospective beforeâ€"after study. Twenty-six patients with severe chronic hemiparetic stroke. Participants were trained with the brain-machine interface system to pick up and release pegs during 40-min sessions and 40 min of standard occupational therapy per day for 10 days. Fugl-Meyer upper-extremity motor (FMA) and Motor Activity Log-14 amount of use (MAL-AOU) scores were assessed before and after the intervention. To test its feasibility, 4 occupational therapists who operated the system for the first time assessed it with the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) 2.0. FMA and MAL-AOU scores improved significantly after brain-machine interface training, with the effect sizes being medium and large, respectively (p<0.01, d=0.55; p<0.01, d=0.88). QUEST effectiveness and safety scores showed feasibility and satisfaction in the clinical setting. Our newly developed compact brain-machine interface system is feasible for use in real-world clinical settings.

Effects of off-axis elliptical training on reducing pain and improving knee function in individuals with patellofemoral pain

PubMed Central

Tsai, Liang-Ching; Lee, Song Joo; Yang, Aaron J.; Ren, Yupeng; Press, Joel M.; Zhang, Li-Qun

2014-01-01

Objective To examine whether an off-axis elliptical training program reduces pain and improves knee function in individuals with patellofemoral pain (PFP). Design Controlled laboratory study, pre-test-post-test. Setting University rehabilitation center. Participants Twelve adult subjects with PFP. Interventions Subjects with PFP completed an exercise program consisting of 18 sessions of lower extremity off-axis training using a custom-made elliptical trainer that allows frontal-plane sliding and transverse-plane pivoting of the footplates. Main Outcome Measures Changes in knee pain and function post-training and 6 weeks following training were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) scores. Lower extremity off-axis control was assessed by pivoting and sliding instability, calculated as the root mean square (RMS) of the footplate pivoting angle and sliding distance during elliptical exercise. Subjects’ single-leg hop distance and proprioception in detecting lower extremity pivoting motion were also evaluated. Results Subjects reported significantly greater KOOS and IKDC scores (increased by 12–18 points) and hop distance (increased by 0.2 m) following training. A significant decrease in the pivoting and sliding RMS was also observed following training. Additionally, subjects with PFP demonstrated improved pivoting proprioception when tested under a minimum-weight-bearing position. Conclusions An off-axis elliptical training program was effective in enhancing lower extremity neuromuscular control on the frontal and transverse planes, reducing pain and improving knee function in persons with PFP. PMID:25591131

Mobile health technology transforms injury severity scoring in South Africa.

PubMed

Spence, Richard Trafford; Zargaran, Eiman; Hameed, S Morad; Navsaria, Pradeep; Nicol, Andrew

2016-08-01

The burden of data collection associated with injury severity scoring has limited its application in areas of the world with the highest incidence of trauma. Since January 2014, electronic records (electronic Trauma Health Records [eTHRs]) replaced all handwritten records at the Groote Schuur Hospital Trauma Unit in South Africa. Data fields required for Glasgow Coma Scale, Revised Trauma Score, Kampala Trauma Score, Injury Severity Score (ISS), and Trauma Score-Injury Severity Score calculations are now prospectively collected. Fifteen months after implementation of eTHR, the injury severity scores were compared as predictors of mortality on three accounts: (1) ability to discriminate (area under receiver operating curve, ROC); (2) ability to calibrate (observed versus expected ratio, O/E); and (3) feasibility of data collection (rate of missing data). A total of 7460 admissions were recorded by eTHR from April 1, 2014 to July 7, 2015, including 770 severely injured patients (ISS > 15) and 950 operations. The mean age was 33.3 y (range 13-94), 77.6% were male, and the mechanism of injury was penetrating in 39.3% of cases. The cohort experienced a mortality rate of 2.5%. Patient reserve predictors required by the scores were 98.7% complete, physiological injury predictors were 95.1% complete, and anatomic injury predictors were 86.9% complete. The discrimination and calibration of Trauma Score-Injury Severity Score was superior for all admissions (ROC 0.9591 and O/E 1.01) and operatively managed patients (ROC 0.8427 and O/E 0.79). In the severely injured cohort, the discriminatory ability of Revised Trauma Score was superior (ROC 0.8315), but no score provided adequate calibration. Emerging mobile health technology enables reliable and sustainable injury severity scoring in a high-volume trauma center in South Africa. Copyright © 2016 Elsevier Inc. All rights reserved.

The Effect of Mixing Entire Male Pigs Prior to Transport to Slaughter on Behaviour, Welfare and Carcass Lesions

PubMed Central

van Staaveren, Nienke; Teixeira, Dayane Lemos; Hanlon, Alison; Boyle, Laura Ann

2015-01-01

Research is needed to validate lesions recorded at meat inspection as indicators of pig welfare on farm. The aims were to determine the influence of mixing pigs on carcass lesions and to establish whether such lesions correlate with pig behaviour and lesions scored on farm. Aggressive and mounting behaviour of pigs in three single sex pens was recorded on Day −5, −2, and −1 relative to slaughter (Day 0). On Day 0 pigs were randomly allocated to 3 treatments (n = 20/group) over 5 replicates: males mixed with females (MF), males mixed with males (MM), and males unmixed (MUM). Aggressive and mounting behaviours were recorded on Day 0 at holding on farm and lairage. Skin/tail lesions were scored according to severity at the farm (Day −1), lairage, and on the carcass (Day 0). Effect of treatment and time on behaviour and lesions were analysed by mixed models. Spearman rank correlations between behaviour and lesion scores and between scores recorded at different stages were determined. In general, MM performed more aggressive behaviour (50.4 ± 10.72) than MUM (20.3 ± 9.55, P < 0.05) and more mounting (30.9 ± 9.99) than MF (11.4 ± 3.76) and MUM (9.8 ± 3.74, P < 0.05). Skin lesion scores increased between farm (Day −1) and lairage (P < 0.001), but this tended to be significant only for MF and MM (P = 0.08). There was no effect of treatment on carcass lesions and no associations were found with fighting/mounting. Mixing entire males prior to slaughter stimulated mounting and aggressive behaviour but did not influence carcass lesion scores. Carcass skin/tail lesions scores were correlated with scores recorded on farm (rskin = 0.21 and rtail = 0.18, P < 0.01) suggesting that information recorded at meat inspection could be used as indicators of pig welfare on farm. PMID:25830336

On the predictability of extreme events in records with linear and nonlinear long-range memory: Efficiency and noise robustness

NASA Astrophysics Data System (ADS)

Bogachev, Mikhail I.; Bunde, Armin

2011-06-01

We study the predictability of extreme events in records with linear and nonlinear long-range memory in the presence of additive white noise using two different approaches: (i) the precursory pattern recognition technique (PRT) that exploits solely the information about short-term precursors, and (ii) the return interval approach (RIA) that exploits long-range memory incorporated in the elapsed time after the last extreme event. We find that the PRT always performs better when only linear memory is present. In the presence of nonlinear memory, both methods demonstrate comparable efficiency in the absence of white noise. When additional white noise is present in the record (which is the case in most observational records), the efficiency of the PRT decreases monotonously with increasing noise level. In contrast, the RIA shows an abrupt transition between a phase of low level noise where the prediction is as good as in the absence of noise, and a phase of high level noise where the prediction becomes poor. In the phase of low and intermediate noise the RIA predicts considerably better than the PRT, which explains our recent findings in physiological and financial records.

Factors that influence the efficiency of beef and dairy cattle recording system in Kenya: A SWOT-AHP analysis.

PubMed

Wasike, Chrilukovian B; Magothe, Thomas M; Kahi, Alexander K; Peters, Kurt J

2011-01-01

Animal recording in Kenya is characterised by erratic producer participation and high drop-out rates from the national recording scheme. This study evaluates factors influencing efficiency of beef and dairy cattle recording system. Factors influencing efficiency of animal identification and registration, pedigree and performance recording, and genetic evaluation and information utilisation were generated using qualitative and participatory methods. Pairwise comparison of factors was done by strengths, weaknesses, opportunities and threats-analytical hierarchical process analysis and priority scores to determine their relative importance to the system calculated using Eigenvalue method. For identification and registration, and evaluation and information utilisation, external factors had high priority scores. For pedigree and performance recording, threats and weaknesses had the highest priority scores. Strengths factors could not sustain the required efficiency of the system. Weaknesses of the system predisposed it to threats. Available opportunities could be explored as interventions to restore efficiency in the system. Defensive strategies such as reorienting the system to offer utility benefits to recording, forming symbiotic and binding collaboration between recording organisations and NARS, and development of institutions to support recording were feasible.

Lack of association between venous hemodynamics, venous morphology and the postthrombotic syndrome after upper extremity deep venous thrombosis.

PubMed

Czihal, M; Paul, S; Rademacher, A; Bernau, C; Hoffmann, U

2015-03-01

To explore the association of the postthrombotic syndrome with venous hemodynamics and morphological abnormalities after upper extremity deep venous thrombosis. Thirty-seven patients with a history of upper extremity deep venous thrombosis treated with anticoagulation alone underwent a single study visit (mean time after diagnosis: 44.4 ± 28.1 months). Presence and severity postthrombotic syndrome were classified according to the modified Villalta score. Venous volume and venous emptying were determined by strain-gauge plethysmography. The arm veins were assessed for postthrombotic abnormalities by ultrasonography. The relationship between postthrombotic syndrome and hemodynamic and morphological sequelae was evaluated using univariate significance tests and Spearman's correlation analysis. Fifteen of 37 patients (40.5%) developed postthrombotic syndrome. Venous volume and venous emptying of the arm affected by upper extremity deep venous thrombosis did not correlate with the Villalta score (rho = 0.17 and 0.19; p = 0.31 and 0.25, respectively). Residual morphological abnormalities, as assessed by ultrasonography, did not differ significantly between patients with and without postthrombotic syndrome (77.3% vs. 86.7%, p = 0.68). Postthrombotic syndrome after upper extremity deep venous thrombosis is not associated with venous hemodynamics or residual morphological abnormalities. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Prognosis of patients presenting extreme acidosis (pH <7) on admission to intensive care unit.

PubMed

Allyn, Jérôme; Vandroux, David; Jabot, Julien; Brulliard, Caroline; Galliot, Richard; Tabatchnik, Xavier; Combe, Patrice; Martinet, Olivier; Allou, Nicolas

2016-02-01

The purpose was to determine prognosis of patients presenting extreme acidosis (pH <7) on admission to the intensive care unit (ICU) and to identify mortality risk factors. We retrospectively analyzed all patients who presented with extreme acidosis within 24 hours of admission to a polyvalent ICU in a university hospital between January 2011 and July 2013. Multivariate analysis and survival analysis were used. Among the 2156 patients admitted, 77 patients (3.6%) presented extreme acidosis. Thirty (39%) patients suffered cardiac arrest before admission. Although the mortality rate predicted by severity score was 93.6%, death occurred in 52 cases (67.5%) in a median delay of 13 (5-27) hours. Mortality rate depended on reason for admission, varying between 22% for cases linked to diabetes mellitus and 100% for cases of mesenteric infarction (P = .002), cardiac arrest before admission (P < .001), type of lactic acidosis (P = .007), high Simplified Acute Physiology Score II (P = .008), and low serum creatinine (P = .012). Patients with extreme acidosis on admission to ICU have a less severe than expected prognosis. Whereas mortality is almost 100% in cases of cardiac arrest before admission, mortality is much lower in the absence of cardiac arrest before admission, which justifies aggressive ICU therapies. Copyright © 2015 Elsevier Inc. All rights reserved.

Extreme temperatures in Southeast Asia caused by El Niño and worsened by global warming

PubMed Central

Thirumalai, Kaustubh; DiNezio, Pedro N.; Okumura, Yuko; Deser, Clara

2017-01-01

In April 2016, southeast Asia experienced surface air temperatures (SATs) that surpassed national records, exacerbated energy consumption, disrupted agriculture and caused severe human discomfort. Here we show using observations and an ensemble of global warming simulations the combined impact of the El Niño/Southern Oscillation (ENSO) phenomenon and long-term warming on regional SAT extremes. We find a robust relationship between ENSO and southeast Asian SATs wherein virtually all April extremes occur during El Niño years. We then quantify the relative contributions of long-term warming and the 2015–16 El Niño to the extreme April 2016 SATs. The results indicate that global warming increases the likelihood of record-breaking April extremes where we estimate that 29% of the 2016 anomaly was caused by warming and 49% by El Niño. These post-Niño Aprils can potentially be anticipated a few months in advance, and thus, help societies prepare for the projected continued increases in extremes. PMID:28585927

How extreme is extreme hourly precipitation?

NASA Astrophysics Data System (ADS)

Papalexiou, Simon Michael; Dialynas, Yannis G.; Pappas, Christoforos

2016-04-01

The importance of accurate representation of precipitation at fine time scales (e.g., hourly), directly associated with flash flood events, is crucial in hydrological design and prediction. The upper part of a probability distribution, known as the distribution tail, determines the behavior of extreme events. In general, and loosely speaking, tails can be categorized in two families: the subexponential and the hyperexponential family, with the first generating more intense and more frequent extremes compared to the latter. In past studies, the focus has been mainly on daily precipitation, with the Gamma distribution being the most popular model. Here, we investigate the behaviour of tails of hourly precipitation by comparing the upper part of empirical distributions of thousands of records with three general types of tails corresponding to the Pareto, Lognormal, and Weibull distributions. Specifically, we use thousands of hourly rainfall records from all over the USA. The analysis indicates that heavier-tailed distributions describe better the observed hourly rainfall extremes in comparison to lighter tails. Traditional representations of the marginal distribution of hourly rainfall may significantly deviate from observed behaviours of extremes, with direct implications on hydroclimatic variables modelling and engineering design.

Adolescent Self-Esteem: Differences by Race/Ethnicity, Gender, and Age

PubMed Central

Bachman, Jerald G.; O’Malley, Patrick M.; Freedman-Doan, Peter; Trzesniewski, Kali H.; Donnellan, M. Brent

2012-01-01

Large-scale representative surveys of 8th-, 10th-, and 12th-grade students in the United States show high self-esteem scores for all groups. African-American students score highest, Whites score slightly higher than Hispanics, and Asian Americans score lowest. Males score slightly higher than females. Multivariate controls for grades and college plans actually heighten these race/ethnic/gender differences. A truncated scoring method, designed to counter race/ethnic differences in extreme response style, reduced but did not eliminate the subgroup differences. Age differences in self-esteem are modest, with 12th graders reporting the highest scores. The findings are highly consistent across 18 annual surveys from 1991 through 2008, and self-esteem scores show little overall change during that period. PMID:22279425

Plethysmography (image)

MedlinePlus

... attached to a pulse volume recorder (plethysmograph) that displays each pulse wave. The test compares the systolic blood pressure of the lower extremity to the upper extremity, to help rule out disease that blocks the arteries in the ...

Definitive Radiotherapy for Ewing Tumors of Extremities and Pelvis: Long-Term Disease Control, Limb Function, and Treatment Toxicity

DOE Office of Scientific and Technical Information (OSTI.GOV)

Indelicato, Daniel J.; Keole, Sameer R.; Shahlaee, Amir H.

2008-11-01

Purpose: More than 70% of Ewing tumors occur in the extremities and pelvis. This study identified factors influencing local control and functional outcomes after management with definitive radiotherapy (RT). Patients and Methods: A total of 75 patients with a localized Ewing tumor of the extremity or pelvis were treated with definitive RT at the University of Florida between 1970 and 2006 (lower extremity tumors in 30, pelvic tumors in 26, and upper extremity tumors in 19). RT was performed on a once-daily (40%) or twice-daily (60%) basis. The median dose was 55.2 Gy in 1.8-Gy daily fractions or 55.0 Gymore » in 1.2-Gy twice-daily fractions. The median observed follow-up was 4.7 years. Functional outcome was assessed using the Toronto Extremity Salvage Score. Results: The 10-year actuarial overall survival, cause-specific survival, freedom from relapse, and local control rate was 48%, 48%, 42%, and 71%, respectively. Of the 72 patients, 3 required salvage amputation. Inferior cause-specific survival was associated with larger tumors (81% for tumors <8 cm vs. 39% for tumors {>=}8 cm, p <0.05). No patient characteristics or treatment variables were predictive of local failure. No fractures occurred in patients treated with hyperfractionation or with tumors of the distal extremities. Severe late complications were more frequently associated with use of <8-MV photons and fields encompassing the entire bone or hemipelvis. A significantly better Toronto Extremity Salvage Score was associated with a late-effect biologically effective dose of <91.7 Gy{sub 3}. Conclusions: Limb preservation was effectively achieved through definitive RT. Treating limited field sizes with hyperfractionated high-energy RT could minimize long-term complications and provides superior functional outcomes.« less

Pattern of external injuries sustained during bomb blast attacks in Karachi, Pakistan from 2000 to 2007.

PubMed

Surani, Arif Anwar; Ali, Salman; Surani, Asif; Zahid, Sohaib; Shoukat, Akber; Varon, Joseph; Surani, Salim

2015-07-01

To evaluate patterns of external injury resulting from bomb blasts in Karachi, and compare the injury profile resulting from explosions in open versus semi-confined blast environments. The retrospective, cross-sectional study was conducted in Karachi and comprised relevant data from January 2000 to October 2007. Casualty medical records and medico-legal certificates of the victims presented to three large public-sector hospitals were evaluated using a self-designed proforma. SPSS 17 was used for statistical analysis. Of the 1146 victims, data of 481(42%) represented the final study sample. Of these, 306(63.6%) were injured in open spaces and 175(36.4%) in semi-confined spaces. Of the 896 recorded injuries, lacerations were encountered as external injury in 427(47.7%) cases, followed by penetrating wounds in 137(15.3%). Lower and upper extremities were injured in 348(38.8%) and 170(19%) victims respectively. Open and semi-confined blast environments produced specific injury pattern and profile (p<0.001). External injuries sustained during bomb blast attacks in Karachi demonstrated specific injury patterns and profiles. Further studies are required to account for internal injuries and classification of injuries based on standardised scoring systems.

Methodology and Implications of Maximum Paleodischarge Estimates for

USGS Publications Warehouse

Channels, M.; Pruess, J.; Wohl, E.E.; Jarrett, R.D.

1998-01-01

Historical and geologic records may be used to enhance magnitude estimates for extreme floods along mountain channels, as demonstrated in this study from the San Juan Mountains of Colorado. Historical photographs and local newspaper accounts from the October 1911 flood indicate the likely extent of flooding and damage. A checklist designed to organize and numerically score evidence of flooding was used in 15 field reconnaissance surveys in the upper Animas River valley of southwestern Colorado. Step-backwater flow modeling estimated the discharges necessary to create longitudinal flood bars observed at 6 additional field sites. According to these analyses, maximum unit discharge peaks at approximately 1.3 m3 s~' km"2 around 2200 m elevation, with decreased unit discharges at both higher and lower elevations. These results (1) are consistent with Jarrett's (1987, 1990, 1993) maximum 2300-m elevation limit for flash-flooding in the Colorado Rocky Mountains, and (2) suggest that current Probable Maximum Flood (PMF) estimates based on a 24-h rainfall of 30 cm at elevations above 2700 m are unrealistically large. The methodology used for this study should be readily applicable to other mountain regions where systematic streamflow records are of short duration or nonexistent. ?? 1998 Regents of the University of Colorado.

An extreme event of sea-level rise along the Northeast Coast of North America in 2009-2010.

PubMed

Goddard, Paul B; Yin, Jianjun; Griffies, Stephen M; Zhang, Shaoqing

2015-02-24

The coastal sea levels along the Northeast Coast of North America show significant year-to-year fluctuations in a general upward trend. The analysis of long-term tide gauge records identified an extreme sea-level rise (SLR) event during 2009-10. Within this 2-year period, the coastal sea level north of New York City jumped by 128 mm. This magnitude of interannual SLR is unprecedented (a 1-in-850 year event) during the entire history of the tide gauge records. Here we show that this extreme SLR event is a combined effect of two factors: an observed 30% downturn of the Atlantic meridional overturning circulation during 2009-10, and a significant negative North Atlantic Oscillation index. The extreme nature of the 2009-10 SLR event suggests that such a significant downturn of the Atlantic overturning circulation is very unusual. During the twenty-first century, climate models project an increase in magnitude and frequency of extreme interannual SLR events along this densely populated coast.

Preparing Postbaccalaureates for Entry and Success in Biomedical PhD Programs

PubMed Central

Hall, Joshua D.; Harrell, Jessica R.; Cohen, Kimberley W.; Miller, Virginia L.; Phelps, Patricia V.; Cook, Jeanette G.

2016-01-01

Certain racial and ethnic groups, individuals with disabilities, and those from low socioeconomic backgrounds remain underrepresented (UR) in the biomedical sciences. This underrepresentation becomes more extreme at each higher education stage. To support UR scholars during the critical transition from baccalaureate to PhD, we established an intensive, 1-yr postbaccalaureate training program. We hypothesized that this intervention would strengthen each participant’s competitiveness for leading PhD programs and build a foundation of skills and self-efficacy important for success during and after graduate school. Scholar critical analysis skills, lab technique knowledge, and Graduate Record Examination scores all improved significantly during the program. Scholars reported significant confidence growth in 21 of 24 categories related to success in research careers. In 5 yr, 91% (41/45) of scholars transitioned directly into PhD programs. Importantly, 40% (18/45) of participating postbaccalaureate scholars had previously been declined acceptance into graduate school; however, 17/18 of these scholars directly entered competitive PhD programs following our training program. Alumni reported they were “extremely well” prepared for graduate school, and 95% (39/41) are currently making progress to graduation with a PhD. In conclusion, we report a model for postbaccalaureate training that could be replicated to increase participation and success among UR scholars in the biomedical sciences. PMID:27496358

The relationship between independent transfer skills and upper limb kinetics in wheelchair users.

PubMed

Tsai, Chung-Ying; Hogaboom, Nathan S; Boninger, Michael L; Koontz, Alicia M

2014-01-01

Transfers are one of the most physically demanding wheelchair activities. The purpose of this study was to determine if using proper transfer skills as measured by the Transfer Assessment Instrument (TAI) is associated with reduced loading on the upper extremities. Twenty-three wheelchair users performed transfers to a level-height bench while a series of forces plates, load cells, and a motion capture system recorded the biomechanics of their natural transferring techniques. Their transfer skills were simultaneously evaluated by two study clinicians using the TAI. Logistic regression and multiple linear regression models were used to determine the relationships between TAI scores and the kinetic variables on both arms across all joints. The results showed that the TAI measured transfer skills were closely associated with the magnitude and timing of joint moments (P < .02, model R(2) values ranged from 0.27 to 0.79). Proper completion of the skills which targeted the trailing arm was associated with lower average resultant moments and rates of rise of resultant moments at the trailing shoulder and/or elbow. Some skills involving the leading side had the effect of increasing the magnitude or rate loading on the leading side. Knowledge of the kinetic outcomes associated with each skill may help users to achieve the best load-relieving effects for their upper extremities.

Optimal volume of injectate for fluoroscopy-guided cervical interlaminar epidural injection in patients with neck and upper extremity pain

PubMed Central

Park, Jun Young; Kim, Doo Hwan; Lee, Kunhee; Choi, Seong-Soo; Leem, Jeong-Gil

2016-01-01

Abstract There is no study of optimal volume of contrast medium to use in cervical interlaminar epidural injections (CIEIs) for appropriate spread to target lesions. To determine optimal volume of contrast medium to use in CIEIs. We analyzed the records of 80 patients who had undergone CIEIs. Patients were divided into 3 groups according to the amount of contrast: 3, 4.5, and 6 mL. The spread of medium to the target level was analyzed. Numerical rating scale data were also analyzed. The dye had spread to a point above the target level in 15 (78.9%), 22 (84.6%), and 32 (91.4%) patients in groups 1 to 3, respectively. The dye reached both sides in 14 (73.7%), 18 (69.2%), and 23 (65.7%) patients, and reached the ventral epidural space in 15 (78.9%), 22 (84.6%), and 30 (85.7%) patients, respectively. There were no significant differences of contrast spread among the groups. There were no significant differences in the numerical rating scale scores among the groups during the 3 months. When performing CIEIs, 3 mL medication is sufficient volume for the treatment of neck and upper-extremity pain induced by lower cervical degenerative disease. PMID:27787378

Optimal volume of injectate for fluoroscopy-guided cervical interlaminar epidural injection in patients with neck and upper extremity pain.

PubMed

Park, Jun Young; Kim, Doo Hwan; Lee, Kunhee; Choi, Seong-Soo; Leem, Jeong-Gil

2016-10-01

There is no study of optimal volume of contrast medium to use in cervical interlaminar epidural injections (CIEIs) for appropriate spread to target lesions. To determine optimal volume of contrast medium to use in CIEIs. We analyzed the records of 80 patients who had undergone CIEIs. Patients were divided into 3 groups according to the amount of contrast: 3, 4.5, and 6 mL. The spread of medium to the target level was analyzed. Numerical rating scale data were also analyzed. The dye had spread to a point above the target level in 15 (78.9%), 22 (84.6%), and 32 (91.4%) patients in groups 1 to 3, respectively. The dye reached both sides in 14 (73.7%), 18 (69.2%), and 23 (65.7%) patients, and reached the ventral epidural space in 15 (78.9%), 22 (84.6%), and 30 (85.7%) patients, respectively. There were no significant differences of contrast spread among the groups. There were no significant differences in the numerical rating scale scores among the groups during the 3 months. When performing CIEIs, 3 mL medication is sufficient volume for the treatment of neck and upper-extremity pain induced by lower cervical degenerative disease.

The influence of lower limb impairments on RaceRunning performance in athletes with hypertonia, ataxia or athetosis.

PubMed

van der Linden, Marietta L; Jahed, Sadaf; Tennant, Nicola; Verheul, Martine H G

2018-03-01

RaceRunning enables athletes with limited or no walking ability to propel themselves independently using a three-wheeled running bike that has a saddle and a chest plate for support but no pedals. For RaceRunning to be included as a Para athletics event, an evidence-based classification system is required. Therefore, the aim of this study was to assess the association between a range of impairment measures and RaceRunning performance. The following impairment measures were recorded: lower limb muscle strength assessed using Manual Muscle Testing (MMT), selective voluntary motor control assessed using the Selective Control Assessment of the Lower Extremity (SCALE), spasticity recorded using both the Australian Spasticity Assessment Score (ASAS) and Modified Ashworth Scale (MAS), passive range of motion (ROM) of the lower extremities and the maximum static step length achieved on a stationary bike (MSSL). Associations between impairment measures and 100-meter race speed were assessed using Spearman's correlation coefficients. Sixteen male and fifteen female athletes (27 with cerebral palsy), aged 23 (SD = 7) years, Gross Motor Function Classification System levels ranging from II to V, participated. The MSSL averaged over both legs and the ASAS, MAS, SCALE, and MMT summed over all joints and both legs, significantly correlated with 100 m race performance (rho: 0.40-0.54). Passive knee extension was the only ROM measure that was significantly associated with race speed (rho = 0.48). These results suggest that lower limb spasticity, isometric leg strength, selective voluntary motor control and passive knee extension impact performance in RaceRunning athletes. This supports the potential use of these measures in a future evidence-based classification system. Copyright © 2018 Elsevier B.V. All rights reserved.

The epidemiology of sports-related injuries in older adults: a central European epidemiologic study.

PubMed

Kammerlander, Christian; Braito, Matthias; Kates, Stephen; Jeske, Christian; Roth, Tobias; Blauth, Michael; Dallapozza, Christian

2012-10-01

The population is rapidly aging and remaining more active over the age of 65. An increasing number of sports related injuries in individuals 65 and older are thus anticipated. The aim of this study is to analyze the epidemiology of sports injuries in the age group aged 65 and older. Data from the medical records of adults aged 65 years and older who were treated for sports-related injuries at a level one trauma center between December 1994 and February 2008 was collected and statistically analyzed. A total of 2635 patients met our inclusion criteria. There were 1647 men (62.5%) and 988 women (37.5%) with a mean age of 70.9 years. The yearly number of injuries doubled during the study period (1996-2007). The most common mechanism of injury was a simple fall from standing height (69%). Nearly 75% of all injuries occurred during alpine skiing, cycling or mountain climbing. The median Injury Severity Score was 4. Minor injuries and wounds (40%) were recorded most commonly followed by fractures (27%), sprains, ligament injuries (19%) and injuries of muscles and tendons (6%). The most frequent diagnoses were minor injuries to the head and ligament injuries around the knee joint. Injuries to the upper extremities occurred in 33.7%, injuries to the lower extremities in 29.4% and injuries to the head occurred in 20% of the patients. Women sustained substantially more fractures than men. Adults aged 65 and older are remaining active in sports, which results in higher numbers of sports related injuries in this age group. Identification of type, mechanism and distribution of the injuries can help with the recognition of risk factors for injury. This may enable us to develop appropriate preventative measures to reduce the incidence, and morbidity of such injuries.

Functional Outcomes 18 Months After Total and Midarm Transplantation: A Case Report.

PubMed

Iglesias, M; Ramírez-Berumen, M; Butrón, P; Alberú-Gómez, J; Salazar-Hernández, F; Macias-Gallardo, J; Leal-Villalpando, R P; Zamudio-Bautista, J; Acosta, V; Jauregui, L; Hernández-Campos, A; Espinosa-Cruz, V; Vázquez-Lamadrid, J; González-Sánchez, J; Cuellar-Rodriguez, J; Sierra-Madero, J G; Gaytan-Cervantes, R; Contreras-Barbosa, S; Navarro-Lara, A; Guzman-Gonzalez, J; Domínguez-Cherit, J; Vilatoba, M; Toussaint-Caire, S; Vega-Boada, F; Gómez-Pérez, F J; Mayorquin-Ruiz, M

2018-04-01

The function reported after arm transplantation is deemed beneficial relative to the marked disability that upper arm amputation causes. We report a 51-year-old man with a Disabilities of the Arm, Shoulder and Hand (DASH) score of 75.83 who underwent bilateral arm transplantation in October 2015. The right arm was transplanted at the glenohumeral joint level, including transplantation of the humeral head, joint capsule, and rotator cuff ligaments and tendons. Additionally, neurorrhaphies were performed at the origin of the terminal branches of the brachial plexus, including the axillary and musculocutaneous nerves. Therefore, this was considered a total arm transplantation. The left arm was transplanted at the transhumeral level, with complete transplantation of the biceps and triceps brachii, and terminolateral neurorrhaphy of the donor musculocutaneous nerve to the receptor radial nerve. A maintenance triple immunosuppression scheme was administered, with tacrolimus levels kept at 10 ng/mL. At 18 months post-transplantation, the intrinsic musculature in the left hand showed electrical registry, DASH score was 67.5, Carroll test score was 28 in both extremities, Hand Transplant Score System was 67.5 in the right extremity and 77.5 in the left extremity, and Short Form-36 score was 96.1. The patient was healthy, with restored body integrity. He could lift medium-sized weightless objects, eat and go to the bathroom by himself, drink liquids with bimanual grasp, swim, dress almost independently, and drive. The functional evolution of the patient was similar to previously reported transplanted arms, even though the right arm transplant involved the glenohumeral joint and axillary and musculocutaneous nerve repair. Copyright © 2017 Elsevier Inc. All rights reserved.

Use and knowledge of Cactaceae in Northeastern Brazil.

PubMed

Lucena, Camilla Marques de; Lucena, Reinaldo Farias Paiva de; Costa, Gabriela Maciel; Carvalho, Thamires Kelly Nunes; Costa, Gyslaynne Gomes da Silva; Alves, Rômulo Romeu da Nóbrega; Pereira, Daniel Duarte; Ribeiro, João Everthon da Silva; Alves, Carlos Antônio Belarmino; Quirino, Zelma Glebya Maciel; Nunes, Ernane Nogueira

2013-08-28

This study aimed to record the use, and knowledge that residents from São Francisco community (Paraiba, Brazil) have regarding the Cactaceae. Semi-structured interviews were carried out with 118 informants; 50 men and 68 women. The cacti cited in this study were organised into use categories and use values were calculated. Differences in the values applied to species and use categories by men and women were compared via a G test (Williams). The nine species identified were: Cereus jamacaru DC., Melocactus bahiensis (Brtitton & Rose) Luetzelb., Nopalea cochenillifera (L.) Salm-Dyck., Opuntia ficus indica (L.) Mill, Opuntia stricta (Haw.) Haw., Pilosocereus gounellei (F.A.C. Weber) Byles & Rowley, Pilosocereus pachycladus F. Ritter, Tacinga inamoena (K. Schum) N.P. Taylor & Stuppy, Tacinga palmadora (Britton & Rose) N.P. Taylor & Stuppy. In total, 1,129 use citations were recorded, divided into 11 categories. The use value categories with the highest scores were forage (0.42), food (0.30) and construction (building) (0.25). P. pachycladus showed the greatest use value, versatility and number of plant parts used. The survey showed that the Cactaceae is extremely important for several uses and categories attributed to different species. Apart from contributing to the ethnobotanical knowledge of the Cactaceae, another important focus of this study was to reinforce the necessity for further studies that record the traditional knowledge about this plant family, which has been lost in younger generations.

Use and knowledge of Cactaceae in Northeastern Brazil

PubMed Central

2013-01-01

Background This study aimed to record the use, and knowledge that residents from São Francisco community (Paraiba, Brazil) have regarding the Cactaceae. Methods Semi-structured interviews were carried out with 118 informants; 50 men and 68 women. The cacti cited in this study were organised into use categories and use values were calculated. Differences in the values applied to species and use categories by men and women were compared via a G test (Williams). Results The nine species identified were: Cereus jamacaru DC., Melocactus bahiensis (Brtitton & Rose) Luetzelb., Nopalea cochenillifera (L.) Salm-Dyck., Opuntia ficus indica (L.) Mill, Opuntia stricta (Haw.) Haw., Pilosocereus gounellei (F.A.C. Weber) Byles & Rowley, Pilosocereus pachycladus F. Ritter, Tacinga inamoena (K. Schum) N.P. Taylor & Stuppy, Tacinga palmadora (Britton & Rose) N.P. Taylor & Stuppy. In total, 1,129 use citations were recorded, divided into 11 categories. The use value categories with the highest scores were forage (0.42), food (0.30) and construction (building) (0.25). P. pachycladus showed the greatest use value, versatility and number of plant parts used. Conclusion The survey showed that the Cactaceae is extremely important for several uses and categories attributed to different species. Apart from contributing to the ethnobotanical knowledge of the Cactaceae, another important focus of this study was to reinforce the necessity for further studies that record the traditional knowledge about this plant family, which has been lost in younger generations. PMID:23981911

A Novel Approach for Lie Detection Based on F-Score and Extreme Learning Machine

PubMed Central

Gao, Junfeng; Wang, Zhao; Yang, Yong; Zhang, Wenjia; Tao, Chunyi; Guan, Jinan; Rao, Nini

2013-01-01

A new machine learning method referred to as F-score_ELM was proposed to classify the lying and truth-telling using the electroencephalogram (EEG) signals from 28 guilty and innocent subjects. Thirty-one features were extracted from the probe responses from these subjects. Then, a recently-developed classifier called extreme learning machine (ELM) was combined with F-score, a simple but effective feature selection method, to jointly optimize the number of the hidden nodes of ELM and the feature subset by a grid-searching training procedure. The method was compared to two classification models combining principal component analysis with back-propagation network and support vector machine classifiers. We thoroughly assessed the performance of these classification models including the training and testing time, sensitivity and specificity from the training and testing sets, as well as network size. The experimental results showed that the number of the hidden nodes can be effectively optimized by the proposed method. Also, F-score_ELM obtained the best classification accuracy and required the shortest training and testing time. PMID:23755136

Plant development scores from fixed-date photographs: the influence of weather variables and recorder experience

NASA Astrophysics Data System (ADS)

Sparks, T. H.; Huber, K.; Croxton, P. J.

2006-05-01

In 1944, John Willis produced a summary of his meticulous record keeping of weather and plants over the 30 years 1913 1942. This publication contains fixed-date, fixed-subject photography taken on the 1st of each month from January to May, using as subjects snowdrop Galanthus nivalis, daffodil Narcissus pseudo-narcissus, horse chestnut Aesculus hippocastanum and beech Fagus sylvatica. We asked 38 colleagues to assess rapidly the plant development in each of these photographs according to a supplied five-point score. The mean scores from this exercise were assessed in relation to mean monthly weather variables preceding the date of the photograph and the consistency of scoring was examined according to the experience of the recorders. Plant development was more strongly correlated with mean temperature than with minimum or maximum temperatures or sunshine. No significant correlations with rainfall were detected. Whilst mean scores were very similar, botanists were more consistent in their scoring of developmental stages than non-botanists. However, there was no overall pattern for senior staff to be more consistent in scoring than junior staff. These results suggest that scoring of plant development stages on fixed dates could be a viable method of assessing the progress of the season. We discuss whether such recording could be more efficient than traditional phenology, especially in those sites that are not visited regularly and hence are less amenable to frequent or continuous observation to assess when a plant reaches a particular growth stage.

The East London glaucoma prediction score: web-based validation of glaucoma risk screening tool

PubMed Central

Stephen, Cook; Benjamin, Longo-Mbenza

2013-01-01

AIM It is difficult for Optometrists and General Practitioners to know which patients are at risk. The East London glaucoma prediction score (ELGPS) is a web based risk calculator that has been developed to determine Glaucoma risk at the time of screening. Multiple risk factors that are available in a low tech environment are assessed to provide a risk assessment. This is extremely useful in settings where access to specialist care is difficult. Use of the calculator is educational. It is a free web based service. Data capture is user specific. METHOD The scoring system is a web based questionnaire that captures and subsequently calculates the relative risk for the presence of Glaucoma at the time of screening. Three categories of patient are described: Unlikely to have Glaucoma; Glaucoma Suspect and Glaucoma. A case review methodology of patients with known diagnosis is employed to validate the calculator risk assessment. RESULTS Data from the patient records of 400 patients with an established diagnosis has been captured and used to validate the screening tool. The website reports that the calculated diagnosis correlates with the actual diagnosis 82% of the time. Biostatistics analysis showed: Sensitivity = 88%; Positive predictive value = 97%; Specificity = 75%. CONCLUSION Analysis of the first 400 patients validates the web based screening tool as being a good method of screening for the at risk population. The validation is ongoing. The web based format will allow a more widespread recruitment for different geographic, population and personnel variables. PMID:23550097

Event attribution: Human influence on the record-breaking cold event in January of 2016 in Eastern China

NASA Astrophysics Data System (ADS)

Qian, C.; Wang, J.; Dong, S.; Yin, H.; Burke, C.; Ciavarella, A.; Dong, B.; Freychet, N.; Lott, F. C.; Tett, S. F.

2017-12-01

It is controversial whether Asian mid-latitude cold surges are becoming more likely as a consequence of Arctic warming. Here, we present an event attribution study in mid-latitude Eastern China. A strong cold surge occurred during 21st-25th January 2016 affecting most areas of China, especially Eastern China. Daily minimum temperature (Tmin) records were broken at many stations. The area averaged anomaly of Tmin over the region (20-44N, 100-124E) for this pentad was the lowest temperature recorded since modern meteorological observations started in 1960. This cold event occurred in a background of the warmest winter Tmin since 1960. Given the vast damages caused by this extreme cold event in Eastern China and the previous mentioned controversy, it is compelling to investigate how much anthropogenic forcing agents have affected the probability of cold events with an intensity equal to or larger than the January 2016 extreme event. We use the Met Office Hadley Centre system for Attribution of extreme weather and Climate Events and station observations to investigate the effect of anthropogenic forcings on the likelihood of such a cold event. Anthropogenic influences are estimated to have reduced the likelihood of an extreme cold event in mid-winter with the intensity equal to or stronger than the record of 2016 in Eastern China by about 2/3.

A Tree-Ring Based Reconstruction (1725-present) of the Position of the Summer North Atlantic Jet Shows a 20th Century Northward Shift

NASA Astrophysics Data System (ADS)

Trouet, V.; Babst, F.

2014-12-01

The position and strength of the Northern Hemisphere polar jet are important modulators of mid-latitude weather extremes and the societal, ecosystem, and economic damage related to them. The position of the North Atlantic jet (NAJ) controls the location of the Atlantic storm track and anomalies in the NAJ position have been related to temperature and precipitation extremes over Europe. In summer, a southern NAJ regime can result in floods in the British Isles (BRIT) and increasing odds of heat waves in the northeastern Mediterranean (NEMED). Variability in the amplitude and speed of the Northern Hemisphere jet stream is hotly debated as a potential mechanism linking recent mid-latitude weather extremes to anthropogenic warming. However, the hypothesis of jet stream variability as a possible mechanism linking Arctic amplification to mid-latitude weather extremes is largely based on data sets with limited temporal extent that do not warrant robust results from a statistical significance perspective. Here, we combined two summer temperature-sensitive tree-ring records from BRIT and NEMED to reconstruct interannual variability in the latitudinal position of the summer NAJ back to 1725. The two well-replicated temperature proxies counter-correlate significantly over the full period and thus illustrate the temperature dipole generated by anomalous NAJ positions. Positive extremes in the NAJ reconstruction correspond to heatwaves recorded in the historical Central England temperature record and negative extremes correspond to reconstructed fire years in Greece. The reconstruction shows a northward shift in the latitudinal NAJ position since the 1930s that is most pronounced in the northern NAJ extremes, suggesting a more frequent occurrence of BRIT hot summers in the 20th century compared to previous centuries.

Virtual reality for upper extremity rehabilitation in early stroke: a pilot randomized controlled trial.

PubMed

Yin, Chan Wai; Sien, Ng Yee; Ying, Low Ai; Chung, Stephanie Fook-Chong Man; Tan May Leng, Dawn

2014-11-01

To investigate the effect of virtual reality (VR) rehabilitation on upper extremity motor performance of patients with early stroke. Pilot randomized controlled trial. Rehabilitation wards. Twenty three adults with stroke (mean age (SD) = 58.35 (13.45) years and mean time since stroke (SD) = 16.30 (7.44) days). Participants were randomly assigned to VR group (n=11) or control group (n=12). VR group received nine 30 minutes upper extremity VR therapy in standing (five weekdays in two weeks) plus conventional therapy, which included physical and occupational therapy. Control group received only conventional therapy, which was comparable to total training time received by VR group (mean training hours (SD):VR = 17.07 (2.86); control = 15.50 (2.79)). The main outcome measure was the Fugl-Meyer Assessment (FMA). Secondary outcomes included Action Research Arm Test, Motor Activity Log and Functional Independence Measure. Results were taken at baseline, post intervention and 1-month post intervention. Participants' feedback and adverse effects were recorded. All participants improved in FMA scores (mean change (SD) = 11.65 (8.56), P<.001). These effects were sustained at one month after intervention (mean (SD) change from baseline = 18.67 (13.26), P<.001). All other outcome measures showed similar patterns. There were no significant differences in improvement between both groups. Majority of the participants found VR training useful and enjoyable, with no serious adverse effects reported. Although additional VR training was not superior to conventional therapy alone, this study demonstrates the feasibility of VR training in early stroke. © The Author(s) 2014.

Improving quality in an internal medicine residency program through a peer medical record audit.

PubMed

Asao, Keiko; Mansi, Ishak A; Banks, Daniel

2009-12-01

This study examined the effectiveness of a quality improvement project of a limited didactic session, a medical record audit by peers, and casual feedback within a residency program. Residents audited their peers' medical records from the clinic of a university hospital in March, April, August, and September 2007. A 24-item quality-of-care score was developed for five common diagnoses, expressed from 0 to 100, with 100 as complete compliance. Audit scores were compared by month and experience of the resident as an auditor. A total of 469 medical records, audited by 12 residents, for 80 clinic residents, were included. The mean quality-of-care score was 89 (95% CI = 88-91); the scores in March, April, August, and September were 88 (95% CI = 85-91), 94 (95% CI = 90-96), 87 (95% CI = 85-89), and 91 (95% CI = 89-93), respectively. The mean score of 58 records of residents who had experience as auditors was 94 (95% CI = 89-96) compared with 89 (95% CI = 87-90) for those who did not. The score significantly varied (P = .0009) from March to April and from April to August, but it was not significantly associated with experience as an auditor with multivariate analysis. Residents' compliance with the standards of care was generally high. Residents responded to the project well, but their performance dropped after a break in the intervention. Continuation of the audit process may be necessary for a sustained effect on quality.

Wound center facility billing: A retrospective analysis of time, wound size, and acuity scoring for determining facility level of service.

PubMed

Fife, Caroline E; Walker, David; Farrow, Wade; Otto, Gordon

2007-01-01

Outpatient wound center facility reimbursement for Medicare beneficiaries can be a challenge to determine and obtain. To compare methods of calculating facility service levels for outpatient wound centers and to demonstrate the advantages of an acuity-based billing system (one that incorporates components of facility work that is non-reimbursable by procedure codes and that represents an activity-based costing approach to medical billing), a retrospective study of 5,098 patient encounters contained in a wound care-specific electronic medical record database was conducted. Approximately 500 patient visits to the outpatient wound center of a Texas regional hospital between April 2003 and November 2004 were categorized by service level in documentation and facility management software. Visits previously billed using a time-based system were compared to the Centers for Medicare and Medicaid Services' proposed three-tiered wound size-based system. The time-based system also was compared to an acuity-based scoring system. The Pearson correlation coefficient between billed level of service by time and estimated level of service by acuity was 0.442 and the majority of follow-up visits were billed as Level 3 and above (on a time level of 1 to 5) , confirming that time is not a surrogate for actual work performed. Wound size also was found to be unrelated to service level (Pearson correlation = 0.017) and 97% of wound areas were < 100 cm2. The acuity-based scoring system produced a near-normal distribution of results, producing more mid-range billings than extremes; no other method produced this distribution. Hospital-based outpatient wound centers should develop, review, and refine acuity score-based models on which to determine billed level of service.

The Effect of Concussion or Mild Traumatic Brain Injury on School Grades, National Examination Scores, and School Attendance: A Systematic Review.

PubMed

Rozbacher, Adrian; Selci, Erin; Leiter, Jeff; Ellis, Michael; Russell, Kelly

2017-07-15

Concussion often results in symptoms, including difficulty concentrating, focusing, and remembering, that are typically managed with cognitive and physical rest. Often, the school environment is not conducive to cognitive rest and may lead to worsening or prolonged symptoms that can contribute to impaired academic performance. The objective of the review was to identify and summarize literature concerning the effects of concussion or mild traumatic brain injury (mTBI) on academic outcomes. MEDLINE, Embase, Scopus, and CINAHL were searched until June 1, 2016. Studies must have been primary literature examining students enrolled in primary, secondary, or post-secondary education, have received a physician diagnosis of concussion or mTBI, and have post-injury academic outcomes assessed in numeric or alphabet grade/grade point average (GPA), school attendance records, or national examination scores. Data were extracted and checked by a second reviewer for accuracy and completeness. Nine studies were included. Among four studies that examined grades, one found a significant difference in pre- and post-grades only in the subject Afrikaans. Three examined national test scores and no significant differences were found between cases and controls. Four examined school absenteeism and found that students who developed post-concussion syndrome missed significantly more school days and took longer to return to school than students with extremity injuries. Although mTBI or concussion is associated with missed school, the results demonstrate minimal impact on school grades and national examination scores at a group level. Further research is needed to identify risk factors for impaired school functioning following mTBI and concussion in individual patients.

Impact of maternal education on cognitive and language scores at 18 to 24 months among extremely preterm neonates.

PubMed

Ko, Gary; Shah, Prakesh; Lee, Shoo K; Asztalos, Elizabeth

2013-10-01

To explore the association between maternal education levels and cognitive and language composite scores of the Bayley Scales of Infant Development, Third Edition at 18 to 24 months' corrected age in extremely preterm infants born at < 29 weeks of gestation. For infants born between 2005 and 2008, maternal education levels and the cognitive and language composite scores were collected. Analysis of covariance was used to determine the relationship between maternal education levels and composite scores after adjusting for neonatal and perinatal factors. For the study period, 457/524 (88%) infants were included in the analysis. With less than a high school education as reference, infants born to mothers with a high school education (adjusted mean difference [MD] = 5.4; 95% confidence interval [CI] 0.9 to 10.0), with partial college or specialty training (MD 8.1; 95% CI 2.8 to 13.5), with a university degree or more (MD 12.6; 95% CI 8.2 to 17.0) had significantly higher cognitive scores. Similarly, infants born to mothers with a university degree or more had significantly higher language scores (MD 10.8; 95% CI 6.1 to 15.5). For infants born at <29 weeks' gestation, both cognitive and language scores were higher as maternal education increased from less than high school level to university or higher level. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Relationship of Parental Knowledge to the Development of Extremely Low Birth Weight Infants.

ERIC Educational Resources Information Center

Dichtelmiller, Margo; And Others

1992-01-01

This study found that mothers (n=40) of extremely high-risk infants (averaging 1000 grams birthweight and 28 weeks gestational age) called upon the same experiences and sources of information as mothers of full-term infants. Infants of mothers with above average knowledge about infancy scored significantly higher on tests of infant development at…

Evaluation of impairment of the upper extremity.

PubMed

Blair, S J; McCormick, E; Bear-Lehman, J; Fess, E E; Rader, E

1987-08-01

Evaluation of impairment of the upper extremity is the product of a team effort by the physician, occupational therapist, physical therapist, and rehabilitation counselor. A careful recording of the anatomic impairment should be made because this is critical in determining the subsequent functional activities of the extremity. The measurement criteria for clinical and functional evaluation includes condition assessment instruments. Some assess the neurovascular system, others assess movements including the monitoring of articular motion and musculotendinous function. Sensibility assessment instruments measure sympathetic response and detect single joint stimulus, discrimination, quantification, and recognition abilities. A detailed description of each assessment is recorded and physical capacity evaluation is only one component of the entire vocational evaluation. This evaluation answers questions regarding the injured worker's ability to return to his previous job. The work simulator is a useful instrument that allows rehabilitation and testing of the injured upper extremity. Job site evaluation includes assessment criteria for work performance, work behavior, and work environment.

Evaluation of Magnetic Resonance Imaging Responsiveness in Active Psoriatic Arthritis at Multiple Timepoints during the First 12 Weeks of Antitumor Necrosis Factor Therapy.

PubMed

Feletar, Marie; Hall, Stephen; Bird, Paul

2016-01-01

To assess the responsiveness of high- and low-field extremity magnetic resonance imaging (MRI) variables at multiple timepoints in the first 12 weeks post-antitumor necrosis factor (anti-TNF) therapy initiation in patients with psoriatic arthritis (PsA) and active dactylitis. Twelve patients with active PsA and clinical evidence of dactylitis involving at least 1 digit were recruited. Patients underwent sequential high-field conventional (1.5 Tesla) and extremity low-field MRI (0.2 Tesla) of the affected hand or foot, pre- and postgadolinium at baseline (pre-TNF), 2 weeks (post-TNF), 6 weeks, and 12 weeks. A blinded observer scored all images on 2 occasions using the PsA MRI scoring system. Eleven patients completed the study, but only 6 patients completed all high-field and low-field MRI assessments. MRI scores demonstrated rapid response to TNF inhibition with score reduction in tenosynovitis, synovitis, and osteitis at 2 weeks. Intraobserver reliability was good to excellent for all variables. High-field MRI demonstrated greater sensitivity to tenosynovitis, synovitis, and osteitis and greater responsiveness to change posttreatment. Treatment responses were maintained to 12 weeks. This study demonstrates the use of MRI in detecting early response to biologic therapy. MRI variables of tenosynovitis, synovitis, and osteitis demonstrated responsiveness posttherapy with high-field scores more responsive to change than low-field scores.

Meteorological and hydrological extremes derived from taxation records: case study for south-western Moravia (Czech Republic)

NASA Astrophysics Data System (ADS)

Chromá, Kateřina; Brázdil, Rudolf; Valášek, Hubert; Zahradníček, Pavel

2013-04-01

Meteorological and hydrological extremes (MHEs) cause great material damage or even loss of human lives in the present time, similarly as it was in the past. In the Czech Lands (recently the Czech Republic), systematic meteorological and hydrological observations started generally in the latter half of the 19th century. Therefore, in order to create long-term series of such extremes, it is necessary to search for other sources of information. Different types of documentary evidence are used in historical climatology and hydrology to find such information. Some of them are related to records connected with taxation system. The taxation system in Moravia allowed farmers to request tax relief if their crops have been damaged by MHEs. The corresponding documents contain information about the type of extreme event and the date of its occurrence; often also impacts on crops or land may be derived. The nature of events leading to damage include particularly hailstorms, torrential rain, flash floods, floods (in regions along larger rivers), less frequently windstorms, late frosts and in some cases also information about droughts or extreme snow depths. However, the results obtained are influenced by uncertainties related to taxation records - their temporal and spatial incompleteness, limitation of the MHEs occurrence in the period of main agricultural work (May-August) and the purpose for which they were originally collected (primarily tax alleviation, i.e. information about MHEs was of secondary importance). All these aspects related to the study of MHEs from taxation records are demonstrated for five estates (Bítov, Budkov, Jemnice with Staré Hobzí, Nové Syrovice and Uherčice) in the south-western part of Moravia for the 18th-19th centuries. The analysis shows importance of taxation records for the study of past MHEs as well as great potential for their use.

Mapping Dependence Between Extreme Rainfall and Storm Surge

NASA Astrophysics Data System (ADS)

Wu, Wenyan; McInnes, Kathleen; O'Grady, Julian; Hoeke, Ron; Leonard, Michael; Westra, Seth

2018-04-01

Dependence between extreme storm surge and rainfall can have significant implications for flood risk in coastal and estuarine regions. To supplement limited observational records, we use reanalysis surge data from a hydrodynamic model as the basis for dependence mapping, providing information at a resolution of approximately 30 km along the Australian coastline. We evaluated this approach by comparing the dependence estimates from modeled surge to that calculated using historical surge records from 79 tide gauges around Australia. The results show reasonable agreement between the two sets of dependence values, with the exception of lower seasonal variation in the modeled dependence values compared to the observed data, especially at locations where there are multiple processes driving extreme storm surge. This is due to the combined impact of local bathymetry as well as the resolution of the hydrodynamic model and its meteorological inputs. Meteorological drivers were also investigated for different combinations of extreme rainfall and surge—namely rain-only, surge-only, and coincident extremes—finding that different synoptic patterns are responsible for each combination. The ability to supplement observational records with high-resolution modeled surge data enables a much more precise quantification of dependence along the coastline, strengthening the physical basis for assessments of flood risk in coastal regions.

Frequency of extreme daily temperatures (HadEX2) over Eurasia documented in a northern Red Sea coral oxygen isotope record during the last century

NASA Astrophysics Data System (ADS)

Ionita-Scholz, Monica; Felis, Thomas; Rimbu, Norel; Lohmann, Gerrit

2017-04-01

The potential of a bimonthly-resolved northern Red Sea coral δ18O record as an archive for the occurrence of extreme daily temperature phenomena over Eurasia during Northern Hemisphere winter is investigated for the 1901-1995 period using extreme indices provided by the HadEX2 dataset (e.g., frost days, ice days, cold nights and cold days). The coral δ18O record reflects a combined signal of temperature and salinity variations in the surface waters of the northern Red Sea, and has been previously shown to provide a proxy for atmospheric circulation changes over the Northern Hemisphere mid-latitudes at interannual to decadal time scales. Here we show, by applying composite analysis, that cooler/more arid (warmer/less arid) winter conditions in the northern Red Sea region, indicated by positive (negative) coral δ18O anomalies (January-February), are related to a strong (weak) Northern Hemisphere polar vortex and, as a consequence, to a decreased (increased) number of days characterized by very cold temperatures and frost over Scandinavia and Central Europe. This situation is associated with an increased (decreased) number of days characterized by very cold temperatures and frost over the Balkan region. The occurrence of these daily temperature extremes is modulated by the frequency of atmospheric blocking over the British Isles and Central Europe, and a shift in the direction of the North Atlantic storm tracks. Importantly, coral records provide a bimonthly to monthly resolution, compared to other high-resolution proxy records which have either an annual resolution (e.g., ice cores, varved sediments) or an annual resolution with a signal that is biased towards a specific season that in most cases is not winter (e.g., tree rings). We argue that bimonthly-resolved northern Red Sea coral δ18O records provide an archive of interannual to decadal variations in the occurrence of extreme daily temperature events over wintertime Eurasia prior to the start of instrumental observations.

RELATIONSHIP OF PRESEASON MOVEMENT SCREENS WITH OVERUSE SYMPTOMS IN COLLEGIATE BASEBALL PLAYERS

PubMed Central

Clifton, Daniel R.; Onate, James A.; Ramsey, Vincent K.; Cromartie, Fred

2017-01-01

Background: The shoulder mobility screen of the Functional Movement Screen™ (FMS™) and the upper extremity patterns of the Selective Functional Movement Assessment (SFMA) assess global, multi-joint movement capabilities in the upper-extremities. Identifying which assessment can most accurately determine if baseball players are at an increased risk of experiencing overuse symptoms in the shoulder or elbow throughout a competitive season may reduce throwing-related injuries requiring medical attention. Purpose: The purpose of this study was to determine if preseason FMS™ or SFMA scores were related to overuse severity scores in the shoulder or elbow during the preseason and competitive season. Study design: Cohort study. Methods: Sixty healthy, male, Division III collegiate baseball players (mean age = 20.1 ± 2.0 years) underwent preseason testing using the FMS™ shoulder mobility screen, and SFMA upper extremity patterns. Their scores were dichotomized into good and bad movement scores, and were compared to weekly questionnaires registering overuse symptoms and pain severity in the shoulder or elbow during the season. Results: Poor FMS™ performance was associated with an increased likelihood of experiencing at least one overuse symptom during the preseason independent of grade and position (adjusted odds ratio [OR] = 5.14, p = 0.03). Poor SFMA performance was associated with an increased likelihood of experiencing at least one overuse symptom during the preseason (adjusted OR = 6.10, p = 0.03) and during the competitive season (adjusted OR = 17.07, p = 0.03) independent of grade and position. Conclusion: FMS™ shoulder mobility and SFMA upper extremity pattern performance were related to the likelihood of experiencing overuse symptoms during a baseball season. Participants with poor FMSTM performances may be more likely to experience at least one overuse symptom in their shoulder or elbow during the preseason. Additionally, individuals with poor SFMA performances may be more likely to report overuse symptoms during the preseason or competitive season. Level of evidence: Level 3 PMID:29158957

Multisource feedback analysis of pediatric outpatient teaching

PubMed Central

2013-01-01

Background This study aims to evaluate the outpatient communication skills of medical students via multisource feedback, which may be useful to map future directions in improving physician-patient communication. Methods Family respondents of patients, a nurse, a clinical teacher, and a research assistant evaluated video-recorded medical students’ interactions with outpatients by using multisource feedback questionnaires; students also assessed their own skills. The questionnaire was answered based on the video-recorded interactions between outpatients and the medical students. Results A total of 60 family respondents of the 60 patients completed the questionnaires, 58 (96.7%) of them agreed with the video recording. Two reasons for reluctance were “personal privacy” issues and “simply disagree” with the video recording. The average satisfaction score of the 58 students was 85.1 points, indicating students’ performance was in the category between satisfied and very satisfied. The family respondents were most satisfied with the “teacher”s attitude,“ followed by ”teaching quality”. In contrast, the family respondents were least satisfied with “being open to questions”. Among the 6 assessment domains of communication skills, the students scored highest on “explaining” and lowest on “giving recommendations”. In the detailed assessment by family respondents, the students scored lowest on “asking about life/school burden”. In the multisource analysis, the nurses’ mean score was much higher and the students’ mean self-assessment score was lower than the average scores on all domains. Conclusion The willingness and satisfaction of family respondents were high in this study. Students scored the lowest on giving recommendations to patients. Multisource feedback with video recording is useful in providing more accurate evaluation of students’ communication competence and in identifying the areas of communication that require enhancement. PMID:24180615

Hologram recording tubes

NASA Technical Reports Server (NTRS)

Rajchman, J. H.

1973-01-01

Optical memories allow extremely large numbers of bits to be stored and recalled in a matter of microseconds. Two recording tubes, similar to conventional image-converting tubes, but having a soft-glass surface on which hologram is recorded, do not degrade under repeated hologram read/write cycles.

Long Term Decline in Eastern US Winter Temperature Extremes.

NASA Astrophysics Data System (ADS)

Trenary, L. L.; DelSole, T. M.; Tippett, M. K.; Doty, B.

2016-12-01

States along the US eastern seaboard have experienced successively harsh winter conditions in recent years. This has prompted speculation that climate change is leading to more extreme winter conditions. In this study we quantify changes in the observed winter extremes over the period 1950-2015, by examining year-to-year differences in intensity, frequency and likelihood of daily cold temperature extremes in the north, mid, and south Atlantic states along the US east coast. Analyzing station data for these three regions, we find that while the north and mid-Atlantic regions experienced record-breaking cold temperatures in 2015, there is no long-term increase in the intensity of cold extremes anywhere along the eastern seaboard. Likewise, despite the record number of cold days in these two regions during 2014 and 2015, there is no systematic increase in the frequency of cold extremes. To determine whether the observed changes are natural or human-forced, we repeat our analysis using a suite of climate simulations, with and without external forcing. Generally, model simulations suggest that human-induced forcing does not significantly influence the range of daily winter temperature. Combining this result with the fact that the observed winter temperatures are becoming warmer and less variable, we conclude that the recent intensification of eastern US cold extremes is only temporary.

Effect of upper extremity nerve damage on activity participation, pain, depression, and quality of life.

PubMed

Bailey, Ryan; Kaskutas, Vicki; Fox, Ida; Baum, Carolyn M; Mackinnon, Susan E

2009-11-01

To explore the relationship between upper extremity nerve damage and activity participation, pain, depression, and perceived quality of life. A total of 49 patients with upper extremity nerve damage completed standardized measures of activity participation, pain, depression, and quality of life. We analyzed scores for all subjects and for 2 diagnostic groups: patients with compressive neuropathy and patients with nerve injury (laceration, tumor, and brachial plexus injury), and explored predictors of overall quality of life. Participants had given up 21% of their previous daily activities; greater activity loss was reported in patients with nerve injury. Pain was moderate and 39% had signs of clinical depression. Physical and psychological quality of life ratings were below the norms. Activity loss was strongly associated with higher levels of depression and lower physical and psychological quality of life. Higher depression scores correlated strongly with lower overall quality of life. Greater pain correlated moderately with higher depression scores and weakly with quality of life; no statistical relationship was found between pain and physical quality of life. Activity participation and depression predicted 61% of the variance in overall quality of life in patients with nerve damage. The results of this study suggest that hand surgeons and therapists caring for patients with nerve compression and nerve injury should discuss strategies to improve activity participation, and decrease pain and depression, to improve overall effect on quality of life throughout the recovery process. Depression screening and referral when indicated should be included in the overall treatment plan for patients with upper extremity nerve damage. Prognostic IV.

The Relationship of Maternal Prepregnancy Body Mass Index and Pregnancy Weight Gain to Neurocognitive Function at Age 10 Years among Children Born Extremely Preterm.

PubMed

Jensen, Elizabeth T; van der Burg, Jelske W; O'Shea, Thomas M; Joseph, Robert M; Allred, Elizabeth N; Heeren, Tim; Leviton, Alan; Kuban, Karl C K

2017-08-01

To assess the association between maternal prepregnancy body mass index and adequacy of pregnancy weight gain in relation to neurocognitive function in school-aged children born extremely preterm. Study participants were 535 ten-year-old children enrolled previously in the prospective multicenter Extremely Low Gestational Age Newborns cohort study who were products of singleton pregnancies. Soon after delivery, mothers provided information about prepregnancy weight. Prepregnancy body mass index and adequacy of weight gain were characterized based on this information. Children underwent a neurocognitive evaluation at 10 years of age. Maternal prepregnancy obesity was associated with increased odds of a lower score for Differential Ability Scales-II Verbal IQ, for Developmental Neuropsychological Assessment-II measures of processing speed and visual fine motor control, and for Wechsler Individual Achievement Test-III Spelling. Children born to mothers who gained an excessive amount of weight were at increased odds of a low score on the Oral and Written Language Scales Oral Expression assessment. Conversely, children whose mother did not gain an adequate amount of weight were at increased odds of a lower score on the Oral and Written Language Scales Oral Expression and Wechsler Individual Achievement Test-III Word Reading assessments. In this cohort of infants born extremely preterm, maternal obesity was associated with poorer performance on some assessments of neurocognitive function. Our findings are consistent with the observational and experimental literature and suggest that opportunities may exist to mitigate risk through education and behavioral intervention before pregnancy. Copyright © 2017 Elsevier Inc. All rights reserved.

Five centuries of Central European temperature extremes reconstructed from tree-ring density and documentary evidence

NASA Astrophysics Data System (ADS)

Battipaglia, Giovanna; Frank, David; Büntgen, Ulf; Dobrovolný, Petr; Brázdil, Rudolf; Pfister, Christian; Esper, Jan

2010-06-01

Future climate change will likely influence the frequency and intensity of weather extremes. As such events are by definition rare, long records are required to understand their characteristics, drivers, and consequences on ecology and society. Herein we provide a unique perspective on regional-scale temperature extremes over the past millennium, using three tree-ring maximum latewood density (MXD) chronologies from higher elevations in the European Alps. We verify the tree-ring-based extremes using documentary evidences from Switzerland, the Czech Republic, and Central Europe that allowed the identification of 44 summer extremes over the 1550-2003 period. These events include cold temperatures in 1579, 1628, 1675, and 1816, as well as warm ones in 1811 and 2003. Prior to 1550, we provide new evidence for cold (e.g., 1068 and 1258) and warm (e.g., 1333) summers derived from the combined MXD records and thus help to characterize high-frequency temperature variability during medieval times. Spatial coherence of the reconstructed extremes is found over Switzerland, with most signatures even extending across Central Europe. We discuss potential limitations of the tree-ring and documentary archives, including the ( i) ability of MXD to particularly capture extremely warm temperatures, ( ii) methodological identification and relative definition of extremes, and ( iii) placement of those events in the millennium-long context of low-frequency climate change.

A Follow-Up of Subjects Scoring above 180 IQ in Terman's "Genetic Studies of Genius."

ERIC Educational Resources Information Center

Feldman, David Henry

1984-01-01

Using the Terman files, 26 subjects with scores above 180 IQ were compared with 26 randomly selected subjects from Terman's sample. Findings were generally that the extra IQ points made little difference and that extremely high IQ does not seem to indicate "genius" in the commonly understood sense. (Author/CL)

The Effects of Routing and Scoring within a Computer Adaptive Multi-Stage Framework

ERIC Educational Resources Information Center

Dallas, Andrew

2014-01-01

This dissertation examined the overall effects of routing and scoring within a computer adaptive multi-stage framework (ca-MST). Testing in a ca-MST environment has become extremely popular in the testing industry. Testing companies enjoy its efficiency benefits as compared to traditionally linear testing and its quality-control features over…

Extreme Mississippi River Floods in the Late Holocene: Reconstructions and Simulations

NASA Astrophysics Data System (ADS)

Munoz, S. E.; Giosan, L.; Donnelly, J. P.; Dee, S.

2016-12-01

Extreme flooding of the Mississippi River is costly in both economic and social terms. Despite ambitious engineering projects conceived in the early 20th century to mitigate damage from extreme floods, economic losses due to flooding have increased over recent years. Forecasting extreme flood occurrence over seasonal or longer time-scales remains a major challenge - especially in light of shifts in hydroclimatic conditions expected in response to continued greenhouse forcing. Here, we present findings from a series of paleoflood records that span the late Holocene derived from laminated sediments deposited in abandoned channels of the Mississippi River. These sedimentary archives record individual overbank floods as unique events beds with upward fining that we identify using grain-size analysis, bulk geochemistry, and radiography. We use sedimentological characteristics to reconstruct flood magnitude by calibrating our records against instrumental streamflow data from nearby gauging stations. We also use the Last Millennium Experiments of the Community Earth System Model (CESM-LME) and historical reanalysis data to examine the state of climate system around river discharge extremes. Our paleo-flood records exhibit strong non-stationarities in flood frequency and magnitude that are associated with fluctuations in the frequency of the El Niño-Southern Oscillation (ENSO), because the warm ENSO phase is associated with increased surface water storage of the lower Mississippi basin that leads to enhanced runoff delivery to the main channel. We also show that the early 20th century was a period of anomalously high flood frequency and magnitude due to the combined effects of river engineering and natural climate variability. Our findings imply that flood risk along the lower Mississippi River is tightly coupled to the frequency of ENSO, highlighting the need for robust projections of ENSO variability under greenhouse warming.

Diagnostic accuracy of sleep bruxism scoring in absence of audio-video recording: a pilot study.

PubMed

Carra, Maria Clotilde; Huynh, Nelly; Lavigne, Gilles J

2015-03-01

Based on the most recent polysomnographic (PSG) research diagnostic criteria, sleep bruxism is diagnosed when >2 rhythmic masticatory muscle activity (RMMA)/h of sleep are scored on the masseter and/or temporalis muscles. These criteria have not yet been validated for portable PSG systems. This pilot study aimed to assess the diagnostic accuracy of scoring sleep bruxism in absence of audio-video recordings. Ten subjects (mean age 24.7 ± 2.2) with a clinical diagnosis of sleep bruxism spent one night in the sleep laboratory. PSG were performed with a portable system (type 2) while audio-video was recorded. Sleep studies were scored by the same examiner three times: (1) without, (2) with, and (3) without audio-video in order to test the intra-scoring and intra-examiner reliability for RMMA scoring. The RMMA event-by-event concordance rate between scoring without audio-video and with audio-video was 68.3 %. Overall, the RMMA index was overestimated by 23.8 % without audio-video. However, the intra-class correlation coefficient (ICC) between scorings with and without audio-video was good (ICC = 0.91; p < 0.001); the intra-examiner reliability was high (ICC = 0.97; p < 0.001). The clinical diagnosis of sleep bruxism was confirmed in 8/10 subjects based on scoring without audio-video and in 6/10 subjects with audio-video. Although the absence of audio-video recording, the diagnostic accuracy of assessing RMMA with portable PSG systems appeared to remain good, supporting their use for both research and clinical purposes. However, the risk of moderate overestimation in absence of audio-video must be taken into account.

Factors affecting development of motor skills in extremely low birth weight children.

PubMed

O'Connor, Anna R; Birch, Eileen E; Spencer, Rand

2009-01-01

The aim of this study is to analyze the impact of ophthalmic and neonatal factors on motor development in extremely low birth weight (ELBW) children. Sixty-four ELBW children at least 3 years of age were recruited. Visual acuity (VA) was assessed using the Teller acuity cards (TACs) and a letter test, if possible. A validated questionnaire assessing 25 fine (part A) and 20 gross motor (part B) skills was administered to the parents. Data were collected on retinopathy of prematurity (ROP) zone, intraventricular haemorrhage (IVH), length of stay in hospital, and number of days on oxygen. Abnormal TAC acuity was associated with significantly lower scores on both parts A and B (part A: 21.5 versus 11.8, p < 0.001; part B: 17.5 versus 13.2, p < 0.001). Linear regression demonstrates a significant direct relationship between letter acuity and score A only (p = 0.03, r(2) = 0.179). Neither length of hospital stay, number of days ventilated, nor a history of IVH were associated with score A or B. However, the presence of ROP zone 1 was associated with a lower score A (p = 0.03). In this ELBW cohort VA and ophthalmic factors were the only factors associated with scores of development, particularly fine motor development.

Comparison of disease activity measures for anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis.

PubMed

Merkel, P A; Cuthbertson, D D; Hellmich, B; Hoffman, G S; Jayne, D R W; Kallenberg, C G M; Krischer, J P; Luqmani, R; Mahr, A D; Matteson, E L; Specks, U; Stone, J H

2009-01-01

Currently, several different instruments are used to measure disease activity and extent in clinical trials of anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis, leading to division among investigative groups and difficulty comparing study results. An exercise comparing six different vasculitis instruments was performed. A total of 10 experienced vasculitis investigators from 5 countries scored 20 cases in the literature of Wegener granulomatosis or microscopic polyangiitis using 6 disease assessment tools: the Birmingham Vasculitis Activity Score (BVAS), The BVAS for Wegener granulomatosis (BVAS/WG), BVAS 2003, a Physician Global Assessment (PGA), the Disease Extent Index (DEI) and the Five Factor Score (FFS). Five cases were rescored by all raters. Reliability of the measures was extremely high (intraclass correlations for the six measures all = 0.98). Within each instrument, there were no significant differences or outliers among the scores from the 10 investigators. Test/retest reliability was high for each measure: range = 0.77 to 0.95. The scores of the five acute activity measures correlated extremely well with one another. Currently available tools for measuring disease extent and activity in ANCA-associated vasculitis are highly correlated and reliable. These results provide investigators with confidence to compare different clinical trial data and helps form common ground as international research groups develop new, improved and universally accepted vasculitis disease assessment instruments.

Open-Source Logic-Based Automated Sleep Scoring Software using Electrophysiological Recordings in Rats

PubMed Central

Gross, Brooks A.; Walsh, Christine M.; Turakhia, Apurva A.; Booth, Victoria; Mashour, George; Poe, Gina R.

2009-01-01

Manual state scoring of physiological recordings in sleep studies is time-consuming, resulting in a data backlog, research delays and increased personnel costs. We developed MATLAB-based software to automate scoring of sleep/waking states in rats, potentially extendable to other animals, from a variety of recording systems. The software contains two programs, Sleep Scorer and Auto-Scorer, for manual and automated scoring. Auto-Scorer is a logic-based program that displays power spectral densities of an electromyographic signal and σ, δ, and θ frequency bands of an electroencephalographic signal, along with the δ/θ ratio and σ ×θ, for every epoch. The user defines thresholds from the training file state definitions which the Auto-Scorer uses with logic to discriminate the state of every epoch in the file. Auto-Scorer was evaluated by comparing its output to manually scored files from 6 rats under 2 experimental conditions by 3 users. Each user generated a training file, set thresholds, and autoscored the 12 files into 4 states (waking, non-REM, transition-to-REM, and REM sleep) in ¼ the time required to manually score the file. Overall performance comparisons between Auto-Scorer and manual scoring resulted in a mean agreement of 80.24 +/− 7.87%, comparable to the average agreement among 3 manual scorers (83.03 +/− 4.00%). There was no significant difference between user-user and user-Auto-Scorer agreement ratios. These results support the use of our open-source Auto-Scorer, coupled with user review, to rapidly and accurately score sleep/waking states from rat recordings. PMID:19615408

Personality scores and smoking behaviour. A longitudinal study.

PubMed Central

Cherry, N; Kiernan, K

1976-01-01

The personality scores at 16 years of age of 2753 people, all members of the National Survey of Health and Development, were related, in a follow-up study, to cigarette smoking behaviour in their young adult years. Survey members who recorded high neuroticism scores were found to be more likely to smoke than those with low scores and, among the smokers, deep inhalers formed the most neurotic group. Extraverts were more likely to smoke than introverts, the mean extraversion score being greatest for the male smokers with a high daily consumption of cigarettes. The personality scores were found to have some power in predicting changes in smoking behaviour. Neurotics and extraverts who had not started to smoke by the time of completing the personality inventory at 16 were more likely than the stable and introverted to take up the habit subsequently. Among survey members who were regular smokers at the time of completing the personality inventory the proportion giving up smoking by the time they reached the age of 25 years was related to consumption level recorded at 20 years and the personality scores recorded at 16, stable extraverts among the men being most likely to stop smoking. PMID:953376

77 FR 68123 - Privacy Act of 1974; System of Records Notice

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-15

... test records, including registrant's first and last name, evaluation data, pretest and posttest scores..., pretest and posttest scores, and registration information, will be disclosed to accrediting bodies (such... educational information, training, best practices, and tools to health professionals as one initiative to help...

Space-time characteristics and statistical predictability of extreme daily precipitation events in the Ohio River Basin

NASA Astrophysics Data System (ADS)

Farnham, D. J.; Doss-Gollin, J.; Lall, U.

2016-12-01

In this study we identify the atmospheric conditions that precede and accompany regional extreme precipitation events with the potential to cause flooding. We begin by identifying a coherent space-time structure in the record of extreme precipitation within the Ohio River Basin through both a Hidden Markov Model and a composite analysis. The transition probabilities associated with the Hidden Markov Model illustrate a tendency for west to east migration of extreme precipitation events (> 99th percentile) at individual stations within the Ohio River Basin. We compute a record of regional extreme precipitation days by requiring that > p% of the basin's stations simultaneously experience extreme precipitation days. A composite analysis of low-level geopotential heights and column integrated precipitable water content for all non-summer seasons confirms a west to east migration and intensification of 1) a low (high) pressure center to the west (east) of the basin, and 2) enhanced precipitable water vapor content that stretches from the Gulf of Mexico to the Northeast US region in the days leading up to regional extreme precipitation days. We define a daily dipole index to summarize the strength of the paired cylonic and aniticyclonic systems to the west and east of the basin and analyze its temporal characteristics and its relationship to the regional extreme precipitation events. Lastly, we investigate and discuss the subseasonal predictability of individual extreme precipitation events and the seasonal predictability of active and inactive seasons, where the activity level is defined by the expected frequency of regional extreme precipitation events.

Effect of foot placements during sit to stand transition on timed up and go test in stroke subjects: A cross sectional study.

PubMed

Joshua, Abraham M; Karnad, Shreekanth D; Nayak, Akshatha; Suresh, B V; Mithra, Prasanna; Unnikrishnan, B

2017-01-01

Timed up and go (TUG) test is been used as a screening tool for the assessment of risk of falling in individuals following stroke. Though TUG test is a quick test, it has fair sensitivity compared to other tests. This study was carried out to obtain and compare test scores for different types of foot placements during sit to stand transition in stroke subjects. A Cross-sectional study with purposive sampling included 28 post stroke subjects who were able to walk 6 meter with or without assistance. Timed Up and Go test was carried out with four different types of foot placements and scores were recorded. The data were compared using Kruskal-Wallis One way analysis of variance and Wilcoxon signed ranks test. There were comparable differences between asymmetric 1 test strategy which involved affected extremity to be placed behind the unaffected and other test strategies (Z = -4.457,-3.848,-4.458; p = 0.000). The initial foot placements during sit to stand transition influenced the time taken to complete the test which was significantly higher in asymmetric 1 strategy, Incorporation of the initial foot placement mainly asymmetric 1 strategy into conventional TUG test would help in identifying accurately the subject's functional mobility and postural stability.

Compelled Body Weight Shift Technique to Facilitate Rehabilitation of Individuals with Acute Stroke.

PubMed

Mohapatra, Sambit; Eviota, Aileen C; Ringquist, Keir L; Muthukrishnan, Sri Ranjini; Aruin, Alexander S

2012-05-01

The study evaluates the effectiveness of Compelled Body Weight Shift (CBWS) approach in the rehabilitation of individuals with stroke. CBWS involves a forced shift of body weight towards a person's affected side by means of a shoe insert that establishes a lift of the nonaffected lower extremity. Eleven patients with acute stroke were randomly assigned to experimental and control groups. The experimental group received a two-week conventional physical therapy combined with CBWS and the control group received only a two-week conventional therapy. Weight bearing, Gait velocity, Berg's Balance, and Fugl-Meyer's Scores were recorded before and after the intervention. Weight bearing on the affected side increased in the experimental group and decreased in the control group. The increase in gait velocity with treatment was significant in both the groups ( P < 0.05). However, experimental group ( P = 0.01) demonstrated larger improvements in gait velocity compared to the control group ( P = 0.002). Berg Balance and Fugl-Meyer scores increased for both the groups. The implementation of a two-week intervention with CBWS resulted in the improvement in weight bearing and gait velocity of individuals with acute stroke. The present preliminary study suggests that CBWS technique could be implemented as an adjunct to conventional rehabilitation program for individuals with acute stroke.

Usefulness of Sweat Management for Patients with Adult Atopic Dermatitis, regardless of Sweat Allergy: A Pilot Study.

PubMed

Kaneko, Sakae; Murota, Hiroyuki; Murata, Susumu; Katayama, Ichiro; Morita, Eishin

2017-01-01

Background . Sweat is an aggravating factor in atopic dermatitis (AD), regardless of age. Sweat allergy may be involved in AD aggravated by sweating. Objective. We investigated whether sweat exacerbates adult AD symptoms and examined the extent of sweat allergy's involvement. Method. We asked 34 AD patients (17 men, 17 women; mean age: 27.8 years) to record the extent to which sweat aggravated their symptoms on a 10-point numerical scale. Participant responses were compared with histamine release tests (HRT). Furthermore, 24 of the patients received instructions on methods of sweat management, and their outcomes were evaluated on a 10-point scale. Results. Sweat HRT results were class ≥ 2 in 13 patients, but HRT results were not correlated with the patients' self-assessments of symptom aggravation by sweat. One month after receiving sweat management instructions, a low mean score of 4.6 was obtained regarding whether active sweating was good, but a high mean score of 7.0 was obtained in response to whether the sweat management instructions had been helpful. Conclusion . Our investigation showed that patients' negative impressions of sweat might derive from crude personal experiences that are typically linked to sweating. Sweat management for patients with adult atopic dermatitis was extremely useful regardless of sweat allergy.

Relief of neuropathic pain after spinal cord injury by brain-computer interface training.

PubMed

Yoshida, Naoki; Hashimoto, Yasunari; Shikota, Mio; Ota, Tetsuo

2016-01-01

The aim of this study was to report the effects of brain-computer interface (BCI) training, a neurofeedback rehabilitation technique, on persistent neuropathic pain (NP) after cervical spinal cord injury (SCI). We present the case of a 71-year-old woman with NP in her left upper extremity after SCI (C8). She underwent BCI training as outpatient rehabilitation for 4 months to enhance event-related desynchronization (ERD), which is triggered by the patient's motor intuition. Scalp electroencephalography was recorded to observe the ERD during every BCI training session. The patient's pain was evaluated with the McGill Pain Questionnaire (MPQ) and a visual analog scale (VAS). The MPQ was performed after every BCI training session, and the patient assessed the VAS score on her own, once every few days during the BCI training period. After the BCI training started, the patient's ERD during the BCI training period increased significantly, from 15.6-30.3%. Moreover, her VAS score decreased gradually, from 8 to 5, after the BCI training started, although the MPQ did not change significantly. BCI training has the potential to provide relief for patients with persistent NP via brain plasticity, and to improve their activities of daily living and quality of life.

Standard of care of erectile dysfunction in U.S. Air Force aircrew and active duty not on flying status.

PubMed

Nast, Justin B

2014-11-01

In 2011, over 3,000 active duty U.S. Air Force (USAF) members were prescribed a phosphodiesterase inhibitor (PDEI). PDEIs are first-line therapy for treating erectile dysfunction and can have significant side effects that could impact aircrew performance. In total, 200 eligible subject records were randomly sampled from the active duty USAF population of those males filling a prescription for a PDEI in June 2011; 100 of those records were from aviators. The electronic records were reviewed and scored to determine if USAF aeromedical standards for prescribing PDEIs were followed, with a minimum score of 0 for no standards met and a maximum of 3 for all standards met. The average score for both groups was 1, with no significant difference between the group scores. A proper aeromedical disposition was documented in 67% of the aviator records. Although there was no significant difference in standard of care for aviators and nonaviators, the overall documented standard of care was poor. Lack of documentation was the primary reason for the low scores and the low percentage of properly rendered aeromedical dispositions. Proper medical record documentation is important for evaluating quality of care and ensuring compliance with regulations in an Air Force aviator population. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Vertebral deformities and fractures are associated with MRI and pQCT measures obtained at the distal tibia and radius of postmenopausal women

PubMed Central

Rajapakse, C. S.; Phillips, E. A.; Sun, W.; Wald, M. J.; Magland, J. F.; Snyder, P. J.; Wehrli, F. W.

2016-01-01

Summary We investigated the association of postmenopausal vertebral deformities and fractures with bone parameters derived from distal extremities using MRI and pQCT. Distal extremity measures showed variable degrees of association with vertebral deformities and fractures, highlighting the systemic nature of postmenopausal bone loss. Introduction Prevalent vertebral deformities and fractures are known to predict incident further fractures. However, the association of distal extremity measures and vertebral deformities in postmenopausal women has not been fully established. Methods This study involved 98 postmenopausal women (age range 60–88 years, mean 70 years) with DXA BMD T-scores at either the hip or spine in the range of −1.5 to −3.5. Wedge, biconcavity, and crush deformities were computed on the basis of spine MRI. Vertebral fractures were assessed using Eastell's criterion. Distal tibia and radius stiffness was computed using MRI-based finite element analysis. BMD at the distal extremities were obtained using pQCT. Results Several distal extremity MRI and pQCT measures showed negative association with vertebral deformity on the basis of single parameter correlation (r up to 0.67) and two-parameter regression (r up to 0.76) models involving MRI stiffness and pQCT BMD. Subjects who had at least one prevalent vertebral fracture showed decreased MRI stiffness (up to 17.9 %) and pQCT density (up to 34.2 %) at the distal extremities compared to the non-fracture group. DXA lumbar spine BMD T-score was not associated with vertebral deformities. Conclusions The association between vertebral deformities and distal extremity measures supports the notion of postmenopausal osteoporosis as a systemic phenomenon. PMID:24221453

Pig carcass tail lesions: the influence of record keeping through an advisory service and the relationship with farm performance parameters.

PubMed

van Staaveren, N; Teixeira, D L; Hanlon, A; Boyle, L A

2017-01-01

Tail lesions are important pig welfare indicators that could be recorded during meat inspection as they are more visible on the carcass than on the live animal. Tail biting is associated with reduced performance in the bitten pig, but it is not clear whether problems with tail biting are reflected in general farm performance figures. Farm advisory services aim to improve farm productivity which could be associated with improvements in pig welfare. Record keeping forms an integral part of such advisory services. The aim of this study was to examine the influence of record keeping in the Teagasc eProfit Monitor (ePM herds) on the prevalence of tail lesion severity scores in Irish slaughter pigs. In addition, we investigated associations between the prevalence of tail lesion scores and production parameters at farm level in ePM herds. Pigs were observed after scalding/dehairing and tail lesion score (0 to 4), sex and farm identification were recorded. Tail lesion scores were collapsed into none/mild lesions (score ⩽1), moderate lesions (score 2) and severe lesions (score ⩾3). The effect of record keeping (ePM herd) on the different tail lesion outcomes was analysed at batch level using the events/trials structure in generalized linear mixed models (PROC GLIMMIX). Spearman's rank correlations were calculated between average tail lesion score of a batch and production parameters. A total of 13 133 pigs were assessed from 73 batches coming from 61 farms. In all, 23 farms were identified as ePM herds. The average prevalence of moderate tail lesions was 26.8% and of severe tail lesions was 3.4% in a batch. Batches coming from ePM herds had a lower prevalence of moderate tail lesions than non-ePM herds (P<0.001). Average tail lesion score was negatively associated with age (P<0.05) and weight (P<0.05) at sale/transfer of weaners, and tended to be positively associated with the number of finishing days (P=0.06). In addition, the prevalence of severe tail lesions was negatively associated with average daily gain in weaners (P<0.05) and tended to do so with average daily gain in finishers (P=0.08). This study provides the first indication that record keeping through an advisory service may help to lower the risk of tail biting, which is associated with improved farm performance.

Persisting behavior problems in extremely low birth weight adolescents.

PubMed

Taylor, H Gerry; Margevicius, Seunghee; Schluchter, Mark; Andreias, Laura; Hack, Maureen

2015-04-01

To describe behavior problems in extremely low birth weight (ELBW, <1000 g) adolescents born 1992 through 1995 based on parent ratings and adolescent self-ratings at age 14 years and to examine changes in parent ratings from ages 8-14. Parent ratings of behavior problems and adolescent self-ratings were obtained for 169 ELBW adolescents (mean birth weight 815 g, gestational age 26 wk) and 115 normal birth weight (NBW) controls at 14 years. Parent ratings of behavior at age 8 years were also available. Behavior outcomes were assessed using symptom severity scores and rates of scores above DSM-IV symptom cutoffs for clinical disorder. The ELBW group had higher symptom severity scores on parent ratings at age 14 years than NBW controls for inattentive attention-deficit hyperactivity disorder (ADHD), anxiety, and social problems (all p's < .01). Rates of parent ratings meeting DSM-IV symptom criteria for inattentive ADHD were also higher for the ELBW group (12% vs. 1%, p < .01). In contrast, the ELBW group had lower symptom severity scores on self-ratings than controls for several scales. Group differences in parent ratings decreased over time for ADHD, especially among females, but were stable for anxiety and social problems. Extremely low birth weight adolescents continue to have behavior problems similar to those evident at a younger age, but these problems are not evident in behavioral self-ratings. The findings suggest that parent ratings provide contrasting perspectives on behavior problems in ELBW youth and support the need to identify and treat these problems early in childhood.

The Coast Artillery Journal. Volume 72, Number 3, March 1930

DTIC Science & Technology

1930-03-01

computation of the score. A careful study of these instructions is necessary in order that the score be correctly computed. The quantities substituted...components: A , B, C, D; the score for a practice is A +B+C- D. D, the penalty co.mpo.nent,is always subtracted. Band C alsoma:r, in extreme cases ,be... studying the subject, and ’Ourown Navy will have a receiving set in every airplane and a two-wayset in each commandplane. In addition to ather

Combining geomorphic and documentary flood evidence to reconstruct extreme events in Mediterranean basins

NASA Astrophysics Data System (ADS)

Thorndycraft, V. R.; Benito, G.; Barriendos, M.; Rico, M.; Sánchez-Moya, Y.; Sopeña, A.; Casas, A.

2009-09-01

Palaeoflood hydrology is the reconstruction of flood magnitude and frequency using geomorphological flood evidence and is particularly valuable for extending the record of extreme floods prior to the availability of instrumental data series. This paper will provide a review of recent developments in palaeoflood hydrology and will be presented in three parts: 1) an overview of the key methodological approaches used in palaeoflood hydrology and the use of historical documentary evidence for reconstructing extreme events; 2) a summary of the Llobregat River palaeoflood case study (Catalonia, NE Spain); and 3) analysis of the AD 1617 flood and its impacts across Catalonia (including the rivers Llobregat, Ter and Segre). The key findings of the Llobregat case study were that at least eight floods occurred with discharges significantly larger than events recorded in the instrumental record, for example at the Pont de Vilomara study reach the palaeodischarges of these events were 3700-4300 m3/s compared to the 1971 flood, the largest on record, of 2300 m3/s. Five of these floods were dated to the last 3000 years and the three events directly dated by radiocarbon all occurred during cold phases of global climate. Comparison of the palaeoflood record with documentary evidence indicated that one flood, radiocarbon dated to cal. AD 1540-1670, was likely to be the AD 1617 event, the largest flood of the last 700 years. Historical records indicate that this event was caused by rainfall occurring from the 2nd to 6th November and the resultant flooding caused widespread socio-economic impacts including the destruction of at least 389 houses, 22 bridges and 17 water mills. Discharges estimated from palaeoflood records and historical flood marks indicate that the Llobregat (4680 m3/s) and Ter (2700-4500 m3/s) rivers witnessed extreme discharges in comparison to observed floods in the instrumental record (2300 and 2350 m3/s, respectively); whilst further east in the Segre River there was no geomorphic evidence of any flooding of greater magnitude than 2000 m3/s, or the 1982 event.

The incidences of and consultation rate for lower extremity complaints in general practice

PubMed Central

van der Waal, J M; Bot, S D M; Terwee, C B; van der Windt, D A W M; Schellevis, F G; Bouter, L M; Dekker, J

2006-01-01

Objective To estimate the incidence and consultation rate of lower extremity complaints in general practice. Methods Data were obtained from the Second Dutch National Survey of General Practice, in which 195 general practitioners (GPs) in 104 practices recorded all contacts with patients during 12 consecutive months in computerised patient records. GPs classified the symptoms and diagnosis for each patient at each consultation according to the International Classification of Primary Care (ICPC). Incidence densities and consultation rates for different complaints were calculated. Results During the registration period 63.2 GP consultations per 1000 person‐years were attributable to a new complaint of the lower extremities. Highest incidence densities were seen for knee complaints: 21.4 per 1000 person‐years for women and 22.8 per 1000 person‐years for men. The incidence of most lower extremity complaints was higher for women than for men and higher in older age. Conclusions Both incidences of and consultation rates for lower extremity complaints are substantial in general practice. This implies a considerable impact on the workload of the GP. PMID:16269430

A direct method for computing extreme value (Gumbel) parameters for gapped biological sequence alignments.

PubMed

Quinn, Terrance; Sinkala, Zachariah

2014-01-01

We develop a general method for computing extreme value distribution (Gumbel, 1958) parameters for gapped alignments. Our approach uses mixture distribution theory to obtain associated BLOSUM matrices for gapped alignments, which in turn are used for determining significance of gapped alignment scores for pairs of biological sequences. We compare our results with parameters already obtained in the literature.

MysiRNA: improving siRNA efficacy prediction using a machine-learning model combining multi-tools and whole stacking energy (ΔG).

PubMed

Mysara, Mohamed; Elhefnawi, Mahmoud; Garibaldi, Jonathan M

2012-06-01

The investigation of small interfering RNA (siRNA) and its posttranscriptional gene-regulation has become an extremely important research topic, both for fundamental reasons and for potential longer-term therapeutic benefits. Several factors affect the functionality of siRNA including positional preferences, target accessibility and other thermodynamic features. State of the art tools aim to optimize the selection of target siRNAs by identifying those that may have high experimental inhibition. Such tools implement artificial neural network models as Biopredsi and ThermoComposition21, and linear regression models as DSIR, i-Score and Scales, among others. However, all these models have limitations in performance. In this work, a neural-network trained new siRNA scoring/efficacy prediction model was developed based on combining two existing scoring algorithms (ThermoComposition21 and i-Score), together with the whole stacking energy (ΔG), in a multi-layer artificial neural network. These three parameters were chosen after a comparative combinatorial study between five well known tools. Our developed model, 'MysiRNA' was trained on 2431 siRNA records and tested using three further datasets. MysiRNA was compared with 11 alternative existing scoring tools in an evaluation study to assess the predicted and experimental siRNA efficiency where it achieved the highest performance both in terms of correlation coefficient (R(2)=0.600) and receiver operating characteristics analysis (AUC=0.808), improving the prediction accuracy by up to 18% with respect to sensitivity and specificity of the best available tools. MysiRNA is a novel, freely accessible model capable of predicting siRNA inhibition efficiency with improved specificity and sensitivity. This multiclassifier approach could help improve the performance of prediction in several bioinformatics areas. MysiRNA model, part of MysiRNA-Designer package [1], is expected to play a key role in siRNA selection and evaluation. Copyright © 2012 Elsevier Inc. All rights reserved.

Muscle dysmorphia symptomatology and extreme drive for muscularity in a 23-year-old woman: a case study.

PubMed

Leone, James E

2009-05-01

We describe a 23-year-old woman with muscle dysmorphia symptomatology and extreme drive for muscularity. In addition to structured case study interviews, 3 questionnaires and a series of semistructured interview questions were administered for elaboration on key issues. The case studies allowed for triangulation of data garnered from the questionnaires. Responses revealed high scores for drive for muscularity, moderate scores for the Adonis complex, and high scores for symptoms of muscle dysmorphia. Muscle dysmorphia and drive for muscularity are more prevalent in men; however, unique cases such as this need to be further explored both empirically and theoretically. Cross-cultural references are needed to assess the overall impact of global social influences. Instruments measuring muscle dysmorphia need to be devised and validated for women as well as men. The strength and conditioning professional needs to be both aware and vigilant in helping people affected with psychosomatic disorders such as muscle dysmorphia or exercise addiction.

Changes in Upper-Extremity Functional Capacity and Daily Performance During Outpatient Occupational Therapy for People With Stroke

PubMed Central

Doman, Caitlin A.; Waddell, Kimberly J.; Bailey, Ryan R.; Moore, Jennifer L.

2016-01-01

OBJECTIVE. This study explored how upper-extremity (UE) functional capacity and daily performance change during the course of outpatient rehabilitation in people with stroke. METHOD. Fifteen participants receiving outpatient occupational therapy services for UE paresis poststroke were enrolled. UE motor capacity was measured with the Action Research Arm Test (ARAT), and UE performance was measured using bilateral, wrist-worn accelerometers. Measurements were taken at or near the start of therapy, at every 10th visit or every 30 days throughout the duration of services, and at discharge. RESULTS. Three patterns were observed: (1) increase in ARAT scores and more normalized accelerometry profiles, (2) increase in ARAT scores but no change in accelerometry profiles, and (3) no change in ARAT scores or in accelerometry profiles. CONCLUSION. UE performance in daily life was highly variable, with inconsistencies between change in UE capacity and change in UE performance. UE capacity and performance are important constructs to assess separately during rehabilitation. PMID:27089298

Interpretation of Renal Quality of Life Profile scores in routine clinical practice: an aid to treatment decision-making.

PubMed

Aawar, Nadine; Moore, Richard; Riley, Stephen; Salek, Sam

2016-07-01

High Renal Quality of Life Profile (RQLP) scores are associated with impaired health-related quality of life; however, the clinical meaning of the scores is difficult for clinicians and healthcare planners to interpret. The aim of this study was to determine clinical significance of RQLP scores which could be used to aid clinical decision-making. The anchor-based technique (a method for categorizing numeric scores to ease interpretation) was used to develop a categorization system for the RQLP scores using a global question (GQ). The GQ scores (i.e. no effect to extremely large effect) were mapped against the RQLP scores, and intraclass correlation coefficient (ICC) was used to test their agreement. The RQLP and the GQ were administered to 260 adult patients (males = 165 and females = 95) with chronic renal failure (CRF). The mean RQLP score was 67.2, median = 61, SD = 41.5, and range 0-172. The mean GQ score was 1.74, median = 2, SD = 1.27, and range 0-4. The mean, mode, and median of the GQ scores for each RQLP score were used to devise several sets of categories of RQLP score, and the ICC test of agreement was calculated. The proposed set of RQLP score banding for adoption includes: 0-20 = no effect on patient's life (GQ = 0, n = 35); 21-51 = small effect on patient's life (GQ = 1, n = 66); 52-93 = moderate effect on patient's life (GQ = 2, n = 87); 94-134 = very large effect on patient's life (GQ = 3, n = 54); and 135-172 = extremely large effect on patient's life (GQ = 4, n = 18). The ICC coefficient for the proposed banding system was 0.80. The proposed categorization of the RQLP will aid the clinical interpretation of change in RQLP score informing treatment decision-making in routine practice.

Quantifying the Causes and Propogation of the 2015 Washington Wildfires

NASA Astrophysics Data System (ADS)

Engel, R.; Marlier, M. E.; Lettenmaier, D. P.

2017-12-01

In the summer of 2015, Washington state experienced wildfires that burned over 450,000 ha, more than five times the average and more than three times the next-most severe fire season in the 30-year record. We examine the confluence of factors that led to the extreme fire season, and evaluate whether 2015 can be used as a predictor of possible future conditions that will be affected by climate warming. In previous work, we have found that 2015 was an extremely warm summer (nearly 1 degree C warmer than the previous year in the 30-year record) but was not particularly anomalous in terms of many other climatic indicators, including reconstructed soil moisture, the Palmer Drought Severity Index (PDSI), and the Canadian Fire Weather Index. However, according to the Dead Fuel Moisture (DFM), a drying index used by the US Forest Service, 2015 was an extreme year of record. The DFM relies on temperature, precipitation, and relative humidity to establish a daily equilibrium moisture content of dead material. We examine both Washington's 2015 fire season and the 30-year fire record with respect to climatology and other potential drivers of fire (e.g. forest health, ignition). Additionally, we explore the role of land cover with respect to fire propagation through the season. While too many potential causes of extreme fires exist to establish a concrete long-term relationship at such a fine scale, we find that the 2015 fire anomaly was at least partially climatically driven.

The ANKLe Score: An Audit of Otolaryngology Emergency Clinic Record Keeping

PubMed Central

Dexter, Sara C; Hayashi, Daichi; Tysome, James R

2008-01-01

INTRODUCTION Accurate and legible medical records are essential to good quality patient care. Guidelines from The Royal College of Surgeons of England (RCSE) state the content required to form a complete medical record, but do not address legibility. An audit of otolaryngology emergency clinic record keeping was performed using a new scoring system. PATIENTS AND METHODS The Adjusted Note Keeping and Legibility (ANKLe) score was developed as an objective and quantitative method to assess both the content and legibility of case notes, incorporating the RCSE guidelines. Twenty consecutive otolaryngology emergency clinic case notes from each of 7 senior house officers were audited against standards for legibility and content using the ANKLe score. A proforma was introduced to improve documentation and handwriting advice was given. A further set of 140 notes (20 notes for each of the 7 doctors) was audited in the same way to provide feedback. RESULTS The introduction of a proforma and advice on handwriting significantly increased the quality of case note entries in terms of content, legibility and overall ANKLe score. CONCLUSIONS Accurate note keeping can be improved by the use of a proforma. The legibility of handwriting can be improved using simple advice. The ANKLe score is an objective assessment tool of the overall quality of medical note documentation which can be adapted for use in other specialties. PMID:18430339

Ergonomic stressors and upper extremity disorders in vehicle manufacturing: cross sectional exposure-response trends

PubMed Central

Punnett, L.

1998-01-01

OBJECTIVE: To evaluate the association between upper extremity soft tissue disorders and exposure to preventable ergonomic stressors in vehicle manufacturing operations. METHODS: A cross sectional study was conducted in one vehicle stamping plant and one engine assembly plant. A standardised physical examination of the upper extremities was performed on all subjects. An interviewer administered questionnaire obtained data on demographics, work history, musculoskeletal symptoms, non-occupational covariates, and psycho-physical (relative intensity) ratings of ergonomic stressors. The primary exposure score was computed by summing the responses to the psychophysical exposure items. Multivariate regression analysis was used to model the prevalence of disorders of the shoulders or upper arms, wrists or hands, and all upper extremity regions (each defined both by symptoms and by physical examination plus symptoms) as a function of exposure quartile. RESULTS: A total of 1315 workers (85% of the target population) was examined. The prevalence of symptom disorders was 22% for the wrists or hands and 15% for the shoulders or upper arms; cases defined on the basis of a physical examination were about 80% as frequent. Disorders of the upper extremities, shoulders, and wrists or hands all increased markedly with exposure score, after adjustment for plant, acute injury, sex, body mass index, systemic disease, and seniority. CONCLUSIONS: Musculoskeletal disorders of the upper extremities were strongly associated with exposure to combined ergonomic stressors. The exposure- response trend was very similar for symptom cases and for physical examination cases. It is important to evaluate all dimensions of ergonomic exposure in epidemiological studies, as exposures often occur in combination in actual workplaces.   PMID:9764102

Peak-discharge frequency and potential extreme peak discharge for natural streams in the Brazos River basin, Texas

USGS Publications Warehouse

Raines, Timothy H.

1998-01-01

The potential extreme peak-discharge curves as related to contributing drainage area were estimated for each of the three hydrologic regions from measured extreme peaks of record at 186 sites with streamflow-gaging stations and from measured extreme peaks at 37 sites without streamflow-gaging stations in and near the Brazos River Basin. The potential extreme peak-discharge curves generally are similar for hydrologic regions 1 and 2, and the curve for region 3 consistently is below the curves for regions 1 and 2, which indicates smaller peak discharges.

Evaluation of the Mangled Extremity Severity Score in Combat-Related Type III Tibia Fracture

DTIC Science & Technology

2014-09-01

Return to duty rates of amputee soldiers in the current conflicts in Afghanistan and Iraq. J Trauma. 2010; 68:1476–1479. 5. Johansen K, Daines M, Howey T...severity score (MESS) in combat related type III tibia fracture. J Orthop Trauma. 2013. 4. Johansen K, Daines M, Howey T, et al. Objective criteria

Validity of the lower extremity functional movement screen in patients with chronic ankle instability.

PubMed

Choi, Ho-Suk; Shin, Won-Seob

2015-06-01

[Purpose] The purpose of this study was to provide evidence of construct validity for the lower extremity functional movement screen (LE-FMS) based on hypothesis testing in patients with chronic ankle instability (CAI). [Subjects] The subjects were 20 healthy subjects and 20 patients with CAI who had a history of ankle sprain with pain for more than 1 day. [Methods] All participants were measured using the Foot and Ankle Disability Index (FADI) and evaluated with the LE-FMS. The screen included the deep squat, the hurdle step (HS) and the in-line lunge (ILL). The symmetry ratios (RS) were accurately measured during the deep squat trial. [Results] Between the two groups, there were significant differences in scores on the LE-FMS, HS, ILL, RS, FADI, and FADI-sport. The FADI was strongly correlated with both LE-FMS score (r=0.807) and ILL score (r=0.896). There was a strong relationship (r=0.818) between LE-FMS score and FADI-sport. [Conclusion] These results suggest that the LE-FMS may be used to detect deficits related to CAI. Additionally, this instrument is reliable in detecting functional limitations in patients with CAI.

Investigating skin-to-skin care patterns with extremely preterm infants in the NICU and their effect on early cognitive and communication performance: a retrospective cohort study.

PubMed

Gonya, Jenn; Ray, William C; Rumpf, R Wolfgang; Brock, Guy

2017-03-20

The primary objective of the study was to investigate how patterns of skin-to-skin care might impact infant early cognitive and communication performance. This was a retrospective cohort study. This study took place in a level-IV all-referral neonatal intensive care unit in the Midwest USA specialising in the care of extremely preterm infants. Data were collected from the electronic medical records of all extremely preterm infants (gestational age <27 weeks) admitted to the unit during 2010-2011 and who completed 6-month and 12-month developmental assessments in the follow-up clinic (n=97). Outcome measures included the cognitive and communication subscales of the Bayley Scales of Infant Development, Third Edition (Bayley-III); and skin-to-skin patterns including: total hours of maternal and paternal participation throughout hospitalisation, total duration in weeks and frequency (hours per week). Extracted data were analysed through a multistep process of logistic regressions, t-tests, χ 2 tests and Fisher's exact tests followed with exploratory network analysis using novel visual analytic software. Infants who received above the sample median in total hours, weekly frequency and total hours from mothers and fathers of skin-to-skin care were more likely to score ≥80 on the cognitive and communication scales of the Bayley-III. However, the results were not statistically significant (p>0.05). Mothers provided the majority of skin-to-skin care with a sharp decline at 30 weeks corrected age, regardless of when extremely preterm infants were admitted. Additional exploratory network analysis suggests that medical and skin-to-skin factors play a parallel, non-synergistic role in contributing to early cognitive and communication performance as assessed through the Bayley-III. This study suggests an association between early and frequent skin-to-skin care with extremely preterm infants and early cognitive and communication performance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

[Burdens at Admission, Short-term Effects and Predictors of Health Status at Discharge among 1 803 Patients with Fibromyalgia Syndrome].

PubMed

Gerdes, N; Farin, E

2016-10-01

Objective: Taking Fibromyalgia syndrome (FMS) as an example, the article illustrates a problem that to our knowledge has not been addressed in rehabilitation research so far: According to our large dataset, a sizeable proportion of patients had to be sent home with extremely severe burdens (<2 nd percentile in the normal population) at discharge - in spite of good improvements during their stay. Data and methods: Since 2009, patients in the RehaKlinikum Bad Säckingen, an in-patient rehab center for orthopedic-rheumatic diseases, answer the questionnaire "Indicators of Rehabilitation Status" (IRES) at the beginning and the end of their stay. We analysed IRES-data of 1 803 patients with FMS (94% women). In addition to analyses of change, we determined the degrees of severity at admission and discharge on the basis of a comparison with the normative sample of the IRES. In order to predict membership of the high-risk group of patients with still "extremely severe" values at discharge, we performed binary logistic regression analyses. Results: At admission, about 90% of the patients showed either "extreme" (65%<2 nd percentile) or "severe" (27% 2 nd -10 th percentile) values on the IRES summary score as well as on the scores for "psychic status", "pain", "symptoms of orthopedic and cardiovascular diseases", and "functioning in everyday life". In sum, then, FMS-patients have come to rehabilitation with multiple burdens of a severe to extreme degree. At discharge, the mean summary score had improved with a "strong" effect size of SRM=1.07. In spite of these good overall improvements, however, 37.4% of the patients went home with "extreme" burdens remaining, even though almost 60% of them had experienced "strong" (28%) or "relevant" (31%) improvements. The most important predictor of affiliation to this "high-risk group" was - as expected - the IRES summary score at admission. But unexpectedly influential were also some characteristics of social status such as lower household income and lower degrees of education. Conclusion: In rehabilitation research, analyses of change between pre- and post-measurement values should be accompanied by assessments of severity of rehabilitation status at discharge because even good improvements do not necessarily mean that a patient has been rehabilitated successfully. © Georg Thieme Verlag KG Stuttgart · New York.

Lower Quarter Y-Balance Test Scores and Lower Extremity Injury in NCAA Division I Athletes.

PubMed

Lai, Wilson C; Wang, Dean; Chen, James B; Vail, Jeremy; Rugg, Caitlin M; Hame, Sharon L

2017-08-01

Functional movement tests that are predictive of injury risk in National Collegiate Athletic Association (NCAA) athletes are useful tools for sports medicine professionals. The Lower Quarter Y-Balance Test (YBT-LQ) measures single-leg balance and reach distances in 3 directions. To assess whether the YBT-LQ predicts the laterality and risk of sports-related lower extremity (LE) injury in NCAA athletes. Case-control study; Level of evidence, 3. The YBT-LQ was administered to 294 NCAA Division I athletes from 21 sports during preparticipation physical examinations at a single institution. Athletes were followed prospectively over the course of the corresponding season. Correlation analysis was performed between the laterality of reach asymmetry and composite scores (CS) versus the laterality of injury. Receiver operating characteristic (ROC) analysis was used to determine the optimal asymmetry cutoff score for YBT-LQ. A multivariate regression analysis adjusting for sex, sport type, body mass index, and history of prior LE surgery was performed to assess predictors of earlier and higher rates of injury. Neither the laterality of reach asymmetry nor the CS correlated with the laterality of injury. ROC analysis found optimal cutoff scores of 2, 9, and 3 cm for anterior, posteromedial, and posterolateral reach, respectively. All of these potential cutoff scores, along with a cutoff score of 4 cm used in the majority of prior studies, were associated with poor sensitivity and specificity. Furthermore, none of the asymmetric cutoff scores were associated with earlier or increased rate of injury in the multivariate analyses. YBT-LQ scores alone do not predict LE injury in this collegiate athlete population. Sports medicine professionals should be cautioned against using the YBT-LQ alone to screen for injury risk in collegiate athletes.

The relationship of undernutrition/psychosocial factors and developmental outcomes of children in extreme poverty in Ethiopia.

PubMed

Worku, Berhanu Nigussie; Abessa, Teklu Gemechu; Wondafrash, Mekitie; Vanvuchelen, Marleen; Bruckers, Liesbeth; Kolsteren, Patrick; Granitzer, Marita

2018-02-09

Extreme poverty is severe deprivation of basic needs and services. Children living in extreme poverty may lack adequate parental care and face increased developmental and health risks. However, there is a paucity of literature on the combined influences of undernutrition and psychosocial factors (such as limited play materials, playground, playtime, interactions of children with their peers and mother-child interaction) on children's developmental outcomes. The main objective of this study was, therefore, to ascertain the association of developmental outcomes and psychosocial factors after controlling nutritional indices. A community-based cross-sectional study design was used to compare the developmental outcomes of extremely poor children (N = 819: 420 girls and 399 boys) younger than 5 years versus age-matched reference children (N = 819: 414 girls and 405 boys) in South-West Ethiopia. Using Denver II-Jimma, development in personal-social, language, fine and gross motor skills were assessed, and social-emotional skills were evaluated using the Ages and Stages Questionnaires: Social-Emotional (ASQ: SE). Nutritional status was derived from the anthropometric method. Independent samples t-test was used to detect mean differences in developmental outcomes between extremely poor and reference children. Multiple linear regression analysis was employed to identify nutritional and psychosocial factors associated with the developmental scores of children in extreme poverty. Children in extreme poverty performed worse in all the developmental domains than the reference children. Among the 819 extremely poor children, 325 (39.7%) were stunted, 135 (16.5%) were underweight and 27 (3.3%) were wasted. The results also disclosed that stunting and underweightness were negatively associated with all the developmental skills. After taking into account the effects of stunting and being underweight on the developmental scores, it was observed that limited play activities, limited child-to-child interactions and mother-child relationships were negatively related mainly to gross motor and language performances of children in extreme poverty. Undernutrition and psychosocial factors were negatively related to the developmental outcomes, independently, of children living in extreme poverty. Intervention, for these children, should integrate home-based play-assisted developmental stimulation and nutritional rehabilitation.

Linear and nonlinear genetic relationships between type traits and productive life in US dairy goats.

PubMed

Castañeda-Bustos, V J; Montaldo, H H; Valencia-Posadas, M; Shepard, L; Pérez-Elizalde, S; Hernández-Mendo, O; Torres-Hernández, G

2017-02-01

Linear or nonlinear genetic relationships between productive life and functional productive life at 72 mo, with final score (SCO), stature, strength, dairyness (DAI), teat diameter, rear legs (side view), rump angle, rump width (RUW), fore udder attachment (FUA), rear udder height, rear udder arch, udder depth (UDD), suspensory ligament (SUS), and teat placement, as well as heritabilities and correlations were estimated from multibreed US dairy goat records. Productive life was defined as the total days in production until 72 mo of age (PL72) for goats having the opportunity to express the trait. Functional productive life (FPL72) was analyzed by incorporating first lactation milk yield, fat yield, protein yield, and SCO in the statistical model. Heritabilities and correlations were estimated using linear mixed models with pedigree additive genetic relationships and ASReml software. Nonlinearity of genetic relationships was assessed based on second-degree polynomial (quadratic) regression models, with the breeding values of PL72 or FPL72 as responses and the breeding values for each type trait (linear and quadratic) as predictor variables. Heritability estimates were 0.19, 0.14, 0.18, 0.20, 0.14, 0.07, 0.28, 0.20, 0.15, 0.13, 0.25, 0.18, 0.20, 0.21, 0.21, and 0.32 for PL72, FPL72, SCO, stature, strength, DAI, teat diameter, rear legs, rump angle, RUW, FUA, rear udder height, rear udder arch, UDD, SUS, and teat placement, respectively. The type traits SCO, RUW, and FUA were the most correlated with PL72 and FPL72, so these may be used as selection criteria to increase longevity in dairy goats. An increase in the coefficient of determination >1% for the second degree, compared with that for the linear model for either PL72 or FPL72, was taken as evidence of a nonlinear genetic relationship. Using this criterion, PL72 showed maximum values at intermediate scores in DAI, UDD, and RUW, and maximum values at extreme scores in FUA and SUS, whereas FPL72 showed maximum values at intermediate scores in DAI and UDD, and maximum values at extreme scores in FUA, RUW, and SUS. Selecting for increased SCO, RUW, and FUA will lead to an increase of FPL72 in goats. Consideration of nonlinear relationships between DAI, FUA, RUW, SUS, and UDD may help in the design of more efficient breeding programs for dairy goats using conformation traits. The Authors. Published by the Federation of Animal Science Societies and Elsevier Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

Extremely low birth weight and body size in early adulthood

PubMed Central

Doyle, L; Faber, B; Callanan, C; Ford, G; Davis, N

2004-01-01

Aims: To determine the body size of extremely low birth weight (ELBW, birth weight 500–999 g) subjects in early adulthood. Methods: Cohort study examining the height and weight of 42 ELBW survivors free of cerebral palsy between birth and 20 years of age. Weight and height measurements were converted to Z (SD) scores. Results: At birth the subjects had weight Z scores substantially below zero (mean birth weight Z score -0.90, 95% CI -1.25 to -0.54), and had been lighter than average at ages 2, 5, and 8 years. However, by 14, and again at 20 years of age their weight Z scores were not significantly different from zero. At ages 2, 5, 8, 14, and 20 years of age their height Z scores were significantly below zero. Their height at 20 years of age was, however, consistent with their parents' height. As a group they were relatively heavy for their height and their mean body mass index (BMI) Z score was almost significantly different from zero (mean difference 0.42, 95% CI -0.02 to 0.84). Their mean BMI (kg/m2) was 24.0 (SD 5.2); 14 had a BMI >25, and four had a BMI >30. Conclusions: Despite their early small size, by early adulthood the ELBW subjects had attained an average weight, and their height was consistent with their parents' height. They were, however, relatively heavy for their height. PMID:15033844

Sexual function in adolescent and young adult survivors of lower extremity bone tumors.

PubMed

Barrera, Maru; Teall, Tanya; Barr, Ronald; Silva, Mariana; Greenberg, Mark

2010-12-15

Improving survival rates and new surgical options have led to increased interest regarding late effects and quality of life in adolescent and young adult survivors of bone cancers, including their sexual functioning. This study investigated sexual functioning in adolescent and young adult survivors of lower limb bone tumors, in relation to surgical treatments, gender differences, depressive symptoms, global self worth, and physical disability. Twenty-eight participants (age range 18-32 years) completed measures of gender specific sexual function, depressive symptoms, global self worth, and physical disability. For analysis, surgical intervention was grouped into limb sparing surgeries (LS; allograft fusion and endoprosthesis) and amputation or Van Nes rotationplasty (AMP). Male survivors reported significantly higher scores than females on total sexual function scores (P = 0.050), sexual drive (P = 0.002), and frequency of sexual thoughts, fantasies or erotic dreams (P = 0.021). Men also reported significantly better physical functioning scores than women (P = 0.012). LS scored significantly lower on frequency of sexual thoughts, fantasies and erotic dreams (P = 0.048) and frequency of sexual experiences (P = 0.016) compared with AMP. In addition, LS reported significantly more depressive symptoms scores (P = 0.004) and lower self worth scores (P = 0.037), than AMP. These results suggest that male survivors of lower extremity bone tumors experience better sexual functioning than women. Survivors of limb sparing surgeries struggle with sexual function, depressive symptoms, and poor self-perception compared to Van Nes rotationplasty and amputation survivors. Copyright © 2010 Wiley-Liss, Inc.

Evaluation of Nevada Test Site Ground Motion and Rock Property Data to Bound Ground Motions at the Yucca Mountain Repository

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hutchings, L J; Foxall, W; Rambo, J

2005-02-14

Yucca Mountain licensing will require estimation of ground motions from probabilistic seismic hazard analyses (PSHA) with annual probabilities of exceedance on the order of 10{sup -6} to 10{sup -7} per year or smaller, which correspond to much longer earthquake return periods than most previous PSHA studies. These long return periods for the Yucca Mountain PSHA result in estimates of ground motion that are extremely high ({approx} 10 g) and that are believed to be physically unrealizable. However, there is at present no generally accepted method to bound ground motions either by showing that the physical properties of materials cannot maintainmore » such extreme motions, or the energy release by the source for such large motions is physically impossible. The purpose of this feasibility study is to examine recorded ground motion and rock property data from nuclear explosions to determine its usefulness for studying the ground motion from extreme earthquakes. The premise is that nuclear explosions are an extreme energy density source, and that the recorded ground motion will provide useful information about the limits of ground motion from extreme earthquakes. The data were categorized by the source and rock properties, and evaluated as to what extent non-linearity in the material has affected the recordings. They also compiled existing results of non-linear dynamic modeling of the explosions carried out by LLNL and other institutions. They conducted an extensive literature review to outline current understanding of extreme ground motion. They also analyzed the data in terms of estimating maximum ground motions at Yucca Mountain.« less

Evaluation of Nevada Test Site Ground Motion and Rock Property Data to Bound Ground Motions at the Yucca Mountain Repository

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hutchings, L H; Foxall, W; Rambo, J

2005-03-09

Yucca Mountain licensing will require estimation of ground motions from probabilistic seismic hazard analyses (PSHA) with annual probabilities of exceedance on the order of 10{sup -6} to 10{sup -7} per year or smaller, which correspond to much longer earthquake return periods than most previous PSHA studies. These long return periods for the Yucca Mountain PSHA result in estimates of ground motion that are extremely high ({approx} 10 g) and that are believed to be physically unrealizable. However, there is at present no generally accepted method to bound ground motions either by showing that the physical properties of materials cannot maintainmore » such extreme motions, or the energy release by the source for such large motions is physically impossible. The purpose of this feasibility study is to examine recorded ground motion and rock property data from nuclear explosions to determine its usefulness for studying the ground motion from extreme earthquakes. The premise is that nuclear explosions are an extreme energy density source, and that the recorded ground motion will provide useful information about the limits of ground motion from extreme earthquakes. The data were categorized by the source and rock properties, and evaluated as to what extent non-linearity in the material has affected the recordings. They also compiled existing results of non-linear dynamic modeling of the explosions carried out by LLNL and other institutions. They conducted an extensive literature review to outline current understanding of extreme ground motion. They also analyzed the data in terms of estimating maximum ground motions at Yucca Mountain.« less

Counting repetitions: an observational study of video game play in people with chronic poststroke hemiparesis.

PubMed

Peters, Denise M; McPherson, Aaron K; Fletcher, Blake; McClenaghan, Bruce A; Fritz, Stacy L

2013-09-01

The use of video gaming as a therapeutic intervention has increased in popularity; however, the number of repetitions in comparison with traditional therapy methods has yet to be investigated. The primary purpose of this study was to document and compare the number of repetitions performed while playing 1 of 2 video gaming systems for a time frame similar to that of a traditional therapy session in individuals with chronic stroke. Twelve participants with chronic stroke (mean age, 66.8 ± 8.2 years; time poststroke, 19.2 ± 15.4 months) completed video game play sessions, using either the Nintendo Wii or the Playstation 2 EyeToy. A total of 203 sessions were captured on video record; of these, 50 sessions for each gaming system were randomly selected for analysis. For each selected record, active upper and lower extremity repetitions were counted for a 36-minute segment of the recorded session. The Playstation 2 EyeToy group produced an average of 302.5 (228.1) upper extremity active movements and 189.3 (98.3) weight shifts, significantly higher than the Nintendo Wii group, which produced an average of 61.9 (65.7) upper extremity active movements and 109.7 (78.5) weight shifts. No significant differences were found in steps and other lower extremity active movements between the 2 systems. The Playstation 2 EyeToy group produced more upper extremity active movements and weight shifting movements than the Nintendo Wii group; the number and type of repetitions varied across games. Active gaming (specifically Playstation 2 EyeToy) provided more upper extremity repetitions than those reported in the literature by using traditional therapy, suggesting that it may be a modality to promote increased active movements in individuals poststroke.

Improving the Statistical Modeling of the TRMM Extreme Precipitation Monitoring System

NASA Astrophysics Data System (ADS)

Demirdjian, L.; Zhou, Y.; Huffman, G. J.

2016-12-01

This project improves upon an existing extreme precipitation monitoring system based on the Tropical Rainfall Measuring Mission (TRMM) daily product (3B42) using new statistical models. The proposed system utilizes a regional modeling approach, where data from similar grid locations are pooled to increase the quality and stability of the resulting model parameter estimates to compensate for the short data record. The regional frequency analysis is divided into two stages. In the first stage, the region defined by the TRMM measurements is partitioned into approximately 27,000 non-overlapping clusters using a recursive k-means clustering scheme. In the second stage, a statistical model is used to characterize the extreme precipitation events occurring in each cluster. Instead of utilizing the block-maxima approach used in the existing system, where annual maxima are fit to the Generalized Extreme Value (GEV) probability distribution at each cluster separately, the present work adopts the peak-over-threshold (POT) method of classifying points as extreme if they exceed a pre-specified threshold. Theoretical considerations motivate the use of the Generalized-Pareto (GP) distribution for fitting threshold exceedances. The fitted parameters can be used to construct simple and intuitive average recurrence interval (ARI) maps which reveal how rare a particular precipitation event is given its spatial location. The new methodology eliminates much of the random noise that was produced by the existing models due to a short data record, producing more reasonable ARI maps when compared with NOAA's long-term Climate Prediction Center (CPC) ground based observations. The resulting ARI maps can be useful for disaster preparation, warning, and management, as well as increased public awareness of the severity of precipitation events. Furthermore, the proposed methodology can be applied to various other extreme climate records.

Paleoflood Data, Extreme Floods and Frequency: Data and Models for Dam Safety Risk Scenarios

NASA Astrophysics Data System (ADS)

England, J. F.; Godaire, J.; Klinger, R.

2007-12-01

Extreme floods and probability estimates are crucial components in dam safety risk analysis and scenarios for water-resources decision making. The field-based collection of paleoflood data provides needed information on the magnitude and probability of extreme floods at locations of interest in a watershed or region. The stratigraphic record present along streams in the form of terrace and floodplain deposits represent direct indicators of the magnitude of large floods on a river, and may provide 10 to 100 times longer records than conventional stream gaging records of large floods. Paleoflood data is combined with gage and historical streamflow estimates to gain insights to flood frequency scaling, model extrapolations and uncertainty, and provide input scenarios to risk analysis event trees. We illustrate current data collection and flood frequency modeling approaches via case studies in the western United States, including the American River in California and the Arkansas River in Colorado. These studies demonstrate the integration of applied field geology, hydraulics, and surface-water hydrology. Results from these studies illustrate the gains in information content on extreme floods, provide data- based means to separate flood generation processes, guide flood frequency model extrapolations, and reduce uncertainties. These data and scenarios strongly influence water resources management decisions.

Two case studies on NARCCAP precipitation extremes

NASA Astrophysics Data System (ADS)

Weller, Grant B.; Cooley, Daniel; Sain, Stephan R.; Bukovsky, Melissa S.; Mearns, Linda O.

2013-09-01

We introduce novel methodology to examine the ability of six regional climate models (RCMs) in the North American Regional Climate Change Assessment Program (NARCCAP) ensemble to simulate past extreme precipitation events seen in the observational record over two different regions and seasons. Our primary objective is to examine the strength of daily correspondence of extreme precipitation events between observations and the output of both the RCMs and the driving reanalysis product. To explore this correspondence, we employ methods from multivariate extreme value theory. These methods require that we account for marginal behavior, and we first model and compare climatological quantities which describe tail behavior of daily precipitation for both the observations and model output before turning attention to quantifying the correspondence of the extreme events. Daily precipitation in a West Coast region of North America is analyzed in two seasons, and it is found that the simulated extreme events from the reanalysis-driven NARCCAP models exhibit strong daily correspondence to extreme events in the observational record. Precipitation over a central region of the United States is examined, and we find some daily correspondence between winter extremes simulated by reanalysis-driven NARCCAP models and those seen in observations, but no such correspondence is found for summer extremes. Furthermore, we find greater discrepancies among the NARCCAP models in the tail characteristics of the distribution of daily summer precipitation over this region than seen in precipitation over the West Coast region. We find that the models which employ spectral nudging exhibit stronger tail dependence to observations in the central region.

The Validity of Computer Audits of Simulated Cases Records.

ERIC Educational Resources Information Center

Rippey, Robert M.; And Others

This paper describes the implementation of a computer-based approach to scoring open-ended problem lists constructed to evaluate student and practitioner clinical judgment from real or simulated records. Based on 62 previously administered and scored problem lists, the program was written in BASIC for a Heathkit H11A computer (equivalent to DEC…

Expressed Vocational Choices and Later Employment Compared with Vocational Preference Inventory and Kuder Preference Record-Vocational Scores

ERIC Educational Resources Information Center

Wiggins, J. D.; Weslander, Darrell

1977-01-01

Expressed vocational choices were more predictive of employment status four years after high school graduation for males than were scores on either the Vocational Preference Inventory or the Kuder Preference Record--Vocational. Predictions for males were more accurate than for females on all measures. (Author)

Multitrait modeling of first vs. later parities for US yield, somatic cell score, and fertility traits

USDA-ARS?s Scientific Manuscript database

Genetic merits in first vs. later parity with correlations <1 were compared to official repeatability models using 88 million lactation records of 34 million cows for yield traits and fewer records for somatic cell score (SCS) and 2 cow fertility traits. Estimated genetic correlations of first with ...

Skill of Predicting Heavy Rainfall Over India: Improvement in Recent Years Using UKMO Global Model

NASA Astrophysics Data System (ADS)

Sharma, Kuldeep; Ashrit, Raghavendra; Bhatla, R.; Mitra, A. K.; Iyengar, G. R.; Rajagopal, E. N.

2017-11-01

The quantitative precipitation forecast (QPF) performance for heavy rains is still a challenge, even for the most advanced state-of-art high-resolution Numerical Weather Prediction (NWP) modeling systems. This study aims to evaluate the performance of UK Met Office Unified Model (UKMO) over India for prediction of high rainfall amounts (>2 and >5 cm/day) during the monsoon period (JJAS) from 2007 to 2015 in short range forecast up to Day 3. Among the various modeling upgrades and improvements in the parameterizations during this period, the model horizontal resolution has seen an improvement from 40 km in 2007 to 17 km in 2015. Skill of short range rainfall forecast has improved in UKMO model in recent years mainly due to increased horizontal and vertical resolution along with improved physics schemes. Categorical verification carried out using the four verification metrics, namely, probability of detection (POD), false alarm ratio (FAR), frequency bias (Bias) and Critical Success Index, indicates that QPF has improved by >29 and >24% in case of POD and FAR. Additionally, verification scores like EDS (Extreme Dependency Score), EDI (Extremal Dependence Index) and SEDI (Symmetric EDI) are used with special emphasis on verification of extreme and rare rainfall events. These scores also show an improvement by 60% (EDS) and >34% (EDI and SEDI) during the period of study, suggesting an improved skill of predicting heavy rains.

Identification of extremely premature infants at high risk of rehospitalization.

PubMed

Ambalavanan, Namasivayam; Carlo, Waldemar A; McDonald, Scott A; Yao, Qing; Das, Abhik; Higgins, Rosemary D

2011-11-01

Extremely low birth weight infants often require rehospitalization during infancy. Our objective was to identify at the time of discharge which extremely low birth weight infants are at higher risk for rehospitalization. Data from extremely low birth weight infants in Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers from 2002-2005 were analyzed. The primary outcome was rehospitalization by the 18- to 22-month follow-up, and secondary outcome was rehospitalization for respiratory causes in the first year. Using variables and odds ratios identified by stepwise logistic regression, scoring systems were developed with scores proportional to odds ratios. Classification and regression-tree analysis was performed by recursive partitioning and automatic selection of optimal cutoff points of variables. A total of 3787 infants were evaluated (mean ± SD birth weight: 787 ± 136 g; gestational age: 26 ± 2 weeks; 48% male, 42% black). Forty-five percent of the infants were rehospitalized by 18 to 22 months; 14.7% were rehospitalized for respiratory causes in the first year. Both regression models (area under the curve: 0.63) and classification and regression-tree models (mean misclassification rate: 40%-42%) were moderately accurate. Predictors for the primary outcome by regression were shunt surgery for hydrocephalus, hospital stay of >120 days for pulmonary reasons, necrotizing enterocolitis stage II or higher or spontaneous gastrointestinal perforation, higher fraction of inspired oxygen at 36 weeks, and male gender. By classification and regression-tree analysis, infants with hospital stays of >120 days for pulmonary reasons had a 66% rehospitalization rate compared with 42% without such a stay. The scoring systems and classification and regression-tree analysis models identified infants at higher risk of rehospitalization and might assist planning for care after discharge.

Identification of Extremely Premature Infants at High Risk of Rehospitalization

PubMed Central

Carlo, Waldemar A.; McDonald, Scott A.; Yao, Qing; Das, Abhik; Higgins, Rosemary D.

2011-01-01

OBJECTIVE: Extremely low birth weight infants often require rehospitalization during infancy. Our objective was to identify at the time of discharge which extremely low birth weight infants are at higher risk for rehospitalization. METHODS: Data from extremely low birth weight infants in Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers from 2002–2005 were analyzed. The primary outcome was rehospitalization by the 18- to 22-month follow-up, and secondary outcome was rehospitalization for respiratory causes in the first year. Using variables and odds ratios identified by stepwise logistic regression, scoring systems were developed with scores proportional to odds ratios. Classification and regression-tree analysis was performed by recursive partitioning and automatic selection of optimal cutoff points of variables. RESULTS: A total of 3787 infants were evaluated (mean ± SD birth weight: 787 ± 136 g; gestational age: 26 ± 2 weeks; 48% male, 42% black). Forty-five percent of the infants were rehospitalized by 18 to 22 months; 14.7% were rehospitalized for respiratory causes in the first year. Both regression models (area under the curve: 0.63) and classification and regression-tree models (mean misclassification rate: 40%–42%) were moderately accurate. Predictors for the primary outcome by regression were shunt surgery for hydrocephalus, hospital stay of >120 days for pulmonary reasons, necrotizing enterocolitis stage II or higher or spontaneous gastrointestinal perforation, higher fraction of inspired oxygen at 36 weeks, and male gender. By classification and regression-tree analysis, infants with hospital stays of >120 days for pulmonary reasons had a 66% rehospitalization rate compared with 42% without such a stay. CONCLUSIONS: The scoring systems and classification and regression-tree analysis models identified infants at higher risk of rehospitalization and might assist planning for care after discharge. PMID:22007016

A multi-train electrical stimulation protocol facilitates transcranial electrical motor evoked potentials and increases induction rate and reproducibility even in patients with preoperative neurological deficits.

PubMed

Ushio, Shuta; Kawabata, Shigenori; Sumiya, Satoshi; Kato, Tsuyoshi; Yoshii, Toshitaka; Yamada, Tsuyoshi; Enomoto, Mitsuhiro; Okawa, Atsushi

2018-06-01

This study sought to evaluate the facilitation effect of repetitive multi-train transcranial electrical stimulation (mt-TES) at 2 repetition rates on transcranial electrical motor evoked potential (Tc-MEP) monitoring during spinal surgery, and to assess the induction rate in patients with impaired motor function from a compromised spinal cord or spinal nerve. We studied 32 consecutive patients with impaired motor function undergoing cervical or thoracic spinal surgery (470 muscles). A series of 10 TESs with 5 pulse trains were preoperatively delivered at 2 repetition rates (1 and 5 Hz). All peak-topeak amplitudes of the MEPs of the upper and lower extremity muscles elicited by the 10 TESs were measured. The induction rates of the lower extremity muscles were also assessed with muscle and preoperative lower extremity motor function scores. In each of the muscles, MEP amplitudes were augmented by about 2-3 times at 1 Hz and 5-6 times at 5 Hz. Under the 5-Hz condition, all limb muscles showed significant amplification. Also, in all preoperative motor function score groups, the amplitudes and induction rates of the lower extremity muscles were significantly increased. Moreover, the facilitation effects tended to peak in the last half of the series of 10 TESs. In all score groups of patients with preoperative neurological deficits, repetitive mt-TES delivered at a frequency of 5 Hz markedly facilitated the MEPs of all limb muscles and increased the induction rate. We recommend this method to improve the reliability of intraoperative monitoring during spinal surgery.

Physical Function, Hyperuricemia, and Gout in Older Adults.

PubMed

Burke, Bridget Teevan; Köttgen, Anna; Law, Andrew; Windham, Beverly Gwen; Segev, Dorry; Baer, Alan N; Coresh, Josef; McAdams-DeMarco, Mara A

2015-12-01

Gout prevalence is high in older adults and those affected are at risk of physical disability, yet it is unclear whether they have worse physical function. We studied gout, hyperuricemia, and physical function in 5,819 older adults (age ≥65 years) attending the 2011-2013 Atherosclerosis Risk in Communities Study visit, a prospective US population-based cohort. Differences in lower extremity function (Short Physical Performance Battery [SPPB] and 4-meter walking speed) and upper extremity function (grip strength) by gout status and by hyperuricemia prevalence were estimated in adjusted ordinal logistic regression (SPPB) and linear regression (walking speed and grip strength) models. Lower scores or times signify worse function. The prevalence of poor physical performance (first quartile) by gout and hyperuricemia was estimated using adjusted modified Poisson regression. Ten percent of participants reported a history of gout and 21% had hyperuricemia. There was no difference in grip strength by history of gout (P = 0.77). Participants with gout performed worse on the SPPB test; they had 0.77 times (95% confidence interval [95% CI] 0.65, 0.90, P = 0.001) the prevalence odds of a 1-unit increase in SPPB score and were 1.18 times (95% CI 1.07, 1.32, P = 0.002) more likely to have poor SPPB performance. Participants with a history of gout had slower walking speed (mean difference -0.03; 95% CI -0.05, -0.01, P < 0.001) and were 1.19 times (95% CI 1.06, 1.34, P = 0.003) more likely to have poor walking speed. Similarly, SPPB score and walking speed, but not grip strength, were worse in participants with hyperuricemia. Older adults with gout and hyperuricemia are more likely to have worse lower extremity, but not upper extremity, function. © 2015, American College of Rheumatology.

From positive psychology to psychopathology: the continuum of attention-deficit hyperactivity disorder.

PubMed

Greven, Corina U; Buitelaar, Jan K; Salum, Giovanni A

2018-03-01

Integration of positive psychology into clinical research and treatment has been slow. This integration can be facilitated by the conceptualisation of mental disorders as the high, symptomatic extreme of continuous normal variation. This assumes that there is also a low, positive extreme, which is, however, unchartered territory. This study aims to examine how well current measures capture the low extreme of mental disorder continua, using attention-deficit hyperactivity disorder (ADHD) as an example. The ability of three validated scales to capture ADHD as a continuous trait was examined using Item Response Theory in a sample of 9,882 adolescents from the UK population-representative Twins Early Development Study. These scales were: the Strengths and Weakness of ADHD Symptoms and Normal behaviour scale (SWAN), Strength and Difficulties Questionnaire (SDQ - hyperactivity subscale), and Conners' Parent Rating Scale (Conners). Only the SWAN reliably differentiated interindividual differences between participants lying at any level of the continuous ADHD latent trait, including the extreme low, positive end (z-scores from -3 to +3). The SDQ showed low reliability across the ADHD latent trait. In contrast, the Conners performed best at differentiating individuals scoring at or above the mean to the high symptomatic range (z-scores from 0 to +3). The SWAN was the only measure to provide indicators of 'positive mental health', endorsed in the presence of particularly good attentive abilities. Scales such as the SWAN that reliably capture ADHD as a continuous trait, including the positive end, are important for not missing meaningful variation in population-based studies. Indicators of positive mental health may be helpful in clinical practice, as positive attributes have been shown to directly influence as well as buffer negative effects of psychiatric symptoms. © 2017 Association for Child and Adolescent Mental Health.

A 13-year analysis from Switzerland of non-fatal sledging (sledding or tobogganing) injuries.

PubMed

Heim, Dominik; Altgeld, Katrin; Hasler, Rebecca M; Aghayev, Emin; Exadaktylos, Aristomenis K

2014-01-01

Winter sports have evolved from an upper class activity to a mass industry. Especially sledging regained popularity at the start of this century, with more and more winter sports resorts offering sledge runs. This study investigated the rates of sledging injuries over the last 13 years and analysed injury patterns specific for certain age groups, enabling us to make suggestions for preventive measures. We present a retrospective analysis of prospectively collected data. From 1996/1997 to 2008/2009, all patients involved in sledging injuries were recorded upon admission to a Level III trauma centre. Injuries were classified into body regions according to the Abbreviated Injury Scale (AIS). The Injury Severity Score (ISS) was calculated. Patients were stratified into 7 age groups. Associations between age and injured body region were tested using the chi-squared test. The slope of the linear regression with 95% confidence intervals was calculated for the proportion of patients with different injured body regions and winter season. 4956 winter sports patients were recorded. 263 patients (5%) sustained sledging injuries. Sledging injury patients had a median age of 22 years (interquartile range [IQR] 14-38 years) and a median ISS of 4 (IQR 1-4). 136 (51.7%) were male. Injuries (AIS ≥ 2) were most frequent to the lower extremities (n=91, 51.7% of all AIS ≥ 2 injuries), followed by the upper extremities (n=48, 27.3%), the head (n=17, 9.7%), the spine (n=7, 4.0%). AIS ≥ 2 injuries to different body regions varied from season to season, with no significant trends (p>0.19). However, the number of patients admitted with AIS ≥ 2 injuries increased significantly over the seasons analysed (p=0.031), as did the number of patients with any kind of sledging injury (p=0.004). Mild head injuries were most frequent in the youngest age group (1-10 years old). Injuries to the lower extremities were more often seen in the age groups from 21 to 60 years (p<0.001). Mild head trauma was mainly found in very young sledgers, and injuries to the lower extremities were more frequent in adults. In accordance with the current literature, we suggest that sledging should be performed in designated, obstacle-free areas that are specially prepared, and that children should always be supervised by adults. The effect of routine use of helmets and other protective devices needs further evaluation, but it seems evident that these should be obligatory on official runs. Copyright © 2012 Elsevier Ltd. All rights reserved.

Statistical distributions of extreme dry spell in Peninsular Malaysia

NASA Astrophysics Data System (ADS)

Zin, Wan Zawiah Wan; Jemain, Abdul Aziz

2010-11-01

Statistical distributions of annual extreme (AE) series and partial duration (PD) series for dry-spell event are analyzed for a database of daily rainfall records of 50 rain-gauge stations in Peninsular Malaysia, with recording period extending from 1975 to 2004. The three-parameter generalized extreme value (GEV) and generalized Pareto (GP) distributions are considered to model both series. In both cases, the parameters of these two distributions are fitted by means of the L-moments method, which provides a robust estimation of them. The goodness-of-fit (GOF) between empirical data and theoretical distributions are then evaluated by means of the L-moment ratio diagram and several goodness-of-fit tests for each of the 50 stations. It is found that for the majority of stations, the AE and PD series are well fitted by the GEV and GP models, respectively. Based on the models that have been identified, we can reasonably predict the risks associated with extreme dry spells for various return periods.

Crowdsourcing: a valid alternative to expert evaluation of robotic surgery skills.

PubMed

Polin, Michael R; Siddiqui, Nazema Y; Comstock, Bryan A; Hesham, Helai; Brown, Casey; Lendvay, Thomas S; Martino, Martin A

2016-11-01

Robotic-assisted gynecologic surgery is common, but requires unique training. A validated assessment tool for evaluating trainees' robotic surgery skills is Robotic-Objective Structured Assessments of Technical Skills. We sought to assess whether crowdsourcing can be used as an alternative to expert surgical evaluators in scoring Robotic-Objective Structured Assessments of Technical Skills. The Robotic Training Network produced the Robotic-Objective Structured Assessments of Technical Skills, which evaluate trainees across 5 dry lab robotic surgical drills. Robotic-Objective Structured Assessments of Technical Skills were previously validated in a study of 105 participants, where dry lab surgical drills were recorded, de-identified, and scored by 3 expert surgeons using the Robotic-Objective Structured Assessments of Technical Skills checklist. Our methods-comparison study uses these previously obtained recordings and expert surgeon scores. Mean scores per participant from each drill were separated into quartiles. Crowdworkers were trained and calibrated on Robotic-Objective Structured Assessments of Technical Skills scoring using a representative recording of a skilled and novice surgeon. Following this, 3 recordings from each scoring quartile for each drill were randomly selected. Crowdworkers evaluated the randomly selected recordings using Robotic-Objective Structured Assessments of Technical Skills. Linear mixed effects models were used to derive mean crowdsourced ratings for each drill. Pearson correlation coefficients were calculated to assess the correlation between crowdsourced and expert surgeons' ratings. In all, 448 crowdworkers reviewed videos from 60 dry lab drills, and completed a total of 2517 Robotic-Objective Structured Assessments of Technical Skills assessments within 16 hours. Crowdsourced Robotic-Objective Structured Assessments of Technical Skills ratings were highly correlated with expert surgeon ratings across each of the 5 dry lab drills (r ranging from 0.75-0.91). Crowdsourced assessments of recorded dry lab surgical drills using a validated assessment tool are a rapid and suitable alternative to expert surgeon evaluation. Copyright © 2016 Elsevier Inc. All rights reserved.

Cartoon distraction alleviates anxiety in children during induction of anesthesia.

PubMed

Lee, Jeongwoo; Lee, Jihye; Lim, Hyungsun; Son, Ji-Seon; Lee, Jun-Rae; Kim, Dong-Chan; Ko, Seonghoon

2012-11-01

We performed this study to determine the beneficial effects of viewing an animated cartoon and playing with a favorite toy on preoperative anxiety in children aged 3 to 7 years in the operating room before anesthesia induction. One hundred thirty children aged 3 to 7 years with ASA physical status I or II were enrolled. Subjects were randomly assigned to 1 of 3 groups: group 1 (control), group 2 (toy), and group 3 (animated cartoon). The children in group 2 were asked to bring their favorite toy and were allowed to play with it until anesthesia induction. The children in group 3 watched their selected animated cartoon until anesthesia induction. Children's preoperative anxiety was determined by the modified Yale Preoperative Anxiety Scale (mYPAS) and parent-recorded anxiety Visual Analog Scale (VAS) the night before surgery, in the preanesthetic holding room, and just before anesthesia induction. In the preanesthetic holding room, the group 2 mYPAS and parent-recorded anxiety VAS scores were significantly lower than those of groups 1 and 3 (mYPAS: P = 0.007; parent-recorded anxiety VAS: P = 0.02). In the operating room, the children in group 3 had the lowest mYPAS and parent-recorded anxiety VAS scores among the 3 groups (mYPAS: P < 0.001; parent-recorded anxiety VAS: P < 0.001). In group 3, the mYPAS and parent-recorded anxiety VAS scores of only 3 and 5 children were increased in the operating room compared with their scores in the preanesthetic holding room, whereas the anxiety scores of 32 and 34 children in group 1 and 25 and 32 children in group 2 had increased (P < 0.001). The number of children whose scores indicated no anxiety (mYPAS score <30) in the operating room was 3 (7%), 9 (23%), and 18 (43%) in groups 1, 2, and 3, respectively (P < 0.001). Allowing the viewing of animated cartoons by pediatric surgical patients is a very effective method to alleviate preoperative anxiety. Our study suggests that this intervention is an inexpensive, easy to administer, and comprehensive method for anxiety reduction in the pediatric surgical population.

The Relationship between Independent Transfer Skills and Upper Limb Kinetics in Wheelchair Users

PubMed Central

Boninger, Michael L.; Koontz, Alicia M.

2014-01-01

Transfers are one of the most physically demanding wheelchair activities. The purpose of this study was to determine if using proper transfer skills as measured by the Transfer Assessment Instrument (TAI) is associated with reduced loading on the upper extremities. Twenty-three wheelchair users performed transfers to a level-height bench while a series of forces plates, load cells, and a motion capture system recorded the biomechanics of their natural transferring techniques. Their transfer skills were simultaneously evaluated by two study clinicians using the TAI. Logistic regression and multiple linear regression models were used to determine the relationships between TAI scores and the kinetic variables on both arms across all joints. The results showed that the TAI measured transfer skills were closely associated with the magnitude and timing of joint moments (P < .02, model R2 values ranged from 0.27 to 0.79). Proper completion of the skills which targeted the trailing arm was associated with lower average resultant moments and rates of rise of resultant moments at the trailing shoulder and/or elbow. Some skills involving the leading side had the effect of increasing the magnitude or rate loading on the leading side. Knowledge of the kinetic outcomes associated with each skill may help users to achieve the best load-relieving effects for their upper extremities. PMID:25162039

Permissive hypotension in extremely low birth weight infants (≤1000 gm).

PubMed

Ahn, So Yoon; Kim, Eun Sun; Kim, Jin Kyu; Shin, Jeong Hee; Sung, Se In; Jung, Ji Mi; Chang, Yun Sil; Park, Won Soon

2012-07-01

We performed this study to evaluate the safety of permissive hypotension management in extremely low birth weight infants (ELBWIs). Medical records of all inborn ELBWIs admitted to Samsung Medical Center from January 2004 to December 2008 were reviewed retrospectively. Of a total of 261 ELBWIs, 47 (18%) required treatment for hypotension (group T), 110 (42%) remained normotensive (group N), and 104 (40%) experienced more than one episode of hypotension without treatment (group P) during the first 72 hours of life. Treatment of hypotension included inotropic support and/or fluid loading. Birth weight and Apgar scores were significantly lower in the T group than the other two groups. In the N group, the rate of pathologically confirmed maternal chorioamnionitis was significantly higher than other two groups, and the rate was higher in the P group than the T group. After adjusting for covariate factors, no significant differences in mortality and major morbidities were found between the N and P groups. However, the mortality rate and the incidence of intraventricular hemorrhage (≥stage 3) and bronchopulmonary dysplasia (≥moderate) were significantly higher in the T group than the other two groups. Long term neurodevelopmental outcomes were not significantly different between the N and P groups. Close observation of hypotensive ELBWIs who showed good clinical perfusion signs without intervention allowed to avoid unnecessary medications and resulted in good neurological outcomes.

''Playstation eyetoy games'' improve upper extremity-related motor functioning in subacute stroke: a randomized controlled clinical trial.

PubMed

Yavuzer, G; Senel, A; Atay, M B; Stam, H J

2008-09-01

To evaluate the effects of ''Playstation EyeToy Games'' on upper extremity motor recovery and upper extremity-related motor functioning of patients with subacute stroke. The authors designed a randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 3 months. A total of 20 hemiparetic inpatients (mean age 61.1 years), all within 12 months post-stroke, received 30 minutes of treatment with ''Playstation EyeToy Games'' per day, consisting of flexion and extension of the paretic shoulder, elbow and wrist as well as abduction of the paretic shoulder or placebo therapy (watching the games for the same duration without physical involvement into the games) in addition to conventional program, 5 days a week, 2-5 hours/day for 4 weeks. Brunnstrom's staging and self-care sub-items of the functional independence measure (FIM) were performed at 0 month (baseline), 4 weeks (post-treatment), and 3 months (follow-up) after the treatment. The mean change score (95% confidence interval) of the FIM self-care score (5.5 [2.9-8.0] vs 1.8 [0.1-3.7], P=0.018) showed significantly more improvement in the EyeToy group compared to the control group. No significant differences were found between the groups for the Brunnstrom stages for hand and upper extremity. ''Playstation EyeToy Games'' combined with a conventional stroke rehabilitation program have a potential to enhance upper extremity-related motor functioning in subacute stroke patients.

Injuries to the upper extremities in polytrauma: limited effect on outcome more than ten years after injury - a cohort study in 629 patients.

PubMed

Macke, C; Winkelmann, M; Mommsen, P; Probst, C; Zelle, B; Krettek, C; Zeckey, C

2017-02-01

To analyse the influence of upper extremity trauma on the long-term outcome of polytraumatised patients. A total of 629 multiply injured patients were included in a follow-up study at least ten years after injury (mean age 26.5 years, standard deviation 12.4). The extent of the patients' injury was classified using the Injury Severity Score. Outcome was measured using the Hannover Score for Polytrauma Outcome (HASPOC), Short Form (SF)-12, rehabilitation duration, and employment status. Outcomes for patients with and without a fracture of the upper extremity were compared and analysed with regard to specific fracture regions and any additional brachial plexus lesion. In all, 307 multiply-injured patients with and 322 without upper extremity injuries were included in the study. The groups with and without upper limb injuries were similar with respect to demographic data and injury pattern, except for midface trauma. There were no significant differences in the long-term outcome. In patients with brachial plexus lesions there were significantly more who were unemployed, required greater retraining and a worse HASPOC. Injuries to the upper extremities seem to have limited effect on long-term outcome in patients with polytrauma, as long as no injury was caused to the brachial plexus. Cite this article: Bone Joint J 2017;99-B:255-60. ©2017 The British Editorial Society of Bone & Joint Surgery.

Nurses' intentions to respond to bioterrorism and other infectious disease emergencies.

PubMed

Grimes, Deanna E; Mendias, Elnora P

2010-01-01

Although nurses historically have responded to natural disasters, little is known about nurses' intentions to respond during bioterrorism and other infectious disease emergencies where they and their families may be at risk. To investigate that question, we surveyed nurses following their participation in a class on bioterrorism. Participants (N = 292) completed a Personal/Professional Profile (PPP), Test of Bioterrorism Knowledge (BT Knowledge), and an Intention to Respond (IR) instrument. IR was measured by participants' scores on their likelihood to care for patients (0 = extremely unlikely, 10 = extremely likely) for each of 10 infectious disease scenarios reflecting different infection risk. We calculated scores for each scenario, totaled them, and examined the total IR related to the participant's PPP and scores on BT Knowledge. Additionally, we examined participants' written comments explaining the reasons for their IR. Total IR scores ranged from 8-100 (mean and median of 70). The IR was higher in scenarios where the infection risk was lower. Overall IR scores were positively related to BT Knowledge and having had previous emergency and disaster experience. Those less likely to respond had dependent children and more years in nursing. Results indicate that nurses differentiated risks associated with different infectious disease situations and may decide to respond during a real emergency based on such information. Implications for nursing administrators and nursing educators are discussed. Copyright 2010 Mosby, Inc. All rights reserved.

Is there an association between astrological data and personality?

PubMed

Hume, N

1977-07-01

A test was made of the hypothesis that personality characteristics can be predicted on the basis of various features of the individual's astrological chart. Astrological charts were prepared for 196 college-age Ss who also were administered the MMPI and the Leary Interpersonal Check List. Ss were divided into those who had extreme scores on any of the 13 personality variables studied and those who did not. For each personality variable, comparisons were made on a large number of astrological dimensions between distributions of Ss with and without extreme test scores. Six hundred thirty-two such comparisons were made and evaluated with chi-square tests. In that the obtained number of statistically significnat chi-squares was less than what would be expected on a chance basis, the hypothesis was rejected.

Methodology and implications of maximum paleodischarge estimates for mountain channels, upper Animas River basin, Colorado, U.S.A.

USGS Publications Warehouse

Pruess, J.; Wohl, E.E.; Jarrett, R.D.

1998-01-01

Historical and geologic records may be used to enhance magnitude estimates for extreme floods along mountain channels, as demonstrated in this study from the San Juan Mountains of Colorado. Historical photographs and local newspaper accounts from the October 1911 flood indicate the likely extent of flooding and damage. A checklist designed to organize and numerically score evidence of flooding was used in 15 field reconnaissance surveys in the upper Animas River valley of southwestern Colorado. Step-backwater flow modeling estimated the discharges necessary to create longitudinal flood bars observed at 6 additional field sites. According to these analyses, maximum unit discharge peaks at approximately 1.3 m3 s-1 km-2 around 2200 m elevation, with decreased unit discharges at both higher and lower elevations. These results (1) are consistent with Jarrett's (1987, 1990, 1993) maximum 2300-m elevation limit for flash-flooding in the Colorado Rocky Mountains, and (2) suggest that current Probable Maximum Flood (PMF) estimates based on a 24-h rainfall of 30 cm at elevations above 2700 m are unrealistically large. The methodology used for this study should be readily applicable to other mountain regions where systematic streamflow records are of short duration or nonexistent.

Psychometric Evaluation of the Lower Extremity Computerized Adaptive Test, the Modified Harris Hip Score, and the Hip Outcome Score.

PubMed

Hung, Man; Hon, Shirley D; Cheng, Christine; Franklin, Jeremy D; Aoki, Stephen K; Anderson, Mike B; Kapron, Ashley L; Peters, Christopher L; Pelt, Christopher E

2014-12-01

The applicability and validity of many patient-reported outcome measures in the high-functioning population are not well understood. To compare the psychometric properties of the modified Harris Hip Score (mHHS), the Hip Outcome Score activities of daily living subscale (HOS-ADL) and sports (HOS-sports), and the Lower Extremity Computerized Adaptive Test (LE CAT). The hypotheses was that all instruments would perform well but that the LE CAT would show superiority psychometrically because a combination of CAT and a large item bank allows for a high degree of measurement precision. Cohort study (diagnosis); Level of evidence, 2. Data were collected from 472 advanced-age, active participants from the Huntsman World Senior Games in 2012. Validity evidences were examined through item fit, dimensionality, monotonicity, local independence, differential item functioning, person raw score to measure correlation, and instrument coverage (ie, ceiling and floor effects), and reliability evidences were examined through Cronbach alpha and person separation index. All instruments demonstrated good item fit, unidimensionality, monotonicity, local independence, and person raw score to measure correlations. The HOS-ADL had high ceiling effects of 36.02%, and the mHHS had ceiling effects of 27.54%. The LE CAT had ceiling effects of 8.47%, and the HOS-sports had no ceiling effects. None of the instruments had any floor effects. The mHHS had a very low Cronbach alpha of 0.41 and an extremely low person separation index of 0.08. Reliabilities for the LE CAT were excellent and for the HOS-ADL and HOS-sports were good. The LE CAT showed better psychometric properties overall than the HOS-ADL, HOS-sports, and mHHS for the senior population. The mHHS demonstrated pronounced ceiling effects and poor reliabilities that should be of concern. The high ceiling effects for the HOS-ADL were also of concern. The LE CAT was superior in all psychometric aspects examined in this study. Future research should investigate the LE CAT for wider use in different populations.

Psychometric Evaluation of the Lower Extremity Computerized Adaptive Test, the Modified Harris Hip Score, and the Hip Outcome Score

PubMed Central

Hung, Man; Hon, Shirley D.; Cheng, Christine; Franklin, Jeremy D.; Aoki, Stephen K.; Anderson, Mike B.; Kapron, Ashley L.; Peters, Christopher L.; Pelt, Christopher E.

2014-01-01

Background: The applicability and validity of many patient-reported outcome measures in the high-functioning population are not well understood. Purpose: To compare the psychometric properties of the modified Harris Hip Score (mHHS), the Hip Outcome Score activities of daily living subscale (HOS-ADL) and sports (HOS-sports), and the Lower Extremity Computerized Adaptive Test (LE CAT). The hypotheses was that all instruments would perform well but that the LE CAT would show superiority psychometrically because a combination of CAT and a large item bank allows for a high degree of measurement precision. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Data were collected from 472 advanced-age, active participants from the Huntsman World Senior Games in 2012. Validity evidences were examined through item fit, dimensionality, monotonicity, local independence, differential item functioning, person raw score to measure correlation, and instrument coverage (ie, ceiling and floor effects), and reliability evidences were examined through Cronbach alpha and person separation index. Results: All instruments demonstrated good item fit, unidimensionality, monotonicity, local independence, and person raw score to measure correlations. The HOS-ADL had high ceiling effects of 36.02%, and the mHHS had ceiling effects of 27.54%. The LE CAT had ceiling effects of 8.47%, and the HOS-sports had no ceiling effects. None of the instruments had any floor effects. The mHHS had a very low Cronbach alpha of 0.41 and an extremely low person separation index of 0.08. Reliabilities for the LE CAT were excellent and for the HOS-ADL and HOS-sports were good. Conclusion: The LE CAT showed better psychometric properties overall than the HOS-ADL, HOS-sports, and mHHS for the senior population. The mHHS demonstrated pronounced ceiling effects and poor reliabilities that should be of concern. The high ceiling effects for the HOS-ADL were also of concern. The LE CAT was superior in all psychometric aspects examined in this study. Future research should investigate the LE CAT for wider use in different populations. PMID:26535291

Physical and mental workload in single-incision laparoscopic surgery and conventional laparoscopy.

PubMed

Koca, Dilek; Yıldız, Sedat; Soyupek, Feray; Günyeli, İlker; Erdemoglu, Ebru; Soyupek, Sedat; Erdemoglu, Evrim

2015-06-01

The aim of the present study is to evaluate mental workload and fatigue in fingers, hand, arm, shoulder in single-incision laparoscopic surgery (SILS) and multiport laparoscopy. Volunteers performed chosen tasks by standard laparoscopy and SILS. Time to complete tasks and finger and hand strength were evaluated. Lateral, tripod, and pulp pinch strengths were measured. Hand dexterity was determined by pegboard. Electromyography recordings were taken from biceps and deltoid muscles of both extremities. The main outcome measurement was median frequency (MF) slope. NASA-TLX was used for mental workload. Time to complete laparoscopic tasks were longer in the SILS group (P < .05). Decrease of strength in fingers and hand were similar in SILS and standard laparoscopy. Pegboard time was increased in both hands after SILS (P < .05). MF slope of biceps muscle and deltoid muscle in SILS was far away from the reference slope. MF slope of biceps muscle and deltoid muscle in standard laparoscopy was close to reference slope, indicating there was more fatigue in biceps and deltoid muscles of both upper extremities in SILS group. NASA-TLX score was 73 ± 13.3 and 42 ± 19.5 in SILS and multiport laparoscopy, respectively (P < .01). Mental demand, physical demand, temporal demand, performance, effort, and frustration were, respectively, scored 10.7 ± 3.8, 11.7 ± 3.5, 12.2 ± 2.7, 11 ± 3, 13.6 ± 2.7, and 13.5 ± 2.8 in SILS and 6.3 ± 3.1, 6.6 ± 3.3, 7.3 ± 3.3, 7.1 ± 4.1, 7.9 ± 3.9, and 6.6 ± 3.8 in standard laparoscopy (P < .01). SILS is mentally and physically demanding, particularly on arms and shoulders. Fatigue of big muscles, effort, and frustration were major challenges of SILS. Ergonomic intervention of instruments are needed to decrease mental and physical workload. © The Author(s) 2014.

Prospective observational study to evaluate risk factors for falls in institutionalized elderly people: the role of cystatin C.

PubMed

Peláez, Verónica Centeno; Ausín, Lourdes; Mambrilla, Marta Ruiz; Gonzalez-Sagrado, Manuel; Pérez Castrillón, José Luis

2015-08-01

To evaluate the role of balance and gait disorders, comorbidities and laboratory abnormalities in the occurrence of falls in an institutionalized elderly population. We made a non-interventional, prospective, observational study in elderly institutionalized people. Comorbidities and information on treatments were obtained. Function and cognition were measured using the Katz Index, the Tinetti Balance and Gait, lower extremity function tests and the Mini-Mental test. At the inclusion, the analytical was made including cystatin C. Falls were recorded for 20 months after inclusion. Patients with falls were older (85 ± 7 vs. 82 ± 8, p = 0.04) and more often female (88 vs. 12 %, p = 0.01). Dyslipidemia, hypertension and antihypertensive treatment were associated with an increased risk of falls. Cystatin C was higher in patients with falls (0.96 ± 0.21 vs. 1.12 ± 0.29, p = 0.02). Functional tests showed differences in the Tinetti balance test (15 ± 2 vs. 13 ± 3, p = 0.04) and lower extremity function balance test (2.8 ± 1.2 vs. 2.2 ± 1.2, p = 0.05). The Mini-Mental State Examination (MMSE) scores were worse in patients with falls (22 ± 4 vs. 25 ± 4, p = 0.01). Only female status (6.2, p = 0.03), the MMSE scores (1.2, p = 0.02) and cystatin C (5.3, p = 0.02) were independent risk factors for falls after logistic regression. Female sex, cognitive impairment and cystatin C were risk factors for falls in non-dependent institutionalized elderly people.

Comparative Analgesic Efficacy of Oxycodone/Acetaminophen Versus Hydrocodone/Acetaminophen for Short-term Pain Management in Adults Following ED Discharge.

PubMed

Chang, Andrew K; Bijur, Polly E; Holden, Lynne; Gallagher, E John

2015-11-01

The objective was to test the hypothesis that oxycodone/acetaminophen provides superior analgesia to hydrocodone/acetaminophen for the treatment of acute extremity pain following emergency department (ED) discharge. This was a prospective, randomized, double-blind clinical trial of nonelderly adult ED patients with acute musculoskeletal extremity pain, randomly allocated at discharge to receive oxycodone/acetaminophen (5 mg/325 mg) or hydrocodone/acetaminophen (5 mg/325 mg). The primary outcome was the between-group difference in improvement in numerical rating scale (NRS) pain scores over a 2-hour period following the most recent ingestion of study drug, obtained during telephone contact 24 hours after ED discharge. Secondary outcomes included proportionate decrease in pain, comparative side-effect profiles, and patient satisfaction. A total of 240 patients were enrolled. The final sample consisted of 220 patients, 107 randomly allocated to oxycodone/acetaminophen and 113 to hydrocodone/acetaminophen. At 24 hours after ED discharge, the mean NRS pain scores prior to the most recent dose of outpatient pain medication were 7.8 and 7.9 in the oxycodone/acetaminophen and hydrocodone/acetaminophen groups, respectively. The mean decreases in pain scores over 2 hours were 4.4 NRS units in the oxycodone/acetaminophen group versus 4.0 NRS units in the hydrocodone/acetaminophen group, for a difference of 0.4 NRS units (95% confidence interval = -0.2 to 1.1 NRS units). Satisfaction with the analgesics was similar. This study design could not detect a clinically or statistically significant difference in analgesic efficacy between oxycodone/acetaminophen (5 mg/325 mg) and hydrocodone/acetaminophen (5 mg/325 mg) for treatment of acute musculoskeletal extremity pain in adults following ED discharge. Both opioids reduced pain scores by approximately 50%. © 2015 by the Society for Academic Emergency Medicine.

Mid-term outcome of endovascular treatment for acute lower extremity deep venous thrombosis.

PubMed

Jiang, Kun; Li, Xiao-Qiang; Sang, Hong-Fei; Qian, Ai-Min; Rong, Jian-Jie; Li, Cheng-Long

2017-04-01

Purposes of the study To evaluate the benefit of stenting the iliac vein in patients with residual iliac vein stenosis treated with catheter-directed thrombolysis for acute iliofemoral deep venous thrombosis. Procedures In this randomized prospective study, patients with a first-time acute lower extremity deep venous thrombosis that had persisted <14 days were treated with catheter-directed thrombolysis. After catheter-directed thrombolysis, patients with >50% residual iliac vein stenosis were randomly divided into two groups: catheter-directed thrombolysis + Stent Group and catheter-directed thrombolysis Alone Group. Patients received urokinase thrombolysis and low-molecular-weight heparin/oral warfarin during the hospitalization period and were administrated oral warfarin after discharge. Cumulative deep vein patency, the Clinical Etiology Anatomic Pathophysiologic classification system, the Venous Clinical Severity Score and the Chronic Venous Insufficiency Questionnaire score were evaluated. Findings The cumulative deep vein patency rate was 74.07% in the catheter-directed thrombolysis + Stent Group and 46.59% in the catheter-directed thrombolysis Alone Group. The mean postoperative Clinical Etiology Anatomic Pathophysiologic classification and Venous Clinical Severity Score was significantly lower in the catheter-directed thrombolysis + Stent Group than in the catheter-directed thrombolysis Alone Group. The mean postoperative Chronic Venous Insufficiency Questionnaire score was significantly higher in the catheter-directed thrombolysis + Stent Group than the catheter-directed thrombolysis Alone Group. Conclusions Placement of an iliac vein stent in patients with residual iliac vein stenosis after catheter-directed thrombolysis for acute lower extremity deep venous thrombosis increases iliac vein patency and improves clinical symptoms and health-related quality of life at mid-term follow-up compared to patients treated with catheter-directed thrombolysis alone.

Weight Status in the First 2 Years of Life and Neurodevelopmental Impairment in Extremely Low Gestational Age Newborns.

PubMed

Belfort, Mandy B; Kuban, Karl C K; O'Shea, T Michael; Allred, Elizabeth N; Ehrenkranz, Richard A; Engelke, Stephen C; Leviton, Alan

2016-01-01

To examine the extent to which weight gain and weight status in the first 2 years of life relate to the risk of neurodevelopmental impairment in extremely preterm infants. In a cohort of 1070 infants born between 23 and 27 weeks' gestation, we examined weight gain from 7-28 days of life (in quartiles) and weight z-score at 12 and 24 months corrected age (in 4 categories: <-2; ≥-2, <-1; ≥1, <1; and ≥1) in relation to these adverse neurodevelopmental outcomes: Bayley-II mental development index <55, Bayley-II psychomotor development index <55, cerebral palsy, Gross Motor Function Classification System ≥1 (cannot walk without assistance), microcephaly. We adjusted for confounders in logistic regression, stratified by sex, and performed separate analyses including the entire sample, and excluding children unable to walk without assistance (motor impairment). Weight gain in the lowest quartile from 7-28 days was not associated with higher risk of adverse outcomes. Children with a 12-month weight z-score <-2 were at increased risk for all adverse outcomes in girls, and for microcephaly and Gross Motor Function Classification System ≥1 in boys. However, excluding children with motor impairment attenuated all associations except that of weight z-score <-2 with microcephaly in girls. Similarly, most associations of low weight z-score at 24 months with adverse outcomes were attenuated with exclusion of children with motor impairment. Excluding children who have gross motor impairment appears to eliminate the association of low weight status with neurodevelopmental impairments at 2 years in extremely preterm infants. Copyright © 2016 Elsevier Inc. All rights reserved.

Genetic evaluation of the total hip score of four populous breeds of dog, as recorded by the New Zealand Veterinary Association Hip Dysplasia Scheme (1991-2011).

PubMed

Soo, M; Sneddon, N W; Lopez-Villalobos, N; Worth, A J

2015-03-01

To use estimated breeding value (EBV) analysis to investigate the genetic trend of the total hip score (to assess canine hip dysplasia) in four populous breeds of dogs using the records from the New Zealand Veterinary Association (NZVA) Canine Hip Dysplasia Scheme database (1991 to 2011). Estimates of heritability and EBV for the NZVA total hip score of individual dogs from the German Shepherd, Labrador Retriever, Golden Retriever and Rottweiler breeds were obtained using restricted maximum likelihood procedures with a within-breed linear animal model. The model included the fixed effects of gender, birth year, birth season, age at scoring and the random effect of animal. The pedigree file included animals recorded between 1990 and 2011. A total of 2,983 NZVA hip score records, from a pedigree of 3,172 animals, were available for genetic evaluation. Genetic trends of the NZVA total hip score were calculated as the regression coefficient of the EBV (weighted by reliabilities) on year of birth. The estimates of heritability for hip score were 0.32 (SE 0.08) in German Shepherd, 0.37 (SE 0.08) in Labrador Retriever, 0.29 (SE 0.08) in Golden Retriever and 0.52 (SE 0.18) in Rottweiler breeds. Genetic trend analysis revealed that only the German Shepherd breed exhibited a genetic trend towards better hip conformation over time, with a decline of 0.13 (SE 0.04) NZVA total hip score units per year (p<0.001). The genetic trends of total hip score for the remaining three breeds were not significantly different from zero (p>0.1). Despite moderate heritability of the NZVA total hip score, there has not been substantial improvement of this trait for the four breeds analysed in the study period. Greater improvement in reducing the prevalence of canine hip dysplasia may be possible if screening were to be compulsory as a requirement for registration of pedigree breeding stock, greater selection pressure were to be applied and selection of breeding stock made on the basis on an individual's EBV rather than the NZVA total hip score alone.

Does one workshop on respecting cultural differences increase health professionals' confidence to improve the care of Australian Aboriginal patients with cancer? An evaluation.

PubMed

Durey, Angela; Halkett, Georgia; Berg, Melissa; Lester, Leanne; Kickett, Marion

2017-09-15

Aboriginal Australians have worse cancer survival rates than other Australians. Reasons include fear of a cancer diagnosis, reluctance to attend mainstream health services and discrimination from health professionals. Offering health professionals education in care focusing on Aboriginal patients' needs is important. The aim of this paper was to evaluate whether participating in a workshop improved the confidence of radiation oncology health professionals in their knowledge, communication and ability to offer culturally safe healthcare to Aboriginal Australians with cancer. Mixed methods using pre and post workshop online surveys, and one delivered 2 months later, were evaluated. Statistical analysis determined the relative proportion of participants who changed from not at all/a little confident at baseline to fairly/extremely confident immediately and 2 months after the workshop. Factor analysis identified underlying dimensions in the items and nonparametric tests recorded changes in mean dimension scores over and between times. Qualitative data was analysed for emerging themes. Fifty-nine participants attended the workshops, 39 (66% response rate) completed pre-workshop surveys, 32 (82% of study participants) completed post-workshop surveys and 25 (64% of study participants) completed surveys 2 months later. A significant increase in the proportion of attendees who reported fair/extreme confidence within 2 days of the workshop was found in nine of 14 items, which was sustained for all but one item 2 months later. Two additional items had a significant increase in the proportion of fair/extremely confident attendees 2 months post workshop compared to baseline. An exploratory factor analysis identified three dimensions: communication; relationships; and awareness. All dimensions' mean scores significantly improved within 2 days (p < 0.005) and persisted to 2 months. The workshop raised awareness about barriers and enablers to delivering services respectful of cultural differences, led to a willingness to reflect on pre-existing beliefs and assumptions about Aboriginal Australians that in some cases resulted in improved care. Single workshops co-delivered by an Aboriginal and non-Aboriginal presenter can be effective in building health professionals' confidence and translating into practice knowledge of respectful care of Aboriginal patients with cancer. Sustaining improvements may require integrating this approach into ongoing professional development.

Investigating Holocene Glacial and Pluvials Events in the Sierra Nevada of California

NASA Astrophysics Data System (ADS)

Ashford, J.; Sickman, J. O.; Lucero, D. M.; Kirby, M.; Gray, A. B.

2016-12-01

Understanding interannual and decadal variation in snowfall and extreme hydrologic events in the Sierra Nevada is hampered by short instrumental record and uncertainty caused by extrapolating paleoclimate data from lower elevation systems to the alpine snow deposition zone. Longer paleo records from high elevation systems are necessary to provide a more accurate record of snow water content and extreme precipitation events over millennial timescales that can be used to test hypotheses regarding teleconnections between Pacific climate variability and water supply and flood risk in California. In October 2013 we collected sediment cores from Pear Lake, an alpine lake in Sequoia National Park. The cores were split and characterized by P-wave velocity, magnetic susceptibility and density scanning along with grain-size analysis at 1-2 cm increments. Radiocarbon dates indicate that the Pear Lake cores contain a 13.5K year record of lake sediment. In contrast to other Sierra Nevada lakes previously cored by our group, high-resolution scanning revealed alternating fine grained, light-dark bands (1 mm to 5 mm thick) for most of the Pear Lake core length. This pattern was interrupted at intervals by homogenous clasts (up to 75 mm thick) ranging in grain size from sand to gravel up to 1 cm diameter. The sand to gravel sized clasts are most likely associated with extreme precipitation events. Preliminary grain-size analysis results show evidence of isolated extreme hydrologic events and sections of increased event frequency which we hypothesize are the result of atmospheric rivers intersecting the southern Sierra Nevada outside of the snow covered period.

Do Standardized Tests Penalize Deep-Thinking, Creative, or Conscientious Students?: Some Personality Correlates of Graduate Record Examinations Test Scores

ERIC Educational Resources Information Center

Powers, Donald E.; Kaufman, James C.

2004-01-01

The objective of the study reported here was to explore the relationship of Graduate Record Examinations (GRE) General Test scores to selected personality traits--conscientiousness, rationality, ingenuity, quickness, creativity, and depth. A sample of 342 GRE test takers completed short personality inventory scales for each trait. Analyses…

Treatment Outcome and Follow-Up Evaluation Based on Client Case Records in a Mental Health Center.

ERIC Educational Resources Information Center

Simons, Lynn S.; And Others

1978-01-01

Evaluated the application of Goal Attainment Scaling (GAS) to client case records as a measure of treatment effectiveness and examined its correspondence to other measures of outcome. Findings were that GAS scores converged significantly with therapist ratings of global improvement and GAS scores obtained from client reports at follow-up.…

Predicting Success in College: SAT® Studies of Classes Graduating since 1980. Research Report No. 2001-2

ERIC Educational Resources Information Center

Burton, Nancy W.; Ramist, Leonard

2001-01-01

Studies predicting success in college for students graduating since 1980 are reviewed. SAT scores and high school records are the most common predictors, but a few studies of other predictors are included. The review establishes that SAT scores and high school records predict academic performance, nonacademic accomplishments, leadership in…

Do HCAHPS Doctor Communication Scores Reflect the Communication Skills of the Attending on Record? A Cautionary Tale from a Tertiary-Care Medical Service.

PubMed

Velez, Vicente J; Kaw, Roop; Hu, Bo; Frankel, Richard M; Windover, Amy K; Bokar, Dan; Rish, Julie M; Rothberg, Michael B

2017-06-01

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores measure patient satisfaction with hospital care. It is not known if these reflect the communication skills of the attending physician on record. The Four Habits Coding Scheme (4HCS) is a validated instrument that measures bedside physician communication skills according to 4 habits, namely: investing in the beginning, eliciting the patient's perspective, demonstrating empathy, and investing in the end. To investigate whether the 4HCS correlates with provider HCAHPS scores. Using a cross-sectional design, consenting hospitalist physicians (n = 28), were observed on inpatient rounds during 3 separate encounters. We compared hospitalists' 4HCS scores with their doctor communication HCAHPS scores to assess the degree to which these correlated with inpatient physician communication skills. We performed sensitivity analysis excluding scores returned by patients cared for by more than 1 hospitalist. A total of 1003 HCAHPS survey responses were available. Pearson correlation between 4HCS and doctor communication scores was not significant, at 0.098 (-0.285, 0.455; P = 0.619). Also, no significant correlations were found between each habit and HCAHPS. When including only scores attributable to 1 hospitalist, Pearson correlation between the empathy habit and the HCAHPS respect score was 0.515 (0.176, 0.745; P = 0.005). Between empathy and overall doctor communication, it was 0.442 (0.082, 0.7; P = 0.019). Attending-of-record HCAHPS scores do not correlate with 4HCS. After excluding patients cared for by more than 1 hospitalist, demonstrating empathy did correlate with the doctor communication and respect HCAHPS scores. Journal of Hospital Medicine 2017;12:421-427. © 2017 Society of Hospital Medicine

The Metadata Coverage Index (MCI): A standardized metric for quantifying database metadata richness.

PubMed

Liolios, Konstantinos; Schriml, Lynn; Hirschman, Lynette; Pagani, Ioanna; Nosrat, Bahador; Sterk, Peter; White, Owen; Rocca-Serra, Philippe; Sansone, Susanna-Assunta; Taylor, Chris; Kyrpides, Nikos C; Field, Dawn

2012-07-30

Variability in the extent of the descriptions of data ('metadata') held in public repositories forces users to assess the quality of records individually, which rapidly becomes impractical. The scoring of records on the richness of their description provides a simple, objective proxy measure for quality that enables filtering that supports downstream analysis. Pivotally, such descriptions should spur on improvements. Here, we introduce such a measure - the 'Metadata Coverage Index' (MCI): the percentage of available fields actually filled in a record or description. MCI scores can be calculated across a database, for individual records or for their component parts (e.g., fields of interest). There are many potential uses for this simple metric: for example; to filter, rank or search for records; to assess the metadata availability of an ad hoc collection; to determine the frequency with which fields in a particular record type are filled, especially with respect to standards compliance; to assess the utility of specific tools and resources, and of data capture practice more generally; to prioritize records for further curation; to serve as performance metrics of funded projects; or to quantify the value added by curation. Here we demonstrate the utility of MCI scores using metadata from the Genomes Online Database (GOLD), including records compliant with the 'Minimum Information about a Genome Sequence' (MIGS) standard developed by the Genomic Standards Consortium. We discuss challenges and address the further application of MCI scores; to show improvements in annotation quality over time, to inform the work of standards bodies and repository providers on the usability and popularity of their products, and to assess and credit the work of curators. Such an index provides a step towards putting metadata capture practices and in the future, standards compliance, into a quantitative and objective framework.

The Influence of Training and Experience on Rater Performance in Scoring Spoken Language

ERIC Educational Resources Information Center

Davis, Larry

2016-01-01

Two factors were investigated that are thought to contribute to consistency in rater scoring judgments: rater training and experience in scoring. Also considered were the relative effects of scoring rubrics and exemplars on rater performance. Experienced teachers of English (N = 20) scored recorded responses from the TOEFL iBT speaking test prior…

Effect of Roy's Adaptation Model-Guided Education on Coping Strategies of the Veterans with Lower Extremities Amputation: A Double-Blind Randomized Controlled Clinical Trial.

PubMed

Farsi, Zahra; Azarmi, Somayeh

2016-04-01

Any defect in the extremities of the body can affect different life aspects. The purpose of this study was to investigate the effect of Roy's adaptation model-guided education on coping strategies of the veterans with lower extremities amputation. In a double-blind randomized controlled clinical trial, 60 veterans with lower extremities amputation referring to Kowsar Orthotics and Prosthetics Center of Veterans Clinic in Tehran, Iran were recruited using convenience method and randomly assigned to intervention and control groups in 2013-2014. Lazarus and Folkman coping strategies questionnaire was used to collect the data. After completing the questionnaires in both groups, maladaptive behaviours were determined in the intervention group and an education program based on Roy's adaptation model was implemented. After 2 months, both groups completed the questionnaires again. Data were analyzed using SPSS software. Independent T-test showed that the score of the dimensions of coping strategies did not have a statistically significant difference between the intervention and control groups in the pre-intervention stage (P>0.05). This test showed a statistically significant difference between the two groups in the post-intervention stage in terms of the scores of different dimensions of coping strategies (P>0.05), except in dimensions of social support seeking and positive appraisal (P>0.05). The findings of this research indicated that the Roy's adaptation model-guided education improved the majority of coping strategies in veterans with lower extremities amputation. It is recommended that further interventions based on Roy's adaptation model should be performed to improve the coping of the veterans with lower extremities amputation. IRCT2014081118763N1.

Shake It Off: A Randomized Pilot Study of the Effect of Whole Body Vibration on Pain in Healing Burn Wounds.

PubMed

Ray, Juliet J; Alvarez, Angel D; Ulbrich, Sondra L; Lessner-Eisenberg, Sharon; Satahoo, Shevonne S; Meizoso, Jonathan P; Karcutskie, Charles A; Mundra, Leela S; Namias, Nicholas; Pizano, Louis R; Schulman, Carl I

Whole body vibration (WBV) has been shown to improve strength in extremities with healed burn wounds. We hypothesize that WBV reduces pain during rehabilitation compared to standard therapy alone. Patients with ≥1% TBSA burn to one or more extremities from October 2014 to December 2015 were randomized to vibration (VIBE) or control. Each burned extremity was tested separately within the assigned group. Patients underwent one to three therapy sessions (S1, S2, S3) consisting of five upper and/or lower extremity exercises with or without WBV. Pain was assessed pre-, mid-, and postsession on a scale of 1 to 10. Mean pain scores at S1 to S3 were compared between groups with paired samples t-tests. An independent t-test was used to compare differences in pain scores between groups. Continuous variables were compared using a t-test or Mann-Whitney U test, and categorical variables were compared using a χ or Fisher's exact test, as appropriate. Forty-eight randomized test extremities (VIBE = 26, control = 22) were analyzed from a total of 31 subjects. There were no significant differences between groups in age, gender, overall TBSA, TBSA in the test extremity, pain medication use before therapy session, or skin grafting before therapy session. At S1, S2, and S3, there was a statistically significant decrease in mid- and postsession pain compared to presession pain in VIBE vs controls. Exposure to WBV decreased pain during and after physical therapy. This modality may be applicable to a variety of soft tissue injuries and warrants additional investigation.

Regional-scale analysis of extreme precipitation from short and fragmented records

NASA Astrophysics Data System (ADS)

Libertino, Andrea; Allamano, Paola; Laio, Francesco; Claps, Pierluigi

2018-02-01

Rain gauge is the oldest and most accurate instrument for rainfall measurement, able to provide long series of reliable data. However, rain gauge records are often plagued by gaps, spatio-temporal discontinuities and inhomogeneities that could affect their suitability for a statistical assessment of the characteristics of extreme rainfall. Furthermore, the need to discard the shorter series for obtaining robust estimates leads to ignore a significant amount of information which can be essential, especially when large return periods estimates are sought. This work describes a robust statistical framework for dealing with uneven and fragmented rainfall records on a regional spatial domain. The proposed technique, named "patched kriging" allows one to exploit all the information available from the recorded series, independently of their length, to provide extreme rainfall estimates in ungauged areas. The methodology involves the sequential application of the ordinary kriging equations, producing a homogeneous dataset of synthetic series with uniform lengths. In this way, the errors inherent to any regional statistical estimation can be easily represented in the spatial domain and, possibly, corrected. Furthermore, the homogeneity of the obtained series, provides robustness toward local artefacts during the parameter-estimation phase. The application to a case study in the north-western Italy demonstrates the potential of the methodology and provides a significant base for discussing its advantages over previous techniques.

The Hunger Stones: a new source for more objective identification of historical droughts

NASA Astrophysics Data System (ADS)

Elleder, Libor

2016-04-01

Extreme droughts recorded recently more frequently in different parts of the world represent the most serious environmental problem. Our contribution identifies periods of hydrological drought. The extreme drought period in summer 2015 enabled the levelling of historical watermarks on the „Hunger Stone" (Hungerstein) in the Elbe in Czech town of Děčín. The comparison of the obtained levels of earlier palaeographic records with systematic measurements in the Děčín profile confirmed the hypothesis that the old watermarks represent the minimal water levels. Moreover, we present a review of so far known Hunger Stones in the Elbe River with their low-level watermarks. For identification of the drought period duration we used the oldest water level records from the Czech Hydrometeorological Institute (CHMI) database archive: Magdeburg (since 1727), Dresden (since 1801), Prague (since 1825) and Decin (since 1851) time-series. We obtained more objective and complex information on all historical droughts between 1727 and 2015. The low water-marks on Hunger Stones give us a possibility for augmentation of systematic records and extended our knowledge's back to 1616. The Hunger Stones in the Elbe River with old watermarks are unique testimony for studying of hydrological extremes, and last but not least also of anthropogenic changes in the riverbed of the Elbe.

On the shape and likelihood of oceanic rogue waves.

PubMed

Benetazzo, Alvise; Ardhuin, Fabrice; Bergamasco, Filippo; Cavaleri, Luigi; Guimarães, Pedro Veras; Schwendeman, Michael; Sclavo, Mauro; Thomson, Jim; Torsello, Andrea

2017-08-15

We consider the observation and analysis of oceanic rogue waves collected within spatio-temporal (ST) records of 3D wave fields. This class of records, allowing a sea surface region to be retrieved, is appropriate for the observation of rogue waves, which come up as a random phenomenon that can occur at any time and location of the sea surface. To verify this aspect, we used three stereo wave imaging systems to gather ST records of the sea surface elevation, which were collected in different sea conditions. The wave with the ST maximum elevation (happening to be larger than the rogue threshold 1.25H s ) was then isolated within each record, along with its temporal profile. The rogue waves show similar profiles, in agreement with the theory of extreme wave groups. We analyze the rogue wave probability of occurrence, also in the context of ST extreme value distributions, and we conclude that rogue waves are more likely than previously reported; the key point is coming across them, in space as well as in time. The dependence of the rogue wave profile and likelihood on the sea state conditions is also investigated. Results may prove useful in predicting extreme wave occurrence probability and strength during oceanic storms.

[Soft tissue sarcoma of the upper extremities. Analysis of factors relevant for prognosis in 160 patients].

PubMed

Lehnhardt, M; Hirche, C; Daigeler, A; Goertz, O; Ring, A; Hirsch, T; Drücke, D; Hauser, J; Steinau, H U

2012-02-01

Soft tissue sarcomas (STS) are a rare entity with reduced prognosis due to their aggressive biology. For an optimal treatment of STS identification of independent prognostic factors is crucial in order to reduce tumor-related mortality and recurrence rates. The surgical oncological concept includes wide excisions with resection safety margins >1 cm which enables acceptable functional results and reduced rates of amputation of the lower extremities. In contrast, individual anatomy of the upper extremities, in particular of the hand, leads to an intentional reduction of resection margins in order to preserve the extremity and its function with the main intention of tumor-free resection margins. In this study, the oncological safety and outcome as well as functional results were validated by a retrospective analysis of survival rate, recurrence rate and potential prognostic factors. A total of 160 patients who had been treated for STS of the upper extremities were retrospectively included. Independent prognostic factors were analyzed (primary versus recurrent tumor, tumor size, resection status, grade of malignancy, additional therapy, localization in the upper extremity). Kaplan-Meier analyses for survival rate and local control were calculated. Further outcome measures were functional results validated by the DASH score and rate of amputation. In 130 patients (81%) wide tumor excision (R0) was performed and in 19 patients (12%) an amputation was necessary. The 5-year overall survival rate was 70% and the 5-year survival rate in primary tumors was 81% whereas in recurrences 55% relapsed locally. The 10-year overall survival rate was 45% and the 5-year recurrence rate was 18% for primary STS and 43% for recurrent STS. Variance analysis revealed primary versus recurrent tumor, tumor size, resection status and grade of malignancy as independent prognostic factors. Analysis of functional results showed a median DASH score of 37 (0-100; 0=contralateral extremity). The 5-year survival and local recurrence rates are comparable to STS wide resections with safety margins >1 cm for the lower extremities and the trunk. Analysis of prognostic factors revealed resection status and the tumor-free resection margins to be the main goals in STS resection of upper extremity.

The Diagnostic Value of 3-Dimensional Sampling Perfection With Application Optimized Contrasts Using Different Flip Angle Evolutions (SPACE) MRI in Evaluating Lower Extremity Deep Venous Thrombus.

PubMed

Wu, Gang; Xie, Ruyi; Zhang, Xiaoli; Morelli, John; Yan, Xu; Zhu, Xiaolei; Li, Xiaoming

2017-12-01

The aim of this study was to evaluate the diagnostic performance of noncontrast magnetic resonance imaging utilizing sampling perfection with application optimized contrasts using different flip angle evolutions (SPACE) in detecting deep venous thrombus (DVT) of the lower extremity and evaluating clot burden. This prospective study was approved by the institutional review board. Ninety-four consecutive patients (42 men, 52 women; age range, 14-87 years; average age, 52.7 years) suspected of lower extremity DVT underwent ultrasound (US) and SPACE. The venous visualization score for SPACE was determined by 2 radiologists independently according to a 4-point scale (1-4, poor to excellent). The sensitivity and specificity of SPACE in detecting DVT were calculated based on segment, limb, and patient, with US serving as the reference standard. The clot burden for each segment was scored (0-3, patent to entire segment occlusion). The clot burden score obtained with SPACE was compared with US using a Wilcoxon test based on region, limb, and patient. Interobserver agreement in assessing DVT (absent, nonocclusive, or occlusive) with SPACE was determined by calculating Cohen kappa coefficients. The mean venous visualization score for SPACE was 3.82 ± 0.50 for reader 1 and 3.81 ± 0.50 for reader 2. For reader 1, sensitivity/specificity values of SPACE in detecting DVT were 96.53%/99.90% (segment), 95.24%/99.04% (limb), and 95.89%/95.24% (patient). For reader 2, corresponding values were 97.20%/99.90%, 96.39%/99.05%, and 97.22%/95.45%. The clot burden assessed with SPACE was not significantly different from US (P > 0.05 for region, limb, patient). Interobserver agreement of SPACE in assessing thrombosis was excellent (kappa = 0.894 ± 0.014). Non-contrast-enhanced 3-dimensional SPACE magnetic resonance imaging is highly accurate in detecting lower extremity DVT and reliable in the evaluation of clot burden. SPACE could serve as an important alternative for patients in whom US cannot be performed.

Flood frequency estimates and documented and potential extreme peak discharges in Oklahoma

USGS Publications Warehouse

Tortorelli, Robert L.; McCabe, Lan P.

2001-01-01

Knowledge of the magnitude and frequency of floods is required for the safe and economical design of highway bridges, culverts, dams, levees, and other structures on or near streams; and for flood plain management programs. Flood frequency estimates for gaged streamflow sites were updated, documented extreme peak discharges for gaged and miscellaneous measurement sites were tabulated, and potential extreme peak discharges for Oklahoma streamflow sites were estimated. Potential extreme peak discharges, derived from the relation between documented extreme peak discharges and contributing drainage areas, can provide valuable information concerning the maximum peak discharge that could be expected at a stream site. Potential extreme peak discharge is useful in conjunction with flood frequency analysis to give the best evaluation of flood risk at a site. Peak discharge and flood frequency for selected recurrence intervals from 2 to 500 years were estimated for 352 gaged streamflow sites. Data through 1999 water year were used from streamflow-gaging stations with at least 8 years of record within Oklahoma or about 25 kilometers into the bordering states of Arkansas, Kansas, Missouri, New Mexico, and Texas. These sites were in unregulated basins, and basins affected by regulation, urbanization, and irrigation. Documented extreme peak discharges and associated data were compiled for 514 sites in and near Oklahoma, 352 with streamflow-gaging stations and 162 at miscellaneous measurements sites or streamflow-gaging stations with short record, with a total of 671 measurements.The sites are fairly well distributed statewide, however many streams, large and small, have never been monitored. Potential extreme peak-discharge curves were developed for streamflow sites in hydrologic regions of the state based on documented extreme peak discharges and the contributing drainage areas. Two hydrologic regions, east and west, were defined using 98 degrees 15 minutes longitude as the dividing line.

Susceptibility to Mortality in Weather Extremes: Effect Modification by Personal and Small Area Characteristics In a Multi-City Case-Only Analysis

PubMed Central

Zanobetti, Antonella; O’Neill, Marie S.; Gronlund, Carina J.; Schwartz, Joel D

2015-01-01

Background Extremes of temperature have been associated with short-term increases in daily mortality. We identified subpopulations with increased susceptibility to dying during temperature extremes, based on personal demographics, small-area characteristics and preexisting medical conditions. Methods We examined Medicare participants in 135 U.S. cities and identified preexisting conditions based on hospitalization records prior to their deaths, from 1985–2006. Personal characteristics were obtained from the Medicare records, and area characteristics were assigned based on zip-code of residence. We conducted a case-only analysis of over 11 million deaths, and evaluated modification of the risk of dying associated with extremely hot days and extremely cold days, continuous temperatures, and water-vapor pressure. Modifiers included preexisting conditions, personal characteristics, zip-code-level population characteristics, and land-cover characteristics. For each effect modifier, a city-specific logistic regression model was fitted and then an overall national estimate was calculated using meta-analysis. Results People with certain preexisting conditions were more susceptible to extreme heat, with an additional 6% (95% confidence interval= 4% – 8%) increase in the risk of dying on an extremely hot day in subjects with previous admission for atrial fibrillation, an additional 8% (4%–12%) in subjects with Alzheimer disease, and an additional 6% (3%–9%) in subjects with dementia. Zip-code level and personal characteristics were also associated with increased susceptibility to temperature. Conclusions We identified several subgroups of the population who are particularly susceptible to temperature extremes, including persons with atrial fibrillation. PMID:24045717

Co-occurring woody species have diverse hydraulic strategies and mortality rates during an extreme drought

USDA-ARS?s Scientific Manuscript database

From 2011 to 2013, Texas experienced its worst drought in recorded history. This event provided a unique natural experiment to assess species-specific responses to extreme drought and mortality of four co-occurring woody species: Quercus fusiformis, Diospyros texana, Prosopis glandulosa and Juniper...

IMPACTS OF CLIMATE-INDUCED CHANGES IN EXTREME EVENTS ON OZONE AND PARTICULATE MATTER AIR QUALITY

EPA Science Inventory

Historical data records of air pollution meteorology from multiple datasets will be compiled and analyzed to identify possible trends in extreme events. Changes in climate and air quality between 2010 and 2050 will be simulated with a suite of models. The consequential effe...

Detection of time delays and directional interactions based on time series from complex dynamical systems

NASA Astrophysics Data System (ADS)

Ma, Huanfei; Leng, Siyang; Tao, Chenyang; Ying, Xiong; Kurths, Jürgen; Lai, Ying-Cheng; Lin, Wei

2017-07-01

Data-based and model-free accurate identification of intrinsic time delays and directional interactions is an extremely challenging problem in complex dynamical systems and their networks reconstruction. A model-free method with new scores is proposed to be generally capable of detecting single, multiple, and distributed time delays. The method is applicable not only to mutually interacting dynamical variables but also to self-interacting variables in a time-delayed feedback loop. Validation of the method is carried out using physical, biological, and ecological models and real data sets. Especially, applying the method to air pollution data and hospital admission records of cardiovascular diseases in Hong Kong reveals the major air pollutants as a cause of the diseases and, more importantly, it uncovers a hidden time delay (about 30-40 days) in the causal influence that previous studies failed to detect. The proposed method is expected to be universally applicable to ascertaining and quantifying subtle interactions (e.g., causation) in complex systems arising from a broad range of disciplines.

Investigation of Ballistic Penetration through Tibia Soft Tissue Simulant

NASA Astrophysics Data System (ADS)

Nguyen, Thuy-Tien N.; Masouros, Spyros D.; Tear, Gareth R.; Proud, William G.; Institute of Shock Physics; CentreBlast Injury Studies, Imperial College London, UK Team

2017-06-01

High energy trauma events such as from explosions and ballistic weapons can cause severe damage to the human body. The resulting injuries are very complex and their mechanism is not fully understood. Secondary blast injuries, effectively ballistic traumas, to the extremities are commonly reported, especially to the tibia. The aim of this study is to quantify the effect of parameters such as projectile mass and velocity, and impact location on injury thresholds in the leg. The bones of the leg were set in biofidelic gelatin tissue simulant. A 32-mm-bore gas gun was used to launch a sabot carrying a carbon steel projectile 0.5 to 1.1 g in mass at the sample with speeds of 50 to 300 m/s. Penetration depth and impact velocity were recorded. The effect of different postures - such as standing and non-weight bearing -- on injury were considered. The resulting injuries were scored clinically and their correlation with the various impact parameters was calculated. The project is funded by the Royal British Legion, United Kingdom.

Pelvic and lower extremity injuries in Homer's Iliad: a review of the literature.

PubMed

Galanakos, Spyridon P; Bot, Arjan G J; Macheras, George A

2015-01-01

The Iliad, composed approximately in the middle of the eighth century bc, constitutes the leading and oldest known example of heroic epic. The Homeric epic presents the conflicts that took place during the last year of the 10-year lasting Trojan War, offering a realistic description of battle wounds. We studied the text of The Iliad in ancient Greek and in the translations in modern Greek and English and searched for all recorded injuries to the pelvis and lower extremities. A total of 16 traumatic injuries of pelvis and lower extremities were described, including 7 fatal wounds, while in 9 cases, the outcome was unknown.The Iliad remains the oldest record of Greek medicine and a unique source of surgical history. To study the vividly reported events is a great experience, particularly for a surgeon.

Record-breaking climate extremes in Africa under stabilized 1.5 °C and 2 °C global warming scenarios

NASA Astrophysics Data System (ADS)

Nangombe, Shingirai; Zhou, Tianjun; Zhang, Wenxia; Wu, Bo; Hu, Shuai; Zou, Liwei; Li, Donghuan

2018-05-01

Anthropogenic forcing is anticipated to increase the magnitude and frequency of extreme events1, the impacts of which will be particularly hard-felt in already vulnerable locations such as Africa2. However, projected changes in African climate extremes remain little explored, particularly in the context of the Paris Agreement targets3,4. Here, using Community Earth System Model low warming simulations5, we examine how heat and hydrological extremes may change in Africa under stabilized 1.5 °C and 2 °C scenarios, focusing on the projected changing likelihood of events that have comparable magnitudes to observed record-breaking seasons. In the Community Earth System Model, limiting end-of-century warming to 1.5 °C is suggested to robustly reduce the frequency of heat extremes compared to 2 °C. In particular, the probability of events similar to the December-February 1991/1992 southern African and 2009/2010 North African heat waves is estimated to be reduced by 25 ± 5% and 20 ± 4%, respectively, if warming is limited to 1.5 °C instead of 2 °C. For hydrometeorological extremes (that is, drought and heavy precipitation), by contrast, signal differences are indistinguishable from the variation between ensemble members. Thus, according to this model, continued efforts to limit warming to 1.5 °C offer considerable benefits in terms of minimizing heat extremes and their associated socio-economic impacts across Africa.

Qualities of dental chart recording and coding.

PubMed

Chantravekin, Yosananda; Tasananutree, Munchulika; Santaphongse, Supitcha; Aittiwarapoj, Anchisa

2013-01-01

Chart recording and coding are the important processes in the healthcare informatics system, but there were only a few reports in the dentistry field. The objectives of this study are to study the qualities of dental chart recording and coding, as well as the achievement of lecture/workshop on this topic. The study was performed by auditing the patient's charts at the TU Dental Student Clinic from July 2011-August 2012. The chart recording mean scores ranged from 51.0-55.7%, whereas the errors in the coding process were presented in the coder part more than the doctor part. The lecture/workshop could improve the scores only in some topics.

Correlation between clinical severity and type and degree of pectus excavatum in twelve brachycephalic dogs.

PubMed

Hassan, Elham A; Hassan, Marwa H; Torad, Faisal A

2018-05-18

The aim of the study was to correlate the clinical severity of pectus excavatum with its type and degree based on objective radiographic evaluation. Twelve brachycephalic dogs were included. Grading of the clinical severity was done based on a 6-point grading score. Thoracic radiographs were used to calculate the frontosagittal and vertebral indices at the tenth thoracic vertebra and the vertebra overlying the excavatum. Correlation between the clinical severity score and frontosagittal and vertebral indices was evaluated using Pearson's correlation coefficient. Typical pectus excavatum was recorded in the caudal sternum in seven dogs, with a mean clinical severity score of 1.7 ± 1.4, whereas in five dogs, atypical mid-sternal deviation was recorded with a mean clinical severity score of 3.8 ± 0.7. A strong correlation (r=0.7) was recorded between the clinical severity score and vertebral index in the atypical form, whereas a weak correlation (r=0.02) was recorded in the typical form (P<0.05). The clinical severity and degree of pectus excavatum was poorly correlated (r=0.3) in the typical form of pectus excavatum, whereas it was strongly correlated (r=0.9) in the atypical form. Pectus excavatum in dogs is associated with compressive cardiopulmonary dysfunction, which depends mainly on the site/type of deviation rather than the degree of deviation.

Quantitative measures with WREX usage.

PubMed

Shank, Tracy M; Wee, Jinyong; Ty, Jennifer; Rahman, Tariq

2017-07-01

This paper presents the results of two surveys conducted with users of a functional upper extremity orthosis called the Wilmington Robotic EXoskeleton (WREX). The WREX is a passive anti-gravity arm orthosis that allows people with neuromuscular disabilities to move their arms in three dimensions. An online user survey with 55 patients was conducted to determine the benefits of the WREX. The survey asked 10 questions related to upper extremity function with and without the WREX as well as subjective impressions of the device. A second survey used a phone interview based on the Canadian Occupational Performance Measure (COPM). Parents rated their child's performance and satisfaction while partaking in important activities both with and without the exoskeleton device. Scores were assessed for change between the two conditions. Twenty-five families responded to this survey. Twenty-four out of 25 subjects reported greater levels of performance and satisfaction when they were wearing the WREX. The mean change in performance score was 3.61 points, and the mean change in satisfaction score was 4.44 points. Results show a statistically significant improvement in arm function for everyday tasks with the WREX.

Weak linkage between the heaviest rainfall and tallest storms.

PubMed

Hamada, Atsushi; Takayabu, Yukari N; Liu, Chuntao; Zipser, Edward J

2015-02-24

Conventionally, the heaviest rainfall has been linked to the tallest, most intense convective storms. However, the global picture of the linkage between extreme rainfall and convection remains unclear. Here we analyse an 11-year record of spaceborne precipitation radar observations and establish that a relatively small fraction of extreme convective events produces extreme rainfall rates in any region of the tropics and subtropics. Robust differences between extreme rainfall and convective events are found in the rainfall characteristics and environmental conditions, irrespective of region; most extreme rainfall events are characterized by less intense convection with intense radar echoes not extending to extremely high altitudes. Rainfall characteristics and environmental conditions both indicate the importance of warm-rain processes in producing extreme rainfall rates. Our results demonstrate that, even in regions where severe convective storms are representative extreme weather events, the heaviest rainfall events are mostly associated with less intense convection.

Nursing activities score.

PubMed

Miranda, Dinis Reis; Nap, Raoul; de Rijk, Angelique; Schaufeli, Wilmar; Iapichino, Gaetano

2003-02-01

The instruments used for measuring nursing workload in the intensive care unit (e.g., Therapeutic Intervention Scoring System-28) are based on therapeutic interventions related to severity of illness. Many nursing activities are not necessarily related to severity of illness, and cost-effectiveness studies require the accurate evaluation of nursing activities. The aim of the study was to determine the nursing activities that best describe workload in the intensive care unit and to attribute weights to these activities so that the score describes average time consumption instead of severity of illness. To define by consensus a list of nursing activities, to determine the average time consumption of these activities by use of a 1-wk observational cross-sectional study, and to compare these results with those of the Therapeutic Intervention Scoring System-28. A total of 99 intensive care units in 15 countries. Consecutive admissions to the intensive care units. Daily recording of nursing activities at a patient level and random multimoment recording of these activities. A total of five new items and 14 subitems describing nursing activities in the intensive care unit (e.g., monitoring, care of relatives, administrative tasks) were added to the list of therapeutic interventions in Therapeutic Intervention Scoring System-28. Data from 2,041 patients (6,451 nursing days and 127,951 multimoment recordings) were analyzed. The new activities accounted for 60% of the average nursing time; the new scoring system (Nursing Activities Score) explained 81% of the nursing time (vs. 43% in Therapeutic Intervention Scoring System-28). The weights in the Therapeutic Intervention Scoring System-28 are not derived from the use of nursing time. Our study suggests that the Nursing Activities Score measures the consumption of nursing time in the intensive care unit. These results should be validated in independent databases.

The record-breaking 2012 spring: Why degree-days were critical in assessing insect and plant development

USDA-ARS?s Scientific Manuscript database

In the spring of 2012, extremely high temperatures were recorded in the upper Midwest during the month of March. This sustained heat wave not only made March the warmest on record, but also induced remarkably fast development of arthropods and plants. In terms of degree-days, however, the arthropod ...

Reading, Mathematics and Fine Motor Skills at 5 Years of Age in US Children who were Extremely Premature at Birth.

PubMed

Lee, Miryoung; Pascoe, John M; McNicholas, Caroline I

2017-01-01

Objectives The prevalence of extreme prematurity at birth has increased, but little research has examined its impact on developmental outcomes in large representative samples within the United States. This study examined the association of extreme prematurity with kindergarteners' reading skills, mathematics skills and fine motor skills. Methods The early childhood longitudinal study-birth cohort, a representative sample of the US children born in 2001 was analyzed for this study. Early reading and mathematics skills and fine motor skills were compared among 200 extremely premature children (EPC) (gestational age <28 wks or birthweight <1000 g), 500 premature children (PC), and 4300 term children (TC) (≥37wks or ≥2500 g). Generalized linear regression analyses included sampling weights, children's age, race, sex, and general health status, and parental marital status and education among singleton children. Results At age 5 years, EPC were 2.6(95 % CI 1.7-3.8) times more likely to fail build a gate and were 3.1(95 % CI 1.6-5.8) times more likely to fail all four drawing tasks compared to TC (p values <0.001). Fine motor performance of PC (failed to build a gate, 1.3[95 % CI 1.0-1.7]; failed to draw all four shapes, 1.1[95 % CI 0.8-1.6]) was not significantly different from TC. Mean early reading scale score (36.8[SE:1.3]) of EPC was 4.0 points lower than TC (p value < 0.0001) while mean reading score (39.9[SE:1.4]) of PC was not significantly different from TC (40.8[SE:1.1]). Mean mathematics scale score were significantly lower for both EPC (35.5[SE:1.0], p value < 0.001) and PC (39.8[SE:0.8], p value = 0.023) compared to TC (41.0[SE:0.6]). Conclusions for Practice Extreme prematurity at birth was associated with cognitive and fine motor delays at age 5 years. This suggests that based on a nationally representative sample of infants, the biological risk of extreme prematurity persists after adjusting for other factors related to development.

Evaluation of Buccal Infiltration with Articaine and Inferior Alveolar Nerve Block with Lignocaine for Pulp Therapy in Mandibular Primary Molars.

PubMed

Chopra, Radhika; Marwaha, Mohita; Bansal, Kalpana; Mittal, Meenu

2016-01-01

Failure of inferior alveolar nerve block in achieving profound anesthesia of the pulp due to various reasons has led to the introduction of more potent local anesthetic agents like articaine. This study was conducted to compare the efficacy of buccal infiltration with articaine in achieving pulpal anesthesia of primary molars as compared to inferior alveolar nerve block with lignocaine. 30 patients (4-8 years) with indication of pulp therapy in at least two mandibular primary molars were selected. Patients were randomly assigned to receive nerve block with lignocaine or infiltration with articaine on first appointment and the other solution on second appointment. All the pulpotomies and pulpectomies were performed by a pediatric dentist. Two researchers standing at a distance of 1.5 m recorded the Pain Scores and Sound, Eye, Motor (SEM) scores. After the completion of procedure, the patient was asked to record the Facial Image score and Heft-Parker Visual Analogue Score (HP-VAS). Pain Score recorded at the time of injection showed significantly more movements with block as compared to infiltration (p<0.001). SEM scores at time of pulp extirpation were also higher for block than infiltration (p<0.001). Articaine infiltration has the potential to replace inferior alveolar nerve block for primary mandibular molars.

A scoring system for ascertainment of incident stroke; the Risk Index Score (RISc).

PubMed

Kass-Hout, T A; Moyé, L A; Smith, M A; Morgenstern, L B

2006-01-01

The main objective of this study was to develop and validate a computer-based statistical algorithm that could be translated into a simple scoring system in order to ascertain incident stroke cases using hospital admission medical records data. The Risk Index Score (RISc) algorithm was developed using data collected prospectively by the Brain Attack Surveillance in Corpus Christi (BASIC) project, 2000. The validity of RISc was evaluated by estimating the concordance of scoring system stroke ascertainment to stroke ascertainment by physician and/or abstractor review of hospital admission records. RISc was developed on 1718 randomly selected patients (training set) and then statistically validated on an independent sample of 858 patients (validation set). A multivariable logistic model was used to develop RISc and subsequently evaluated by goodness-of-fit and receiver operating characteristic (ROC) analyses. The higher the value of RISc, the higher the patient's risk of potential stroke. The study showed RISc was well calibrated and discriminated those who had potential stroke from those that did not on initial screening. In this study we developed and validated a rapid, easy, efficient, and accurate method to ascertain incident stroke cases from routine hospital admission records for epidemiologic investigations. Validation of this scoring system was achieved statistically; however, clinical validation in a community hospital setting is warranted.

The Motor Activity Log-28: assessing daily use of the hemiparetic arm after stroke.

PubMed

Uswatte, G; Taub, E; Morris, D; Light, K; Thompson, P A

2006-10-10

Data from monkeys with deafferented forelimbs and humans after stroke indicate that tests of the motor capacity of impaired extremities can overestimate their spontaneous use. Before the Motor Activity Log (MAL) was developed, no instruments assessed spontaneous use of a hemiparetic arm outside the treatment setting. To study the MAL's reliability and validity for assessing real-world quality of movement (QOM scale) and amount of use (AOU scale) of the hemiparetic arm in stroke survivors. Participants in a multisite clinical trial completed a 30-item MAL before and after treatment (n = 106) or an equivalent no-treatment period (n = 116). Participants also completed the Stroke Impact Scale (SIS) and wore accelerometers that monitored arm movement for three consecutive days outside the laboratory. All were 3 to 12 months post-stroke and had mild to moderate paresis of an upper extremity. After an item analysis, two MAL tasks were eliminated. Revised participant MAL QOM scores were reliable (r =0.82). Validity was also supported. During the first observation period, the correlation between QOM and SIS Hand Function scale scores was 0.72. The corresponding correlation for QOM and accelerometry values was 0.52. Participant QOM and AOU scores were highly correlated (r = 0.92). The participant Motor Activity Log is reliable and valid in individuals with subacute stroke. It might be employed to assess the real-world effects of upper extremity neurorehabilitation and detect deficits in spontaneous use of the hemiparetic arm in daily life.

Peritoneal drainage does not stabilize extremely low birth weight infants with perforated bowel: data from the NET Trial.

PubMed

Rees, Clare M; Eaton, Simon; Khoo, A Kate; Kiely, Edward M; Pierro, Agostino

2010-02-01

Proponents of peritoneal drainage (PD) hypothesize that it allows stabilization before laparotomy. We examined this hypothesis by comparing clinical status before and after either PD or primary laparotomy (LAP). In an ethically approved, international, prospective randomized controlled trial (2002-2006), extremely low birth weight (<1000 g) infants with pneumoperitoneum received primary PD (n = 35) or LAP (n = 34). Physiologic data were collected prospectively and organ failure scores calculated and compared between preprocedure and day 1 after procedure. Data, expressed as mean +/- SD or median (range), were analyzed using appropriate statistical tests. There was no postprocedure improvement in either PD or LAP group comparing heart rate (PD, P = 1.0; LAP, P = .6), blood pressure (PD, P = .6; LAP, P = .8), inotrope requirement (PD, P = .2; LAP, P = .3), or Arterial partial pressure of oxygen/fraction of inspired oxygen ratio (PD, P = .1; LAP, P = .5). Infants managed with PD had a worsening cardiovascular status (P = .05). There were no differences in total organ failure score in either group (PD, P = .5; LAP, P = 1). Only 4 infants survived with PD alone with no difference between preprocedure and postprocedure organ failure score (P = .4). Peritoneal drainage does not immediately improve clinical status in extremely low birth weight infants with bowel perforation. The use of PD as a stabilizing or temporizing measure is not supported by these results. Copyright 2010 Elsevier Inc. All rights reserved.

Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board.

PubMed

Papadakis, Maxine A; Hodgson, Carol S; Teherani, Arianne; Kohatsu, Neal D

2004-03-01

To determine if medical students who demonstrate unprofessional behavior in medical school are more likely to have subsequent state board disciplinary action. A case-control study was conducted of all University of California, San Francisco, School of Medicine graduates disciplined by the Medical Board of California from 1990-2000 (68). Control graduates (196) were matched by medical school graduation year and specialty choice. Predictor variables were male gender, undergraduate grade point average, Medical College Admission Test scores, medical school grades, National Board of Medical Examiner Part 1 scores, and negative excerpts describing unprofessional behavior from course evaluation forms, dean's letter of recommendation for residencies, and administrative correspondence. Negative excerpts were scored for severity (Good/Trace versus Concern/Problem/Extreme). The outcome variable was state board disciplinary action. The alumni graduated between 1943 and 1989. Ninety-five percent of the disciplinary actions were for deficiencies in professionalism. The prevalence of Concern/Problem/Extreme excerpts in the cases was 38% and 19% in controls. Logistic regression analysis showed that disciplined physicians were more likely to have Concern/Problem/Extreme excerpts in their medical school file (odds ratio, 2.15; 95% confidence interval, 1.15-4.02; p =.02). The remaining variables were not associated with disciplinary action. Problematic behavior in medical school is associated with subsequent disciplinary action by a state medical board. Professionalism is an essential competency that must be demonstrated for a student to graduate from medical school.

Early sitting, standing, and walking in conjunction with contemporary Bobath approach for stroke patients with severe motor deficit.

PubMed

Tang, Qingping; Tan, Lihong; Li, Baojun; Huang, Xiaosong; Ouyang, Chunhong; Zhan, Hailan; Pu, Qinqin; Wu, Lixiang

2014-01-01

The commonly used therapeutic approach, the contemporary Bobath approach (CBA), is not sufficient to restore independent locomotion for individuals with severe motor deficit (SMD) after stroke. Therefore, we propose that the early sitting, standing, and walking in conjunction with the CBA (ECBA) be used to treat individuals with SMD after stroke. To investigate whether ECBA may enhance mobility and balance in subjects with SMD after stroke. Thirty-three men and 15 women, aged 60 to 74 years, with SMD after stroke were recruited for the study. CBA or ECBA was performed with the subjects 5 times per week in 50-minute sessions for 8 weeks. The Stroke Rehabilitation Assessment of Movement (STREAM) and the Berg Balance Scale were implemented before treatment and at 4 and 8 weeks after treatment, respectively. The STREAM scores indicated that ECBA was more efficient than the CBA intervention for lower extremity mobility, F(1, 46) = 24.0, P < .001, and basic mobility, F(1, 46) = 102.6, P < .001. Overall STREAM scores were higher in the ECBA group, F(1, 46) =24.1, P < .001, after 8 weeks of therapy. Balance scores of the ECBA subjects were higher than those of the CBA subjects after 8 weeks of therapy, F(1, 46) = 73.1, P < .001. However, there was no difference in upper extremity mobility between the 2 groups. ECBA is a valuable intervention to improve lower extremity mobility, basic mobility, and balance ability for individuals with SMD after stroke.

Quantifying Observed Temperature Extremes in the Southeastern United States

NASA Astrophysics Data System (ADS)

Sura, P.; Stefanova, L. B.; Griffin, M.; Worsnop, R.

2011-12-01

There is broad consensus that the most hazardous effects of climate change are related to a potential increase (in frequency and/or intensity) of extreme weather and climate events. In particular, the statistics of regional daily temperature extremes are of practical interest for the agricultural community and energy suppliers. This is notably true for the Southeastern United States where winter hard freezes are a relatively rare and potentially catastrophic event. Here we use a long record of quality-controlled observations collected from 272 National Weather Service (NWS) Cooperative Observing Network (COOP) stations throughout Florida, Georgia, Alabama, and South and North Carolina to provide a detailed climatology of temperature extremes in the Southeastern United States. We employ two complementary approaches. First, we analyze the effect of El Nino-Southern Oscillation (ENSO) and the Arctic Oscillation (AO) on the non-Gaussian (i.e. higher order) statistics of wintertime daily minimum and maximum temperatures. We find a significant and spatially varying impact of ENSO and AO on the non-Gaussian statistics of daily maximum and minimum temperatures throughout the domain. Second, the extremes of the temperature distributions are studied by calculating the 1st and 99th percentiles, and then analyzing the number of days with record low/high temperatures per season. This analysis of daily temperature extremes reveals oscillating, multi-decadal patterns with spatially varying centers of action.

Efficacy of postoperative pain management in head and neck cancer patients.

PubMed

Hinther, Ashley; Nakoneshny, Steven C; Chandarana, Shamir P; Wayne Matthews, T; Dort, Joseph C

2018-05-02

Our study quantifies the effectiveness of perioperative pain control in a cohort of patients undergoing major head and neck surgery with free flap reconstruction. Our long-term goal is to improve pain control and thereby increase mobility, decrease postoperative complications and decrease hospital stay. A retrospective analysis was performed at a tertiary, academic head and neck surgical oncology program in Calgary, Alberta, Canada from January 1, 2015 - December 31, 2015. Pain scores were recorded prospectively. Primary outcomes were frequency of postoperative pain assessments and pain intensity using the numeric rating scale. The cohort included 41 patients. Analysis was limited to pain scores recorded from postoperative days 1-14. There was an average of 7.3 pain measurements per day (SD 4.6, range 1-24) with the most frequent monitoring on postoperative days 1-4. Median pain scores ranged from 0 to 4.5 with the highest median score on postoperative day 6. The daily maximum pain scores recorded ranged from 8 to 10 with scores of 10 recorded on postoperative days 1, 2, 3, 5, 7, 8, and 10. Patients most frequently had inadequate pain control on postoperative days 1, 2, 4, and 5 with the majority occurring on postoperative day 1. Postoperative pain control could be improved at our centre. The frequency of pain assessments is also highly variable. Ongoing measurement, audit, and feedback of analgesic protocol effectiveness is an excellent first step in improving perioperative pain management in patients undergoing major head and neck cancer surgery with free flap reconstruction.

[Results of training in the electronic health records in a tertiary care hospital].

PubMed

Alva Espinosa, Carlos; Fuentes Domínguez, Marco Antonio; Garibay Huarte, Tania

2014-12-01

To assess the user evaluation of the electronic health records system together with its training program and to investigate the relation between the number of training sessions and the corresponding evaluation scores given by the participants. An anonymous survey was conducted between the medical, nursing and social worker personnel. The survey included seven multiple-choice questions with a numerical scale from 1 to 10 and an additional open question. IBM SPSS Statistics v18 software was used to perform ANOVA variance analysis. In total, 340 workers participated in this study; 317 were included in the statistical analysis, out of which 76% had one or two training sessions, 13.9% received three or more sessions and 10% had no training. The mean global training evaluation by the participants was 5.9 ± 2.3, median 6.3, while the electronic records system evaluation was 5.2 ± 2.3, median 5.5. In relation to the training and electronic records system it was observed that higher evaluation scores were obtained with increasing number of training sessions (p < 0.001). On the electronic records systems, personnel with no training evaluated the system with a mean score of 3.9 ± 2.7, while those who received three or more training sessions evaluated the system with a mean score of 6.1 ± 1.8 (p < 0.001).

Compelled Body Weight Shift Technique to Facilitate Rehabilitation of Individuals with Acute Stroke

PubMed Central

Mohapatra, Sambit; Eviota, Aileen C.; Ringquist, Keir L.; Muthukrishnan, Sri Ranjini; Aruin, Alexander S.

2014-01-01

Background The study evaluates the effectiveness of Compelled Body Weight Shift (CBWS) approach in the rehabilitation of individuals with stroke. CBWS involves a forced shift of body weight towards a person’s affected side by means of a shoe insert that establishes a lift of the nonaffected lower extremity. Methods Eleven patients with acute stroke were randomly assigned to experimental and control groups. The experimental group received a two-week conventional physical therapy combined with CBWS and the control group received only a two-week conventional therapy. Weight bearing, Gait velocity, Berg’s Balance, and Fugl-Meyer’s Scores were recorded before and after the intervention. Results Weight bearing on the affected side increased in the experimental group and decreased in the control group. The increase in gait velocity with treatment was significant in both the groups (P < 0.05). However, experimental group (P = 0.01) demonstrated larger improvements in gait velocity compared to the control group (P = 0.002). Berg Balance and Fugl-Meyer scores increased for both the groups. Conclusion The implementation of a two-week intervention with CBWS resulted in the improvement in weight bearing and gait velocity of individuals with acute stroke. The present preliminary study suggests that CBWS technique could be implemented as an adjunct to conventional rehabilitation program for individuals with acute stroke. PMID:25530888

Development and validation of an Overreporting Scale for the Personality Inventory for DSM-5 (PID-5).

PubMed

Sellbom, Martin; Dhillon, Sonya; Bagby, R Michael

2018-05-01

Our aim in the current study was to develop a validity scale for the Personality Inventory for DSM-5 (PID-5) to detect noncredible overreported responding. To this end, we used a rare symptoms approach and identified extreme response options on PID-5 items that were infrequently endorsed by students in 3 different university samples (N = 1,370) and in a psychiatric patient sample (N = 194). The resulting 10-item scale (the PID-5-ORS) produced adequate-to-good estimates of internal reliability and was significantly correlated with the Minnesota Multiphasic Personality Inventory-2 Restructued Form (MMPI-2-RF) overreporting validity scales, providing evidence of concurrent validity. The criterion validity of the PID-5-ORS was demonstrated in an analog simulation design study. More specifically, university students instructed to overreport (n = 80) scored substantially higher on the PID-5-ORS relative to both a group of genuine psychiatric patients and students instructed to complete the PID-5 under standard (honest) instructions (n = 161); the effect size magnitudes associated with these differences were large. Classification accuracy analyses further revealed that high scores on the PID-5-ORS were associated with high specificity (and thus, low rates of false positive classifications) in differentiating overreporters from genuine patients, with sensitivity being somewhat weaker. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Upper extremity pain and computer use among engineering graduate students.

PubMed

Schlossberg, Eric B; Morrow, Sandra; Llosa, Augusto E; Mamary, Edward; Dietrich, Peter; Rempel, David M

2004-09-01

The objective of this study was to investigate risk factors associated with persistent or recurrent upper extremity and neck pain among engineering graduate students. A random sample of 206 Electrical Engineering and Computer Science (EECS) graduate students at a large public university completed an online questionnaire. Approximately 60% of respondents reported upper extremity or neck pain attributed to computer use and reported a mean pain severity score of 4.5 (+/-2.2; scale 0-10). In a final logistic regression model, female gender, years of computer use, and hours of computer use per week were significantly associated with pain. The high prevalence of upper extremity pain reported by graduate students suggests a public health need to identify interventions that will reduce symptom severity and prevent impairment.

The Imprint of Extreme Climate Events in Century-Long Time Series of Wood Anatomical Traits in High-Elevation Conifers

PubMed Central

Carrer, Marco; Brunetti, Michele; Castagneri, Daniele

2016-01-01

Extreme climate events are of key importance for forest ecosystems. However, both the inherent infrequency, stochasticity and multiplicity of extreme climate events, and the array of biological responses, challenges investigations. To cope with the long life cycle of trees and the paucity of the extreme events themselves, our inferences should be based on long-term observations. In this context, tree rings and the related xylem anatomical traits represent promising sources of information, due to the wide time perspective and quality of the information they can provide. Here we test, on two high-elevation conifers (Larix decidua and Picea abies sampled at 2100 m a.s.l. in the Eastern Alps), the associations among temperature extremes during the growing season and xylem anatomical traits, specifically the number of cells per ring (CN), cell wall thickness (CWT), and cell diameter (CD). To better track the effect of extreme events over the growing season, tree rings were partitioned in 10 sectors. Climate variability has been reconstructed, for 1800–2011 at monthly resolution and for 1926–2011 at daily resolution, by exploiting the excellent availability of very long and high quality instrumental records available for the surrounding area, and taking into account the relationship between meteorological variables and site topographical settings. Summer temperature influenced anatomical traits of both species, and tree-ring anatomical profiles resulted as being associated to temperature extremes. Most of the extreme values in anatomical traits occurred with warm (positive extremes) or cold (negative) conditions. However, 0–34% of occurrences did not match a temperature extreme event. Specifically, CWT and CN extremes were more clearly associated to climate than CD, which presented a bias to track cold extremes. Dendroanatomical analysis, coupled to high-quality daily-resolved climate records, seems a promising approach to study the effects of extreme events on trees, but further investigations are needed to improve our comprehension of the critical role of such elusive events in forest ecosystems. PMID:27242880

Mortality, Disenrollment, and Spending Persistence in Medicaid and CHIP.

PubMed

DeLia, Derek

2017-03-01

Research on spending persistence has not focused on Medicaid and the Children's Health Insurance Program (Medicaid/CHIP), which includes a complex and growing population. The objective of the study was to describe patterns of expenditure persistence, mortality, and disenrollment among nondually eligible Medicaid/CHIP enrollees and identify factors predicting these outcomes. The study is based on New Jersey Medicaid/CHIP claims data from 2011 to 2014. Descriptive and multinomial regression methods were used to characterize persistently extreme spenders, defined as those appearing in the top 1% of statewide spending every year, according to demographics, Medicaid/CHIP eligibility, nursing facility residence, patient risk scores, and clinical diagnostic categories measured in 2011. Similar analyses were done for persistently high spenders (ie, always in the top 10% but not always top 1%) as well as decedents, disenrollees, and moderate spenders (ie, at least 1 year outside of the top 10%). Nondually eligible NJ Medicaid/CHIP enrollees in 2011. One fourth of extreme spenders in 2011 remained in that category throughout 2011-2014. Almost all (89.3%) of the persistently extreme spenders were aged, blind, or disabled. Within the aged, blind, or disabled population, the strongest predictors of persistently extreme spending were diagnoses involving developmental disability, HIV/AIDS, central nervous system conditions, psychiatric disorders, type 1 diabetes, and renal conditions. Individuals in nursing facilities and those with very high risk scores were more likely to die or have persistently high spending than to have persistently extreme spending. The study highlights unique features of spending persistence within Medicaid/CHIP and provides methodological contributions to the broader persistence literature.

Work-related physical and psychosocial risk factors for sick leave in patients with neck or upper extremity complaints.

PubMed

Bot, Sandra D M; Terwee, Caroline B; van der Windt, Daniëlle A W M; van der Beek, Allard J; Bouter, Lex M; Dekker, Joost

2007-08-01

To study work-related physical and psychosocial risk factors for sick leave among patients who have visited their general practitioner for neck or upper extremity complaints. Three hundred and forty two patients with neck or upper extremity complaints completed self-report questionnaires at baseline and after 3 months. Cox regression models were used to investigate the association between work-related risk factors and sick leave (i.e., lost days from work due to neck or upper extremity complaints in 3 months). Effect modification by sick leave at baseline, sex, worrying and musculoskeletal co-morbidity was evaluated by adding product terms to the regression models. In the subgroup of patients who scored high on the pain copying scale "worrying" the hazard ratio of sick leave was 1.32 (95% CI 1.07-1.62) per 10% increase in heavy physical work. The subgroup of patients who were sitting for long periods of time had a reduced risk of sick leave as compared to patients who did not spend a lot of time sitting, again only in patients who scored high on the pain coping scale "worrying" (adjusted HR=0.17, 95%-CI 0.04-0.72). Other work-related risk factors were not significantly related to sick leave. Heavy physical work increased the risk of sick leave and prolonged sitting reduced the risk of sick leave in a subgroup of patients who worried much about their pain. Additional large longitudinal studies of sufficiently large size among employees with neck or upper extremity complaints are needed to confirm our results.

Orthopedic trauma surgery and hospital cost analysis in refugees; the effect of the Syrian civil War.

PubMed

Duramaz, Altuğ; Bilgili, Mustafa Gökhan; Bayram, Berhan; Ziroğlu, Nezih; Bayrak, Alkan; Avkan, Mustafa Cevdet

2017-05-01

The aim of this study was to evaluate the musculoskeletal injury types, injury mechanisms, surgical techniques and treatment costs of Syrian refugees. Totally 158 patients (67 female, 91 male) treated in our clinic in 34 months period between January 2012 and October 2014 were included in the study. The mean age of the patients was 39.3 years (range: 18-82 years). The patients were evaluated for age, gender, mechanism of injury, location and type of fracture, presence of accompanying injuries, injury severity score, surgical technique, complications, mortality/morbidity and treatment cost. The injuries were more frequently reported in lower extremities, upper extremities and axial skeleton, respectively. Blunt trauma was significantly higher in upper extremity injuries compared with the other types of injuries (p = 0.001). Fractures were most commonly reported in foot/ankle region and in males, hand/wrist fractures were significantly higher than that of the females. Plate fixation of upper extremity fractures and intramedullary nailing in lower extremity fractures were the most commonly preferred treatment modalities. The mean hospitalization period of patients was 5.6 days and the mean treatment cost was 3844 Turkish Liras (TL). In this study, it was shown that there was a statistically significant increase in the cost of health expenses in patients with fall from heights or gunshot wound, with fractures in axial skeleton or with the ISS score between 16 and 66. The cost rise was associated with worse prognosis, complications, intensive care treatments and prolonged hospitalization periods.

Stability of cooperation under image scoring in group interactions.

PubMed

Nax, Heinrich H; Perc, Matjaž; Szolnoki, Attila; Helbing, Dirk

2015-07-15

Image scoring sustains cooperation in the repeated two-player prisoner's dilemma through indirect reciprocity, even though defection is the uniquely dominant selfish behaviour in the one-shot game. Many real-world dilemma situations, however, firstly, take place in groups and, secondly, lack the necessary transparency to inform subjects reliably of others' individual past actions. Instead, there is revelation of information regarding groups, which allows for 'group scoring' but not for image scoring. Here, we study how sensitive the positive results related to image scoring are to information based on group scoring. We combine analytic results and computer simulations to specify the conditions for the emergence of cooperation. We show that under pure group scoring, that is, under the complete absence of image-scoring information, cooperation is unsustainable. Away from this extreme case, however, the necessary degree of image scoring relative to group scoring depends on the population size and is generally very small. We thus conclude that the positive results based on image scoring apply to a much broader range of informational settings that are relevant in the real world than previously assumed.

Does a web-based feedback training program result in improved reliability in clinicians' ratings of the Global Assessment of Functioning (GAF) Scale?

PubMed

Støre-Valen, Jakob; Ryum, Truls; Pedersen, Geir A F; Pripp, Are H; Jose, Paul E; Karterud, Sigmund

2015-09-01

The Global Assessment of Functioning (GAF) Scale is used in routine clinical practice and research to estimate symptom and functional severity and longitudinal change. Concerns about poor interrater reliability have been raised, and the present study evaluated the effect of a Web-based GAF training program designed to improve interrater reliability in routine clinical practice. Clinicians rated up to 20 vignettes online, and received deviation scores as immediate feedback (i.e., own scores compared with expert raters) after each rating. Growth curves of absolute SD scores across the vignettes were modeled. A linear mixed effects model, using the clinician's deviation scores from expert raters as the dependent variable, indicated an improvement in reliability during training. Moderation by content of scale (symptoms; functioning), scale range (average; extreme), previous experience with GAF rating, profession, and postgraduate training were assessed. Training reduced deviation scores for inexperienced GAF raters, for individuals in clinical professions other than nursing and medicine, and for individuals with no postgraduate specialization. In addition, training was most beneficial for cases with average severity of symptoms compared with cases with extreme severity. The results support the use of Web-based training with feedback routines as a means to improve the reliability of GAF ratings performed by clinicians in mental health practice. These results especially pertain to clinicians in mental health practice who do not have a masters or doctoral degree. (c) 2015 APA, all rights reserved.

Turkish Version of Kolcaba's Immobilization Comfort Questionnaire: A Validity and Reliability Study.

PubMed

Tosun, Betül; Aslan, Özlem; Tunay, Servet; Akyüz, Aygül; Özkan, Hüseyin; Bek, Doğan; Açıksöz, Semra

2015-12-01

The purpose of this study was to determine the validity and reliability of the Turkish version of the Immobilization Comfort Questionnaire (ICQ). The sample used in this methodological study consisted of 121 patients undergoing lower extremity arthroscopy in a training and research hospital. The validity study of the questionnaire assessed language validity, structural validity and criterion validity. Structural validity was evaluated via exploratory factor analysis. Criterion validity was evaluated by assessing the correlation between the visual analog scale (VAS) scores (i.e., the comfort and pain VAS scores) and the ICQ scores using Spearman's correlation test. The Kaiser-Meyer-Olkin coefficient and Bartlett's test of sphericity were used to determine the suitability of the data for factor analysis. Internal consistency was evaluated to determine reliability. The data were analyzed with SPSS version 15.00 for Windows. Descriptive statistics were presented as frequencies, percentages, means and standard deviations. A p value ≤ .05 was considered statistically significant. A moderate positive correlation was found between the ICQ scores and the VAS comfort scores; a moderate negative correlation was found between the ICQ and the VAS pain measures in the criterion validity analysis. Cronbach α values of .75 and .82 were found for the first and second measurements, respectively. The findings of this study reveal that the ICQ is a valid and reliable tool for assessing the comfort of patients in Turkey who are immobilized because of lower extremity orthopedic problems. Copyright © 2015. Published by Elsevier B.V.

Record keeping in Norwegian general practice.

PubMed

Lönberg, N C; Bentsen, B G

1984-11-01

Routines of medical record keeping were studied in a random sample of 50 out of 228 general practitioners in two counties, Möre & Romsdal and Sör-Tröndelag. One doctor refused to participate and one had retired. The 48 physicians were interviewed and a questionnaire was completed with details about their record keeping. The standard of the records was assessed according to legibility, quality of notes, past history and tidiness using a score system. All general practitioners had records for every patient, but the quality of the records varied considerably. More than 50 per cent used handwriting in progress notes, which varied from diagnostic labels to extended reports. Few records contained accessible background information about the patient concerned, and many records contained large amounts of old and irrelevant papers. The record-scores varied from 3 to maximum 10 with an average of 6.7. Higher Standards of recording in general practice are called for, since the quality of records does not only affect the individual patient, but, in the end, the quality of medical care in general.

Spatiotemporal variability of hydrometeorological extremes and their impacts in the Jihlava region in the 1650-1880 period

NASA Astrophysics Data System (ADS)

Dolak, Lukas; Brazdil, Rudolf; Chroma, Katerina; Valasek, Hubert; Reznickova, Ladislava

2017-04-01

Different documentary evidence (taxation records, chronicles, insurance reports etc.) and secondary sources (peer-reviewed papers, historical literature, newspapers) are used for reconstruction of hydrometeorological extremes (HMEs) in the former Jihlava region in the 1651-1880 period. The study describes the system of tax alleviation in Moravia, presents assessment of the impacts of HMEs with regard to physical-geographical characteristic of area studied, presents up to now non-utilized documentary evidence (early fire and hail damage insurance claims) and application of the new methodological approaches for the analysis of HMEs impacts. During the period studied more than 500 HMEs were analysed for the 19 estates (past basic economic units) in the region. Thunderstorm in 1651 in Rančířov (the Jihlava estate), which caused damage on the fields and meadows, is the first recorded extreme event. Downpours causing flash floods and hailstorms are the most frequently recorded natural disasters. Together with floods, droughts, windstorms, blizzards, late frosts and lightning strikes starting fires caused enormous damage as well. The impacts of HMEs are classified into three categories: impacts on agricultural production, material property and the socio-economic impacts. Natural disasters became the reasons of losses of human lives, property, supplies and farming equipment. HMEs caused damage to fields and meadows, depletion of livestock and triggered the secondary consequences as lack of seeds and finance, high prices, indebtedness, poverty and deterioration in field fertility. The results are discussed with respect to uncertainties associated with documentary evidences and their spatiotemporal distribution. The paper shows that particularly archival records, preserved in the Moravian Land Archives in Brno and other district archives, represent a unique source of data contributing to the better understanding of extreme events and their impacts in the past.

Hydrometeorological extremes reconstructed from documentary evidence for the Jihlava region in the 17th-19th centuries

NASA Astrophysics Data System (ADS)

Dolak, Lukas; Brazdil, Rudolf; Chroma, Katerina; Valasek, Hubert; Belinova, Monika; Reznickova, Ladislava

2016-04-01

Different documentary evidence (taxation records, chronicles, insurance reports etc.) is used for reconstruction of hydrometeorological extremes (HMEs) in the Jihlava region (central part of the recent Czech Republic) in the 17th-19th centuries. The aim of the study is description of the system of tax alleviation in Moravia, presentation of utilization of early fire and hail damage insurance claims and application of the new methodological approaches for the analysis of HMEs impacts. During the period studied more than 400 HMEs were analysed for the 16 estates (past basic economic units). Late frost on 16 May 1662 on the Nove Mesto na Morave estate, which destroyed whole cereals and caused damage in the forests, is the first recorded extreme event. Downpours causing flash floods and hailstorms are the most frequently recorded natural disasters. Moreover, floods, droughts, windstorms, blizzards, late frosts and lightning strikes starting fires caused enormous damage as well. The impacts of HMEs are classified into three categories: impacts on agricultural production, material property and the socio-economic impacts. Natural disasters became the reasons of losses of human lives, property, supplies and farming equipment. HMEs caused damage to fields and meadows, depletion of livestock and triggered the secondary consequences as lack of seeds and finance, high prices, indebtedness, poverty and deterioration in field fertility. The results are discussed with respect to uncertainties associated with documentary evidences and their spatiotemporal distribution. Archival records, preserved in the Moravian Land Archives in Brno and other district archives, create a unique source of data contributing to the better understanding of extreme events and their impacts.

Attribution of the 2015 record high sea surface temperatures over the central equatorial Pacific and tropical Indian Ocean

NASA Astrophysics Data System (ADS)

Park, In-Hong; Min, Seung-Ki; Yeh, Sang-Wook; Weller, Evan; Kim, Seon Tae

2017-04-01

This study assessed the anthropogenic contribution to the 2015 record-breaking high sea surface temperatures (SSTs) observed in the central equatorial Pacific and tropical Indian Ocean. Considering a close link between extreme warm events in these regions, we conducted a joint attribution analysis using a fraction of attributable risk approach. Probability of occurrence of such extreme anomalies and long-term trends for the two oceanic regions were compared between CMIP5 multi-model simulations with and without anthropogenic forcing. Results show that the excessive warming in both regions is well beyond the range of natural variability and robustly attributable to human activities due to greenhouse gas increase. We further explored associated mechanisms including the Bjerknes feedback and background anthropogenic warming. It is concluded that background warming was the main contribution to the 2015 extreme SST event over the central equatorial Pacific Ocean on a developing El Niño condition, which in turn induced the extreme SST event over the tropical Indian Ocean through the atmospheric bridge effect.

Documentary evidence of economic character as a source for the study of hydrometeorological extremes

NASA Astrophysics Data System (ADS)

Chromá, K.; Brázdil, R.; Valášek, H.

2009-04-01

Various human activities, such as agriculture, forestry and water management, have always been influenced by climate variability and hydrometeorological extremes. From this reason historical economic records often include information about contemporaneous weather as well as descriptions of its impacts. This study deals with the interpretation of hydrometeorological extremes for the territory of Moravia (eastern part of the Czech Republic) derived from taxation records and reports of domain and estate administrators. Information obtained reflects the occurrence of floods, convective storms (including hailstorms), windstorms, late spring and early autumn frosts. Based on data from eight domains or estates, frequency series of floods and convective storms (including hailstorms) were compiled for the period 1650-1849. Detail analysis of disastrous weather event from 10 August 1694 in the Pernštejn domain is used to demonstrate the potential of such data for the study of hydrometeorological extremes and their impacts on human activity. Another example is analysis of data about tax reduction due to hailstorm damage on agriculture crops in Moravia in the period 1896-1906.

Comparing continuous and dichotomous scoring of the balanced inventory of desirable responding.

PubMed

Stöber, Joachim; Dette, Dorothea E; Musch, Jochen

2002-04-01

The Balanced Inventory of Desirable Responding (BIDR; Paulhus, 1994) is a widely used instrument to measure the 2 components of social desirability: self-deceptive enhancement and impression management. With respect to scoring of the BIDR, Paulhus (1994) authorized 2 methods, namely continuous scoring (all answers on the continuous answer scale are counted) and dichotomous scoring (only extreme answers are counted). In this article, we report 3 studies with student samples, and continuous and dichotomous scoring of BIDR subscales are compared with respect to reliability, convergent validity, sensitivity to instructional variations, and correlations with personality. Across studies, the scores from continuous scoring (continuous scores) showed higher Cronbach's alphas than those from dichotomous scoring (dichotomous scores). Moreover, continuous scores showed higher convergent correlations with other measures of social desirability and more consistent effects with self-presentation instructions (fake-good vs. fake-bad instructions). Finally, continuous self-deceptive enhancement scores showed higher correlations with those traits of the Five-factor model for which substantial correlations were expected (i.e., Neuroticism, Extraversion, and Conscientiousness). Consequently, these findings indicate that continuous scoring may be preferable to dichotomous scoring when assessing socially desirable responding with the BIDR.

Childhood IQ and In-Service Mortality in Scottish Army Personnel during World War II

ERIC Educational Resources Information Center

Corley, Janie; Crang, Jeremy A.; Deary, Ian J.

2009-01-01

The Scottish Mental Survey of 1932 (SMS1932) provides a record of intelligence test scores for almost a complete year-of-birth group of children born in 1921. By linking UK Army personnel records, the Scottish National War Memorial data, and the SMS1932 dataset it was possible to examine the effect of childhood intelligence scores on wartime…

Detecting determinism with improved sensitivity in time series: rank-based nonlinear predictability score.

PubMed

Naro, Daniel; Rummel, Christian; Schindler, Kaspar; Andrzejak, Ralph G

2014-09-01

The rank-based nonlinear predictability score was recently introduced as a test for determinism in point processes. We here adapt this measure to time series sampled from time-continuous flows. We use noisy Lorenz signals to compare this approach against a classical amplitude-based nonlinear prediction error. Both measures show an almost identical robustness against Gaussian white noise. In contrast, when the amplitude distribution of the noise has a narrower central peak and heavier tails than the normal distribution, the rank-based nonlinear predictability score outperforms the amplitude-based nonlinear prediction error. For this type of noise, the nonlinear predictability score has a higher sensitivity for deterministic structure in noisy signals. It also yields a higher statistical power in a surrogate test of the null hypothesis of linear stochastic correlated signals. We show the high relevance of this improved performance in an application to electroencephalographic (EEG) recordings from epilepsy patients. Here the nonlinear predictability score again appears of higher sensitivity to nonrandomness. Importantly, it yields an improved contrast between signals recorded from brain areas where the first ictal EEG signal changes were detected (focal EEG signals) versus signals recorded from brain areas that were not involved at seizure onset (nonfocal EEG signals).

Detecting determinism with improved sensitivity in time series: Rank-based nonlinear predictability score

NASA Astrophysics Data System (ADS)

Naro, Daniel; Rummel, Christian; Schindler, Kaspar; Andrzejak, Ralph G.

2014-09-01

The rank-based nonlinear predictability score was recently introduced as a test for determinism in point processes. We here adapt this measure to time series sampled from time-continuous flows. We use noisy Lorenz signals to compare this approach against a classical amplitude-based nonlinear prediction error. Both measures show an almost identical robustness against Gaussian white noise. In contrast, when the amplitude distribution of the noise has a narrower central peak and heavier tails than the normal distribution, the rank-based nonlinear predictability score outperforms the amplitude-based nonlinear prediction error. For this type of noise, the nonlinear predictability score has a higher sensitivity for deterministic structure in noisy signals. It also yields a higher statistical power in a surrogate test of the null hypothesis of linear stochastic correlated signals. We show the high relevance of this improved performance in an application to electroencephalographic (EEG) recordings from epilepsy patients. Here the nonlinear predictability score again appears of higher sensitivity to nonrandomness. Importantly, it yields an improved contrast between signals recorded from brain areas where the first ictal EEG signal changes were detected (focal EEG signals) versus signals recorded from brain areas that were not involved at seizure onset (nonfocal EEG signals).

Advanced Nursing Process quality: Comparing the International Classification for Nursing Practice (ICNP) with the NANDA-International (NANDA-I) and Nursing Interventions Classification (NIC).

PubMed

Rabelo-Silva, Eneida Rejane; Dantas Cavalcanti, Ana Carla; Ramos Goulart Caldas, Maria Cristina; Lucena, Amália de Fátima; Almeida, Miriam de Abreu; Linch, Graciele Fernanda da Costa; da Silva, Marcos Barragan; Müller-Staub, Maria

2017-02-01

To assess the quality of the advanced nursing process in nursing documentation in two hospitals. Various standardised terminologies are employed by nurses worldwide, whether for teaching, research or patient care. These systems can improve the quality of nursing records, enable care continuity, consistency in written communication and enhance safety for patients and providers alike. Cross-sectional study. A total of 138 records from two facilities (69 records from each facility) were analysed, one using the NANDA-International and Nursing Interventions Classification terminology (Centre 1) and one the International Classification for Nursing Practice (Centre 2), by means of the Quality of Diagnoses, Interventions, and Outcomes instrument. Quality of Diagnoses, Interventions, and Outcomes scores range from 0-58 points. Nursing records were dated 2012-2013 for Centre 1 and 2010-2011 for Centre 2. Centre 1 had a Quality of Diagnoses, Interventions, and Outcomes score of 35·46 (±6·45), whereas Centre 2 had a Quality of Diagnoses, Interventions, and Outcomes score of 31·72 (±4·62) (p < 0·001). Centre 2 had higher scores in the 'Nursing Diagnoses as Process' dimension, whereas in the 'Nursing Diagnoses as Product', 'Nursing Interventions' and 'Nursing Outcomes' dimensions, Centre 1 exhibited superior performance; acceptable reliability values were obtained for both centres, except for the 'Nursing Interventions' domain in Centre 1 and the 'Nursing Diagnoses as Process' and 'Nursing Diagnoses as Product' domains in Centre 2. The quality of nursing documentation was superior at Centre 1, although both facilities demonstrated moderate scores considering the maximum potential score of 58 points. Reliability analyses showed satisfactory results for both standardised terminologies. Nursing leaders should use a validated instrument to investigate the quality of nursing records after implementation of standardised terminologies. © 2016 John Wiley & Sons Ltd.

Changes in extremes due to half a degree warming in observations and models

NASA Astrophysics Data System (ADS)

Fischer, E. M.; Schleussner, C. F.; Pfleiderer, P.

2017-12-01

Assessing the climate impacts of half-a-degree warming increments is high on the post-Paris science agenda. Discriminating those effects is particularly challenging for climate extremes such as heavy precipitation and heat extremes for which model uncertainties are generally large, and for which internal variability is so important that it can easily offset or strongly amplify the forced local changes induced by half a degree warming. Despite these challenges we provide evidence for large-scale changes in the intensity and frequency of climate extremes due to half a degree warming. We first assess the difference in extreme climate indicators in observational data for the 1960s and 1970s versus the recent past, two periods differ by half a degree. We identify distinct differences for the global and continental-scale occurrence of heat and heavy precipitation extremes. We show that those observed changes in heavy precipitation and heat extremes broadly agree with simulated historical differences and are informative for the projected differences between 1.5 and 2°C warming despite different radiative forcings. We therefore argue that evidence from the observational record can inform the debate about discernible climate impacts in the light of model uncertainty by providing a conservative estimate of the implications of 0.5°C warming. A limitation of using the observational record arises from potential non-linearities in the response of climate extremes to a certain level of warming. We test for potential non-linearities in the response of heat and heavy precipitation extremes in a large ensemble of transient climate simulations. We further quantify differences between a time-window approach in a coupled model large ensemble vs. time-slice experiments using prescribed SST experiments performed in the context of the HAPPI-MIP project. Thereby we provide different lines of evidence that half a degree warming leads to substantial changes in the expected occurrence of heat and heavy precipitation extremes.

A short baseline strainmeter using fiber-optic Bragg-Grating (FBG) sensor and a nano-optic interferometer

NASA Astrophysics Data System (ADS)

Coutant, O.; Demengin, M.; Le Coarer, E.; Gaffet, S.

2013-12-01

Strain recordings from tiltmeters or borehole volumetric strainmeters on volcanoes reveal extremely rich signal of deformation associated with eruptive processes. The ability to detect and record signals of the order of few tens of nanostrain is complementary to other monitoring techniques, and of great interest to monitor and model the volcanic processes. Strain recording remains however a challenge, for both the instrumental and the installation point of view. We present in this study the first results of strain recordings, using a new fiber-optic Bragg-Grating (FBG) sensor. FBG sensors are known for many years and used as strain gauges in civil engineering. They are however limited in this case to microstrain capability. We use here a newly developped interferometer named SWIFTS whose main characteristics are i) an extremely high optical wavelength precision and ii) a small design and low power requirements allowing an easy field deployment. Our FBG sensor uses a short baseline, 3cm long Bragg network. We show preliminary results obtained from a several months recordings in the low noise underground laboratory at Rustrel (LSBB), south of France.

Sex Differences in Reported Pain Across 11,000 Patients Captured in Electronic Medical Records

PubMed Central

Ruau, David; Liu, Linda Y.; Clark, J. David; Angst, Martin S.; Butte, Atul J.

2011-01-01

Clinically recorded pain scores are abundant in patient health records but are rarely used in research. The use of this information could help improve clinical outcomes. For example, a recent report by the Institute of Medicine stated that ineffective use of clinical information contributes to under-treatment of patient subpopulations — especially women. This study used diagnosis-associated pain scores from a large hospital database to document sex differences in reported pain. We used de-identified electronic medical records from Stanford Hospital and Clinics for more than 72,000 patients. Each record contained at least one disease-associated pain score. We found over 160,000 pain scores in more than 250 primary diagnoses, and analyzed differences in disease-specific pain reported by men and women. After filtering for diagnoses with minimum encounter numbers, we found diagnosis-specific sex differences in reported pain. The most significant differences occurred in patients with disorders of the musculoskeletal, circulatory, respiratory and digestive systems, followed by infectious diseases, and injury and poisoning. We also discovered sex-specific differences in pain intensity in previously unreported diseases, including disorders of the cervical region, and acute sinusitis (p = 0.01, 0.017, respectively). Pain scores were collected during hospital encounters. No information about the use of pre-encounter over-the-counter medications was available. To our knowledge, this is the largest data-driven study documenting sex differences of disease-associated pain. It highlights the utility of EMR data to corroborate and expand on results of smaller clinical studies. Our findings emphasize the need for future research examining the mechanisms underlying differences in pain. PMID:22245360

Correlates of diabetes-related distress in type 2 diabetes: Findings from the benchmarking network for clinical and humanistic outcomes in diabetes (BENCH-D) study.

PubMed

Pintaudi, Basilio; Lucisano, Giuseppe; Gentile, Sandro; Bulotta, Angela; Skovlund, Soren E; Vespasiani, Giacomo; Rossi, Maria C; Nicolucci, Antonio

2015-11-01

To evaluate correlates of high diabetes-related distress (HD) among individuals with type 2 diabetes mellitus (T2DM). The study involved a sample of patients with T2DM who filled in the Problem Areas in Diabetes questionnaire (PAID-5); a score ≥ 40 indicates HD. Additional instruments included: SF12 health survey (SF12), Well-Being Index (WHO-5), Diabetes Empowerment Scale-Short Form (DES-SF), Patient Assessment of Chronic Illness Care-Short Form (PACIC-SF), Health Care Climate-Short Form (HCC-SF), Global Satisfaction with Diabetes Treatment (GSDT), Summary of Diabetes Self-Care Activities (SDSCA-6); Barriers to Medications (BM), Perceived Social Support (PSS). Clinical data were extracted from computerized medical records. Multivariable logistic regression analyses were performed to identify correlates of HD. Of 2374 patients (mean age 65.0±10.2 years, diabetes duration 14.0±15.3 years, 59.9% males), 1429 (60.2%) had HD. Compared to patients with a PAID-5 score<40 those with HD were more often female, living alone, had a lower level of education, higher HbA1c levels, a greater perceived impact of hyperglycemic and hypoglycemic symptoms, a greater number of diabetes-related complications, lower scores of WHO-5, DES-SF, PSS, GSDT, SF-12 PCS, SDSCA-healthy diet and physical activity subscales, higher scores of BM and SDSCA-SMBG component. Multivariable analyses confirmed the relationship between HD and symptoms of hyperglycemia, levels of empowerment, global satisfaction with treatment, perception of barriers to medication, and psychological well-being. Conclusion HD is extremely common among people with T2DM, affecting almost two-thirds of patients. High levels of distress are associated with worse clinical and psychosocial outcomes and should be considered as a key patient-centered indicator. Copyright © 2015 Elsevier Inc. All rights reserved.

Are Elite Female Soccer Athletes at Risk for Disordered Eating Attitudes, Menstrual Dysfunction, and Stress Fractures?

PubMed

Prather, Heidi; Hunt, Devyani; McKeon, Kathryn; Simpson, Scott; Meyer, E Blair; Yemm, Ted; Brophy, Robert

2016-03-01

To determine the prevalence of stress fractures, menstrual dysfunction and disordered eating attitudes in elite female soccer athletes. Cross-sectional descriptive study. Female soccer athletes were recruited from a national level youth soccer club, an NCAA Division I university team, and a women's professional team. Two hundred twenty female soccer athletes with a mean age of 16.4 ± 4 years and BMI of 20.8 ± 2 kg/m(2) completed the study, representing all athletes from the included teams. One-time surveys completed by the athletes. Height and weight were recorded, and body mass index (BMI) was calculated for each athlete. Athletes reported age of menarche, history of missing 3 or more menses within a 12-month period and stress fracture. The Eating Attitudes Test (EAT-26) was used to assess the athlete's body perception and attitudes toward eating. Of the 220 soccer athletes, 3 athletes (1.6%) had a low BMI for their age, and 19 (8.6%) reported stress fractures of the lower extremity. Among athletes who had reached menarche, the average onset was 13 + 1 year; menstrual dysfunction were present in 21 (19.3%). On the EAT-26, 1 player scored in the high risk range (>20) and 17 (7.7%) scored in the intermediate risk range (10-19) for eating disorders. Athletes with an EAT-26 score ≥ 10 points had a significantly higher prevalence of menstrual dysfunction in the past year compared to athletes with an EAT-26 score of less than 10 (P = .02). Elite female soccer athletes are susceptible to stress fractures and menstrual dysfunction and have delayed onset of menarche despite normal BMI and appropriate body perception and attitudes towards eating. Further studies are needed to better understand stress fracture risk in female soccer athletes and in other team sports to determine how these findings relate to long-term bone health in this population. Copyright © 2016. Published by Elsevier Inc.

Investigating the Written Exam Scores' Prediction Power of TEOG Exam Scores

ERIC Educational Resources Information Center

Kontas, Hakki; Özpolat, Esen Turan

2017-01-01

The purpose of this study was to investigate exam scores' predicting Transition from Primary to Secondary Education (TEOG) exam scores. The research data were obtained from the records of 1035 students studying at the first term of eighth grade in 2015-2016 academic year in e-school system. The research was on relational screening model. Linear…

The effect of benzocaine and ketoprofen gels on pain during fixed orthodontic appliance treatment: a randomised, double-blind, crossover trial.

PubMed

Eslamian, Ladan; Borzabadi-Farahani, Ali; Gholami, Hadi

2016-05-01

To compare the analgesic effect of topical benzocaine (5%) and ketoprofen (1.60 mg/mL) after 2 mm activation of 7 mm long delta loops used for maxillary en-masse orthodontic space closure. Twenty patients (seven males, 13 females, 15-25 years of age, mean age of 19.5 years) participated in a randomised crossover, double-blind trial. After appliance activation, participants were instructed to use analgesic gels and record pain perception at 2, 6, 24 hours and 2, 3 and 7 days (at 18.00 hrs), using a visual analogue scale ruler (VAS, 0-4). Each patient received all three gels (benzocaine, ketoprofen, and a control (placebo)) randomly, but at three different appliance activation visits following a wash-over gap of one month. After the first day, the patients were instructed to repeat gel application twice a day at 10:00 and 18:00 hrs for three days. The recorded pain scores were subjected to non-parametric analysis. The highest pain was recorded at 2 and 6 hours. Pain scores were significantly different between the three groups (Kruskal-Wallis test, p < 0.01). The overall mean (SD) pain scores for the benzocaine 5%, ketoprofen, and control (placebo) groups were 0.89 (0.41), 0.68 (0.34), and 1.15 (0.81), respectively. The pain scores were significantly different between the ketoprofen and control groups (mean difference = 0.47, p = 0.005). All groups demonstrated significant differences in pain scores at the six different time intervals (p < 0.05) and there was no gender difference (p > 0.05). A significant pain reduction was observed following the use of ketoprofen when tested against a control gel (placebo). The highest pain scores were experienced in patients administered the placebo and the lowest scores in patients who applied ketoprofen gel. Benzocaine had an effect mid-way between ketoprofen and the placebo. The highest pain scores were recorded 2 hours following force application, which decreased to the lowest scores after 7 days.

Stability of cooperation under image scoring in group interactions

NASA Astrophysics Data System (ADS)

Nax, Heinrich H.; Perc, Matjaž; Szolnoki, Attila; Helbing, Dirk

2015-07-01

Image scoring sustains cooperation in the repeated two-player prisoner’s dilemma through indirect reciprocity, even though defection is the uniquely dominant selfish behaviour in the one-shot game. Many real-world dilemma situations, however, firstly, take place in groups and, secondly, lack the necessary transparency to inform subjects reliably of others’ individual past actions. Instead, there is revelation of information regarding groups, which allows for ‘group scoring’ but not for image scoring. Here, we study how sensitive the positive results related to image scoring are to information based on group scoring. We combine analytic results and computer simulations to specify the conditions for the emergence of cooperation. We show that under pure group scoring, that is, under the complete absence of image-scoring information, cooperation is unsustainable. Away from this extreme case, however, the necessary degree of image scoring relative to group scoring depends on the population size and is generally very small. We thus conclude that the positive results based on image scoring apply to a much broader range of informational settings that are relevant in the real world than previously assumed.

The relationship of live animal muscular and skeletal scores, ultrasound measurements and carcass classification scores with carcass composition and value in steers.

PubMed

Conroy, S B; Drennan, M J; Kenny, D A; McGee, M

2009-11-01

This study examined the relationship of muscular and skeletal scores and ultrasound measurements in the live animal, and carcass conformation and fat scores with carcass composition and value using 336 steers, slaughtered at 2 years of age. Live animal scores and measurements were recorded at 8 to 12 months of age and pre-slaughter. Following slaughter, each carcass was classified for conformation and fatness and the right side dissected into meat, fat and bone. Carcass conformation scores and fat scores were both measured on a continuous 15-point scale and ranged from 2.0 to 12.0 and from 2.8 to 13.3, respectively. Pre-slaughter muscular scores showed positive correlations (P < 0.001) ranging from 0.31 to 0.86 with carcass meat proportion, proportion of high-value cuts in the carcass, conformation score and carcass value, significant negative correlations with carcass fat (r = -0.13) and bone (r = -0.81) proportions, and generally low non-significant relationships with the proportion of high-value cuts in meat and carcass fat score. Pre-slaughter ultrasound muscle depth and carcass conformation score showed similar correlations with carcass traits to those using the pre-slaughter muscular scoring procedure. Pre-slaughter ultrasound fat depth showed positive correlations (P < 0.001) with carcass fat proportion (r = 0.59) and fat score (r = 0.63), and significant negative correlations (-0.23 to -0.50) with carcass meat and bone proportions, high-value cuts in the carcass and in meat, and carcass value. Pre-slaughter skeletal scores generally showed poor correlations ranging from -0.38 to 0.52 with the various carcass traits. Corresponding correlations (-0.26 to 0.44) involving records collected at 8 to 12 months of age were lower than those using pre-slaughter records. A one-unit increase in carcass conformation score increased carcass meat proportion and value by 11.2 g/kg and 5.6 cents/kg, respectively. Corresponding values for fat score were -8.2 g/kg and -5.1 cents/kg. In conclusion, both pre-slaughter live animal scores/measurements and carcass classification scores, explained an appreciable amount of the total variation in carcass meat, fat and bone proportions and carcass value, and a moderate amount of the variation in proportion of high-value meat cuts in the carcass.

Predicting Depression among Patients with Diabetes Using Longitudinal Data. A Multilevel Regression Model.

PubMed

Jin, H; Wu, S; Vidyanti, I; Di Capua, P; Wu, B

2015-01-01

This article is part of the Focus Theme of Methods of Information in Medicine on "Big Data and Analytics in Healthcare". Depression is a common and often undiagnosed condition for patients with diabetes. It is also a condition that significantly impacts healthcare outcomes, use, and cost as well as elevating suicide risk. Therefore, a model to predict depression among diabetes patients is a promising and valuable tool for providers to proactively assess depressive symptoms and identify those with depression. This study seeks to develop a generalized multilevel regression model, using a longitudinal data set from a recent large-scale clinical trial, to predict depression severity and presence of major depression among patients with diabetes. Severity of depression was measured by the Patient Health Questionnaire PHQ-9 score. Predictors were selected from 29 candidate factors to develop a 2-level Poisson regression model that can make population-average predictions for all patients and subject-specific predictions for individual patients with historical records. Newly obtained patient records can be incorporated with historical records to update the prediction model. Root-mean-square errors (RMSE) were used to evaluate predictive accuracy of PHQ-9 scores. The study also evaluated the classification ability of using the predicted PHQ-9 scores to classify patients as having major depression. Two time-invariant and 10 time-varying predictors were selected for the model. Incorporating historical records and using them to update the model may improve both predictive accuracy of PHQ-9 scores and classification ability of the predicted scores. Subject-specific predictions (for individual patients with historical records) achieved RMSE about 4 and areas under the receiver operating characteristic (ROC) curve about 0.9 and are better than population-average predictions. The study developed a generalized multilevel regression model to predict depression and demonstrated that using generalized multilevel regression based on longitudinal patient records can achieve high predictive ability.

Quantitative measures detect sensory and motor impairments in multiple sclerosis.

PubMed

Newsome, Scott D; Wang, Joseph I; Kang, Jonathan Y; Calabresi, Peter A; Zackowski, Kathleen M

2011-06-15

Sensory and motor dysfunction in multiple sclerosis (MS) is often assessed with rating scales which rely heavily on clinical judgment. Quantitative devices may be more precise than rating scales. To quantify lower extremity sensorimotor measures in individuals with MS, evaluate the extent to which they can detect functional systems impairments, and determine their relationship to global disability measures. We tested 145 MS subjects and 58 controls. Vibration thresholds were quantified using a Vibratron-II device. Strength was quantified by a hand-held dynamometer. We also recorded Expanded Disability Status Scale (EDSS) and Timed 25-Foot Walk (T25FW). t-tests and Wilcoxon-rank sum were used to compare group data. Spearman correlations were used to assess relationships between each measure. We also used a step-wise linear regression model to determine how much the quantitative measures explain the variance in the respective functional systems scores (FSS). EDSS scores ranged from 0-7.5, mean disease duration was 10.4 ± 9.6 years, and 66% were female. In relapsing-remitting MS, but not progressive MS, poorer vibration sensation correlated with a worse EDSS score, whereas progressive groups' ankle/hip strength changed significantly with EDSS progression. Interestingly, not only did sensorimotor measures significantly correlate with global disability measures (i.e., EDSS), but they had improved sensitivity, as they detected impairments in up to 32% of MS subjects with normal sensory and pyramidal FSS. Sensory and motor deficits in MS can be quantified using clinically accessible tools and distinguish differences among MS subtypes. We show that quantitative sensorimotor measures are more sensitive than FSS from the EDSS. These tools have the potential to be used as clinical outcome measures in practice and for future MS clinical trials of neurorehabilitative and neuroreparative interventions. Copyright © 2011 Elsevier B.V. All rights reserved.

Effectiveness of intense, activity-based physical therapy for individuals with spinal cord injury in promoting motor and sensory recovery: Is olfactory mucosa autograft a factor?

PubMed Central

Larson, Cathy A.; Dension, Paula M.

2013-01-01

Background/objectives Rehabilitation for individuals with spinal cord injury (SCI) is expanding to include intense, activity-based, out-patient physical therapy (PT). The study's primary purposes were to (i) examine the effectiveness of intense PT in promoting motor and sensory recovery in individuals with SCI and (ii) compare recovery for individuals who had an olfactory mucosa autograft (OMA) with individuals who did not have the OMA while both groups participated in the intense PT program. Methods Prospective, non-randomized, non-blinded, intervention study. Using the American Spinal Injury Association examination, motor and sensory scores for 23 (7 OMA, 6 matched control and 10 other) participants were recorded. Results Mean therapy dosage was 137.3 total hours. The participants’ total, upper and lower extremity motor scores improved significantly while sensory scores did not improve during the first 60 days and from initial to discharge examination. Incomplete SCI or paraplegia was associated with greater motor recovery. Five of 14 participants converted from motor-complete to motor-incomplete SCI. Individuals who had the OMA and participated in intense PT did not have greater sensory or greater magnitude or rate of motor recovery as compared with participants who had intense PT alone. Conclusion This study provides encouraging evidence as to the effectiveness of intense PT for individuals with SCI. Future research is needed to identify the optimal therapy dosage and specific therapeutic activities required to generate clinically meaningful recovery for individuals with SCI including those who elect to undergo a neural recovery/regenerative surgical procedure and those that elect intense therapy alone. PMID:23433335

Quantitative measures detect sensory and motor impairments in multiple sclerosis

PubMed Central

Newsome, Scott D.; Wang, Joseph I.; Kang, Jonathan Y.; Calabresi, Peter A.; Zackowski, Kathleen M.

2011-01-01

Background Sensory and motor dysfunction in multiple sclerosis (MS) is often assessed with rating scales which rely heavily on clinical judgment. Quantitative devices may be more precise than rating scales. Objective To quantify lower extremity sensorimotor measures in individuals with MS, evaluate the extent to which they can detect functional systems impairments, and determine their relationship to global disability measures. Methods We tested 145 MS subjects and 58 controls. Vibration thresholds were quantified using a Vibratron-II device. Strength was quantified by a hand-held dynamometer. We also recorded Expanded Disability Status Scale (EDSS) and timed 25-foot walk (T25FW). T-tests and Wilcoxon-rank sum were used to compare group data. Spearman correlations were used to assess relationships between each measure. We also used a step-wise linear regression model to determine how much the quantitative measures explain the variance in the respective functional systems scores (FSS). Results EDSS scores ranged from 0-7.5, mean disease duration was 10.4±9.6 years, and 66% were female. In RRMS, but not progressive MS, poorer vibration sensation correlated with a worse EDSS score, whereas progressive groups’ ankle/hip strength changed significantly with EDSS progression. Interestingly, not only did sensorimotor measures significantly correlate with global disability measures (EDSS), but they had improved sensitivity, as they detected impairments in up to 32% of MS subjects with normal sensory FSS. Conclusions Sensory and motor deficits can be quantified using clinically accessible tools and distinguish differences among MS subtypes. We show that quantitative sensorimotor measures are more sensitive than FSS from the EDSS. These tools have the potential to be used as clinical outcome measures in practice and for future MS clinical trials of neurorehabilitative and neuroreparative interventions. PMID:21458828

Montreal Archive of Sleep Studies: an open-access resource for instrument benchmarking and exploratory research.

PubMed

O'Reilly, Christian; Gosselin, Nadia; Carrier, Julie; Nielsen, Tore

2014-12-01

Manual processing of sleep recordings is extremely time-consuming. Efforts to automate this process have shown promising results, but automatic systems are generally evaluated on private databases, not allowing accurate cross-validation with other systems. In lacking a common benchmark, the relative performances of different systems are not compared easily and advances are compromised. To address this fundamental methodological impediment to sleep study, we propose an open-access database of polysomnographic biosignals. To build this database, whole-night recordings from 200 participants [97 males (aged 42.9 ± 19.8 years) and 103 females (aged 38.3 ± 18.9 years); age range: 18-76 years] were pooled from eight different research protocols performed in three different hospital-based sleep laboratories. All recordings feature a sampling frequency of 256 Hz and an electroencephalography (EEG) montage of 4-20 channels plus standard electro-oculography (EOG), electromyography (EMG), electrocardiography (ECG) and respiratory signals. Access to the database can be obtained through the Montreal Archive of Sleep Studies (MASS) website (http://www.ceams-carsm.ca/en/MASS), and requires only affiliation with a research institution and prior approval by the applicant's local ethical review board. Providing the research community with access to this free and open sleep database is expected to facilitate the development and cross-validation of sleep analysis automation systems. It is also expected that such a shared resource will be a catalyst for cross-centre collaborations on difficult topics such as improving inter-rater agreement on sleep stage scoring. © 2014 European Sleep Research Society.

Profile and genetic parameters of dairy cattle locomotion score and lameness across lactation.

PubMed

Kougioumtzis, A; Valergakis, G E; Oikonomou, G; Arsenos, G; Banos, G

2014-01-01

This study investigated the profile of locomotion score and lameness before the first calving and throughout the first (n=237) and second (n=66) lactation of 303 Holstein cows raised on a commercial farm. Weekly heritability estimates of locomotion score and lameness, and their genetic and phenotypic correlations with milk yield, body condition score, BW and reproduction traits were derived. Daughter future locomotion score and lameness predictions from their sires��� breeding values for conformation traits were also calculated. First-lactation cows were monitored weekly from 6 weeks before calving to the end of lactation. Second-lactation cows were monitored weekly throughout lactation. Cows were locomotion scored on a scale from one (sound) to five (severely lame); a score greater than or equal to two defined presence of lameness. Cows��� weekly body condition score and BW was also recorded. These records were matched to corresponding milk yield records, where the latter were 7-day averages on the week of inspection. The total number of repeated records amounted to 12 221. Data were also matched to the farm���s reproduction database, from which five traits were derived. Statistical analyses were based on uni- and bivariate random regression models. The profile analysis showed that locomotion and lameness problems in first lactation were fewer before and immediately after calving, and increased as lactation progressed. The profile of the two traits remained relatively constant across the second lactation. Highest heritability estimates were observed in the weeks before first calving (0.66 for locomotion score and 0.54 for lameness). Statistically significant genetic correlations were found for first lactation weekly locomotion score and lameness with body condition score, ranging from ���0.31 to ���0.65 and from ���0.44 to ���0.76, respectively, suggesting that cows genetically pre-disposed for high body condition score have fewer locomotion and lameness issues. Negative (favourable) phenotypic correlations between first lactation weekly locomotion score/lameness and milk yield averaged ���0.27 and ���0.17, respectively, and were attributed to management factors. Also a phenotypic correlation between lameness and conception rate of ���0.19 indicated that lame cows were associated with lower success at conceiving. First-lactation daughter locomotion score and/or lameness predictions from sires��� estimated breeding values for conformation traits revealed a significant linear effect of rear leg side view, rear leg rear view, overall conformation, body condition score and locomotion, and a quadratic effect of foot angle.

Quantitative assessment of upper extremities motor function in multiple sclerosis.

PubMed

Daunoraviciene, Kristina; Ziziene, Jurgita; Griskevicius, Julius; Pauk, Jolanta; Ovcinikova, Agne; Kizlaitiene, Rasa; Kaubrys, Gintaras

2018-05-18

Upper extremity (UE) motor function deficits are commonly noted in multiple sclerosis (MS) patients and assessing it is challenging because of the lack of consensus regarding its definition. Instrumented biomechanical analysis of upper extremity movements can quantify coordination with different spatiotemporal measures and facilitate disability rating in MS patients. To identify objective quantitative parameters for more accurate evaluation of UE disability and relate it to existing clinical scores. Thirty-four MS patients and 24 healthy controls (CG) performed a finger-to-nose test as fast as possible and, in addition, clinical evaluation kinematic parameters of UE were measured by using inertial sensors. Generally, a higher disability score was associated with an increase of several temporal parameters, like slower task performance. The time taken to touch their nose was longer when the task was fulfilled with eyes closed. Time to peak angular velocity significantly changed in MS patients (EDSS > 5.0). The inter-joint coordination significantly decreases in MS patients (EDSS 3.0-5.5). Spatial parameters indicated that maximal ROM changes were in elbow flexion. Our findings have revealed that spatiotemporal parameters are related to the UE motor function and MS disability level. Moreover, they facilitate clinical rating by supporting clinical decisions with quantitative data.

When personality and culture clash: the psychological distress of allocentrics in an individualist culture and idiocentrics in a collectivist culture.

PubMed

Caldwell-Harris, Catherine L; Ayçiçegi, Ayse

2006-09-01

Because humans need both autonomy and interdependence, persons with either an extreme collectivist orientation (allocentrics) or extreme individualist values (idiocentrics) may be at risk for possession of some features of psychopathology. Is an extreme personality style a risk factor primarily when it conflicts with the values of the surrounding society? Individualism-collectivism scenarios and a battery of clinical and personality scales were administered to nonclinical samples of college students in Boston and Istanbul. For students residing in a highly individualistic society (Boston), collectivism scores were positively correlated with depression, social anxiety, obsessive-compulsive disorder and dependent personality. Individualism scores, particularly horizontal individualism, were negatively correlated with these same scales. A different pattern was obtained for students residing in a collectivist culture, Istanbul. Here individualism (and especially horizontal individualism) was positively correlated with scales for paranoid, schizoid, narcissistic, borderline and antisocial personality disorder. Collectivism (particularly vertical collectivism) was associated with low report of symptoms on these scales. These results indicate that having a personality style which conflicts with the values of society is associated with psychiatric symptoms. Having an orientation inconsistent with societal values may thus be a risk factor for poor mental health.

Contralaterally Controlled Neuromuscular Electrical Stimulation for Recovery of Ankle Dorsiflexion

PubMed Central

Knutson, Jayme S.; Hansen, Kristine; Nagy, Jennifer; Bailey, Stephanie N.; Gunzler, Douglas D.; Sheffler, Lynne R.; Chae, John

2013-01-01

Objective Compare the effects of contralaterally controlled neuromuscular electrical stimulation (CCNMES) versus cyclic neuromuscular electrical stimulation (NMES) on lower extremity impairment, functional ambulation, and gait characteristics. Design Twenty-six stroke survivors with chronic (≥6mo) footdrop during ambulation were randomly assigned to six weeks of CCNMES or cyclic NMES. Both groups had ten sessions per week of self-administered home application of either CCNMES or cyclic NMES plus two sessions per week of gait training with a physical therapist. Primary outcomes included lower extremity Fugl-Meyer score, modified Emory Functional Ambulation Profile, and gait velocity. Assessments were made at pretreatment, posttreatment, and at 1 and 3 months posttreatment. Results There were no significant differences between groups in the outcome trajectories for any of the measures. With data from both groups pooled, there were significant but modest and sustained improvements in the Fugl-Meyer score and the modified Emory Functional Ambulation Profile, but not in gait velocity. Conclusions The results support the hypothesis that gait training combined with either CCNMES or cyclic NMES reduces lower extremity impairment and functional ambulation, but do not support the hypothesis that CCNMES is more effective than cyclic NMES in chronic patients. PMID:23867888

X-shooter Finds an Extremely Primitive Star

NASA Astrophysics Data System (ADS)

Caffau, E.; Bonifacio, P.; François, P.; Sbordone, L.; Monaco, L.; Spite, M.; Spite, F.; Ludwig, H.-G.; Cayrel, R.; Zaggia, S.; Hammer, F.; Randich, S.; Molaro, P.; Hill, V.

2011-12-01

Low-mass extremely metal-poor (EMP) stars hold the fossil record of the chemical composition of the early phases of the Universe in their atmospheres. Chemical analysis of such objects provides important constraints on these early phases. EMP stars are rather rare objects: to dig them out, large amounts of data have to be considered. We have analysed stars from the Sloan Digital Sky Survey using an automatic procedure and selected a sample of good candidate EMP stars, which we observed with the spectrographs X-shooter and UVES. We could confirm the low metallicity of our sample of stars, and we succeeded in finding a record metal-poor star.

Unveiling the signals from extremely noisy microseismic data for high-resolution hydraulic fracturing monitoring.

PubMed

Huang, Weilin; Wang, Runqiu; Li, Huijian; Chen, Yangkang

2017-09-20

Microseismic method is an essential technique for monitoring the dynamic status of hydraulic fracturing during the development of unconventional reservoirs. However, one of the challenges in microseismic monitoring is that those seismic signals generated from micro seismicity have extremely low amplitude. We develop a methodology to unveil the signals that are smeared in the strong ambient noise and thus facilitate a more accurate arrival-time picking that will ultimately improve the localization accuracy. In the proposed technique, we decompose the recorded data into several morphological multi-scale components. In order to unveil weak signal, we propose an orthogonalization operator which acts as a time-varying weighting in the morphological reconstruction. The orthogonalization operator is obtained using an inversion process. This orthogonalized morphological reconstruction can be interpreted as a projection of the higher-dimensional vector. We first test the proposed technique using a synthetic dataset. Then the proposed technique is applied to a field dataset recorded in a project in China, in which the signals induced from hydraulic fracturing are recorded by twelve three-component (3-C) geophones in a monitoring well. The result demonstrates that the orthogonalized morphological reconstruction can make the extremely weak microseismic signals detectable.

Development of the TeamOBS-PPH - targeting clinical performance in postpartum hemorrhage.

PubMed

Brogaard, Lise; Hvidman, Lone; Hinshaw, Kim; Kierkegaard, Ole; Manser, Tanja; Musaeus, Peter; Arafeh, Julie; Daniels, Kay I; Judy, Amy E; Uldbjerg, Niels

2018-06-01

This study aimed to develop a valid and reliable TeamOBS-PPH tool for assessing clinical performance in the management of postpartum hemorrhage (PPH). The tool was evaluated using video-recordings of teams managing PPH in both real-life and simulated settings. A Delphi panel consisting of 12 obstetricians from the UK, Norway, Sweden, Iceland, and Denmark achieved consensus on (i) the elements to include in the assessment tool, (ii) the weighting of each element, and (iii) the final tool. The validity and reliability were evaluated according to Cook and Beckman. (Level 1) Four raters scored four video-recordings of in situ simulations of PPH. (Level 2) Two raters scored 85 video-recordings of real-life teams managing patients with PPH ≥1000 mL in two Danish hospitals. (Level 3) Two raters scored 15 video-recordings of in situ simulations of PPH from a US hospital. The tool was designed with scores from 0 to 100. (Level 1) Teams of novices had a median score of 54 (95% CI 48-60), whereas experienced teams had a median score of 75 (95% CI 71-79; p < 0.001). (Level 2) The intra-rater [intra-class correlation (ICC) = 0.96] and inter-rater (ICC = 0.83) agreements for real-life PPH were strong. The tool was applicable in all cases: atony, retained placenta, and lacerations. (Level 3) The tool was easily adapted to in situ simulation settings in the USA (ICC = 0.86). The TeamOBS-PPH tool appears to be valid and reliable for assessing clinical performance in real-life and simulated settings. The tool will be shared as the free TeamOBS App. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

Evaluation of Factors Affecting Acute Postoperative Pain Levels After Arthroscopic Rotator Cuff Repair.

PubMed

Cuff, Derek J; O'Brien, Kathleen C; Pupello, Derek R; Santoni, Brandon G

2016-07-01

To evaluate multiple preoperative and operative factors that may be predictive of and correlate with acute postoperative pain levels after arthroscopic rotator cuff repair. One hundred eighty-one patients underwent arthroscopic rotator cuff surgery along with subacromial decompression and met the inclusion criteria for this study. Postoperative visual analog scale (VAS) scores were obtained on postoperative days 1, 7, and 90. Multivariate linear regression analysis was used to correlate postoperative VAS scores with multiple independent factors, including preoperative subjective pain tolerance, preoperative VAS score, preoperative narcotic use, sex, smoking status, number of suture anchors used, tear size, single- or double-row repair, and patient age. Preoperative subjective pain tolerance, notably those patients rating themselves as having an extremely high pain tolerance, was the most significant predictor of high VAS pain scores on both postoperative day 1 (P = .0001) and postoperative day 7 (P < .0001). Preoperative narcotic use was also significantly predictive (P = .010) of high pain scores on postoperative day 1 and day 7 (P = .019), along with nonsmokers (P = .008) and younger patients (P = .006) being predictive on day 7. There were no patient factors that were predictive of VAS scores 3 months postoperatively (P = .567). Preoperative subjective pain tolerance, notably those patients rating themselves as having an extremely high pain tolerance, was the strongest factor predicting high acute pain levels after arthroscopic rotator cuff surgery. Preoperative narcotic use, smokers, and younger patients were also predictive of higher pain levels during the first postoperative week. Level IV, prognostic case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

The impact of confounder selection in propensity scores when applied to prospective cohort studies in pregnancy.

PubMed

Xu, Ronghui; Hou, Jue; Chambers, Christina D

2018-06-01

Our work was motivated by small cohort studies on the risk of birth defects in infants born to pregnant women exposed to medications. We controlled for confounding using propensity scores (PS). The extremely rare events setting renders the matching or stratification infeasible. In addition, the PS itself may be formed via different approaches to select confounders from a relatively long list of potential confounders. We carried out simulation experiments to compare different combinations of approaches: IPW or regression adjustment, with 1) including all potential confounders without selection, 2) selection based on univariate association between the candidate variable and the outcome, 3) selection based on change in effects (CIE). The simulation showed that IPW without selection leads to extremely large variances in the estimated odds ratio, which help to explain the empirical data analysis results that we had observed. Copyright © 2018 Elsevier Inc. All rights reserved.

The effects of below-elbow immobilization on driving performance.

PubMed

Jones, Evan M; Barrow, Aaron E; Skordas, Nic J; Green, David P; Cho, Mickey S

2017-02-01

There is limited research to guide physicians and patients in deciding whether it is safe to drive while wearing various forms of upper extremity immobilization. The purpose of this study is to evaluate the effect of below-elbow removable splints and fiberglass casts on automobile driving performance. 20 healthy subjects completed 10 runs through a closed, cone-marked driving course while wearing a randomized sequence of four different types of immobilization on each extremity (short arm thumb spica fiberglass cast, short arm fiberglass cast, short arm thumb spica splint, and short arm wrist splint). The first and last driving runs were without immobilization and served as controls. Performance was measured based on evaluation by a certified driving instructor (pass/fail scoring), cones hit, run time, and subject-perceived driving difficulty (1-10 analogue scoring). The greatest number of instructor-scored failures occurred while immobilized in right arm spica casts (n=6; p=0.02) and left arm spica casts (n=5; p=0.049). The right arm spica cast had the highest subject-perceived difficulty (5.2±1.9; p<0.001). All forms of immobilization had significantly increased perceived difficulty compared to control, except for the left short arm splint (2.5±1.6; p>0.05). There was no significant difference in number of cones hit or driving time between control runs and runs with any type of immobilization. Drivers should use caution when wearing any of the forms of upper extremity immobilization tested in this study. All forms of immobilization, with exception of the left short arm splint significantly increased perceived driving difficulty. However, only the fiberglass spica casts (both left and right arm), significantly increased drive run failures due to loss of vehicle control. We recommend against driving when wearing a below-elbow fiberglass spica cast on either extremity. Copyright © 2016. Published by Elsevier Ltd.

Reliability, validity, and sensitivity to change of the lower extremity functional scale in individuals affected by stroke.

PubMed

Verheijde, Joseph L; White, Fred; Tompkins, James; Dahl, Peder; Hentz, Joseph G; Lebec, Michael T; Cornwall, Mark

2013-12-01

To investigate reliability, validity, and sensitivity to change of the Lower Extremity Functional Scale (LEFS) in individuals affected by stroke. The secondary objective was to test the validity and sensitivity of a single-item linear analog scale (LAS) of function. Prospective cohort reliability and validation study. A single rehabilitation department in an academic medical center. Forty-three individuals receiving neurorehabilitation for lower extremity dysfunction after stroke were studied. Their ages ranged from 32 to 95 years, with a mean of 70 years; 77% were men. Test-retest reliability was assessed by calculating the classical intraclass correlation coefficient, and the Bland-Altman limits of agreement. Validity was assessed by calculating the Pearson correlation coefficient between the instruments. Sensitivity to change was assessed by comparing baseline scores with end of treatment scores. Measurements were taken at baseline, after 1-3 days, and at 4 and 8 weeks. The LEFS, Short-Form-36 Physical Function Scale, Berg Balance Scale, Six-Minute Walk Test, Five-Meter Walk Test, Timed Up-and-Go test, and the LAS of function were used. The test-retest reliability of the LEFS was found to be excellent (ICC = 0.96). Correlated with the 6 other measures of function studied, the validity of the LEFS was found to be moderate to high (r = 0.40-0.71). Regarding the sensitivity to change, the mean LEFS scores from baseline to study end increased 1.2 SD and for LAS 1.1 SD. LEFS exhibits good reliability, validity, and sensitivity to change in patients with lower extremity impairments secondary to stroke. Therefore, the LEFS can be a clinically efficient outcome measure in the rehabilitation of patients with subacute stroke. The LAS is shown to be a time-saving and reasonable option to track changes in a patient's functional status. Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Number of Black Children in Extreme Poverty Hits Record High. Analysis Background.

ERIC Educational Resources Information Center

Children's Defense Fund, Washington, DC.

To examine the experiences of black children and poverty, researchers conducted a computer analysis of data from the U.S. Census Bureau's Current Population Survey, the source of official government poverty statistics. The data are through 2001. Results indicated that nearly 1 million black children were living in extreme poverty, with after-tax…

Soil enzyme activities during the 2011 Texas record drought/heat wave and implications to biogeochemical cycling and organic matter dynamics

USDA-ARS?s Scientific Manuscript database

Extreme weather events such as severe droughts and heat waves may have permanent consequences on soil quality and functioning in agroecosystems. The Southern High Plains (SHP) region of Texas, U.S., a large cotton producing area, experienced a historically extreme drought and heat wave during 2011,...

Cool North European summers and possible links to explosive volcanic eruptions

NASA Astrophysics Data System (ADS)

Jones, P. D.; Melvin, T. M.; Harpham, C.; Grudd, H.; Helama, S.

2013-06-01

Exactly dated tree-ring measurements such as ring width (TRW) and maximum latewood density (MXD), which are sensitive to summer temperatures, can provide possible routes to investigate the occurrence of hemispheric-wide cool summers that might be linked to explosive tropical volcanic eruptions. These measurements can provide much longer records than the instrumental period, enabling much longer periods to be assessed and offers the potential to look at much larger eruptions than recorded over the last 200 years. This paper looks at TRW evidence from Northern Fennoscandia extending over the last 7500 years, using two independently produced chronologies from northern Sweden and northern Finland. TRW is less responsive than MXD to cool summer temperatures, but MXD is only available for the last 2000 years. Additionally, looking at a relatively small location, compared to the Northern Hemisphere average, adds considerable noise. Progress in this area is likely to be made by developing more millennial-long TRW series across northern high latitudes or being able to develop MXD series from the sub-fossil material, which comprises most of the samples prior to the last 1000 years. The three most extreme negative values for the region for the last 2000 years are 1601, 542, and 1837, although the latter is not extreme in a long instrumental record for the region. The most extreme year of all occurred in 330BC. Of the 20 most extreme negative years, nine occurred during the AD years with the remaining 11 occurring during the prior 5500 years.

Extreme daily precipitation: the case of Serbia in 2014

NASA Astrophysics Data System (ADS)

Tošić, Ivana; Unkašević, Miroslava; Putniković, Suzana

2017-05-01

The extreme daily precipitation in Serbia was examined at 16 stations during the period 1961-2014. Two synoptic situations in May and September of 2014 were analysed, when extreme precipitation was recorded in western and eastern Serbia, respectively. The synoptic situation from 14 to 16 May 2014 remained nearly stationary over the western and central Serbia for the entire period. On 15 May 2014, the daily rainfall broke previous historical records in Belgrade (109.8 mm), Valjevo (108.2 mm) and Loznica (110 mm). Precipitation exceeded 200 mm in 72 h, producing the most catastrophic floods in the recent history of Serbia. In Negotin (eastern Serbia), daily precipitation of 161.3 mm was registered on 16 September 2014, which was the maximum value recorded during the period 1961-2014. The daily maximum in 2014 was registered at 6 out of 16 stations. The total annual precipitation for 2014 was the highest for the period 1961-2014 at almost all stations in Serbia. A non-significant positive trend was found for all precipitation indices: annual daily maximum precipitation, the total precipitation in consecutive 3 and 5 days, the total annual precipitation, and number of days with at least 10 and 20 mm of precipitation. The generalised extreme value distribution was fitted to the annual daily maximum precipitation. The estimated 100-year return levels were 123.4 and 147.4 mm for the annual daily maximum precipitation in Belgrade and Negotin, respectively.

Mandatory Closure Versus Nonintervention for Patent Ductus Arteriosus in Very Preterm Infants.

PubMed

Sung, Se In; Chang, Yun Sil; Chun, Ji Young; Yoon, Shin Ae; Yoo, Hye Soo; Ahn, So Yoon; Park, Won Soon

2016-10-01

To determine whether a nonintervention approach for treating hemodynamically significant patent ductus arteriosus (PDA) is associated with decreased mortality and/or morbidity compared with a mandatory closure approach in extremely low birth weight infants. We reviewed the medical records of 178 infants of 23-26 weeks' gestational age with PDA, requiring ventilator treatment, and with hemodynamically significant PDA ≥2 mm in size. Mandatory closure was used during period I (July 2009 to December 2011, n = 81), and nonintervention was used during period II (January 2012 to June 2014, n = 97). During period I, 64% of infants were first treated with indomethacin, and 82% were ultimately ligated surgically. During period II, no infant was treated with indomethacin and/or ligation. The average postnatal day of PDA closure was day 13 and day 44 during periods I and II, respectively. There was significantly more use of diuretics and fluid restriction during period II compared with period I. There was no difference in mortality or morbidities such as necrotizing enterocolitis or intraventricular hemorrhage. The incidence of bronchopulmonary dysplasia (BPD) and the propensity score adjusted OR of BPD were significantly lower during period II compared with period I. Despite longer PDA exposure, nonintervention was associated with significantly less BPD compared with mandatory closure. Additional study is warranted to determine the benefits and risks of non-intervention for the hemodynamically significant PDA in extremely low birth weight infants. Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.

Bleeding and starving: fasting and delayed refeeding after upper gastrointestinal bleeding.

PubMed

Fonseca, Jorge; Meira, Tânia; Nunes, Ana; Santos, Carla Adriana

2014-01-01

Early refeeding after nonvariceal upper gastrointestinal bleeding is safe and reduces hospital stay/costs. The aim of this study was obtaining objective data on refeeding after nonvariceal upper gastrointestinal bleeding. From 1 year span records of nonvariceal upper gastrointestinal bleeding patients that underwent urgent endoscopy: clinical features; rockall score; endoscopic data, including severity of lesions and therapy; feeding related records of seven days: liquid diet prescription, first liquid intake, soft/solid diet prescription, first soft/solid intake. From 133 patients (84 men) Rockall classification was possible in 126: 76 score ≥5, 50 score <5. One persistent bleeding, eight rebled, two underwent surgery, 13 died. Ulcer was the major bleeding cause, 63 patients underwent endoscopic therapy. There was 142/532 possible refeeding records, no record 37% patients. Only 16% were fed during the first day and half were only fed on third day or later. Rockall <5 patients started oral diet sooner than Rockall ≥5. Patients that underwent endoscopic therapy were refed earlier than those without endotherapy. Most feeding records are missing. Data reveals delayed refeeding, especially in patients with low-risk lesions who should have been fed immediately. Nonvariceal upper gastrointestinal bleeding patients must be refed earlier, according to guidelines.

Automated extraction of clinical traits of multiple sclerosis in electronic medical records

PubMed Central

Davis, Mary F; Sriram, Subramaniam; Bush, William S; Denny, Joshua C; Haines, Jonathan L

2013-01-01

Objectives The clinical course of multiple sclerosis (MS) is highly variable, and research data collection is costly and time consuming. We evaluated natural language processing techniques applied to electronic medical records (EMR) to identify MS patients and the key clinical traits of their disease course. Materials and methods We used four algorithms based on ICD-9 codes, text keywords, and medications to identify individuals with MS from a de-identified, research version of the EMR at Vanderbilt University. Using a training dataset of the records of 899 individuals, algorithms were constructed to identify and extract detailed information regarding the clinical course of MS from the text of the medical records, including clinical subtype, presence of oligoclonal bands, year of diagnosis, year and origin of first symptom, Expanded Disability Status Scale (EDSS) scores, timed 25-foot walk scores, and MS medications. Algorithms were evaluated on a test set validated by two independent reviewers. Results We identified 5789 individuals with MS. For all clinical traits extracted, precision was at least 87% and specificity was greater than 80%. Recall values for clinical subtype, EDSS scores, and timed 25-foot walk scores were greater than 80%. Discussion and conclusion This collection of clinical data represents one of the largest databases of detailed, clinical traits available for research on MS. This work demonstrates that detailed clinical information is recorded in the EMR and can be extracted for research purposes with high reliability. PMID:24148554

The prevalence of premature ejaculation and its clinical characteristics in Korean men according to different definitions.

PubMed

Lee, S W; Lee, J H; Sung, H H; Park, H J; Park, J K; Choi, S K; Kam, S C

2013-01-01

This study compared the prevalence of premature ejaculation (PE) diagnosed by the PE diagnostic tool (PEDT) score, self-reporting and stopwatch-recorded intravaginal ejaculation latency time (IELT). It examined the characteristics of males diagnosed with PE by each criterion. A questionnaire survey enrolled 2081 subjects from March to October, 2010. Stopwatch-recorded IELT was measured in 1035 of the 2081 subjects. We aimed to determine whether PE has an influence on the frequency and satisfaction of sexual intercourse, the degree of libido/erectile function and the satisfaction. These factors were evaluated according to different definitions of PE to assess whether the definition used yielded differences in the data. The prevalence of PE, based on a PEDT score of ≥11, self-reporting and stopwatch-recorded IELT of ≤1 min was 11.3%, 19.5% and 3%, respectively. The prevalence of PE diagnoses based on PEDT score and self-reporting increased with age, but stopwatch-recorded IELT-based diagnoses did not. Males experiencing PE showed lower levels of libido, erectile function and frequency and satisfaction of sexual intercourse compared with non-PE males. PE males felt that they did not satisfy their partners in terms of the partners' sexual satisfaction and frequency of orgasm, in comparison with non-PE males. PE is a highly prevalent sexual dysfunction in males. Regardless of whether the PE diagnosis was made on the basis of self-reporting, PEDT score or stopwatch-recorded IELT, subjective symptoms were similar among PE males.

The emotional importance of key: do Beatles songs written in different keys convey different emotional tones?

PubMed

Whissel, R; Whissel, C

2000-12-01

Lyrics from 155 songs written by the Lennon-McCartney team were scored using the Dictionary of Affect in Language. Resultant scores (pleasantness, activation, and imagery of words) were compared across key signatures using one way analyses of variance. Words from songs written in minor keys were less pleasant and less active than those from songs written in major keys. Words from songs written in the key of F scored extremely low on all three measures. Lyrics from the keys of C, D, and G were relatively active in tone. Results from Dictionary scoring were compared with assignments of character to keys made more than one century ago and with current musicians' opinions.

To the fringe and back: Violent extremism and the psychology of deviance.

PubMed

Kruglanski, Arie W; Jasko, Katarzyna; Chernikova, Marina; Dugas, Michelle; Webber, David

2017-04-01

We outline a general psychological theory of extremism and apply it to the special case of violent extremism (VE). Extremism is defined as motivated deviance from general behavioral norms and is assumed to stem from a shift from a balanced satisfaction of basic human needs afforded by moderation to a motivational imbalance wherein a given need dominates the others. Because motivational imbalance is difficult to sustain, only few individuals do, rendering extreme behavior relatively rare, hence deviant. Thus, individual dynamics translate into social patterns wherein majorities of individuals practice moderation, whereas extremism is the province of the few. Both extremism and moderation require the ability to successfully carry out the activities that these demand. Ability is partially determined by the activities' difficulty, controllable in part by external agents who promote or oppose extremism. Application of this general framework to VE identifies the specific need that animates it and offers broad guidelines for addressing this pernicious phenomenon. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Utilization of a novel digital measurement tool for quantitative assessment of upper extremity motor dexterity: a controlled pilot study.

PubMed

Getachew, Ruth; Lee, Sunghoon I; Kimball, Jon A; Yew, Andrew Y; Lu, Derek S; Li, Charles H; Garst, Jordan H; Ghalehsari, Nima; Paak, Brian H; Razaghy, Mehrdad; Espinal, Marie; Ostowari, Arsha; Ghavamrezaii, Amir A; Pourtaheri, Sahar; Wu, Irene; Sarrafzadeh, Majid; Lu, Daniel C

2014-08-13

The current methods of assessing motor function rely primarily on the clinician's judgment of the patient's physical examination and the patient's self-administered surveys. Recently, computerized handgrip tools have been designed as an objective method to quantify upper-extremity motor function. This pilot study explores the use of the MediSens handgrip as a potential clinical tool for objectively assessing the motor function of the hand. Eleven patients with cervical spondylotic myelopathy (CSM) were followed for three months. Eighteen age-matched healthy participants were followed for two months. The neuromotor function and the patient-perceived motor function of these patients were assessed with the MediSens device and the Oswestry Disability Index respectively. The MediSens device utilized a target tracking test to investigate the neuromotor capacity of the participants. The mean absolute error (MAE) between the target curve and the curve tracing achieved by the participants was used as the assessment metric. The patients' adjusted MediSens MAE scores were then compared to the controls. The CSM patients were further classified as either "functional" or "nonfunctional" in order to validate the system's responsiveness. Finally, the correlation between the MediSens MAE score and the ODI score was investigated. The control participants had lower MediSens MAE scores of 8.09%±1.60%, while the cervical spinal disorder patients had greater MediSens MAE scores of 11.24%±6.29%. Following surgery, the functional CSM patients had an average MediSens MAE score of 7.13%±1.60%, while the nonfunctional CSM patients had an average score of 12.41%±6.32%. The MediSens MAE and the ODI scores showed a statistically significant correlation (r=-0.341, p<1.14×10⁻⁵). A Bland-Altman plot was then used to validate the agreement between the two scores. Furthermore, the percentage improvement of the the two scores after receiving the surgical intervention showed a significant correlation (r=-0.723, p<0.04). The MediSens handgrip device is capable of identifying patients with impaired motor function of the hand. The MediSens handgrip scores correlate with the ODI scores and may serve as an objective alternative for assessing motor function of the hand.

Assessing storm events for energy meteorology: using media and scientific reports to track a North Sea autumn storm.

NASA Astrophysics Data System (ADS)

Kettle, Anthony

2016-04-01

Important issues for energy meteorology are to assess meteorological conditions for normal operating conditions and extreme events for the ultimate limit state of engineering structures. For the offshore environment in northwest Europe, energy meteorology encompasses weather conditions relevant for petroleum production infrastructure and also the new field of offshore wind energy production. Autumn and winter storms are an important issue for offshore operations in the North Sea. The weather in this region is considered as challenging for extreme meteorological events as the Gulf of Mexico with its attendant hurricane risk. The rise of the Internet and proliferation of digital recording devices has placed a much greater amount of information in the public domain than was available to national meteorological agencies even 20 years ago. This contribution looks at reports of meteorology and infrastructure damage from a storm in the autumn of 2006 to trace the spatial and temporal record of meteorological events. Media reports give key information to assess the events of the storm. The storm passed over northern Europe between Oct.31-Nov. 2, 2006, and press reports from the time indicate that its most important feature was a high surge that inundated coastal areas. Sections of the Dutch and German North Sea coast were affected, and there was record flooding in Denmark and East Germany in the southern Baltic Sea. Extreme wind gusts were also reported that were strong enough to damage roofs and trees, and there was even tornado recorded near the Dutch-German border. Offshore, there were a series of damage reports from ship and platforms that were linked with sea state, and reports of rogue waves were explicitly mentioned. Many regional government authorities published summaries of geophysical information related to the storm, and these form part of a regular series of online winter storm reports that started as a public service about 15 years ago. Depending on the issuing authority, these reports include wind speed and atmospheric pressure for a number of stations. However, there is also important ancillary information that includes satellite images, weather radar pictures, sea state recordings, tide gauge records, and coastal surveys. When collated together, the literature survey gives good view of events related to the autumn storm. The key information from media reports is backed up by quantitative numbers from the scientific literature. For energy meteorology in the offshore environment, there is an outline of extreme wave events that may be important to help define the ultimate limit state of engineering structures and the return periods of extreme waves. While this contribution focusses on events from an old storm in the autumn of 2006, more severe regional storms have occurred since then, and the scientific literature indicates that these may be linked with climate warming. Literature surveys may help to fully define extreme meteorological conditions offshore and benefit different branches of the energy industry in Europe.

Validity of GRE General Test Scores and TOEFL Scores for Graduate Admission to a Technical University in Western Europe

ERIC Educational Resources Information Center

Zimmermann, Judith; von Davier, Alina A.; Buhmann, Joachim M.; Heinimann, Hans R.

2018-01-01

Graduate admission has become a critical process in tertiary education, whereby selecting valid admissions instruments is key. This study assessed the validity of Graduate Record Examination (GRE) General Test scores for admission to Master's programmes at a technical university in Europe. We investigated the indicative value of GRE scores for the…

Traditional plants used for the treatment of diabetes mellitus in Sursagar constituency, Jodhpur, Rajasthan - An ethnomedicinal survey.

PubMed

Goyal, Manoj

2015-11-04

In Jodhpur, large number of people suffering with non-insulin dependent diabetes mellitus (type 2 diabetes). They are using medicinal plants along with modern medicine for the management of diabetes. The aim of this work is to document the anti-diabetic plants and determine the most relevant anti-diabetic plant species using the Disease Consensus Index. Ethnomedicinal survey was conducted for selection of anti-diabetic plant. Structured questionnaire was developed for calculation of Disease Consensus Index and administered to fifty Type 2 diabetic patients for recording their response. Twenty-one species of anti-diabetic plants were recorded, Momordica charantia (score: 0.71), Azadirachta indica (score: 0.64), Trigonella foenum-graecum (score: 0.63), Capparis decidua (score: 0.60), Withania coagulans (score: 0.54), Gymnema sylvestre (score: 0.52) and Syzygium cumini (score: 0.51) were the most significant anti-diabetic plants of the area of study, having DCI more than 0.5. Use of anti-diabetic plants is prevalent diabetic patients of the area. C. decidua, W. coagulans and G. sylvestre are recommend the further phytochemical and pharmacological investigation due to high DCI score and relatively unexplored status. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Behavioral Outcomes of Extremely Low Birth Weight Children at Age 8 Years

PubMed Central

Hack, Maureen; Taylor, Hudson G.; Schluchter, Mark; Andreias, Laura; Drotar, Dennis; Klein, Nancy

2011-01-01

Objective To describe the prevalence of behavioral problems and symptomatology suggestive of Autism and Asperger’s disorders at age 8 years among extremely low birth weight (ELBW, <1 kg) children, born 1992 through 1995. Method Parent reports of the behavior of 219 ELBW (mean birth weight, 810 g; gestational age 26 weeks) were compared with 176 normal birth weight children of similar maternal sociodemographic status, sex, and age. Behavior was assessed via the Child Symptom Inventory that includes both Symptom Severity Scores and scores meeting DSM-IV criteria for disorders. Results ELBW compared with normal birth weight children had significantly higher mean Symptom Severity Scores for the inattentive, hyperactive, and combined types of attention-deficit hyperactivity disorder (all p < .001) as well as higher scores for Generalized Anxiety (p < .01) and Autistic (p < .001) and Asperger’s (p < .01) disorders. When DSM-IV criteria were considered, ELBW children also had significantly higher rates of attention-deficit hyperactivity disorder of the inattentive (10% vs 3%, p < .01) and combined (5% vs 0.6%, p < .05) types. Conclusions Attention-deficit hyperactivity disorder, mainly the inattentive type is prevalent among ELBW children. Our findings of an increase in symptoms pertaining to Autistic and Asperger’s disorders at school age agree with recent reports of others during early childhood. Early identification and intervention for these problems might improve child functioning and ameliorate parent and child distress. PMID:19322106

Malnutrition in school children in an urban-rural region of the extreme South of São Paulo city.

PubMed

Pandolfi, Marcela Maria; Sandrini, Fabio; Oliveira, Maurício Rocco de; Armond, Jane de Eston; Zöllner, Ana Cristina Ribeiro; Juliano, Yara; Souza, Patrícia Colombo de

2011-12-01

To evaluate the persistence of nutritional deficit in a sample of schoolchildren. A cross-sectional study of 1,761 schoolchildren between 6 and 10 years from 3 schools. They were assessed by Z scores of weight for height and height for age, according to the World Health Organization. The variables studied were gender, age, grade and school year. The χ² test was used to relate the nutritional deficit with the variables. Of all children 8.5% were malnourished according to the weight for height Z score, 21.6%, according to height for age. The analysis of the weight for height Z score revealed that 59.7% were male and 40.3% female. The mean age was 8.9 years. As to the Z score of height for age, 53.9% were males and 46.1% females. The risk of malnutrition was higher among boys: 59.7% for the weight for height index and 53.9% for height for age. There was no statistical difference between schools, gender and school year. As to nutritional status, school period (p < 0.0001) and students' grade (p = 0.0105), we observed statistical significance. Malnutrition still persists among the low-income population and males had a higher percentage of malnutrition. Nutritional evaluation of students is an extremely important tool for understanding the dynamics of child nutrition and development.

PROMIS Physical Function Computer Adaptive Test Compared With Other Upper Extremity Outcome Measures in the Evaluation of Proximal Humerus Fractures in Patients Older Than 60 Years.

PubMed

Morgan, Jordan H; Kallen, Michael A; Okike, Kanu; Lee, Olivia C; Vrahas, Mark S

2015-06-01

To compare the PROMIS Physical Function Computer Adaptive Test (PROMIS PF CAT) to commonly used traditional PF measures for the evaluation of patients with proximal humerus fractures. Prospective. Two Level I trauma centers. Forty-seven patients older than 60 years with displaced proximal humerus fractures treated between 2006 and 2009. Evaluation included completion of the PROMIS PF CAT, the Constant Shoulder Score, the Disabilities of the Arm, Shoulder, and Hand (DASH) and the Short Musculoskeletal Functional Assessment (SMFA). Observed correlations among the administered PF outcome measures. On average, patients responded to 86 outcome-related items for this study: 4 for the PROMIS PF CAT (range: 4-8 items), 6 for the Constant Shoulder Score, 30 for the DASH, and 46 for the SMFA. Time to complete the PROMIS PF CAT (median completion time = 98 seconds) was significantly less than that for the DASH (median completion time = 336 seconds, P < 0.001) and for the SMFA (median completion time = 482 seconds, P < 0.001). PROMIS PF CAT scores correlated statistically significantly and were of moderate-to-high magnitude with all other PF outcome measure scores administered. This study suggests using the PROMIS PF CAT as a sole PF outcome measure can yield an assessment of upper extremity function similar to those provided by traditional PF measures, while substantially reducing patient assessment time.

The Automated Assessment of Postural Stability: Balance Detection Algorithm.

PubMed

Napoli, Alessandro; Glass, Stephen M; Tucker, Carole; Obeid, Iyad

2017-12-01

Impaired balance is a common indicator of mild traumatic brain injury, concussion and musculoskeletal injury. Given the clinical relevance of such injuries, especially in military settings, it is paramount to develop more accurate and reliable on-field evaluation tools. This work presents the design and implementation of the automated assessment of postural stability (AAPS) system, for on-field evaluations following concussion. The AAPS is a computer system, based on inexpensive off-the-shelf components and custom software, that aims to automatically and reliably evaluate balance deficits, by replicating a known on-field clinical test, namely, the Balance Error Scoring System (BESS). The AAPS main innovation is its balance error detection algorithm that has been designed to acquire data from a Microsoft Kinect ® sensor and convert them into clinically-relevant BESS scores, using the same detection criteria defined by the original BESS test. In order to assess the AAPS balance evaluation capability, a total of 15 healthy subjects (7 male, 8 female) were required to perform the BESS test, while simultaneously being tracked by a Kinect 2.0 sensor and a professional-grade motion capture system (Qualisys AB, Gothenburg, Sweden). High definition videos with BESS trials were scored off-line by three experienced observers for reference scores. AAPS performance was assessed by comparing the AAPS automated scores to those derived by three experienced observers. Our results show that the AAPS error detection algorithm presented here can accurately and precisely detect balance deficits with performance levels that are comparable to those of experienced medical personnel. Specifically, agreement levels between the AAPS algorithm and the human average BESS scores ranging between 87.9% (single-leg on foam) and 99.8% (double-leg on firm ground) were detected. Moreover, statistically significant differences in balance scores were not detected by an ANOVA test with alpha equal to 0.05. Despite some level of disagreement between human and AAPS-generated scores, the use of an automated system yields important advantages over currently available human-based alternatives. These results underscore the value of using the AAPS, that can be quickly deployed in the field and/or in outdoor settings with minimal set-up time. Finally, the AAPS can record multiple error types and their time course with extremely high temporal resolution. These features are not achievable by humans, who cannot keep track of multiple balance errors with such a high resolution. Together, these results suggest that computerized BESS calculation may provide more accurate and consistent measures of balance than those derived from human experts.

Effect of a Task-Oriented Rehabilitation Program on Upper Extremity Recovery Following Motor Stroke: The ICARE Randomized Clinical Trial.

PubMed

Winstein, Carolee J; Wolf, Steven L; Dromerick, Alexander W; Lane, Christianne J; Nelsen, Monica A; Lewthwaite, Rebecca; Cen, Steven Yong; Azen, Stanley P

2016-02-09

Clinical trials suggest that higher doses of task-oriented training are superior to current clinical practice for patients with stroke with upper extremity motor deficits. To compare the efficacy of a structured, task-oriented motor training program vs usual and customary occupational therapy (UCC) during stroke rehabilitation. Phase 3, pragmatic, single-blind randomized trial among 361 participants with moderate motor impairment recruited from 7 US hospitals over 44 months, treated in the outpatient setting from June 2009 to March 2014. Structured, task-oriented upper extremity training (Accelerated Skill Acquisition Program [ASAP]; n = 119); dose-equivalent occupational therapy (DEUCC; n = 120); or monitoring-only occupational therapy (UCC; n = 122). The DEUCC group was prescribed 30 one-hour sessions over 10 weeks; the UCC group was only monitored, without specification of dose. The primary outcome was 12-month change in log-transformed Wolf Motor Function Test time score (WMFT, consisting of a mean of 15 timed arm movements and hand dexterity tasks). Secondary outcomes were change in WMFT time score (minimal clinically important difference [MCID] = 19 seconds) and proportion of patients improving ≥25 points on the Stroke Impact Scale (SIS) hand function score (MCID = 17.8 points). Among the 361 randomized patients (mean age, 60.7 years; 56% men; 42% African American; mean time since stroke onset, 46 days), 304 (84%) completed the 12-month primary outcome assessment; in intention-to-treat analysis, mean group change scores (log WMFT, baseline to 12 months) were, for the ASAP group, 2.2 to 1.4 (difference, 0.82); DEUCC group, 2.0 to 1.2 (difference, 0.84); and UCC group, 2.1 to 1.4 (difference, 0.75), with no significant between-group differences (ASAP vs DEUCC: 0.14; 95% CI, -0.05 to 0.33; P = .16; ASAP vs UCC: -0.01; 95% CI, -0.22 to 0.21; P = .94; and DEUCC vs UCC: -0.14; 95% CI, -0.32 to 0.05; P = .15). Secondary outcomes for the ASAP group were WMFT change score, -8.8 seconds, and improved SIS, 73%; DEUCC group, WMFT, -8.1 seconds, and SIS, 72%; and UCC group, WMFT, -7.2 seconds, and SIS, 69%, with no significant pairwise between-group differences (ASAP vs DEUCC: WMFT, 1.8 seconds; 95% CI, -0.8 to 4.5 seconds; P = .18; improved SIS, 1%; 95% CI, -12% to 13%; P = .54; ASAP vs UCC: WMFT, -0.6 seconds, 95% CI, -3.8 to 2.6 seconds; P = .72; improved SIS, 4%; 95% CI, -9% to 16%; P = .48; and DEUCC vs UCC: WMFT, -2.1 seconds; 95% CI, -4.5 to 0.3 seconds; P = .08; improved SIS, 3%; 95% CI, -9% to 15%; P = .22). A total of 168 serious adverse events occurred in 109 participants, resulting in 8 patients withdrawing from the study. Among patients with motor stroke and primarily moderate upper extremity impairment, use of a structured, task-oriented rehabilitation program did not significantly improve motor function or recovery beyond either an equivalent or a lower dose of UCC upper extremity rehabilitation. These findings do not support superiority of this program among patients with motor stroke and primarily moderate upper extremity impairment. clinicaltrials.gov Identifier: NCT00871715.

Effect of a Task-Oriented Rehabilitation Program on Upper Extremity Recovery Following Motor Stroke

PubMed Central

Winstein, Carolee J.; Wolf, Steven L.; Dromerick, Alexander W.; Lane, Christianne J.; Nelsen, Monica A.; Lewthwaite, Rebecca; Cen, Steven Yong; Azen, Stanley P.

2016-01-01

IMPORTANCE Clinical trials suggest that higher doses of task-oriented training are superior to current clinical practice for patients with stroke with upper extremity motor deficits. OBJECTIVE To compare the efficacy of a structured, task-oriented motor training program vs usual and customary occupational therapy (UCC) during stroke rehabilitation. DESIGN, SETTING, AND PARTICIPANTS Phase 3, pragmatic, single-blind randomized trial among 361 participants with moderate motor impairment recruited from 7 US hospitals over 44 months, treated in the outpatient setting from June 2009 to March 2014. INTERVENTIONS Structured, task-oriented upper extremity training (Accelerated Skill Acquisition Program[ASAP]; n = 119); dose-equivalent occupational therapy (DEUCC; n = 120); or monitoring-only occupational therapy (UCC; n = 122). The DEUCC group was prescribed 30 one-hour sessions over 10 weeks; the UCC group was only monitored, without specification of dose. MAIN OUTCOMES AND MEASURES The primary outcome was 12-month change in log-transformed Wolf Motor Function Test time score (WMFT, consisting of a mean of 15 timed arm movements and hand dexterity tasks). Secondary outcomes were change in WMFT time score (minimal clinically important difference [MCID] = 19 seconds) and proportion of patients improving ≥25 points on the Stroke Impact Scale (SIS) hand function score (MCID = 17.8 points). RESULTS Among the 361 randomized patients (mean age, 60.7 years; 56% men; 42% African American; mean time since stroke onset, 46 days), 304 (84%) completed the 12-month primary outcome assessment; in intention-to-treat analysis, mean group change scores (log WMFT, baseline to 12 months) were, for the ASAP group, 2.2 to 1.4 (difference, 0.82); DEUCC group, 2.0 to 1.2 (difference, 0.84); and UCC group, 2.1 to 1.4 (difference, 0.75), with no significant between-group differences (ASAP vs DEUCC:0.14; 95% CI, −0.05 to 0.33; P = .16; ASAP vs UCC: −0.01; 95% CI, −0.22 to 0.21; P = .94; and DEUCC vs UCC: −0.14; 95% CI, −0.32 to 0.05; P = .15). Secondary outcomes for the ASAP group were WMFT change score, −8.8 seconds, and improved SIS, 73%; DEUCC group, WMFT, −8.1 seconds, and SIS, 72%; and UCC group, WMFT, −7.2 seconds, and SIS, 69%, with no significant pairwise between-group differences (ASAP vs DEUCC: WMFT, 1.8 seconds; 95% CI, −0.8 to 4.5 seconds; P = .18; improved SIS, 1%; 95% CI, −12% to 13%; P = .54; ASAP vs UCC: WMFT, −0.6 seconds, 95% CI, −3.8 to 2.6 seconds; P = .72; improved SIS, 4%; 95% CI, −9% to 16%; P = .48; and DEUCC vs UCC: WMFT, −2.1 seconds; 95% CI, −4.5 to 0.3 seconds; P = .08; improved SIS, 3%; 95% CI, −9% to 15%; P = .22). A total of 168 serious adverse events occurred in 109 participants, resulting in 8 patients withdrawing from the study. CONCLUSIONS AND RELEVANCE Among patients with motor stroke and primarily moderate upper extremity impairment, use of a structured, task-oriented rehabilitation program did not significantly improve motor function or recovery beyond either an equivalent or a lower dose of UCC upper extremity rehabilitation. These findings do not support superiority of this program among patients with motor stroke and primarily moderate upper extremity impairment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00871715 PMID:26864411

Drought analysis in the Tons River Basin, India during 1969-2008

NASA Astrophysics Data System (ADS)

Meshram, Sarita Gajbhiye; Gautam, Randhir; Kahya, Ercan

2018-05-01

The primary focus of this study is the analysis of droughts in the Tons River Basin during the period 1969-2008. Precipitation data observed at four gauging stations are used to identify drought over the study area. The event of drought is derived from the standardized precipitation index (SPI) on a 3-month scale. Our results indicated that severe drought occurred in the Allahabad, Rewa, and Satna stations in the years 1973 and 1979. The droughts in this region had occurred mainly due to erratic behavior in monsoons, especially due to long breaks between monsoons. During the drought years, the deficiency of the annual rainfall in the analysis of annual rainfall departure had varied from -26% in 1976 to -60% in 1973 at Allahabad station in the basin. The maximum deficiency of annual and seasonal rainfall recorded in the basin is 60%. The maximum seasonal rainfall departure observed in the basin is in the order of -60% at Allahabad station in 1973, while maximum annual rainfall departure had been recorded as -60% during 1979 at the Satna station. Extreme dry events ( z score <-2) were detected during July, August, and September. Moreover, severe dry events were observed in August, September, and October. The drought conditions in the Tons River Basin are dominantly driven by total rainfall throughout the period between June and November.

Convergence between observations and interviews in clinical diagnosis of reactive attachment disorder and disinhibited social engagement disorder.

PubMed

Giltaij, Hans Peter; Sterkenburg, Paula Sophia; Schuengel, Carlo

2017-10-01

A comprehensive approach is needed for diagnosing disordered attachment behavior due to the multifaceted nature of attachment. Differences between various indicators can pose a challenge for deciding on the proper diagnosis. This study assessed the convergence between clinical interview assessment and observation-based clinical diagnosis, and their linkages with inadequate care. Participating children ( N = 55) had intelligence quotients (IQs) between 50 and 85 and were referred for psychiatric consultation. Data were obtained by structured review of medical records, the Disturbances of Attachment Interview (DAI), and the Clinical Observation of Attachment (COA) procedure. Of the 18 children identified using the DAI with Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) diagnosis of reactive attachment disorder (RAD) and/or disinhibited social engagement disorder (DSED), only 7 received a clinical DSM-5 diagnosis of RAD and/or DSED. Observed maladaptive attachment behavior in the COA was strongly associated with DAI scores and with clinical diagnosis of DSM-5 RAD and/or DSED. There was a significantly higher prevalence of extremes of insufficient care in children who were classified with RAD by DAI or DSM-5 and/or with DSED by DSM-5 compared to those with no attachment disorder. Using structured observation and record assessment leads to more conservative identification of RAD or DSED than using the DAI.

Validation of use of subsets of teeth when applying the total mouth periodontal score (TMPS) system in dogs.

PubMed

Harvey, Colin E; Laster, Larry; Shofer, Frances S

2012-01-01

A total mouth periodontal score (TMPS) system in dogs has been described previously. Use of buccal and palatal/lingual surfaces of all teeth requires observation and recording of 120 gingivitis scores and 120 periodontitis scores. Although the result is a reliable, repeatable assessment of the extent of periodontal disease in the mouth, observing and recording 240 data points is time-consuming. Using data from a previously reported study of periodontal disease in dogs, correlation analysis was used to determine whether use of any of seven different subsets of teeth can generate TMPS subset gingivitis and periodontitis scores that are highly correlated with TMPS all-site, all-teeth scores. Overall, gingivitis scores were less highly correlated than periodontitis scores. The minimal tooth set with a significant intra-class correlation (> or = 0.9 of means of right and left sides) for both gingivitis scores and attachment loss measurements consisted of the buccal surface of the maxillary third incisor canine, third premolar fourth premolar; and first molar teeth; and, the mandibular canine, third premolar, fourth premolar and first molar teeth on one side (9 teeth, 15 root sites). Use of this subset of teeth, which reduces the number of data points per dog from 240 to 30 for gingivitis and periodontitis at each scoring episode, is recommended when calculating the gingivitis and periodontitis scores using the TMPS system.

Tract-Specific Diffusion Tensor Imaging Reveals Laterality of Neurological Symptoms in Patients with Cervical Compression Myelopathy.

PubMed

Maki, Satoshi; Koda, Masao; Saito, Junya; Takahashi, Sho; Inada, Taigo; Kamiya, Koshiro; Ota, Mitsutoshi; Iijima, Yasushi; Masuda, Yoshitada; Matsumoto, Koji; Kojima, Masatoshi; Takahashi, Kazuhisa; Obata, Takayuki; Yamazaki, Masashi; Furuya, Takeo

2016-12-01

Patients with cervical compression myelopathy (CCM) generally present bilateral neurological symptoms in their extremities. However, a substantial portion of patients with CCM exhibit laterality of neurological symptoms. The aim of this study was to assess the correlation between intrinsic structural damage and laterality of symptoms using spinal cord diffusion tensor imaging (DTI) of the corticospinal tract. We enrolled 10 healthy volunteers and 40 patients with CCM in this study. We evaluated motor function using the American Spinal Injury Association (ASIA) motor score for left and right extremities. For DTI acquisitions, a 3.0-T magnetic resonance imaging system with diffusion-weighted spin-echo sequence was used. Regions-of-interest in the lateral column tracts were determined. We determined the correlations between fractional anisotropy (FA) and ASIA motor scores. An FA asymmetry index was calculated using left and right regions-of-interest. Four patients exhibited laterality of symptoms in their extremities, for which left and right ASIA scores correlated moderately with FA in the left and right lateral columns, respectively (left: ρ = 0.64, P < 0.001; right: ρ = 0.67, P < 0.001). The area under the receiver-operator characteristic curve showed that the FA asymmetry index indicated laterality of symptoms. Using tract-specific DTI, we demonstrated that microstructural damages in the left and right corticospinal tracts correlated with corresponding neurological symptoms in the ipsilateral side and the FA asymmetry index could indicate laterality in neurological symptoms of patients with CCM. Copyright © 2016 Elsevier Inc. All rights reserved.

Correlates of depression, anxiety and stress among Malaysian university students.

PubMed

Shamsuddin, Khadijah; Fadzil, Fariza; Ismail, Wan Salwina Wan; Shah, Shamsul Azhar; Omar, Khairani; Muhammad, Noor Azimah; Jaffar, Aida; Ismail, Aniza; Mahadevan, Raynuha

2013-08-01

University students face not only challenges related with independent living, but also academic challenges. This predisposes them to depression, anxiety and stress, which are fairly common. The aim was to assess the prevalence of depression, anxiety and stress, and identify their correlates among university students. A cross-sectional study was conducted on 506 students between the ages of 18 and 24 years from four public universities in the Klang Valley, Malaysia. Through an anonymous, self administered questionnaire, they were assessed by the Depression Anxiety Stress Scale-21 (DASS-21). Data on socio-demographic, family characteristics and living arrangement were also obtained. Student's t-test and one-way ANOVA were used to explore association between these aspects. Analysis showed among all students, 27.5% had moderate, and 9.7% had severe or extremely severe depression; 34% had moderate, and 29% had severe or extremely severe anxiety; and 18.6% had moderate and 5.1% had severe or extremely severe stress scores based on the DASS-21 inventory. Both depression and anxiety scores were significantly higher among older students (20 and above) and those born in rural areas. Whereas, higher stress scores were significantly higher among older students (20 and above), females, Malays and those whose family had either low or high incomes compared to those with middle incomes. The prevalence of anxiety is much higher than either depression or stress, with some differences in their correlates except for age. These differences need to be further explored for development of better intervention programs and appropriate support services targeting this group. Copyright © 2013 Elsevier B.V. All rights reserved.

Fraternal Birth Order and Extreme Right-Handedness as Predictors of Sexual Orientation and Gender Nonconformity in Men.

PubMed

Kishida, Mariana; Rahman, Qazi

2015-07-01

The present study explored whether there were relationships between number of older brothers, handedness, recalled childhood gender nonconformity (CGN), and sexual orientation in men. We used data from previous British studies conducted in our laboratory (N = 1,011 heterosexual men and 921 gay men). These men had completed measures of demographic variables, number and sex of siblings, CGN, and the Edinburgh Handedness Inventory. The results did not replicate the fraternal birth order effect. However, gay men had fewer "other siblings" than heterosexual men (even after controlling for the stopping-rule and family size). In a sub-sample (425 gay men and 478 heterosexual men) with data available on both sibling sex composition and handedness scores, gay men were found to show a significantly greater likelihood of extreme right-handedness and non-right-handedness compared to heterosexual men. There were no significant effects of sibling sex composition in this sub-sample. In a further sub-sample (N = 487) with data available on sibling sex composition, handedness, and CGN, we found that men with feminine scores on CGN were more extremely right-handed and had fewer other-siblings compared to masculine scoring men. Mediation analysis revealed that handedness was associated with sexual orientation directly and also indirectly through the mediating factor of CGN. We were unable to replicate the fraternal birth order effect in our archived dataset but there was evidence for a relationship among handedness, sexual orientation, and CGN. These data help narrow down the number of possible neurodevelopmental pathways leading to variations in male sexual orientation.

Extreme climatic events drive mammal irruptions: regression analysis of 100-year trends in desert rainfall and temperature

PubMed Central

Greenville, Aaron C; Wardle, Glenda M; Dickman, Chris R

2012-01-01

Extreme climatic events, such as flooding rains, extended decadal droughts and heat waves have been identified increasingly as important regulators of natural populations. Climate models predict that global warming will drive changes in rainfall and increase the frequency and severity of extreme events. Consequently, to anticipate how organisms will respond we need to document how changes in extremes of temperature and rainfall compare to trends in the mean values of these variables and over what spatial scales the patterns are consistent. Using the longest historical weather records available for central Australia – 100 years – and quantile regression methods, we investigate if extreme climate events have changed at similar rates to median events, if annual rainfall has increased in variability, and if the frequency of large rainfall events has increased over this period. Specifically, we compared local (individual weather stations) and regional (Simpson Desert) spatial scales, and quantified trends in median (50th quantile) and extreme weather values (5th, 10th, 90th, and 95th quantiles). We found that median and extreme annual minimum and maximum temperatures have increased at both spatial scales over the past century. Rainfall changes have been inconsistent across the Simpson Desert; individual weather stations showed increases in annual rainfall, increased frequency of large rainfall events or more prolonged droughts, depending on the location. In contrast to our prediction, we found no evidence that intra-annual rainfall had become more variable over time. Using long-term live-trapping records (22 years) of desert small mammals as a case study, we demonstrate that irruptive events are driven by extreme rainfalls (>95th quantile) and that increases in the magnitude and frequency of extreme rainfall events are likely to drive changes in the populations of these species through direct and indirect changes in predation pressure and wildfires. PMID:23170202

Work-related physical and psychosocial risk factors for sick leave in patients with neck or upper extremity complaints

PubMed Central

Terwee, Caroline B.; van der Windt, Daniëlle A. W. M.; van der Beek, Allard J.; Bouter, Lex M.; Dekker, Joost

2007-01-01

Objectives To study work-related physical and psychosocial risk factors for sick leave among patients who have visited their general practitioner for neck or upper extremity complaints. Methods Three hundred and forty two patients with neck or upper extremity complaints completed self-report questionnaires at baseline and after 3 months. Cox regression models were used to investigate the association between work-related risk factors and sick leave (i.e., lost days from work due to neck or upper extremity complaints in 3 months). Effect modification by sick leave at baseline, sex, worrying and musculoskeletal co-morbidity was evaluated by adding product terms to the regression models. Results In the subgroup of patients who scored high on the pain copying scale “worrying” the hazard ratio of sick leave was 1.32 (95% CI 1.07–1.62) per 10% increase in heavy physical work. The subgroup of patients who were sitting for long periods of time had a reduced risk of sick leave as compared to patients who did not spend a lot of time sitting, again only in patients who scored high on the pain coping scale “worrying” (adjusted HR = 0.17, 95%-CI 0.04–0.72). Other work-related risk factors were not significantly related to sick leave. Conclusions Heavy physical work increased the risk of sick leave and prolonged sitting reduced the risk of sick leave in a subgroup of patients who worried much about their pain. Additional large longitudinal studies of sufficiently large size among employees with neck or upper extremity complaints are needed to confirm our results. PMID:17410376

Efficacy of combined treatment with vacuum sealing drainage and recombinant human epidermal growth factor for refractory wounds in the extremities and its effect on serum levels of IL-6, TNF-α and IL-2

PubMed Central

Tan, Lei; Hou, Zhongyu; Gao, Yanzhi

2018-01-01

The objective of this study was to investigate the efficacy of combined treatment with vacuum sealing drainage (VSD) and recombinant human epidermal growth factor (rhEGF) for refractory wounds in the extremities, and its effect on serum levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and IL-2. Ninety-eight patients with refractory wounds in the extremities were recruited and randomly divided into the combined treatment group (underwent VSD and rhEGF treatment) and control group (underwent VSD only) with 49 cases each. Formation of granulation tissue on the wound surface was assessed and scored. The wound healing rate was calculated after 1 week of treatment, and the time of complete healing was recorded. Serum levels of IL-6, IL-2, and TNF-α were measured using enzyme-linked immunosorbent assay. After 1 week of treatment, granulation tissue formation on wound surfaces was significantly improved (p<0.05) compared with that before treatment in both groups. Moreover, granulation tissue formation on wound surfaces was superior in the combined treatment group than in the control group (p<0.05). The wound healing rate was 63.50±4.75% in the combined treatment group and 31.79±3.52% in the control group, and the difference was statistically significant (p<0.05). The time of complete healing was 15.11±2.24 days in the combined treatment group and 19.63±2.76 days in the control group, and the difference was statistically significant (p<0.05). The serum levels of IL-6, IL-2, and TNF-α, in the two groups were significantly lower than those before treatment (p<0.05). Moreover, the levels in the combined treatment group were significantly lower than those in the control group (p<0.05). In conclusion, combined treatment with VSD and rhEGF reduced inflammation and shortened the time of complete healing of refractory wounds in the extremities. Measurement of the levels of related inflammatory factors provided a reference for the prognosis of refractory wounds. PMID:29250151

TRAJECTORY AND CORRELATES OF GROWTH OF EXTREMELY LOW BIRTH WEIGHT ADOLESCENTS

PubMed Central

Hack, Maureen; Schluchter, Mark; Margevicius, Seunghee; Andreias, Laura; Taylor, Gerry; Cuttler, Leona

2014-01-01

Background Catch-up growth may predispose to obesity and metabolic sequelae. We sought to examine the trajectory and correlates of growth and catch-up among extremely low birth weight (ELBW, <1 kg) adolescents. Methods Cohort study of 148 neurologically normal ELBW children and 115 normal birth weight (NBW) controls born 1992 through 1995. Longitudinal measures of gender-specific growth of ELBW children from birth, and growth and measures of obesity of ELBW and NBW children at 14 years. Results Following neonatal growth failure, ELBW children had accelerated growth, but at 8 years they still had lower weight and height z scores than NBW children. By 14 years ELBW boys had caught up in growth to their NBW controls but ELBW girls remained significantly smaller. ELBW children however did not differ from their controls in measures of obesity. In hierarchical multiple regression analyses only maternal BMI and weight gain during infancy and childhood predicted the ELBW children’s 14-year weight z scores, BMI z scores and abdominal circumference. Perinatal risk factors including intrauterine growth only predicted growth up to 20 months. Conclusion Maternal BMI and rate of growth, rather than perinatal factors, predict 14-year obesity among neurologically normal ELBW adolescents. PMID:24216539

Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer.

PubMed

Ramsey, Scott D; Bansal, Aasthaa; Fedorenko, Catherine R; Blough, David K; Overstreet, Karen A; Shankaran, Veena; Newcomb, Polly

2016-03-20

Patients with cancer are more likely to file for bankruptcy than the general population, but the impact of severe financial distress on health outcomes among patients with cancer is not known. We linked Western Washington SEER Cancer Registry records with federal bankruptcy records for the region. By using propensity score matching to account for differences in several demographic and clinical factors between patients who did and did not file for bankruptcy, we then fit Cox proportional hazards models to examine the relationship between bankruptcy filing and survival. Between 1995 and 2009, 231,596 persons were diagnosed with cancer. Patients who filed for bankruptcy (n = 4,728) were more likely to be younger, female, and nonwhite, to have local- or regional- (v distant-) stage disease at diagnosis, and have received treatment. After propensity score matching, 3,841 patients remained in each group (bankruptcy v no bankruptcy). In the matched sample, mean age was 53.0 years, 54% were men, mean income was $49,000, and majorities were white (86%), married (60%), and urban (91%) and had local- or regional-stage disease at diagnosis (84%). Both groups received similar initial treatments. The adjusted hazard ratio for mortality among patients with cancer who filed for bankruptcy versus those who did not was 1.79 (95% CI, 1.64 to 1.96). Hazard ratios varied by cancer type: colorectal, prostate, and thyroid cancers had the highest hazard ratios. Excluding patients with distant-stage disease from the models did not have an effect on results. Severe financial distress requiring bankruptcy protection after cancer diagnosis appears to be a risk factor for mortality. Further research is needed to understand the process by which extreme financial distress influences survival after cancer diagnosis and to find strategies that could mitigate this risk. © 2016 by American Society of Clinical Oncology.

Individual and community level risk-factors for alcohol use disorder among conflict-affected persons in Georgia.

PubMed

Roberts, Bayard; Murphy, Adrianna; Chikovani, Ivdity; Makhashvili, Nino; Patel, Vikram; McKee, Martin

2014-01-01

The evidence on alcohol use disorder among conflict-affected civilian populations remains extremely weak, despite a number of potential risk-factors. The aim of this study is to examine patterns of alcohol use disorder among conflict-affected persons in the Republic of Georgia. A cross-sectional survey of 3600 randomly selected internally displaced persons (IDPs) and former IDPs. Two alcohol use disorder outcomes were measured: (i) having at least hazardous alcohol use (AUDIT score ≥ 8); (ii) episodic heavy drinking (consuming >60 grams of pure alcohol per drinking session at least once a week). Individual level demographic and socio-economic characteristics were also recorded, including mental disorders. Community level alcohol environment characteristics relating to alcohol availability, marketing and pricing were recorded in the respondents' communities and a factor analysis conducted to produce a summary alcohol environment factor score. Logistic regression analyses examined associations between individual and community level factors with the alcohol use disorder outcomes (among men only). Of the total sample, 71% of men and 16% of women were current drinkers. Of the current drinkers (N = 1386), 28% of men and 1% of women were classified as having at least hazardous alcohol use; and 12% of men and 2% of women as episodic heavy drinkers. Individual characteristics significantly associated with both outcomes were age and experiencing a serious injury, while cumulative trauma events and depression were also associated with having at least hazardous alcohol use. For the community level analysis, a one unit increase in the alcohol environment factor was associated with a 1.27 fold increase in episodic heavy drinking among men (no significant association with hazardous alcohol use). The findings suggest potential synergies for treatment responses for alcohol use disorder and depression among conflict-affected populations in Georgia, as well as the need for stronger alcohol control policies in Georgia.

Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer

PubMed Central

Bansal, Aasthaa; Fedorenko, Catherine R.; Blough, David K.; Overstreet, Karen A.; Shankaran, Veena; Newcomb, Polly

2016-01-01

Purpose Patients with cancer are more likely to file for bankruptcy than the general population, but the impact of severe financial distress on health outcomes among patients with cancer is not known. Methods We linked Western Washington SEER Cancer Registry records with federal bankruptcy records for the region. By using propensity score matching to account for differences in several demographic and clinical factors between patients who did and did not file for bankruptcy, we then fit Cox proportional hazards models to examine the relationship between bankruptcy filing and survival. Results Between 1995 and 2009, 231,596 persons were diagnosed with cancer. Patients who filed for bankruptcy (n = 4,728) were more likely to be younger, female, and nonwhite, to have local- or regional- (v distant-) stage disease at diagnosis, and have received treatment. After propensity score matching, 3,841 patients remained in each group (bankruptcy v no bankruptcy). In the matched sample, mean age was 53.0 years, 54% were men, mean income was $49,000, and majorities were white (86%), married (60%), and urban (91%) and had local- or regional-stage disease at diagnosis (84%). Both groups received similar initial treatments. The adjusted hazard ratio for mortality among patients with cancer who filed for bankruptcy versus those who did not was 1.79 (95% CI, 1.64 to 1.96). Hazard ratios varied by cancer type: colorectal, prostate, and thyroid cancers had the highest hazard ratios. Excluding patients with distant-stage disease from the models did not have an effect on results. Conclusion Severe financial distress requiring bankruptcy protection after cancer diagnosis appears to be a risk factor for mortality. Further research is needed to understand the process by which extreme financial distress influences survival after cancer diagnosis and to find strategies that could mitigate this risk. PMID:26811521

Individual and Community Level Risk-Factors for Alcohol Use Disorder among Conflict-Affected Persons in Georgia

PubMed Central

Roberts, Bayard; Murphy, Adrianna; Chikovani, Ivdity; Makhashvili, Nino; Patel, Vikram; McKee, Martin

2014-01-01

Background The evidence on alcohol use disorder among conflict-affected civilian populations remains extremely weak, despite a number of potential risk-factors. The aim of this study is to examine patterns of alcohol use disorder among conflict-affected persons in the Republic of Georgia. Methods A cross-sectional survey of 3600 randomly selected internally displaced persons (IDPs) and former IDPs. Two alcohol use disorder outcomes were measured: (i) having at least hazardous alcohol use (AUDIT score ≥8); (ii) episodic heavy drinking (consuming >60 grams of pure alcohol per drinking session at least once a week). Individual level demographic and socio-economic characteristics were also recorded, including mental disorders. Community level alcohol environment characteristics relating to alcohol availability, marketing and pricing were recorded in the respondents' communities and a factor analysis conducted to produce a summary alcohol environment factor score. Logistic regression analyses examined associations between individual and community level factors with the alcohol use disorder outcomes (among men only). Results Of the total sample, 71% of men and 16% of women were current drinkers. Of the current drinkers (N = 1386), 28% of men and 1% of women were classified as having at least hazardous alcohol use; and 12% of men and 2% of women as episodic heavy drinkers. Individual characteristics significantly associated with both outcomes were age and experiencing a serious injury, while cumulative trauma events and depression were also associated with having at least hazardous alcohol use. For the community level analysis, a one unit increase in the alcohol environment factor was associated with a 1.27 fold increase in episodic heavy drinking among men (no significant association with hazardous alcohol use). Conclusion The findings suggest potential synergies for treatment responses for alcohol use disorder and depression among conflict-affected populations in Georgia, as well as the need for stronger alcohol control policies in Georgia. PMID:24865450

Rank score and permutation testing alternatives for regression quantile estimates

USGS Publications Warehouse

Cade, B.S.; Richards, J.D.; Mielke, P.W.

2006-01-01

Performance of quantile rank score tests used for hypothesis testing and constructing confidence intervals for linear quantile regression estimates (0 ≤ τ ≤ 1) were evaluated by simulation for models with p = 2 and 6 predictors, moderate collinearity among predictors, homogeneous and hetero-geneous errors, small to moderate samples (n = 20–300), and central to upper quantiles (0.50–0.99). Test statistics evaluated were the conventional quantile rank score T statistic distributed as χ2 random variable with q degrees of freedom (where q parameters are constrained by H 0:) and an F statistic with its sampling distribution approximated by permutation. The permutation F-test maintained better Type I errors than the T-test for homogeneous error models with smaller n and more extreme quantiles τ. An F distributional approximation of the F statistic provided some improvements in Type I errors over the T-test for models with > 2 parameters, smaller n, and more extreme quantiles but not as much improvement as the permutation approximation. Both rank score tests required weighting to maintain correct Type I errors when heterogeneity under the alternative model increased to 5 standard deviations across the domain of X. A double permutation procedure was developed to provide valid Type I errors for the permutation F-test when null models were forced through the origin. Power was similar for conditions where both T- and F-tests maintained correct Type I errors but the F-test provided some power at smaller n and extreme quantiles when the T-test had no power because of excessively conservative Type I errors. When the double permutation scheme was required for the permutation F-test to maintain valid Type I errors, power was less than for the T-test with decreasing sample size and increasing quantiles. Confidence intervals on parameters and tolerance intervals for future predictions were constructed based on test inversion for an example application relating trout densities to stream channel width:depth.

Predicting recovery of voluntary upper extremity movement in subacute stroke patients with severe upper extremity paresis.

PubMed

Koh, Chia-Lin; Pan, Shin-Liang; Jeng, Jiann-Shing; Chen, Bang-Bin; Wang, Yen-Ho; Hsueh, I-Ping; Hsieh, Ching-Lin

2015-01-01

Prediction of voluntary upper extremity (UE) movement recovery is largely unknown in patients with little voluntary UE movement at admission. The present study aimed to investigate (1) the extent and variation of voluntary UE movement recovery, and (2) the best predictive model of the recovery of voluntary UE movement by clinical variables in patients with severe UE paresis. Prospective cohort study. 140 (out of 590) stroke patients with severe UE paresis completed all assessments. Voluntary UE movement was assessed using the UE subscale of the Stroke Rehabilitation Assessment of Movement (STREAM-UE). Two outcome measures, STREAM-UE scores at discharge (DC(STREAM-UE)) and changes between admission and discharge (Δ(STREAM-UE)), were investigated to represent the final states and improvement of the recovery of voluntary UE movement. Stepwise regression analyses were used to investigate 19 clinical variables and to find the best predictive models of the two outcome measures. The participants showed wide variation in both DC(STREAM-UE) and Δ(STREAM-UE). 3.6% of the participants almost fully recovered at discharge (DC(STREAM-UE) > 15). A large improvement (Δ(STREAM-UE) >= 10) occurred in 16.4% of the participants, while 32.9% of the participants did not have any improvement. The four predictors for the DC(STREAM-UE) (R(2) = 35.0%) were 'baseline STREAM-UE score', 'hemorrhagic stroke', 'baseline National Institutes of Health Stroke Scale (NIHSS) score', and 'cortical lesion excluding primary motor cortex'. The three predictors for the Δ(STREAM-UE) (R(2) = 22.0%) were 'hemorrhagic stroke', 'baseline NIHSS score', and 'cortical lesion excluding primary motor cortex'. Recovery of voluntary UE movement varied widely in patients with severe UE paresis after stroke. The predictive power of clinical variables was poor. Both results indicate the complex nature of voluntary UE movement recovery in patients with severe UE paresis after stroke.

The power and robustness of maximum LOD score statistics.

PubMed

Yoo, Y J; Mendell, N R

2008-07-01

The maximum LOD score statistic is extremely powerful for gene mapping when calculated using the correct genetic parameter value. When the mode of genetic transmission is unknown, the maximum of the LOD scores obtained using several genetic parameter values is reported. This latter statistic requires higher critical value than the maximum LOD score statistic calculated from a single genetic parameter value. In this paper, we compare the power of maximum LOD scores based on three fixed sets of genetic parameter values with the power of the LOD score obtained after maximizing over the entire range of genetic parameter values. We simulate family data under nine generating models. For generating models with non-zero phenocopy rates, LOD scores maximized over the entire range of genetic parameters yielded greater power than maximum LOD scores for fixed sets of parameter values with zero phenocopy rates. No maximum LOD score was consistently more powerful than the others for generating models with a zero phenocopy rate. The power loss of the LOD score maximized over the entire range of genetic parameters, relative to the maximum LOD score calculated using the correct genetic parameter value, appeared to be robust to the generating models.

Can the presence of an infection be predicted before a revision total hip arthroplasty? Preliminary study to establish an infection score.

PubMed

Jenny, J-Y; Adamczewski, B; De Thomasson, E; Godet, J; Bonfait, H; Delaunay, C

2016-04-01

The diagnosis of periprosthetic joint infection can be challenging, in part because there is no universal diagnostic test. Current recommendations include several diagnostic criteria, and are mainly based on the results of deep microbiological samples; however, these only provide a diagnosis after surgery. A predictive infection score would improve the management of revision arthroplasty cases. The purpose of this study was to define a composite infection score using standard clinical, radiological and laboratory data that can be used to predict whether an infection is present before a total hip arthroplasty (THA) revision procedure. The infection score will make it possible to differentiate correctly between infected and non-infected patients in 75% of cases. One hundred and four records from patients who underwent THA revision for any reason were analysed retrospectively: 43 with infection and 61 without infection. There were 54 men and 50 women with an average age of 70±12 years (range 30-90). A univariate analysis was performed to look for individual discriminating factors between the data in the medical records of infected and non-infected patients. A multivariate analysis subsequently integrated these factors together. A composite score was defined and its diagnostic effectiveness was evaluated as the percentage of correctly classified records, along with its sensitivity and specificity. The score consisted of the following individually weighed factors: body mass index, presence of diabetes, mechanical complication, wound healing disturbance and fever. This composite infection score was able to distinguish correctly between the infected patients (positive score) and non-infected patients (negative score) in 78% of cases; the sensitivity was 57% and the specificity 93%. Once this score is evaluated prospectively, it could be an important tool for defining the medical - surgical strategy during THA revision, no matter the reason for revision. Level IV - retrospective study. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Effectiveness of dental checkups incorporating tooth brushing instruction.

PubMed

Furusawa, Masahiro; Takahashi, Jun-ichi; Isoyama, Motoko; Kitamura, Yoshiko; Kashima, Tomoko; Ueshima, Fumie; Nakahama, Noriko; Araki, Misako; Rokukawa, Yasuko; Takahashi, Yoshikazu; Makiishi, Takemi; Yatabe, Ken-ichi

2011-01-01

The purpose of this study was to compare the effectiveness of dental checkups incorporating tooth-brushing instruction (TBI) with that of conventional dental checkups. A team consisting of one dentist and three dental hygienists saw an average of 60 employees per day on-site at an airline company. The patient's teeth were stained with a disclosing tablet and the results recorded on a Plaque Control Record (PCR) chart. The patient was then given TBI. After recording the relevant data, including TBI given and PCR scores, the charts were stored. Checkups were performed in a total of 3,854 patients between 2001 and 2005 and changes in annual scores investigated. In addition, annual shifts in mean score in patients receiving checkups over all five years were compared with those in patients receiving checkups for the first time in each of the five years. The mean score in patients receiving a checkup in 2001 was 35.1%, declining by 2.6 points to 32.5% in 2005. Among patients receiving checkups over all five years, the mean score in 2001 was 34.0%, declining by 11.2 points to 22.8% in 2005. Over the five-year period, the mean score in patients receiving checkups was 34.1%. In patients receiving checkups over all five years, the proportion with PCR scores <30% increased each year. This was because the number of patients with PCR scores ≥60% decreased each year. These findings suggest that TBI is effective in reducing poor plaque control. When compared with in patients who had not received TBI, five consecutive years of checkups was clearly effective. These results indicate that checkups incorporating TBI are more effective than conventional dental checkups that simply check for caries. In future, this type of checkup should contribute to improved preventative dentistry with minimal intervention.

Determining Health-Related Quality-of-Life Outcomes Using the SF-6D Following Total Hip Arthroplasty.

PubMed

Elmallah, Randa K; Chughtai, Morad; Adib, Farshad; Bozic, Kevin J; Kurtz, Steven M; Mont, Michael A

2017-03-15

Following total hip arthroplasty, patients' perception of their postoperative improvement and health plays a large role in satisfaction with and success of the surgical procedure. The Short Form-6D (SF-6D) is a health-related quality-of-life measure that assigns numerical value to the perception of patients' own health. The purpose was to determine SF-6D values of patients after total hip arthroplasty, to determine whether score changes were clinically relevant, and to compare these with postoperative functional improvements. We evaluated 188 patients who underwent primary total hip arthroplasty at 7 institutions and who had a mean age of 69 years (range, 47 to 88 years) and a mean body mass index of 28.8 kg/m (range, 19.8 to 38.9 kg/m). The SF-6D values were obtained from patients' SF-36 scores, and clinical relevance of value changes was determined using effect size. Using previous research, effect sizes were considered small between 0.2 and 0.5, moderate between 0.6 to 0.8, and large at >0.8. Clinical correlation was assessed using the Lower-Extremity Activity Scale and Harris hip scores. Patients were assessed preoperatively and postoperatively at 6 months and 1, 2, 3, and 5 years. The SF-6D scores improved from preoperatively and achieved significance (p < 0.05) at all points. The effect size demonstrated good clinical relevance up to the latest follow-up: 1.27 at 6 months, 1.30 at 1 year, 1.07 at 2 years, 1.08 at 3 years, and 1.05 at 5 years. The Lower-Extremity Activity Scale improved at all follow-up points from preoperatively to 1.8 at 6 months, 2.0 at 1 year, 1.8 at 2 years, 1.5 at 3 years, and 1.6 points at 5 years. The Harris hip score improved to 38 points at 6 months, 40 points at 1 year, 38 points at 2 years, 39 points at 3 years, and 41 points at 5 years postoperatively. The improvements in the Lower-Extremity Activity Scale and the Harris hip score significantly positively correlated (p < 0.01) with the SF-6D scores at all time points. SF-6D scores after total hip arthroplasty correlate with functional outcomes and have clinical relevance, as demonstrated by their effect size. Incorporating this straightforward and easy-to-use measurement tool when evaluating patients following total hip arthroplasty will facilitate future cost-utility analyses. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Monthly paleostreamflow reconstruction from annual tree-ring chronologies

Treesearch

J. H. Stagge; D. E. Rosenberg; R. J. DeRose; T. M. Rittenour

2018-01-01

Paleoclimate reconstructions are increasingly used to characterize annual climate variability prior to the instrumental record, to improve estimates of climate extremes, and to provide a baseline for climate change projections. To date, paleoclimate records have seen limited engineering use to estimate hydrologic risks because water systems models and managers usually...

76 FR 17673 - Bienvenido Tan, M.D.; Denial of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-30

...]'' and that his ``prescribing was `an extreme departure from the standard of care expected of a licensed... reprimanded the Respondent `for his departures from the standard of care regarding his medical record keeping... each party's experts (who had examined various patient records) regarding the standard of care for...

Impact of the clinical ultrasound elective course on retention of anatomical knowledge by second-year medical students in preparation for board exams.

PubMed

Kondrashov, Peter; Johnson, Jane C; Boehm, Karl; Rice, Daris; Kondrashova, Tatyana

2015-03-01

Ultrasound has been integrated into a gross anatomy course taught during the first year at an osteopathic medical school. A clinical ultrasound elective course was developed to continue ultrasound training during the second year of medical school. The purpose of this study was to evaluate the impact of this elective course on the understanding of normal anatomy by second-year students. An anatomy exam was administered to students enrolled in the clinical ultrasound elective course before the start of the course and after its conclusion. Wilcoxon signed ranks tests were used to determine whether exam scores changed from the pre-test to the post-test. Scores from two classes of second-year students were analyzed. Students who took the elective course showed significant improvement in the overall anatomy exam score between the pre-test and post-test (P < 0.001). Scores for exam questions pertaining to the heart, abdomen, upper extremity, and lower extremity also significantly improved from the pretest to post-test (P < 0.001), but scores for the neck and eye showed no significant improvement. The clinical ultrasound elective course offered during the second year of medical school provided students with an important review of key anatomical concepts while preparing them for board exams. Our results suggested that more emphasis should be placed on head and neck ultrasound to improve student performance in those areas. Musculoskeletal, abdominal, and heart ultrasound labs were more successful for retaining relevant anatomical information. © 2014 Wiley Periodicals, Inc.

Patient data system for monitoring shunts.

PubMed

Frank, E; Su, E; Smith, K

1988-01-01

Rapidly locating accurate data on a patient's shunt system is often extremely difficult. We have developed a simple system to fill a perceived need for recording current data on a patients shunt. This system employs an easily updated record in the patient's hospital or clinic chart as well as a wallet-sized data card for the patient or his family to carry. The data in the chart include the configuration of the patient's current shunt system and a graphic record of previous shunt problems. The small patient data card describes the age of the shunt system and its current configuration. We have found that this system provides assistance in the routine follow-up of patients with shunts and plays an extremely necessary role in the emergency evaluation of these patients, particularly when an emergency evaluation is undertaken in facilities distant from the location of regular treatment.

Assessing, Modeling, and Monitoring the Impacts of Extreme Climate Events

NASA Astrophysics Data System (ADS)

Murnane, Richard J.; Diaz, Henry F.

2006-01-01

Extreme weather and climate events provide dramatic content for the news media, and the past few years have supplied plenty of material. The 2004 and 2005 Atlantic hurricane seasons were very active; the United States was struck repeatedly by landfalling major hurricanes. A five-year drought in the southwestern United States was punctuated in 2003 by wildfires in southern California that caused billions of dollars in losses. Ten cyclones of at least tropical storm strength struck Japan in 2004, easily breaking the 1990 and 1993 records of six cyclones each year. Hurricane Catarina was the first recorded hurricane in the South Atlantic. Europe's summer of 2003 saw record-breaking heat that caused tens of thousands of deaths. These events have all been widely publicized, and they naturally raise several questions: Is climate changing, and if so, why? What can we expect in the future? How can we better respond to climate variability regardless of its source?

Pilot Project for Spaceborne Massive Optical Storage Devices

NASA Technical Reports Server (NTRS)

Chen, Y. J.

1996-01-01

A space bound storage device has many special requirements. In addition to large storage capacity, fas read/ write time, and high reliability, it also needs to have small volume, light weight, low power consumption, radiation hardening, ability to operate in extreme temperature ranges, etc. Holographic optical recording technology, which has been making major advancements in recent years, is an extremely promising candidate. The goal of this pilot project is to demonstrate a laboratory bench-top holographic optical recording storage system (HORSS) based on nonlinear polymer films 1 and/or other advanced photo-refractive materials. This system will be used as a research vehicle to study relevant optical properties of novel holographic optical materials, to explore massive optical storage technologies based on the photo-refractive effect and to evaluate the feasibility of developing a massive storage system, based on holographic optical recording technology, for a space bound experiment in the near future.

Notes From the Field: Direct Observation Versus Rating by Videos for the Assessment of Central Venous Catheterization Skills.

PubMed

Ma, Irene W Y; Zalunardo, Nadia; Brindle, Mary E; Hatala, Rose; McLaughlin, Kevin

2015-09-01

Blinded assessments of technical skills using video-recordings may offer more objective assessments than direct observations. This study seeks to compare these two modalities. Two trained assessors independently assessed 18 central venous catheterization performances by direct observation and video-recorded assessments using two tools. Although sound quality was deemed adequate in all videos, portions of the video for wire handling and drape handling were frequently out of view (n = 13, 72% for wire-handling; n = 17, 94% for drape-handling). There were no differences in summary global rating scores, checklist scores, or pass/fail decisions for either modality (p > 0.05). Inter-rater reliability was acceptable for both modalities. Of the 26 discrepancies identified between direct observation and video-recorded assessments, three discrepancies (12%) were due to inattention during video review, while one (4%) discrepancy was due to inattention during direct observation. In conclusion, although scores did not differ between the two assessment modalities, techniques of video-recording may significantly impact individual items of assessments. © The Author(s) 2014.

Extreme sexual behavior in dementia as a specific manifestation of disinhibition.

PubMed

Bartelet, Marjukka; Waterink, Wim; van Hooren, Susan

2014-01-01

In nursing homes, extreme sexual behavior is one of the most challenging behaviors in dementia. Despite this, however, there is no conformity in the literature regarding how to label and define this type of behavior. Examples of labels used include inappropriate sexual behavior, improper sexual behavior, sexually disinhibited behavior, or hyper sexuality. According to recent theoretical perspectives, extreme sexual behavior may be regarded as a part of disinhibited behavior or could be considered as an independent neuropsychiatric symptom. In this multicenter study, it was investigated whether there is a relationship between extreme sexual behavior and the typical neuropsychiatric symptoms seen in dementia. In 179 residents diagnosed with dementia, extreme sexual behavior was measured using an observation scale. Twelve neuropsychiatric symptoms were measured by the Neuropsychiatric Inventory. Multivariate analysis of covariance with gender showed that residents with observed extreme sexual behavior (n = 43) only showed a higher score on neuropsychiatric symptom 'disinhibition', as compared to residents with non-observed sexual behavior (n = 136). In addition, the effect size was large. These findings indicate that among residents with dementia, extreme sexual behaviors should not be considered as an independent neuropsychiatric symptom. Instead, disinhibition may be an important underlying mechanism for extreme sexual behavior and thus validates the label 'sexually disinhibited behavior'.

Missing rings in Pinus halepensis – the missing link to relate the tree-ring record to extreme climatic events

Treesearch

Klemen Novak; Martin de Luis; Miguel A. Saz; Luis A. Longares; Roberto Serrano-Notivoli; Josep Raventos; Katarina Cufar; Jozica Gricar; Alfredo Di Filippo; Gianluca Piovesan; Cyrille B.K. Rathgeber; Andreas Papadopoulos; Kevin T. Smith

2016-01-01

Climate predictions for the Mediterranean Basin include increased temperatures, decreased precipitation, and increased frequency of extreme climatic events (ECE). These conditions are associated with decreased tree growth and increased vulnerability to pests and diseases. The anatomy of tree rings responds to these environmental conditions. Quantitatively, the width of...

To what extent do clinical notes by general practitioners reflect actual medical performance? A study using simulated patients.

PubMed Central

Rethans, J J; Martin, E; Metsemakers, J

1994-01-01

BACKGROUND. Review of clinical notes is used extensively as an indirect method of assessing doctors' performance. However, to be acceptable it must be valid. AIM. This study set out to examine the extent to which clinical notes in medical records of general practice consultations reflected doctors' actual performance during consultations. METHOD. Thirty nine general practitioners in the Netherlands were consulted by four simulated patients who were indistinguishable from real patients and who reported on the consultations. The complaints presented by the simulated patients were tension headache, acute diarrhoea and pain in the shoulder, and one presented for a check up for non-insulin dependent diabetes. Later, the doctors forwarded their medical records of these patients to the researchers. Content of consultations was measured against accepted standards for general practice and then compared with content of clinical notes. An index, or content score, was calculated as the measure of agreement between actions which had actually been recorded and actions which could have been recorded in the clinical notes. A high content score reflected a consultation which had been recorded well in the medical record. The correlation between number of actions across the four complaints recorded in the clinical notes and number of actions taken during the consultations was also calculated. RESULTS. The mean content score (interquartile range) for the four types of complaint was 0.32 (0.27-0.37), indicating that of all actions undertaken, only 32% had been recorded. However, mean content scores for the categories 'medication and therapy' and 'laboratory examination' were much higher than for the categories 'history' and 'guidance and advice' (0.68 and 0.64, respectively versus 0.29 and 0.22, respectively). The correlation between number of actions across the four complaints recorded in the clinical notes and number of actions taken during the consultations was 0.54 (P < 0.05). CONCLUSION. The use of clinical notes to audit doctors' performance in Dutch general practice is invalid. However, the use of clinical notes to rank doctors according to those who perform many or a few actions in a consultation may be justified. PMID:8185988

Assessment of intracranial collaterals on CT angiography in anterior circulation acute ischemic stroke.

PubMed

Yeo, L L L; Paliwal, P; Teoh, H L; Seet, R C; Chan, B P; Ting, E; Venketasubramanian, N; Leow, W K; Wakerley, B; Kusama, Y; Rathakrishnan, R; Sharma, V K

2015-02-01

Intracranial collaterals influence the prognosis of patients treated with intravenous tissue plasminogen activator in acute anterior circulation ischemic stroke. We compared the methods of scoring collaterals on pre-tPA brain CT angiography for predicting functional outcomes in acute anterior circulation ischemic stroke. Two hundred consecutive patients with acute anterior circulation ischemic stroke treated with IV-tPA during 2010-2012 were included. Two independent neuroradiologists evaluated intracranial collaterals by using the Miteff system, Maas system, the modified Tan scale, and the Alberta Stroke Program Early CT Score 20-point methodology. Good and extremely poor outcomes at 3 months were defined by modified Rankin Scale scores of 0-1 and 5-6 points, respectively. Factors associated with good outcome on univariable analysis were younger age, female sex, hypertension, diabetes mellitus, atrial fibrillation, small infarct core (ASPECTS ≥8), vessel recanalization, lower pre-tPA NIHSS scores, and good collaterals according to Tan methodology, ASPECTS methodology, and Miteff methodology. On multivariable logistic regression, only lower NIHSS scores (OR, 1.186 per point; 95% CI, 1.079-1.302; P = .001), recanalization (OR, 5.599; 95% CI, 1.560-20.010; P = .008), and good collaterals by the Miteff method (OR, 3.341; 95% CI, 1.203-5.099; P = .014) were independent predictors of good outcome. Poor collaterals by the Miteff system (OR, 2.592; 95% CI, 1.113-6.038; P = .027), Maas system (OR, 2.580; 95% CI, 1.075-6.187; P = .034), and ASPECTS method ≤5 points (OR, 2.685; 95% CI, 1.156-6.237; P = .022) were independent predictors of extremely poor outcomes. Only the Miteff scoring system for intracranial collaterals is reliable for predicting favorable outcome in thrombolyzed acute anterior circulation ischemic stroke. However, poor outcomes can be predicted by most of the existing methods of scoring intracranial collaterals. © 2015 by American Journal of Neuroradiology.

The role of the subtropical North Atlantic water cycle in recent US extreme precipitation events

NASA Astrophysics Data System (ADS)

Li, Laifang; Schmitt, Raymond W.; Ummenhofer, Caroline C.

2018-02-01

The role of the oceanic water cycle in the record-breaking 2015 warm-season precipitation in the US is analyzed. The extreme precipitation started in the Southern US in the spring and propagated northward to the Midwest and the Great Lakes in the summer of 2015. This seasonal evolution of precipitation anomalies represents a typical mode of variability of US warm-season precipitation. Analysis of the atmospheric moisture flux suggests that such a rainfall mode is associated with moisture export from the subtropical North Atlantic. In the spring, excessive precipitation in the Southern US is attributable to increased moisture flux from the northwestern portion of the subtropical North Atlantic. The North Atlantic moisture flux interacts with local soil moisture which enables the US Midwest to draw more moisture from the Gulf of Mexico in the summer. Further analysis shows that the relationship between the rainfall mode and the North Atlantic water cycle has become more significant in recent decades, indicating an increased likelihood of extremes like the 2015 case. Indeed, two record-high warm-season precipitation events, the 1993 and 2008 cases, both occurred in the more recent decades of the 66 year analysis period. The export of water from the North Atlantic leaves a marked surface salinity signature. The salinity signature appeared in the spring preceding all three extreme precipitation events analyzed in this study, i.e. a saltier-than-normal subtropical North Atlantic in spring followed by extreme Midwest precipitation in summer. Compared to the various sea surface temperature anomaly patterns among the 1993, 2008, and 2015 cases, the spatial distribution of salinity anomalies was much more consistent during these extreme flood years. Thus, our study suggests that preseason salinity patterns can be used for improved seasonal prediction of extreme precipitation in the Midwest.

Quasi-Supervised Scoring of Human Sleep in Polysomnograms Using Augmented Input Variables

PubMed Central

Yaghouby, Farid; Sunderam, Sridhar

2015-01-01

The limitations of manual sleep scoring make computerized methods highly desirable. Scoring errors can arise from human rater uncertainty or inter-rater variability. Sleep scoring algorithms either come as supervised classifiers that need scored samples of each state to be trained, or as unsupervised classifiers that use heuristics or structural clues in unscored data to define states. We propose a quasi-supervised classifier that models observations in an unsupervised manner but mimics a human rater wherever training scores are available. EEG, EMG, and EOG features were extracted in 30s epochs from human-scored polysomnograms recorded from 42 healthy human subjects (18 to 79 years) and archived in an anonymized, publicly accessible database. Hypnograms were modified so that: 1. Some states are scored but not others; 2. Samples of all states are scored but not for transitional epochs; and 3. Two raters with 67% agreement are simulated. A framework for quasi-supervised classification was devised in which unsupervised statistical models—specifically Gaussian mixtures and hidden Markov models—are estimated from unlabeled training data, but the training samples are augmented with variables whose values depend on available scores. Classifiers were fitted to signal features incorporating partial scores, and used to predict scores for complete recordings. Performance was assessed using Cohen's K statistic. The quasi-supervised classifier performed significantly better than an unsupervised model and sometimes as well as a completely supervised model despite receiving only partial scores. The quasi-supervised algorithm addresses the need for classifiers that mimic scoring patterns of human raters while compensating for their limitations. PMID:25679475

Quasi-supervised scoring of human sleep in polysomnograms using augmented input variables.

PubMed

Yaghouby, Farid; Sunderam, Sridhar

2015-04-01

The limitations of manual sleep scoring make computerized methods highly desirable. Scoring errors can arise from human rater uncertainty or inter-rater variability. Sleep scoring algorithms either come as supervised classifiers that need scored samples of each state to be trained, or as unsupervised classifiers that use heuristics or structural clues in unscored data to define states. We propose a quasi-supervised classifier that models observations in an unsupervised manner but mimics a human rater wherever training scores are available. EEG, EMG, and EOG features were extracted in 30s epochs from human-scored polysomnograms recorded from 42 healthy human subjects (18-79 years) and archived in an anonymized, publicly accessible database. Hypnograms were modified so that: 1. Some states are scored but not others; 2. Samples of all states are scored but not for transitional epochs; and 3. Two raters with 67% agreement are simulated. A framework for quasi-supervised classification was devised in which unsupervised statistical models-specifically Gaussian mixtures and hidden Markov models--are estimated from unlabeled training data, but the training samples are augmented with variables whose values depend on available scores. Classifiers were fitted to signal features incorporating partial scores, and used to predict scores for complete recordings. Performance was assessed using Cohen's Κ statistic. The quasi-supervised classifier performed significantly better than an unsupervised model and sometimes as well as a completely supervised model despite receiving only partial scores. The quasi-supervised algorithm addresses the need for classifiers that mimic scoring patterns of human raters while compensating for their limitations. Copyright © 2015 Elsevier Ltd. All rights reserved.

Censored rainfall modelling for estimation of fine-scale extremes

NASA Astrophysics Data System (ADS)

Cross, David; Onof, Christian; Winter, Hugo; Bernardara, Pietro

2018-01-01

Reliable estimation of rainfall extremes is essential for drainage system design, flood mitigation, and risk quantification. However, traditional techniques lack physical realism and extrapolation can be highly uncertain. In this study, we improve the physical basis for short-duration extreme rainfall estimation by simulating the heavy portion of the rainfall record mechanistically using the Bartlett-Lewis rectangular pulse (BLRP) model. Mechanistic rainfall models have had a tendency to underestimate rainfall extremes at fine temporal scales. Despite this, the simple process representation of rectangular pulse models is appealing in the context of extreme rainfall estimation because it emulates the known phenomenology of rainfall generation. A censored approach to Bartlett-Lewis model calibration is proposed and performed for single-site rainfall from two gauges in the UK and Germany. Extreme rainfall estimation is performed for each gauge at the 5, 15, and 60 min resolutions, and considerations for censor selection discussed.

Historical warnings of future food insecurity with unprecedented seasonal heat.

PubMed

Battisti, David S; Naylor, Rosamond L

2009-01-09

Higher growing season temperatures can have dramatic impacts on agricultural productivity, farm incomes, and food security. We used observational data and output from 23 global climate models to show a high probability (>90%) that growing season temperatures in the tropics and subtropics by the end of the 21st century will exceed the most extreme seasonal temperatures recorded from 1900 to 2006. In temperate regions, the hottest seasons on record will represent the future norm in many locations. We used historical examples to illustrate the magnitude of damage to food systems caused by extreme seasonal heat and show that these short-run events could become long-term trends without sufficient investments in adaptation.

Observations of solar active regions and solar flares by OSO-7

NASA Technical Reports Server (NTRS)

Neupert, W. M.

1977-01-01

Contributions made to the physics of coronal active regions and flares by the extreme ultraviolet and soft X-ray spectroheliograph on OSO-7 were discussed. Coronal structures above active regions were discussed from the point of view of their morphology and physical properties, including their relationship to photospheric and coronal magnetic fields. OSO-7 also recorded flares with sufficient spatial and temporal resolution to record, in some instances for the first time, the extreme ultraviolet and soft X-ray emission associated with such chromospheric phenomena as filament activation and the emergence of satellite sunspots. Flare phenomena were reviewed in terms of the several stages of evolution typically associated with the event.

Are maturation, growth and lower extremity alignment associated with overuse injury in elite adolescent ballet dancers?

PubMed

Bowerman, Erin; Whatman, Chris; Harris, Nigel; Bradshaw, Elizabeth; Karin, Janet

2014-11-01

To identify growth, maturation and biomechanical risk factors for overuse injury in elite adolescent ballet dancers. Maturation (Tanner scale), growth (foot length change) and age at onset of menarche were recorded in elite adolescent ballet dancers. A modified knee valgus angle and lateral tilt of the pelvis were measured using 2D video during two dance movements (fondu, temps levé) to quantify lower extremity alignment. Overuse dance injuries were recorded by a physiotherapist. The injury rate ratio (RR) associated with each variable was estimated using over-dispersed Poisson regression modelling. Changes in right foot length (RR = 1.41, CI = 0.93-2.13), right knee angles during the fondu (RR = 0.68, CI = 0.45-1.03) and temps levé (RR = 0.72, CI = 0.53-0.98), and pelvic angles during the temps levé on the left (RR = 0.52, CI = 0.30-0.90) and fondu on the right (RR = 1.28, CI = 0.91-1.80) were associated with substantial changes in injury risk. Rate of growth in elite adolescent ballet dancers is likely associated with an increase in risk of lower extremity overuse injury and better right lower extremity alignment is likely associated with a reduction in risk of right lower extremity overuse injury. Copyright © 2014 Elsevier Ltd. All rights reserved.

Evaluation of Daily Extreme Precipitation Derived From Long-term Global Satellite Quantitative Precipitation Estimates (QPEs)

NASA Astrophysics Data System (ADS)

Prat, O. P.; Nelson, B. R.; Nickl, E.; Ferraro, R. R.

2017-12-01

This study evaluates the ability of different satellite-based precipitation products to capture daily precipitation extremes over the entire globe. The satellite products considered are the datasets belonging to the Reference Environmental Data Records (REDRs) program (PERSIANN-CDR, GPCP, CMORPH, AMSU-A,B, Hydrologic bundle). Those products provide long-term global records of daily adjusted Quantitative Precipitation Estimates (QPEs) that range from 20-year (CMORPH-CDR) to 35-year (PERSIANN-CDR, GPCP) record of daily adjusted global precipitation. The AMSU-A,B, Hydro-bundle is an 11-year record of daily rain rate over land and ocean, snow cover and surface temperature over land, and sea ice concentration, cloud liquid water, and total precipitable water over ocean among others. The aim of this work is to evaluate the ability of the different satellite QPE products to capture daily precipitation extremes. This evaluation will also include comparison with in-situ data sets at the daily scale from the Global Historical Climatology Network (GHCN-Daily), the Global Precipitation Climatology Centre (GPCC) gridded full data daily product, and the US Climate Reference Network (USCRN). In addition, while the products mentioned above only provide QPEs, the AMSU-A,B hydro-bundle provides additional hydrological information (precipitable water, cloud liquid water, snow cover, sea ice concentration). We will also present an analysis of those additional variables available from global satellite measurements and their relevance and complementarity in the context of long-term hydrological and climate studies.

[Level of completion of the prehospital care and transfer record as a quality indicator in an emergency medical service].

PubMed

Ballestros Peña, Sendoa; Lorrio Palomino, Sergio; Ariz Zubiaur, Mónica

2012-11-01

BASICS: A Prehospital Care and Transfer Recording (PCTR) is an out-of-hospital medical recording. This paper was made to assess and compare the level of fulfillment of the basic parameters of the PCTR developed by the Life Support Units with nurses (Life Support Units with Nurse, LSUwN and without nurses (Basic Life Support Units, BLSU) from SAMUR Bilbao in 2010. A descriptive, retrospective and comparative study was performed by analysing a randomized sample of 660 PCTR (precision 3%), aiming to check the fulfillment of the basic data. 98.33% of total recordings were readable. In overall, fulfillment rate was 90.31% (CI 89.24- 97.3 71%) of all basic parameters for LSUwN PCTR and 84.81% (CI 83.56 to 86%) for BLSU. 34.1% of PCTR were completely and correctly fulfilled. The LSUwN scored significantly better (p < 0.000). There were recording failures in "date and time", "address" and "physical examination". There were differences between the recording of clinical and administrative information (88.64% vs 86.72%, p = 0.02). In order to consider a parameter has optimal, it has to reach 100% of fulfillment. If it doesn't, and its score reaches no more than 80%, it should be reviewed. In this case, the results would be considered acceptable, but the administrative items of BLSU records, and allergies in both units should be strengthened. LSUwN has obtained better scores. The need of recording clinical information must be instilled as evidence of quality care.

Privacy Impact Assessment for the Lead-based Paint System of Records

EPA Pesticide Factsheets

The Lead-based Paint System of Records collects personally identifiable information, test scores, and submitted fees. Learn how this data is collected, how it will be used, access to the data, the purpose of data collection, and record retention policies.

A late Pleistocene long pollen record from Lake Urmia, NW Iran

NASA Astrophysics Data System (ADS)

Djamali, Morteza; de Beaulieu, Jacques-Louis; Shah-hosseini, Madjid; Andrieu-Ponel, Valérie; Ponel, Philippe; Amini, Abdolhossein; Akhani, Hossein; Leroy, Suzanne A. G.; Stevens, Lora; Lahijani, Hamid; Brewer, Simon

2008-05-01

A palynological study based on two 100-m long cores from Lake Urmia in northwestern Iran provides a vegetation record spanning 200 ka, the longest pollen record for the continental interior of the Near East. During both penultimate and last glaciations, a steppe of Artemisia and Poaceae dominated the upland vegetation with a high proportion of Chenopodiaceae in both upland and lowland saline ecosystems. While Juniperus and deciduous Quercus trees were extremely rare and restricted to some refugia, Hippophaë rhamnoides constituted an important phanerophyte, particularly during the late last glacial period. A pronounced expansion in Ephedra shrub-steppe occurred at the end of the penultimate late-glacial period but was followed by extreme aridity that favoured an Artemisia steppe. Very high lake levels, registered by both pollen and sedimentary markers, occurred during the middle of the last glaciation and late part of the penultimate glaciation. The late-glacial to early Holocene transition is represented by a succession of Hippophaë, Ephedra, Betula, Pistacia and finally Juniperus and Quercus. The last interglacial period (Eemian), slightly warmer and moister than the Holocene, was followed by two interstadial phases similar in pattern to those recorded in the marine isotope record and southern European pollen sequences.

Beef customer satisfaction: USDA quality grade and marination effects on consumer evaluations of top round steaks.

PubMed

Behrends, J M; Goodson, K J; Koohmaraie, M; Shackelford, S D; Wheeler, T L; Morgan, W W; Reagan, J O; Gwartney, B L; Wise, J W; Savell, J W

2005-03-01

An in-home beef study evaluated consumer ratings of top round steaks (semimembranosus) as influenced by USDA quality grade (top Choice or high Select), city (Chicago or Philadelphia), consumer segment (beef loyalists = heavy consumers of beef; budget rotators = cost-driven and split meat consumption between beef and chicken; and variety rotators = higher incomes and education and split meat consumption among beef, poultry, and other foods), degree of doneness, cooking method, and marination. Consumers evaluated each steak for overall like, tenderness, juiciness, flavor like, and flavor amount using 10-point scales (1 = dislike extremely, not at all tender, not at all juicy, dislike extremely, and none at all to 10 = like extremely, extremely tender, extremely juicy, like extremely, and an extreme amount of flavor, respectively). Quality grade affected several consumer sensory traits, with top Choice receiving higher (P < or = 0.004) tenderness, juiciness, and flavor like scores than high Select. Consumers in Chicago rated steaks cooked "medium and less" higher for overall like, tenderness, juiciness, flavor like, and flavor amount than those in Philadelphia (city x degree of doneness; P < or = 0.020). Steaks braised by customers in Philadelphia received among the highest scores for overall like, tenderness, juiciness, flavor like, and flavor amount compared with any cooking method used by customers in Chicago (cooking method x city; P < or = 0.026). Overall like and flavor amount ratings were least (P < 0.05) for steaks that were marinated and cooked to "medium and less" degree of doneness (marination x degree of doneness; P < or = 0.014). Braised steaks received among the highest values for overall like, tenderness, juiciness, flavor like, and flavor amount when cooked to "medium and less" or "medium well and more" (cooking method x degree of doneness; P < or = 0.008). Correlation and stepwise regression analysis indicated that flavor like was pivotal in customers' satisfaction with top round steaks, and was the sensory trait most highly correlated to overall like, followed by tenderness, flavor amount, and juiciness. Preparation of top round steaks was crucial in consumers' likes and dislikes, and by improving flavor, higher consumer satisfaction may be achieved.

Effect of whole-body vibration exercise in a sitting position prior to therapy on muscle tone and upper extremity function in stroke patients.

PubMed

Boo, Jung-A; Moon, Sang-Hyun; Lee, Sun-Min; Choi, Jung-Hyun; Park, Si-Eun

2016-01-01

[Purpose] The purpose of this study was to determine the effect of whole-body vibration exercise in a sitting position prior to therapy in stroke patients. [Subjects and Methods] Fourteen chronic stroke patients were included in this study. Prior to occupational therapy, whole-body exercise was performed for 10 minutes, 5 times per week, for a total of 8 weeks. Muscle tone and upper extremity function were measured. The Modified Ashworth Scale (MAS) was used to measure muscle tone, and the Manual Function Test (MFT) and Fugl-Meyer Assessment scale (FugM) were used to measure upper extremity function. [Results] MAS score was significantly decreased, and MFT and FugM were significantly increased. [Conclusion] These results indicate that whole-body vibration exercise in a sitting position prior to therapy had a positive effect on muscle tone, and upper extremity function in stroke patients.

Intensive care unit depth of sleep: proof of concept of a simple electroencephalography index in the non-sedated

PubMed Central

2014-01-01

Introduction Intensive care unit (ICU) patients are known to experience severely disturbed sleep, with possible detrimental effects on short- and long- term outcomes. Investigation into the exact causes and effects of disturbed sleep has been hampered by cumbersome and time consuming methods of measuring and staging sleep. We introduce a novel method for ICU depth of sleep analysis, the ICU depth of sleep index (IDOS index), using single channel electroencephalography (EEG) and apply it to outpatient recordings. A proof of concept is shown in non-sedated ICU patients. Methods Polysomnographic (PSG) recordings of five ICU patients and 15 healthy outpatients were analyzed using the IDOS index, based on the ratio between gamma and delta band power. Manual selection of thresholds was used to classify data as either wake, sleep or slow wave sleep (SWS). This classification was compared to visual sleep scoring by Rechtschaffen & Kales criteria in normal outpatient recordings and ICU recordings to illustrate face validity of the IDOS index. Results When reduced to two or three classes, the scoring of sleep by IDOS index and manual scoring show high agreement for normal sleep recordings. The obtained overall agreements, as quantified by the kappa coefficient, were 0.84 for sleep/wake classification and 0.82 for classification into three classes (wake, non-SWS and SWS). Sensitivity and specificity were highest for the wake state (93% and 93%, respectively) and lowest for SWS (82% and 76%, respectively). For ICU recordings, agreement was similar to agreement between visual scorers previously reported in literature. Conclusions Besides the most satisfying visual resemblance with manually scored normal PSG recordings, the established face-validity of the IDOS index as an estimator of depth of sleep was excellent. This technique enables real-time, automated, single channel visualization of depth of sleep, facilitating the monitoring of sleep in the ICU. PMID:24716479

Comparison of continuous interscalene block and subacromial infusion of local anesthetic for postoperative analgesia after open shoulder surgery.

PubMed

Baskan, Semih; Cankaya, Deniz; Unal, Hidayet; Yoldas, Burak; Taspinar, Vildan; Deveci, Alper; Tabak, Yalcin; Baydar, Mustafa

2017-01-01

This study compared the efficacy of continuous interscalene block (CISB) and subacromial infusion of local anesthetic (CSIA) for postoperative analgesia after open shoulder surgery. This randomized, prospective, double-blinded, single-center study included 40 adult patients undergoing open shoulder surgery. All patients received a standardized general anesthetic. The patients were separated into group CISB and group CSIA. A loading dose of 40 mL 0.25% bupivacaine was administered and patient-controlled analgesia was applied by catheter with 0.1% bupivacaine 5 mL/h throughout 24 h basal infusion, 2 mL bolus dose, and 20 min knocked time in both groups postoperatively. Visual analog scale (VAS) scores, additional analgesia need, local anesthetic consumption, complications, and side effects were recorded during the first 24 h postoperatively. The range of motion (ROM) score was recorded preoperatively and in the first and third weeks postoperatively. A statistically significant difference was determined between the groups in respect of consumption of local anesthetic, VAS scores, additional analgesia consumption, complications, and side effects, with lower values recorded in the CISB group. There were no significant differences in ROM scoring in the preoperative and postoperative third week between the two groups but there were significant differences in ROM scoring in the postoperative first week, with higher ROM scoring values in the group CISB patients. The results of this study have shown that continuous interscalene infusion of bupivacaine is an effective and safe method of postoperative analgesia after open shoulder surgery.

Inaccurate, inadequate and inconsistent: A content analysis of burn first aid information online.

PubMed

Burgess, J D; Cameron, C M; Cuttle, L; Tyack, Z; Kimble, R M

2016-12-01

With the popularity of the Internet as a primary source of health-related information, the aim of this website content analysis was to assess the accuracy and quality of burn first aid information available on the Internet. Using the search term 'burn first aid' in four popular search engines, the first 10 websites from each search engine were recorded. From a total of 40 websites recorded, 14 websites were evaluated after removing duplicates. Websites were assessed on content accuracy by four independent reviewers with checks conducted on inter-rater reliability. Website quality was recorded based on Health on the Net Code of Conduct (HONcode) principles. Country of origin for the 14 websites was the US (7), Australia (6), and New Zealand (1). The mean content accuracy score was 5.6 out of 10. The mean website quality score was 6.6 out of 12. Australasian websites scored lower for quality but higher for accuracy. The US websites scored higher for quality than accuracy. Website usability and accuracy in a crisis situation were also assessed. The median crisis usability score was 3 out of five, and the median crisis accuracy score was 3.5 out of five. The inaccurate and inconsistent burn first aid treatments that appear online are reflected in the often-incorrect burn first aid treatments seen in patients attending emergency departments. Global consistency in burn first aid information is needed to avoid confusion by members of the public. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Contribution of inter-muscular synchronization in the modulation of tremor intensity in Parkinson's disease.

PubMed

He, Xin; Hao, Man-Zhao; Wei, Ming; Xiao, Qin; Lan, Ning

2015-12-01

Involuntary central oscillations at single and double tremor frequencies drive the peripheral neuromechanical system of muscles and joints to cause tremor in Parkinson's disease (PD). The central signal of double tremor frequency was found to correlate more directly to individual muscle EMGs (Timmermann et al. 2003). This study is aimed at investigating what central components of oscillation contribute to inter-muscular synchronization in a group of upper extremity muscles during tremor in PD patients. 11 idiopathic, tremor dominant PD subjects participated in this study. Joint kinematics during tremor in the upper extremity was recorded along with EMGs of six upper arm muscles using a novel experimental apparatus. The apparatus provided support for the upper extremity on a horizontal surface with reduced friction, so that resting tremor in the arm can be recorded with a MotionMonitor II system. In each subject, the frequencies of rhythmic firings in upper arm muscles were determined using spectral analysis. Paired and pool-averaged coherence analyses of EMGs for the group of muscles were performed to correlate the level of inter-muscular synchronization to tremor amplitudes at shoulder and elbow. The phase shift between synchronized antagonistic muscle pairs was calculated to aid coherence analysis in the muscle pool. Recorded EMG revealed that rhythmic firings were present in most recorded muscles, which were either synchronized to form phase-locked bursting cycles at a subject specific frequency, or unsynchronized with a random phase distribution. Paired coherence showed a stronger synchronization among a subset of recorded arm muscles at tremor frequency than that at double tremor frequency. Furthermore, the number of synchronized muscles in the arm was positively correlated to tremor amplitudes at elbow and shoulder. Pool-averaged coherence at tremor frequency also showed a better correlation with the amplitude of resting tremor than that of double tremor frequency, indicating that the neuromechanical coupling in peripheral neuromuscular system was stronger at tremor frequency. Both paired and pool-averaged coherences are more consistent indexes to correlate to tremor intensity in a group of upper extremity muscles of PD patients. The central drive at tremor frequency contributes mainly to synchronize peripheral muscles in the modulation of tremor intensity.

The impact of foot arch height on quality of life in 6-12 year olds.

PubMed

López López, Daniel; Bouza Prego, M de Los Ángeles; Requeijo Constenla, Ana; Saleta Canosa, Jesús Luis; Bautista Casasnovas, Adolfo; Tajes, Francisco Alonso

2014-01-01

To determine whether arch height has an effect on the health-related quality of life of schoolchildren. One hundred and thirteen schoolchildren attended an out-patient centre where self-reported data were recorded, their feet were classified into one of three groups according to their arch index (high, normal or low) and the scores obtained from the Foot Health Status Questionnaire (FHSQ - Spanish version) were compared. The groups with high, low and normal arch recorded lower scores in Section One for the general foot health and footwear domains and higher scores in foot pain and foot function. In Section Two they obtained lower scores in general health and higher scores in physical activity, social capacity and vigour. Comparison of the scores obtained reveals that arch height has a negative impact on quality of life. Given the limited extent of available evidence in respect of the aetiology and treatment of foot diseases and deformities, these findings reveal the need to implement programmes to promote foot health and carry out further research into this commonly occurring disabling condition.

Sedimentary records of Typhoon Haiyan in the South China Sea

NASA Astrophysics Data System (ADS)

Su, C. C.; Chen, Y. H.; Chang, J. H.; Hsu, H. H.; Yu, P. S.; Liu, C. S.

2016-12-01

South China Sea (SCS), which is located at the boundary of the Eurasian, Philippine Sea, and Indian plates, is the largest marginal sea of the northwest Pacific and also on the North Western Pacific corridor of typhoons. The unique tectonic setting and climatic conditions make it has to face the severe natural hazards, like submarine landslides, and high sediment discharges which induced by typhoon. On November 8, 2013, the Typhoon Haiyan, which was one of the largest tropical cyclones ever recorded in western Pacific, devastated Philippines and caused catastrophic destruction. Before the Typhoon Haiyan reached Hainan Province, China and Quangninh Province, Vietnam, it emerged over the SCS. How was the large amount of terrestrial materials distributed and recorded in deep sea sediments by such intense typhoon? Is it possible for us to reconstruct the history of extreme tropical cyclones by using deep sea cores? In this study, twelve gravity cores were collected in the Central SCS Basin and around Taiping Island (Itu Aba Island) from 2014 to 2015 and a series of analysis including Multi-Sensor Core Logger, XRF Core Scanner, core surface and X-radiograph images, grain size, and excess 210Pb chronology were conducted for modern extreme event records in cores and attempt to evaluate the possibility of reconstructed extreme typhoon records in cores from the SCS. On core surface images, an obvious brownish oxidized layer exist in core top with higher 210Pb activities beneath the layer. According to the sampling time, we conjecture the oxidized layer might formed by Typhoon Haiyan in 2013. In addition, the Itrax data shows high manganese content only exist in this layer which might related to the modern industrial pollution delivered by typhoon induced flooding from Philippines. The Power Barge 103 of Napocor in Estancia IIoilo was dislodged from its mount by Typhoon Haiyan and the United Nations Disaster Assessment and Coordination Team reported 600,000 liters of bunker fuel had spilled. To clarify the relationship between the oil spill and high manganese records in sediments, some further analysis is needed. Our analysis result shows, in the Central SCS Basin, over 80 cm turbidite layer was deposited by Typhoon Haiyan and it will take more than 4000 years to deposit on seafloor without the impact of extreme events.

Lake Sediments show the Frequency of 21st Century Extreme Flooding in the UK is Unprecedented

NASA Astrophysics Data System (ADS)

Chiverrell, R. C.; Sear, D. A.; Warburton, J.; Macdonald, N.; Schillereff, D. N.; Dearing, J.; Croudace, I. W. C.

2016-12-01

Flooding in northwest England has been reconstructed from the coarse grained units preserved in lake sediment sequences at Bassenthwaite Lake, a record that includes the floods of December 2015 (Storm Desmond) and November 2009 and shows they were the most extreme in over 600 years. The inception and propagation of a lake sediment flood event horizon in the aftermath of the December 2015 storms in the UK has been explored as part of NERC Urgency Grant that focuses on Bassenthwaite Lake, Brotherswater, Buttermere and Ullswater. Our approach involves repeat coring of locations over 6-12 months, sediment trapping, and testing how this recent extreme event has settled into the sediment record. For Bassenthwaite Lake linking our new sediment palaeoflood series to river discharges, provides the first assessment of flood frequency and magnitude based on lake sediments for the UK. We show that recent devastating flooding in NW England in 2009 was the largest event in 415 years, had a recurrence interval far larger (1:9000 year) than conventional analysis based on short term records suggest (1:700 year), and occurred during a cluster of floods that is unprecedented in 600 years. Particle size characteristics of flood laminations, after correction for variations in the stability of catchment sediment sources, were correlated on a hydrodynamic basis with recorded river flows. The particle size flood record is underpinned by a robust chronology to CE 1420 derived from radionuclide (Pb210, Am241, and Cs137) dating and correlations to the rich history of metal (Pb, Zn, Ba and Cu) mining in the catchment accurately recorded in the sediment geochemistry. The sediment palaeoflood series reveals five flood rich periods (CE 1460-1500, 1580-1680, 1780-1820, 1850-1925, 1970-present), and these correspond with positive phases of reconstructed winter NAOI and other Atlantic circulation patterns. The hydro-climatology of the extreme events (top 1% of floods) in our series, show that 67% of floods have occurred in the 21st Century during a period of prolonged warmer northern Hemisphere temperatures and positive NAOI winter index. Our approach is widely applicable wherever suitable lakes are found offering the possibility of quantitative long term flood series for different hydroclimatic regions of the world.

Do High-elevation Lakes Record Variations in Snowfall and Atmospheric Rivers in the Sierra Nevada of California?

NASA Astrophysics Data System (ADS)

Ashford, J.; Sickman, J. O.; Lucero, D. M.

2014-12-01

Understanding the underlying causes of interannual variation in snowfall and extreme hydrologic events in the Sierra Nevada is hampered by short instrumental records and the difficulties in reconstructing climate using a traditional paleo-record such as tree-rings. New paleo proxies are needed to provide a record of snowpack water content and extreme precipitation events over millennial timescales which can be used to test hypotheses regarding teleconnections between Pacific climate variability and water supply and flood risk in California. In October 2013 we collected sediment cores from Pear Lake (z = 27 m), an alpine lake in Sequoia National Park. The cores were split and characterized by P-wave velocity, magnetic susceptibility and density scanning. Radiocarbon dates indicate that the Pear Lake cores contain a 13.5K yr record of lake sediment. In contrast to other Sierra Nevada lakes previously cored by our group, high-resolution scanning revealed alternating light-dark bands (~1 mm to 5 mm thick) for most of the Pear Lake core length. This pattern was interrupted at intervals by homogenous clasts (up to 75 mm thick) ranging in grain size from sand to gravel up to 1 cm diameter. We hypothesize that the light-dark banding results from the breakdown of persistent hypolimnetic anoxia during spring snowmelt and autumn overturn. We speculate that the thicknesses of the dark bands are controlled by the duration of anoxia which in turn is controlled by the volume and duration of snowmelt. The sand to gravel sized clasts are most likely associated with extreme precipitation events resulting from atmospheric rivers intersecting the southern Sierra Nevada. We hypothesize that centimeter-sized clasts are deposited in large avalanches and that the sands are deposited in large rain events outside of the snow-cover period.

A comparison of extreme rainfall characteristics in the Brazilian Amazon derived from two gridded data sets and a national rain gauge network

NASA Astrophysics Data System (ADS)

Clarke, Robin T.; Bulhoes Mendes, Carlos Andre; Costa Buarque, Diogo

2010-07-01

Two issues of particular importance for the Amazon watershed are: whether annual maxima obtained from reanalysis and raingauge records agree well enough for the former to be useful in extending records of the latter; and whether reported trends in Amazon annual rainfall are reflected in the behavior of annual extremes in precipitation estimated from reanalyses and raingauge records. To explore these issues, three sets of daily precipitation data (1979-2001) from the Brazilian Amazon were analyzed (NCEP/NCAR and ERA-40 reanalyses, and records from the raingauge network of the Brazilian water resources agency - ANA), using the following variables: (1) mean annual maximum precipitation totals, accumulated over one, two, three and five days; (2) linear trends in these variables; (3) mean length of longest within-year "dry" spell; (4) linear trends in these variables. Comparisons between variables obtained from all three data sources showed that reanalyses underestimated time-trends and mean annual maximum precipitation (over durations of one to five days), and the correlations between reanalysis and spatially-interpolated raingauge estimates were small for these two variables. Both reanalyses over-estimated mean lengths of dry period relative to the mean length recorded by the raingauge network. Correlations between the trends calculated from all three data sources were small. Time-trends averaged over the reanalysis grid-squares, and spatially-interpolated time trends from raingauge data, were all clustered around zero. In conclusion, although the NCEP/NCAR and ERA-40 gridded data-sets may be valuable for studies of inter-annual variability in precipitation totals, they were found to be inappropriate for analysis of precipitation extremes.

Characteristics of Extreme Geoelectric Fields and Their Possible Causes: Localized Peak Enhancements

NASA Astrophysics Data System (ADS)

Pulkkinen, A. A.; Ngwira, C. M.; Bernabeu, E.; Eichner, J.; Viljanen, A.; Crowley, G.

2015-12-01

One of the major challenges pertaining to extreme geomagnetic storms is to understand the basic processes associated with the development of dynamic magnetosphere-ionosphere currents, which generate large induced surface geoelectric fields. Previous studies point out the existence of localized peak geoelectric field enhancements during extreme storms. We examined induced global geoelectric fields derived from ground-based magnetometer recordings for 12 extreme geomagnetic storms between the years 1982--2005. However for the present study, an in-depth analysis was performed for two important extreme storms, October 29, 2003 and March 13, 1989. The primary purpose of this paper is to provide further evidence on the existence of localized peak geoelectric field enhancements, and to show that the structure of the geoelectric field during these localized extremes at single sites can differ greatly from globally and regionally averaged fields. Although the physical processes that govern the development of these localized extremes are still not clear, we discuss some possible causes.

Mortality in Code Blue; can APACHE II and PRISM scores be used as markers for prognostication?

PubMed

Bakan, Nurten; Karaören, Gülşah; Tomruk, Şenay Göksu; Keskin Kayalar, Sinem

2018-03-01

Code blue (CB) is an emergency call system developed to respond to cardiac and respiratory arrest in hospitals. However, in literature, no scoring system has been reported that can predict mortality in CB procedures. In this study, we aimed to investigate the effectiveness of estimated APACHE II and PRISM scores in the prediction of mortality in patients assessed using CB to retrospectively analyze CB calls. We retrospectively examined 1195 patients who were evaluated by the CB team at our hospital between 2009 and 2013. The demographic data of the patients, diagnosis and relevant de-partments, reasons for CB, cardiopulmonary resuscitation duration, mortality calculated from the APACHE II and PRISM scores, and the actual mortality rates were retrospectively record-ed from CB notification forms and the hospital database. In all age groups, there was a significant difference between actual mortality rate and the expected mortality rate as estimated using APACHE II and PRISM scores in CB calls (p<0.05). The actual mortality rate was significantly lower than the expected mortality. APACHE and PRISM scores with the available parameters will not help predict mortality in CB procedures. Therefore, novels scoring systems using different parameters are needed.

Sea ice convergence along the Arctic coasts of Greenland and the Canadian Arctic Archipelago: Variability and extremes (1992-2014)

NASA Astrophysics Data System (ADS)

Kwok, Ron

2015-09-01

After the summer of 2013, a convergence-induced tail in the thickness distribution of the ice cover is found along the Arctic coasts of Greenland and Canadian Arctic Archipelago. Prompted by this, a normalized ice convergence index (ICI) is introduced to examine the variability and extremes in convergence in a 23 year record (1992-2014) of monthly ice drift. Large-scale composites of circulation patterns, characteristic of regional convergence and divergence, are examined. Indeed, the ICI shows the June 2013 convergence event to be an extreme (i.e., ICI > 2). Furthermore, there is a cluster of 9 months over a 17 month period with positive ICIs (i.e., >1) following the record summer minimum ice extent (SMIE) in 2012; the imprint of ice dynamics from this cluster of positive ICIs likely contributed to higher SMIEs in 2013 and 2014. The impact of convergence on SMIE is discussed, and the increase in Arctic ice volume in 2013 is underscored.

Mean and extreme sea level changes in the southwestern Baltic Sea

NASA Astrophysics Data System (ADS)

Schmidt, Jessica; Patzke, Justus; Dangendorf, Sönke; Arns, Arne; Jensen, Jürgen; Fröhle, Peter

2016-04-01

In this contribution an overview over the BMBF project AMSeL_Ostsee (2015-2018) for the assessment of mean and extreme sea level changes over the past 150 years in the southwestern Baltic Sea is presented. We compile several high resolution tide gauge records provided by the Water and Shipping Administration (WSV) along the German Baltic Sea coastline and merge them in internationally available data bases (UHSLC, PSMSL, and data officially available at national authorities). In addition, we make efforts in digitizing historical records to expand the number of available data sets in this complex and vulnerable coastal region. To separate absolute from relative long-term changes in sea level the vertical land motion (VLM) at specific sites is assessed. Possible sources of VLM are independently assessed by using different state-of-the-art approaches, that is: Glacial Isostatic Adjustment (GIA) modelled by viscoelastic Earth models, GPS derived VLM, and the difference between tide gauge and nearby satellite altimetry. The VLM corrected tide gauge records are further assessed for linear and non-linear trends as well as possible acceleration/deceleration patterns by applying advanced time series models such as Singular System Analysis (SSA) combined with a Monte-Carlo-Autoregressive-Padding approach (Wahl et al., 2010). These trend assessments are applied to mean and extreme sea levels independently to prove whether observed changes in extremes are either due to an underlying trend on mean sea levels or changes in storminess. References: Wahl, T., Jensen, J., Frank, T. (2011): On analysing sea level rise in the German Bight since 1844, NHESS, 10, 171-179.

Influence of early variables in traumatic brain injury on functional independence measure scores and rehabilitation length of stay and charges.

PubMed

Cowen, T D; Meythaler, J M; DeVivo, M J; Ivie, C S; Lebow, J; Novack, T A

1995-09-01

To determine the relationship between early variables (initial Glasgow Coma Scale [GCS] scores, computed tomography [CT] findings, presence of skeletal trauma, age, length of acute hospitalization) and outcome variables (Functional Independence Measure [FIM] scores, rehabilitation length of stay [LOS], rehabilitation charges) in traumatic brain injury (TBI). Inception cohort. University tertiary care rehabilitation center. 91 patients with TBI. Inpatient rehabilitation. FIM, rehabilitation LOS, and rehabilitation charges. Patients in the severely impaired (GCS = 3 to 7) group showed significantly lower (p = .01) mean admission and discharge motor scores (21.26, 39.83) than patients in the mildly impaired (GCS = 13 to 15) group (38.86, 55.29). Cognitive scores were also significantly lower (p < .01) in the severely impaired group on admission (26.73 vs 54.14) and discharge (42.28 vs 66.48). These findings continued to be statistically significant (p < .01) after regression analysis accounted for the other early variables previously listed. Regression analysis also illustrated that longer acute hospitalization LOS was independently associated with significantly lower admission motor (p < .01) and cognitive (p = .05) scores, and significantly higher (p = .01) rehabilitation charges. Patients with CT findings of intracranial bleed with skull fracture had longer total LOS (70.88 vs 43.08 days; p < .05), rehabilitation LOS (30.01 vs 19.68 days; p < .10), and higher rehabilitation charges ($43,346 vs $25,780; p < .05). Paradoxically, those patients in a motor vehicle crash with an extremity bone fracture had significantly higher (p = .002; p = .04 after regression analysis) FIM cognitive scores on admission (48.30 vs 27.28) and discharge (64.74 vs 45.78) than those without a fracture. Finally, data available on rehabilitation admission were used to predict discharge outcomes. The percentage of explained variance for each outcome variable is as follows: discharge FIM motor score, 69.5%; discharge FIM cognitive score, 71.2%; rehabilitation LOS, 54.1%; rehabilitation charges, 61.1%. The most powerful predictor of LOS and charges was the admission FIM motor score (p < .001), followed by CT findings (p = .02) and age (p = .04). Information readily available on rehabilitation admission, particularly the FIM motor score, may be useful in predicting discharge FIM scores as well as utilization of medical rehabilitation resources. Earlier transfer to rehabilitation may result in higher functional status and lower rehabilitation charges, as well as lower acute hospitalization charges. The presence of extremity fractures encountered during a motor vehicle crash is associated with a more favorable outcome in TBI as evidenced by higher discharge FIM cognitive scores.

The influence of birth size on intelligence in healthy children.

PubMed

Broekman, Birit F P; Chan, Yiong-Huak; Chong, Yap-Seng; Quek, Swee-Chye; Fung, Daniel; Low, Yen-Ling; Ooi, Yoon-Phaik; Gluckman, Peter D; Meaney, Michael J; Wong, Tien-Yin; Saw, Seang-Mei

2009-06-01

Birth parameters have been hypothesized to have an influence on IQ. However, studies within the range of normal birth size have been sparse. With this study we examined the associations between birth length, birth weight, head circumference, and gestational age within the normal birth size range in relation to childhood IQ in Asian children. A cohort of 1979 of 2913 Asian children aged 7 to 9 years, recruited from 3 schools in Singapore, were followed yearly from 1999 onward. Birth parameters were recorded by health personnel. Childhood IQ was measured with the Raven's Standard Progressive Matrices at ages 8 to 12. The mean IQ score across the sample (n = 1645) was 114.2. After controlling for multiple confounders for every 1-cm increment in birth length, 1 kg in birth weight, or 1 cm in head circumference, there was a corresponding increase in IQ of 0.49 points (P for trend < .001), 2.19 points (P for trend = .007) and .62 points (P for trend = .003), respectively. These associations persisted even after exclusion of premature children and children with extreme weights and head circumferences. Longer birth length, higher birth weight, or larger head circumferences within the normal birth size range are associated with higher IQ scores in Asian children. Our results suggest that antenatal factors reflected in altered rates of growth but within the normative range of pregnancy experiences play a role in generating cognitive potential. This has implications for targeting early intervention and preventative programs.

Inhaled methoxyflurane as a prehospital analgesic in children.

PubMed

Babl, Franz E; Jamison, Sarah R; Spicer, Maureen; Bernard, Stephen

2006-08-01

Despite widespread use of methoxyflurane as an inhaled analgesic by ambulance services in Australia there are no published data as to its use pattern, efficacy and safety in the prehospital setting. We set out to characterize methoxyflurane use in children in the prehospital setting. An observational case series was conducted over an 8 month period. Children who received methoxyflurane while being transported to a tertiary children's hospital by ambulance were enrolled. We analysed indications for use, verbal numerical pain scores, adverse events and depth of sedation based on paramedic, patient, parent and ED staff surveys and review of ambulance care records. During the study period 105 patients were enrolled with an age range of 15 months to 17 years (median age 11 years). Methoxyflurane was mainly used for extremity injuries (82%). Paramedic pain scores dropped from a mean of 7.9 (95% confidence interval [CI] 7.5-8.3) prior to methoxyflurane use to 4.5 (95% CI 3.9-5.0) at 2-5 min and to 3.2 (95% CI 2.8-3.7) at 10 min. There were no serious adverse events (one-sided 97.5% CI 0-3%). Mild adverse events occurred in 38 patients (36.2%; 95% CI 27.0-46.1%). Five of 15 (33.3%) patients under 5 years of age were deeply sedated. In the present paediatric case series methoxyflurane appears to be an efficacious analgesic with a low adverse events profile. In young children in particular it can briefly lead to deep sedation.

Use of force sensors to detect and analyse lameness in dairy cows.

PubMed

Kujala, M; Pastell, M; Soveri, T

2008-03-22

Force sensors were used to detect lameness in dairy cows in two trials. In the first trial, leg weights were recorded during approximately 12,000 milkings with balances built into the floor of the milking robot. Cows that put less weight on one leg or kicked frequently during milking were checked first with a locomotion scoring system and then with a clinical inspection. A locomotion score of more than 2 was considered lame, and these cows' hooves were examined at hoof trimming to determine the cause and to identify any hoof lesions. In the second trial 315 locomotion scores were recorded and compared with force sensor data. The force sensors proved to be a good method for recognising lameness. Computer curves drawn from force sensor data helped to find differences between leg weights, thus indicating lameness and its duration. Sole ulcers and white line disease were identified more quickly by force sensors than by locomotion scoring, but joint problems were more easily detected by locomotion scoring.

Signal amplification of FISH for automated detection using image cytometry.

PubMed

Truong, K; Boenders, J; Maciorowski, Z; Vielh, P; Dutrillaux, B; Malfoy, B; Bourgeois, C A

1997-05-01

The purpose of this study was to improve the detection of FISH signals, in order that spot counting by a fully automated image cytometer be comparable to that obtained visually under the microscope. Two systems of spot scoring, visual and automated counting, were investigated in parallel on stimulated human lymphocytes with FISH using a biotinylated centromeric probe for chromosome 3. Signal characteristics were first analyzed on images recorded with a coupled charge device (CCD) camera. Number of spots per nucleus were scored visually on these recorded images versus automatically with a DISCOVERY image analyzer. Several fluochromes, amplification and pretreatments were tested. Our results for both visual and automated scoring show that the tyramide amplification system (TSA) gives the best amplification of signal if pepsin treatment is applied prior to FISH. Accuracy of the automated scoring, however, remained low (58% of nuclei containing two spots) compared to the visual scoring because of the high intranuclear variation between FISH spots.

36 CFR 1234.14 - What are the requirements for environmental controls for records storage facilities?

Code of Federal Regulations, 2014 CFR

2014-07-01

... through leaks or condensation, relative humidities in excess of 70%, extremes of heat combined with relative humidity in excess of 55%, and poor air circulation during periods of elevated heat and relative humidity are all factors that contribute to mold growth. (b) Nontextual temporary records. Nontextual...

36 CFR § 1234.14 - What are the requirements for environmental controls for records storage facilities?

Code of Federal Regulations, 2013 CFR

2013-07-01

... through leaks or condensation, relative humidities in excess of 70%, extremes of heat combined with relative humidity in excess of 55%, and poor air circulation during periods of elevated heat and relative humidity are all factors that contribute to mold growth. (b) Nontextual temporary records. Nontextual...

36 CFR 1234.14 - What are the requirements for environmental controls for records storage facilities?

Code of Federal Regulations, 2012 CFR

2012-07-01

... through leaks or condensation, relative humidities in excess of 70%, extremes of heat combined with relative humidity in excess of 55%, and poor air circulation during periods of elevated heat and relative humidity are all factors that contribute to mold growth. (b) Nontextual temporary records. Nontextual...

Taxation records as a source of information for the study of historical floods in Southern Moravia, Czech Republic

NASA Astrophysics Data System (ADS)

Brázdil, Rudolf; Valášek, Hubert; Chromá, Kateřina; Dolák, Lukáš; Řezníčková, Ladislava; Dobrovolný, Petr

2014-05-01

The taxation system in Moravia allowed farmers to request tax relief if their crop yields had been negatively affected by hydrometeorological extremes. Firstly, the owners of land or individual farmers sent basic information about what had taken place, together with a detailed description of the damage, to the state executive (regional offices). After this, commissioners appointed by the regional administrator were obliged to inspect the places affected personally (in situ) and make records. Finally, the state executive made its decision as to whether to allow or reject the tax relief requested. The whole process was reflected in various surviving archival documents which contain information about the type of extreme event and the date of its occurrence, while the impact on crops may often be derived. Taxation documents of 201 estates in Southern Moravia, Czech Republic, prevailingly located in Moravian Land Archives in Brno, were studied to find information about hydrometeorological extremes. Such information is included for 84 of them. These data covering mainly the 18th-19th centuries were used for the study of historical floods (flash floods) complemented by other documentary sources and systematic hydrological observations (water stages, discharges) in the instrumental period (from the 1880s). Obtained flood data are analysed with respect to their temporal (frequency, seasonality) and spatial changes. Finally, uncertainties related to taxation records, such as their temporal and spatial incompleteness, the limits of the period of outside agricultural work (i.e. mainly May-August) and the purpose for which they were originally collected (primarily tax alleviation, i.e. information about hydrometeorological extremes was of secondary importance) are discussed with respect to results obtained. Taxation records constitute an important source of data for the study of historical floods with a great potential to be used in many European countries.

Gabapentin Does Not Appear to Improve Postoperative Pain and Sleep Patterns in Patients Who Concomitantly Receive Regional Anesthesia for Lower Extremity Orthopedic Surgery: A Randomized Control Trial

PubMed Central

Amin, Shawn; Reilly, Mark C.; Shulman, Steven

2017-01-01

In recent years, gabapentin has gained popularity as an adjuvant therapy for the treatment of postoperative pain. Numerous studies have shown a decrease in pain score, even with immediate postoperative activity, which is significant for early post-op ambulation and regaining functionality sooner. However, studies have been in conclusive in patients undergoing lower extremity orthopedic surgery. For this reason, we hoped to study the effect of gabapentin on postoperative pain in patients undergoing total knee arthroplasty, total hip arthroplasty, or a hip fracture repair. This was done in the setting of ensuring adequate postoperative analgesia with regional blocks and opioid PCA, as is protocol at our institution. Given the sedative effects of gabapentin and the potential for improving postoperative sleep patterns, we also studied the drug's effect on this aspect of our patient's postoperative course. We utilized the Pittsburg Sleep Quality Index and Visual Analog Scale for pain to obtain a more objective standardized score amongst our study population. Our results indicate that gabapentin does not offer any additional relief in pain or improve sleep habits in patients who have received either a femoral or lumbar plexus block for lower extremity orthopedic surgery. This trial is registered with NCT01546857. PMID:28348503

Effect of virtual reality versus conventional physiotherapy on upper extremity function in children with obstetric brachial plexus injury

PubMed Central

El-Shamy, Shamekh; Alsharif, Rabab

2017-01-01

Objectives: The objective was to evaluate the effects of virtual reality versus conventional physiotherapy on upper extremity function in children with obstetric brachial plexus injury. Methods: Forty children with Erb’s palsy were selected for this randomized controlled study. They were assigned randomly to either group A (conventional physiotherapy program) or group B (virtual reality program using Armeo® spring for 45 min three times/week for 12 successive weeks). Mallet system scores for shoulder function and shoulder abduction, and external rotation range of motion (ROM) were obtained; shoulder abductor, and external rotators isometric strength were evaluated pre-and post-treatment using Mallet scoring system, standard universal goniometer, and handheld dynamometer. Results: The results of this study indicate that the children in both groups showed improvement in shoulder functions post-treatment with greater improvements in group B. The abduction muscle strength after treatment was 8.53 and 11.3 Nm for group A and group B, respectively. The external rotation muscle strength after treatment was 5.88 and 7.45 Nm for group A and group B, respectively. Conclusions: The virtual reality program is a significantly more effective than conventional physiotherapy program in improving the upper extremity functions in children with obstetric brachial plexus injury. PMID:29199193

Reduced heart rate variability and vagal tone in anxiety: trait versus state, and the effects of autogenic training.

PubMed

Miu, Andrei C; Heilman, Renata M; Miclea, Mircea

2009-01-28

This study investigated heart rate variability (HRV) in healthy volunteers that were selected for extreme scores of trait anxiety (TA), during two opposite psychophysiological conditions of mental stress, and relaxation induced by autogenic training. R-R intervals, HF and LF powers, and LF/HF ratios were derived from short-term electrocardiographic recordings made during mental stress and relaxation by autogenic training, with respiratory rate and skin conductance being controlled for in all the analyses. The main finding was that high TA was associated with reduced R-R intervals and HF power across conditions. In comparison to mental stress, autogenic training increased HRV and facilitated the vagal control of the heart. There were no significant effects of TA or the psychophysiological conditions on LF power, or LF/HF ratio. These results support the view that TA, which is an important risk factor for anxiety disorders and predictor of cardiovascular morbidity and mortality, is associated with autonomic dysfunction that seems likely to play a pathogenetic role in the long term.

Tuffaceous Mud is a Volumetrically Important Volcaniclastic Facies of Submarine Arc Volcanism and Record of Climate Change

NASA Astrophysics Data System (ADS)

Gill, J. B.; Bongiolo, E. M.; Miyazaki, T.; Hamelin, C.; Jutzeler, M.; DeBari, S.; Jonas, A.-S.; Vaglarov, B. S.; Nascimento, L. S.; Yakavonis, M.

2018-04-01

The inorganic portion of tuffaceous mud and mudstone in an oceanic island arc can be mostly volcanic in origin. Consequently, a large volume of submarine volcaniclastic material is as extremely fine-grained as products of subaerial eruptions (<100 µm). Using results of IODP Expedition 350 in the Izu rear arc, we show that such material can accumulate at high rates (12-20 cm/k.y.) within 13 km of the nearest seamount summit and scores of km behind the volcanic front. The geochemistry of bulk, acid-leached mud, and its discrete vitriclasts, shows that >75% of the mud is volcanic, and that most of it was derived from proximal rear arc volcanic sources. It faithfully preserves integrated igneous geochemical information about arc evolution in much the same way that terrigenous shales track the evolution of continental crust. In addition, their high sedimentation rate enables high resolution study of climate cycles, including the effects of Pleistocene glaciation on the behavior of the Kuroshio Current in the Shikoku Basin south of Japan.

Time Burden of Standardized Hip Questionnaires.

PubMed

Chughtai, Morad; Khlopas, Anton; Mistry, Jaydev B; Gwam, Chukwuweike U; Elmallah, Randa K; Mont, Michael A

2016-04-01

Many standardized scales and questionnaires have been developed to assess outcomes of patients undergoing total hip arthroplasty (THA). However, these surveys can be a burden to both patients and orthopaedists as some are time-inefficient. In addition, there is a paucity of reports assessing the time it takes to complete them. In this study we aimed to: (1) assess how long it takes to complete the most common standardized hip questionnaires; (2) determine the presence of variation in completion time; and (3) evaluate the effects of age, gender, and level of education on completion time. Based on a previous study, we selected the seven most commonly used hip scoring systems-Western Ontario and McMaster Universities Hip Outcome Assessment (WOMAC), Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Larson Score, Short-form 36 (SF-36), modified Merle d'Aubigne and Postel Score (MDA), and Lower Extremity Functional Scale (LEFS). The standardized scales and questionnaires were randomly administered to 70 subjects. The subjects were unaware that they were being timed during completion of the questionnaire. We obtained the coefficients of variation of time for each questionnaire. The mean time to complete the questionnaire was then stratified and compared based on age, gender, and level of education. The mean time to complete each of the systems is listed in ascending order: Modified Merle d'Aubigne and Postel Score (MDA), Lower Extremity Functional Scale (LEFS), Western Ontario and McMaster Universities Hip Outcome Assessment (WOMAC), Harris Hip Score (HHS), Larson Score, Hip Disability and Osteoarthritis Outcome Score (HOOS), and Short-form 36 (SF-36). The WOMAC and Larson Score coefficients of variation were the largest, and the HOOS and MDA were the smallest. There was a significantly higher mean time to completion in those who were above or equal to the age of 55 years as compared to those who were below the age of 55 (227 vs. 166 seconds). There was no significant association found in time of completion between gender or education level. Standardized scales and questionnaire which assess THA patients can be burdensome and time-inefficient, which may lead to task-induced fatigue. This may result in inaccurate THA patient assessments, which do not reflect the patient's true state. Future studies should aim to create an encompassing questionnaire that is time efficient and can replace all currently used validated systems.

The 25-question Geriatric Locomotive Function Scale predicts the risk of recurrent falls in postoperative patients with cervical myelopathy.

PubMed

Kimura, Atsushi; Takeshita, Katsushi; Inoue, Hirokazu; Seichi, Atsushi; Kawasaki, Yosuke; Yoshii, Toshitaka; Inose, Hiroyuki; Furuya, Takeo; Takeuchi, Kazuhiro; Matsunaga, Shunji; Seki, Shoji; Tsushima, Mikito; Imagama, Shiro; Koda, Masao; Yamazaki, Masashi; Mori, Kanji; Nishimura, Hirosuke; Endo, Kenji; Yamada, Kei; Sato, Kimiaki; Okawa, Atsushi

2018-01-01

Fall-induced injuries represent a major public health concern for older individuals. The relationship between risk of falling and the severity of locomotive syndrome (LS) remains largely unknown. We conducted a retrospective analysis of patients who had undergone surgery from January 2012 to December 2013 and completed at least 1 year of follow-up at 12 participating institutes. Patients completed a questionnaire survey regarding their fall experience during a routine postoperative follow-up. Questionnaire items included the number of falls during the prior postoperative year and the 25-question Geriatric Locomotive Function Scale (GLFS-25). The severity of cervical myelopathy was assessed using the Japanese Orthopaedic Association (JOA) score. We analyzed the association between the incidence of falling and the severity of LS measured by the GLFS-25. Of 360 patients, 61 (16.9%) experienced 1 fall; 31 (8.6%), 2-3 falls; 4 (1.1%), 4-5 falls; and 6 (1.7%), ≥6 falls during the first postoperative year. Thus, 102 (28%) patients experienced at least 1 fall, and 41 (11%) experienced recurrent falls (2 or more falls) during the time period. The mean GLFS-25 score was 30.2 ± 22.7, and 242 (62%) patients had GLFS-25 scores of 16 or higher, which fulfilled the diagnostic criteria for LS. When subjects were categorized into recurrent fallers and non-recurrent fallers, recurrent fallers had a significantly higher GLFS-25 score and a significantly lower extremity motor function score of the JOA score than non-recurrent fallers. The GLFS-25 and lower extremity motor function score of the JOA score yielded the areas under the receiver operating characteristic curves of 0.674 and 0.607, respectively, to differentiate recurrent fallers from non-recurrent fallers. Postoperative patients with cervical myelopathy had a 62% prevalence of LS. The GLFS-25 may be useful to predict the risk of recurrent falls in patients with cervical myelopathy. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.