Accuracy of a disability instrument to identify workers likely to develop upper extremity musculoskeletal disorders.

PubMed

Stover, Bert; Silverstein, Barbara; Wickizer, Thomas; Martin, Diane P; Kaufman, Joel

2007-06-01

Work related upper extremity musculoskeletal disorders (MSD) result in substantial disability, and expense. Identifying workers or jobs with high risk can trigger intervention before workers are injured or the condition worsens. We investigated a disability instrument, the QuickDASH, as a workplace screening tool to identify workers at high risk of developing upper extremity MSDs. Subjects included workers reporting recurring upper extremity MSD symptoms in the past 7 days (n = 559). The QuickDASH was reasonably accurate at baseline with sensitivity of 73% for MSD diagnosis, and 96% for symptom severity. Specificity was 56% for diagnosis, and 53% for symptom severity. At 1-year follow-up sensitivity and specificity for MSD diagnosis was 72% and 54%, respectively, as predicted by the baseline QuickDASH score. For symptom severity, sensitivity and specificity were 86% and 52%. An a priori target sensitivity of 70% and specificity of 50% was met by symptom severity, work pace and quality, and MSD diagnosis. The QuickDASH may be useful for identifying jobs or workers with increased risk for upper extremity MSDs. It may provide an efficient health surveillance screening tool useful for targeting early workplace intervention for prevention of upper extremity MSD problems.

Severe hyperkalemia can be detected immediately by quantitative electrocardiography and clinical history in patients with symptomatic or extreme bradycardia: a retrospective cross-sectional study.

PubMed

Chon, Sung-Bin; Kwak, Young Ho; Hwang, Seung-Sik; Oh, Won Sup; Bae, Jun-Ho

2013-12-01

Detecting severe hyperkalemia is challenging. We explored its prevalence in symptomatic or extreme bradycardia and devised a diagnostic rule. This retrospective cross-sectional study included patients with symptomatic (heart rate [HR] ≤ 50/min with dyspnea, chest pain, altered mentality, dizziness/syncope/presyncope, general weakness, oliguria, or shock) or extreme (HR ≤ 40/min) bradycardia at an emergency department for 46 months. Risk factors for severe hyperkalemia were chosen by multiple logistic regression analysis from history (sex, age, comorbidities, and medications), vital signs, and electrocardiography (ECG; maximum precordial T-wave amplitude, PR, and QRS intervals). The derived diagnostic index was validated using bootstrapping method. Among the 169 participants enrolled, 87 (51.5%) were female. The mean (SD) age was 71.2 (12.5) years. Thirty-six (21.3%) had severe hyperkalemia. The diagnostic summed "maximum precordial T ≥ 8.5 mV (2)," "atrial fibrillation/junctional bradycardia (1)," "HR ≤ 42/min (1)," "diltiazem medication (2)," and "diabetes mellitus (1)." The C-statistics were 0.86 (0.80-0.93) and were validated. For scores of 4 or higher, sensitivity was 0.50, specificity was 0.92, and positive likelihood ratio was 6.02. The "ECG-only index," which sums the 3 ECG findings, had a sensitivity of 0.50, specificity of 0.90, and likelihood ratio (+) of 5.10 for scores of 3 or higher. Severe hyperkalemia is prevalent in symptomatic or extreme bradycardia and detectable by quantitative electrocardiographic parameters and history. © 2013.

Neurologic and developmental disability after extremely preterm birth. EPICure Study Group.

PubMed

Wood, N S; Marlow, N; Costeloe, K; Gibson, A T; Wilkinson, A R

2000-08-10

Small studies show that many children born as extremely preterm infants have neurologic and developmental disabilities. We evaluated all children who were born at 25 or fewer completed weeks of gestation in the United Kingdom and Ireland from March through December 1995 at the time when they reached a median age of 30 months. Each child underwent a formal assessment by an independent examiner. Development was evaluated with use of the Bayley Scales of Infant Development, and neurologic function was assessed by a standardized examination. Disability and severe disability were defined by predetermined criteria. At a median age of 30 months, corrected for gestational age, 283 (92 percent) of the 308 surviving children were formally assessed. The mean (+/-SD) scores on the Bayley Mental and Psychomotor Developmental Indexes, referenced to a population mean of 100, were 84+/-12 and 87+/-13, respectively. Fifty-three children (19 percent) had severely delayed development (with scores more than 3 SD below the mean), and a further 32 children (11 percent) had scores from 2 SD to 3 SD below the mean. Twenty-eight children (10 percent) had severe neuromotor disability, 7 (2 percent) were blind or perceived light only, and 8 (3 percent) had hearing loss that was uncorrectable or required aids. Overall, 138 children had disability (49 percent; 95 percent confidence interval, 43 to 55 percent), including 64 who met the criteria for severe disability (23 percent; 95 percent confidence interval, 18 to 28 percent). When data from 17 assessments by local pediatricians were included, 155 of the 314 infants discharged (49 percent) had no disability. Severe disability is common among children born as extremely preterm infants.

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.

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.

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.

Characteristics of Severely Emotionally Disturbed Adolescents with Extreme Scores on the Reynolds Adolescent Depression Scale.

ERIC Educational Resources Information Center

Hagborg, Winston J.

This study examined self-reported depression among severely emotionally disturbed adolescents at a private school serving publicly funded adolescents enrolled in a therapeutically supportive, non-residential educational program. From a sample of 45 students, using the Reynolds Adolescent Depression Scale (RADS), 15 students were selected for a…

Severity of child pedestrian injuries due to bonnet-type-vehicle collision.

PubMed

Hitosugi, Masahito; Kawato, Hitoshi; Gomei, Sayaka; Mizuno, Koji; Tokudome, Shogo

2013-10-01

The aim of this study was to clarify the pattern of child pedestrian injury, injury severity, and its relation to collision velocity in bonnet-type-vehicle collision. In-depth data were retrospectively collected from the Institute for Traffic Accident Research and Data Analysis on pedestrians younger than 13 years old with any bodily injuries from collisions with bonnet-type vehicles between 1993 and 2004. Forty-seven patients from 43 collisions with a mean age of 6.9 ± 2.5 years were included in the study. Injury severity was not significantly different between patients who were hit by the front of the vehicle and those who were hit by the side of the vehicle. In front collisions, impact with the vehicle was associated with significantly higher Abbreviated Injury Scale (AIS) scores than those for impact with the road, especially for the lower extremities (mean: 1.2 vs 0.2, P < 0.001). Injury severity of the lower extremities and collision velocity were examined. The estimated collision velocity of the vehicle was not significantly different between patients with lower extremity AIS scores of 0 or 1 and those of 2 or 3. Some pediatric pedestrians suffer from collisions with bonnet-type vehicles without lower extremity fractures owing to the characteristics of child pedestrians. Providing injury prevention programs for children in communities and schools, developing active safety devices in the vehicle, and modifying the vehicle body to a pediatric pedestrian-friendly structure may increase pedestrian protection. © 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society.

Effectiveness of Anti-Dementia Drugs in Extremely Severe Alzheimer's Disease: A 12-Week, Multicenter, Randomized, Single-Blind Study.

PubMed

Hong, Yun Jeong; Choi, Seong Hye; Jeong, Jee Hyang; Park, Kyung Won; Na, Hae Ri

2018-01-01

There is insufficient evidence to guide decisions concerning how long anti-dementia drug (ADD) regimens should be maintained in severe Alzheimer's disease (AD). We investigated whether patients with extremely severe AD who were already receiving donepezil or memantine benefited from continuing treatment. In this randomized and rater-blinded trial, 65 AD patients with a Mini-Mental State Examination score from 0 to 5 and a score of 6c or worse on Functional Assessment Staging were randomly assigned to an ADD-continuation group (N = 30) or an ADD-discontinuation group (N = 35). The current use of donepezil or memantine was maintained for 12 weeks in the ADD-continuation group and was discontinued after baseline in the ADD-discontinuation group. Efficacy measures were obtained at baseline and 12 weeks. The primary efficacy variable was the change from baseline to the end of the study in Baylor Profound Mental State Examination (BPMSE) scores. The change in the BPMSE from baseline to the end of the study in the ADD-continuation group (a 0.4-point improvement) was not equivalent to that in the ADD-discontinuation group (a 0.5-point decline), as determined by two one-sided tests of equivalence. Study withdrawals due to adverse events (11.4% versus 6.7%) were more frequent in the ADD-discontinuation group than in the ADD-continuation group. Continued treatment with donepezil or memantine seems unequal and might be superior to withdrawal of the drugs in terms of the effects on global cognition in patients with extremely severe AD. Current Controlled Trials number: KCT0000874 (CRIS).

Evaluation of whether extremely high enthesitis or Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores suggest fibromyalgia and confound the anti-TNF response in early non-radiographic axial spondyloarthritis.

PubMed

Dougados, Maxime; Logeart, Isabelle; Szumski, Annette; Coindreau, Javier; Jones, Heather

2017-01-01

Differentiating between pain from spondyloarthritis (SpA) and pain from fibromyalgia is challenging. We evaluated patients with non-radiographic axial SpA (nr-axSpA) to determine the percentage of patients with extremely high enthesitis and/or Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores, the relationship between extreme scores and depression, and the effect of extreme scores on treatment outcomes with etanercept. Patients with nr-axSpA received double-blind etanercept 50 mg or placebo weekly and were divided into those who did vs did not have extreme scores at baseline. Extreme scores were defined as the highest quintile for enthesitis score (≥6), and/or scores ≥8 on three of five BASDAI items (excluding morning stiffness duration). Depression was assessed with the Hospital Anxiety and Depression Scale, depression subscale (HADS-D) and medication use. Week 12 outcomes included Assessment of SpondyloArthritis (ASAS) 40 and ASAS partial remission. At baseline, 35/213 (16.4%) patients met extreme enthesitis criteria, 31 (14.6%) met extreme BASDAI criteria, 12 (5.6%) met both, and 135 (63.4%) met neither. More patients with extreme scores than without met the HADS-D definition of depression: 35/68 (51.5%) vs. 27/118 (22.9%), p<0.0001. For patients with vs. without extreme scores who received etanercept, no significant difference existed in week 12 ASAS 40: 13/41 (31.7%) vs. 21/60 (35.0%), respectively, or ASAS partial remission: 8/41 (19.5%) vs. 19/60 (31.7%). Extreme enthesitis and/or BASDAI scores were associated with measurements of depression, but did not affect week 12 ASAS 40 or ASAS partial remission.

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

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.

Premenstrual symptoms: another look.

PubMed Central

Woods, N F

1987-01-01

A collection of over 200 symptoms has been labeled premenstrual syndrome. Common belief is that most women experience a marked increase in symptoms premenses. Cyclic variations in the prevalence of commonly cited perimenstrual symptoms were estimated from daily symptom recording. A community-based, multiethnic sample of 345 women recorded symptom severity from "not present" to "extreme" for 90 days. Maximum total reported symptom score occurred during menses, not during premenses. When individual symptoms are considered, the prevalence of those rated as moderate to extreme during menses is less than 15 percent. A method for identifying symptom severity patterns throughout the menstrual cycle is described. Six symptom severity patterns were identified. Only 13 percent of the women exhibited a pattern of increased symptom severity in the premenses. Another 13 percent had a pattern of decreased symptom severity in the premenses. PMID:3120207

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

Mental health assessed by the Strengths and Difficulties Questionnaire for children born extremely preterm without severe disabilities at 11 years of age: a Norwegian, national population-based study.

PubMed

Fevang, Silje Katrine Elgen; Hysing, Mari; Sommerfelt, Kristian; Elgen, Irene

2017-12-01

The aims were to investigate mental health problems with the Strength and Difficulties Questionnaire (SDQ) in children born extremely preterm/extremely low birth weight (EP/ELBW) without severe disabilities compared to controls, and to identify peri-, or neonatal factors possibly predicting later mental health problems. A national Norwegian cohort of 11-year-old EP/ELBW children, excluding those with intellectual disabilities, non-ambulatory cerebral palsy, blindness and/or deafness, was assessed. Parents and teachers completed the SDQ. Mean scores and scores ≥90th percentile for the control group, combined (parent and/or teacher reporting the child ≥90th percentile), and pervasive ratings (both parent and teacher reporting the child ≥90th percentile) were presented. The controls consisted of an unselected population of all 11-year-old children born in 1995 who attended public or private schools in Bergen. Of the eligible children, 216 (64%) EP/ELBW and 1882 (61%) control children participated. The EP/ELBW children had significantly higher scores and/or increased risk of parent, teacher, combined, and pervasive rated hyperactivity/inattention, emotional-, and peer problems (OR 2.1-6.3). Only parents reported the EP/ELBW children to be at an increased risk of conduct problems (OR 1.6, 95% CI 1.1-2.6). Only low maternal education at birth was significantly associated with mental health problems at 11 years of age (OR 2.5, 95% CI 1.2-5.4). EP/ELBW children without severe disabilities had increased risk of symptoms of hyperactivity/inattention, emotional-, and peer problems. None of the peri- or neonatal factors were significantly associated with later mental health problems, except for low maternal education.

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.

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.

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.

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.

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.

Decreased Visual Function Scores on a Low Luminance Questionnaire Is Associated with Impaired Dark Adaptation.

PubMed

Yazdanie, Mohammad; Alvarez, Jason; Agrón, Elvira; Wong, Wai T; Wiley, Henry E; Ferris, Frederick L; Chew, Emily Y; Cukras, Catherine

2017-09-01

We investigate whether responses on a Low Luminance Questionnaire (LLQ) in patients with a range of age-related macular degeneration (AMD) severity are associated with their performance on focal dark adaptation (DA) testing and with choroidal thickness. Cross-sectional, single-center, observational study. A total of 113 participants older than 50 years of age with a range of AMD severity. Participants answered the LLQ on the same day they underwent DA testing using a focal dark adaptometer measuring rod intercept time (RIT). We performed univariable and multivariable analyses of the LLQ scores and age, RIT, AMD severity, subfoveal choroidal thickness [SFCT], phakic status, and best-corrected visual acuity. The primary outcome of this study was the score on the 32-question LLQ. Each item in the LLQ is designated to 1 of 6 subscales describing functional problems in low luminance: driving, emotional distress, mobility, extreme lighting, peripheral vision, and general dim lighting. Scores were computed for each subscale, in addition to a weighted total mean score. Responses from 113 participants (mean age, 76.2±9.3 years; 58.4% were female) and 113 study eyes were analyzed. Univariable analysis demonstrated that lower scores on all LLQ subscales were correlated with prolonged DA testing (longer RIT) and decreased choroidal thickness. All associations were statistically significant except for the association of choroidal thickness and "peripheral vision." The strongest association was the LLQ subscale of driving with RIT (r =-0.97, P < 0.001). Multivariable analysis for each of the LLQ subscale outcomes, adjusted for age, included RIT, with total LLQ score, "driving," "extreme lighting," and "mobility" also including choroidal thickness. In all multivariable analyses, RIT had a stronger association than choroidal thickness. This cross-sectional analysis demonstrates associations of patient-reported functional deficits, as assessed on the LLQ, with both reduced DA and reduced choroidal thickness, in a population of older adults with varying degrees of AMD severity and good visual acuity in at least 1 eye. These analyses suggest that local functional measurements of DA testing (RIT) and choroidal thickness are associated with patient-reported functional deficits. Published by Elsevier Inc.

The Fear-Avoidance Components Scale (FACS): Responsiveness to Functional Restoration Treatment in a Chronic Musculoskeletal Pain Disorder (CMPD) Population.

PubMed

Neblett, Randy; Mayer, Tom G; Williams, Mark J; Asih, Sali; Cuesta-Vargas, Antonio I; Hartzell, Meredith M; Gatchel, Robert J

2017-12-01

To assess the clinical validity and factor structure of the Fear-Avoidance Components Scale (FACS), a new fear-avoidance measure. In this study, 426 chronic musculoskeletal pain disorder patients were admitted to a Functional Restoration Program (FRP). They were categorized into 5 FACS severity levels, from subclinical to extreme, at admission, and again at discharge. Associations with objective lifting performance and other patient-reported psychosocial measures were determined at admission and discharge, and objective work outcomes for this predominantly disabled cohort, were assessed 1 year later. Those patients in the severe and extreme FACS severity groups at admission were more likely to "drop out" of treatment than those in the lower severity groups (P=0.05). At both admission and discharge, the FACS severity groups were highly and inversely correlated with objective lifting performance and patient-reported fear-avoidance-related psychosocial variables, including kinesiophobia, pain intensity, depressive symptoms, perceived disability, perceived injustice, and insomnia (Ps<0.001). All variables showed improvement at FRP discharge. Patients in the extreme FACS severity group at discharge were less likely to return to, or retain, work 1 year later (P≤0.02). A factor analysis identified a 2-factor solution. Strong associations were found among FACS scores and other patient-reported psychosocial and objective lifting performance variables at both admission and discharge. High discharge-FACS scores were associated with worse work outcomes 1 year after discharge. The FACS seems to be a valid and clinically useful measure for predicting attendance, physical performance, distress, and relevant work outcomes in FRP treatment of chronic musculoskeletal pain disorder patients.

Upper-extremity and mobility subdomains from the Patient-Reported Outcomes Measurement Information System (PROMIS) adult physical functioning item bank.

PubMed

Hays, Ron D; Spritzer, Karen L; Amtmann, Dagmar; Lai, Jin-Shei; Dewitt, Esi Morgan; Rothrock, Nan; Dewalt, Darren A; Riley, William T; Fries, James F; Krishnan, Eswar

2013-11-01

To create upper-extremity and mobility subdomain scores from the Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning adult item bank. Expert reviews were used to identify upper-extremity and mobility items from the PROMIS item bank. Psychometric analyses were conducted to assess empirical support for scoring upper-extremity and mobility subdomains. Data were collected from the U.S. general population and multiple disease groups via self-administered surveys. The sample (N=21,773) included 21,133 English-speaking adults who participated in the PROMIS wave 1 data collection and 640 Spanish-speaking Latino adults recruited separately. Not applicable. We used English- and Spanish-language data and existing PROMIS item parameters for the physical functioning item bank to estimate upper-extremity and mobility scores. In addition, we fit graded response models to calibrate the upper-extremity items and mobility items separately, compare separate to combined calibrations, and produce subdomain scores. After eliminating items because of local dependency, 16 items remained to assess upper extremity and 17 items to assess mobility. The estimated correlation between upper extremity and mobility was .59 using existing PROMIS physical functioning item parameters (r=.60 using parameters calibrated separately for upper-extremity and mobility items). Upper-extremity and mobility subdomains shared about 35% of the variance in common, and produced comparable scores whether calibrated separately or together. The identification of the subset of items tapping these 2 aspects of physical functioning and scored using the existing PROMIS parameters provides the option of scoring these subdomains in addition to the overall physical functioning score. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Abbreviated injury scale scoring in traffic fatalities: comparison of computerized tomography and autopsy.

PubMed

Leth, Peter Mygind; Ibsen, Marlene

2010-06-01

The purpose of this investigation is to evaluate the value of postmortem computerized tomography (CT) for Abbreviated Injury Scale (AIS) scoring and Injury Severity Scoring (ISS) of traffic fatalities. This is a prospective investigation of a consecutive series of 52 traffic fatalities from Southern Denmark that were CT scanned and autopsied. The AIS and ISS scores based on CT and autopsy (AU) were registered in a computer database and compared. Kappa values for reproducibility of AIS-severity scores and ISS scores were calculated. On an average, there was a 94% agreement between AU and CT in detecting the presence or absence of lesions in the various anatomic regions, and the severity scores were the same in 90% of all cases (range, 75-100%). When different severity scoring was obtained, CT detected more lesions with a high severity score in the facial skeleton, pelvis, and extremities, whereas AU detected more lesions with high scores in the soft tissues (especially in the aorta), cranium, and ribs. The kappa value for reproducibility of AIS scores confirmed that the agreement between the two methods was good. The lowest kappa values (>0.6) were found for the facial skeleton, cerebellum, meninges, neck organs, lungs, kidneys, and gastrointestinal tract. In these areas, the kappa value provided moderate agreement between CT and AU. For all other areas, there was a substantial agreement between the two methods. The ISS scores obtained by CT and by AU were calculated and were found to be with no or moderate variation in 85%. Rupture of the aorta was often overlooked by CT, resulting in too low ISS scoring. The most precise postmortem AIS and ISS scorings of traffic fatalities was obtained by a combination of AU and CT. If it is not possible to perform an AU, then CT may be used as an acceptable alternative for AIS scoring. We have identified one important obstacle for postmortem ISS scoring, namely that aorta ruptures are not easily detected by post mortem CT.

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

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.

Crash analysis of lower extremity injuries in children restrained in forward-facing car seats during front and rear impacts.

PubMed

Bennett, Tellen D; Kaufman, Robert; Schiff, Melissa; Mock, Charles; Quan, Linda

2006-09-01

The mechanism, crash characteristics, and spectrum of lower extremity injuries in children restrained in forward-facing car seats during front and rear impacts have not been described. We identified in two databases children who sustained lower extremity injuries while restrained in forward-facing car seats. To identify the mechanism, we analyzed crash reconstructions from three frontal-impact cases from the Crash Injury Research and Engineering Network. To further describe the crash and injury characteristics we evaluated children between 1 and 4 years of age with lower extremity injuries from front or rear impacts in the National Automotive Sampling System (NASS) Crashworthiness Data System (CDS) database. Crash reconstruction data demonstrated that the likely mechanism of lower extremity injury was contact between the legs and the front seatbacks. In the CDS database, we identified 15 children with lower extremity injuries in a forward-facing child seat, usually (13 out of 15) placed in the rear seat, incurred in frontal impacts (11 out of 15). Several (5 out of 15) children were in unbelted or improperly secured forward-facing car seats. Injury Severity Scores varied widely (5-50). Children in forward-facing car seats involved in severe front or rear crashes may incur a range of lower extremity injury from impact with the car interior component in front of them. Crash scene photography can provide useful information about anatomic sites at risk for injury and alert emergency department providers to possible subtle injury.

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.

Secondary Psychometric Examination of the Dimensional Obsessive-Compulsive Scale: Classical Testing, Item Response Theory, and Differential Item Functioning.

PubMed

Thibodeau, Michel A; Leonard, Rachel C; Abramowitz, Jonathan S; Riemann, Bradley C

2015-12-01

The Dimensional Obsessive-Compulsive Scale (DOCS) is a promising measure of obsessive-compulsive disorder (OCD) symptoms but has received minimal psychometric attention. We evaluated the utility and reliability of DOCS scores. The study included 832 students and 300 patients with OCD. Confirmatory factor analysis supported the originally proposed four-factor structure. DOCS total and subscale scores exhibited good to excellent internal consistency in both samples (α = .82 to α = .96). Patient DOCS total scores reduced substantially during treatment (t = 16.01, d = 1.02). DOCS total scores discriminated between students and patients (sensitivity = 0.76, 1 - specificity = 0.23). The measure did not exhibit gender-based differential item functioning as tested by Mantel-Haenszel chi-square tests. Expected response options for each item were plotted as a function of item response theory and demonstrated that DOCS scores incrementally discriminate OCD symptoms ranging from low to extremely high severity. Incremental differences in DOCS scores appear to represent unbiased and reliable differences in true OCD symptom severity. © The Author(s) 2014.

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.

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.

The value of the injury severity score in pediatric trauma: Time for a new definition of severe injury?

PubMed

Brown, Joshua B; Gestring, Mark L; Leeper, Christine M; Sperry, Jason L; Peitzman, Andrew B; Billiar, Timothy R; Gaines, Barbara A

2017-06-01

The Injury Severity Score (ISS) is the most commonly used injury scoring system in trauma research and benchmarking. An ISS greater than 15 conventionally defines severe injury; however, no studies evaluate whether ISS performs similarly between adults and children. Our objective was to evaluate ISS and Abbreviated Injury Scale (AIS) to predict mortality and define optimal thresholds of severe injury in pediatric trauma. Patients from the Pennsylvania trauma registry 2000-2013 were included. Children were defined as younger than 16 years. Logistic regression predicted mortality from ISS for children and adults. The optimal ISS cutoff for mortality that maximized diagnostic characteristics was determined in children. Regression also evaluated the association between mortality and maximum AIS in each body region, controlling for age, mechanism, and nonaccidental trauma. Analysis was performed in single and multisystem injuries. Sensitivity analyses with alternative outcomes were performed. Included were 352,127 adults and 50,579 children. Children had similar predicted mortality at ISS of 25 as adults at ISS of 15 (5%). The optimal ISS cutoff in children was ISS greater than 25 and had a positive predictive value of 19% and negative predictive value of 99% compared to a positive predictive value of 7% and negative predictive value of 99% for ISS greater than 15 to predict mortality. In single-system-injured children, mortality was associated with head (odds ratio, 4.80; 95% confidence interval, 2.61-8.84; p < 0.01) and chest AIS (odds ratio, 3.55; 95% confidence interval, 1.81-6.97; p < 0.01), but not abdomen, face, neck, spine, or extremity AIS (p > 0.05). For multisystem injury, all body region AIS scores were associated with mortality except extremities. Sensitivity analysis demonstrated ISS greater than 23 to predict need for full trauma activation, and ISS greater than 26 to predict impaired functional independence were optimal thresholds. An ISS greater than 25 may be a more appropriate definition of severe injury in children. Pattern of injury is important, as only head and chest injury drive mortality in single-system-injured children. These findings should be considered in benchmarking and performance improvement efforts. Epidemiologic study, level III.

Clinical effect of acupuncture on cervical spondylotic radiculopathy: results of a case series.

PubMed

Nakajima, Miwa; Inoue, Motohiro; Itoi, Megumi; Kitakoji, Hiroshi

2013-12-01

To observe the effectiveness of acupuncture applied to the cervical region of patients with upper extremity radicular symptoms due to cervical spondylotic radiculopathy (CSR). 15 subjects diagnosed with CSR and with upper extremity pain and/or paraesthesiae for 13.1±18.0 months were selected. The 15 patients had 16 affected limbs and scored a total of 17 symptom scores of pain and/or paraesthesiae. All patients were treated with acupuncture once a week for 4 weeks at up to 10 sites in the cervical paraspinal region centred on the affected area. The severity of the symptoms was recorded using a visual analogue scale (VAS) and functional evaluation was conducted using a Neck Disability Index (NDI). A significant reduction over time was seen for both mean VAS (p<0.0001) and NDI (p<0.0001). Changes were still significant at 4-week follow-up. A 50% reduction in symptoms was scored for 15 of the 17 symptoms scored. Favourable results were seen in nearly 90% of cases. These results show that acupuncture treatment to the cervical region may be effective as a conservative therapy for treating CSR.

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.

Determinants of health-related quality of life in psoriasis patients in Malaysia.

PubMed

Nyunt, Wint Wint Thu; Low, Wah Yun; Ismail, Rokiah; Sockalingam, Sargunan; Min, Aung Ko Ko

2015-03-01

Psoriasis is a chronic dermatological disorder that has a negative impact on quality of life (QoL). This hospital-based cross-sectional study determined factors associated with health-related QoL (HRQoL) impairment in adult psoriasis patients. HRQoL was assessed using the Dermatology Life Quality Index (DLQI). Disease severity was assessed using the Psoriasis Area and Severity Index (PASI). A total of 223 patients, aged 18 to 83 years, were recruited. For 67 (30%) patients, psoriasis had very large to extremely large effect on their life (DLQI score = 11-30). The median DLQI score was 7 (interquartile range = 7). Factors significantly associated with severe impact on HRQoL (DLQI ≥ 10) were disease severity, single status, working status, sports activities, nail dystrophy, exposed area involvement, itch, disturbed sleep, stress, and infection. The factor predictive of severe impact of psoriasis on HRQoL was disease severity. A holistic approach in the management, including psychosocial issues, is absolutely crucial for the optimal care of psoriasis patients. © 2013 APJPH.

Early Conventional MRI for Prediction of Neurodevelopmental Impairment in Extremely-Low-Birth-Weight Infants.

PubMed

Slaughter, Laurel A; Bonfante-Mejia, Eliana; Hintz, Susan R; Dvorchik, Igor; Parikh, Nehal A

2016-01-01

Extremely-low-birth-weight (ELBW; ≤1,000 g) infants are at high risk for neurodevelopmental impairments. Conventional brain MRI at term-equivalent age is increasingly used for prediction of outcomes. However, optimal prediction models remain to be determined, especially for cognitive outcomes. The aim was to evaluate the accuracy of a data-driven MRI scoring system to predict neurodevelopmental impairments. 122 ELBW infants had a brain MRI performed at term-equivalent age. Conventional MRI findings were scored with a standardized algorithm and tested using a multivariable regression model to predict neurodevelopmental impairment, defined as one or more of the following at 18-24 months' corrected age: cerebral palsy, bilateral blindness, bilateral deafness requiring amplification, and/or cognitive/language delay. Results were compared with a commonly cited scoring system. In multivariable analyses, only moderate-to-severe gyral maturational delay was a significant predictor of overall neurodevelopmental impairment (OR: 12.6, 95% CI: 2.6, 62.0; p < 0.001). Moderate-to-severe gyral maturational delay also predicted cognitive delay, cognitive delay/death, and neurodevelopmental impairment/death. Diffuse cystic abnormality was a significant predictor of cerebral palsy (OR: 33.6, 95% CI: 4.9, 229.7; p < 0.001). These predictors exhibited high specificity (range: 94-99%) but low sensitivity (30-67%) for the above outcomes. White or gray matter scores, determined using a commonly cited scoring system, did not show significant association with neurodevelopmental impairment. In our cohort, conventional MRI at term-equivalent age exhibited high specificity in predicting neurodevelopmental outcomes. However, sensitivity was suboptimal, suggesting additional clinical factors and biomarkers are needed to enable accurate prognostication. © 2016 S. Karger AG, Basel.

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

Manual physical therapy combined with high-intensity functional rehabilitation for severe lower extremity musculoskeletal injuries: a case series*

PubMed Central

Crowell, Michael S.; Deyle, Gail D.; Owens, Johnny; Gill, Norman W.

2016-01-01

Objectives Severe lower extremity trauma accounts for large healthcare costs and often results in elective amputation and poor long-term outcomes. The purpose of this case series is to describe an orthopedic manual physical therapy (OMPT) approach combined with a return to run (RTR) clinical pathway consisting of high-intensity functional rehabilitation with a custom energy-storing orthosis. Methods Three consecutive male patients, aged 21–23 years, with severe lower extremity musculoskeletal injuries were treated with a combined intervention that included a mean (SD) of 12 (2·1) OMPT sessions and 24 (8·7) functional rehabilitation sessions over a mean of 6 weeks (1·0). Additional training with a custom energy-storing orthosis consisted of a mean of 15 (1·2) additional sessions over 4 weeks. Patient self-report outcome measures and a variety of physical performance tests captured change in function. Results Baseline lower extremity functional scale (LEFS) and foot and ankle ability measure activities of daily living subscale (FAAM-ADL) scores indicated severe disability. All patients exceeded the minimal clinically important difference (MCID) in at least one self-report outcome or physical performance test without a brace. Two of three patients exceeded the MCID for at least two physical performance tests after training with and utilizing a custom energy-storing orthosis. Discussion Clinically meaningful changes in self-reported function or physical performance were observed in all patients. A multi-modal approach, including manual therapy and functional exercise, may address the entire spectrum of impairments in patients with severe lower extremity trauma, resulting in improvements in both braced and un-braced function. PMID:27252581

Hybrid external fixation in high-energy elbow fractures: a modular system with a promising future.

PubMed

Lerner, A; Stahl, S; Stein, H

2000-12-01

Severe, high-energy, periarticular elbow injuries producing a "floating joint" are a major surgical challenge. Their reconstruction and rehabilitation are not well documented. Therefore, the following reports our experience with treating such injuries caused by war wounds. Seven adults with compound open peri- and intra-articular elbow fractures were treated in hybrid ring tubular fixation frames. After debridement, bone stabilization, and neurovascular reconstructions, early controlled daily movements were started in the affected joint. These seven patients had together seven humeral, five radial, and six ulnar fractures. All fractures united at a median time of 180 days. No deep infection developed. The functional end results assessed by the Khalfayan functional score were excellent in two, good in one, and fair in four of these severely mangled upper extremities. None was amputated. The Mangled Extremity Severity Score has been shown to be unable to provide a reliable assessment for severe high-energy limb injuries surgically managed with the modular hybrid thin wire tubular external fixation system. This hybrid system is a very useful addition to the surgical armamentarium of orthopedic trauma surgeons. It both allows complex surgical reconstructions and reduces the incidence of deep infections in these heavily contaminated injuries. The hybrid circular (thin wire) external fixation system is very modular and may provide secure skeletal stabilization even in cases of severely comminuted juxta-articular fractures on both sides of the elbow joint (floating elbow) with severe damage to soft tissues. This fixation system allows individual fixation of forearm bone fractures, thus allowing the preservation of pronation-supination movements.

Severe retinopathy of prematurity predicts delayed white matter maturation and poorer neurodevelopment.

PubMed

Glass, Torin J A; Chau, Vann; Gardiner, Jane; Foong, Justin; Vinall, Jillian; Zwicker, Jill G; Grunau, Ruth E; Synnes, Anne; Poskitt, Kenneth J; Miller, Steven P

2017-11-01

To determine whether severe retinopathy of prematurity (ROP) is associated with (1) abnormal white matter maturation and (2) neurodevelopmental outcomes at 18 months' corrected age (CA) compared with neonates without severe ROP. We conducted a prospective longitudinal cohort of extremely preterm neonates born 24-28 weeks' gestational age recruited between 2006 and 2013 with brain MRIs obtained both early in life and at term-equivalent age. Severe ROP was defined as ROP treated with retinal laser photocoagulation. Using diffusion tensor imaging and tract-based spatial statistics (TBSS), white matter maturation was assessed by mean fractional anisotropy (FA) in seven predefined regions of interest. Neurodevelopmental outcomes were assessed with Bayley Scales of Infant and Toddler Development-III (Bayley-III) composite scores at 18 months' CA. Subjects were compared using Fisher's exact, Kruskal-Wallis and generalised estimating equations. Families were recruited from the neonatal intensive care unit at BC Women's Hospital. Of 98 extremely preterm neonates (median: 26.0 weeks) assessed locally for ROP, 19 (19%) had severe ROP and 83 (85%) were assessed at 18 months' CA. Severe ROP was associated with lower FA in the posterior white matter, and with decreased measures of brain maturation in the optic radiations, posterior limb of the internal capsule (PLIC) and external capsule on TBSS. Bayley-III cognitive and motor scores were lower in infants with severe ROP. Severe ROP is associated with maturational delay in the optic radiations, PLIC, external capsule and posterior white matter, housing the primary visual and motor pathways, and is associated with poorer cognitive and motor outcomes at 18 months' CA. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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.

The Modified Checklist for Autism in Toddlers in extremely low gestational age newborns: individual items associated with motor, cognitive, vision and hearing limitations.

PubMed

Luyster, Rhiannon J; Kuban, Karl C K; O'Shea, T Michael; Paneth, Nigel; Allred, Elizabeth N; Leviton, Alan

2011-07-01

The Modified Checklist for Autism in Toddlers (M-CHAT) has yielded elevated rates of screening failure for children born preterm or with low birthweight. We extended these findings with a detailed examination of M-CHAT items in a large sample of children born at extremely low gestational age. The sample was grouped according to children's current limitations and degree of impairment. The aim was to better understand how disabilities might influence M-CHAT scores. Fourteen participating institutions of the Extremely Low Gestational Age Newborns (ELGAN) Study prospectively collected information about 1086 infants who were born before the 28th week of gestation and had an assessment at age 24-months. The 24-month visit included a neurological assessment, the Bayley Scales of Infant Development, Second edition (BSID-II), M-CHAT and a medical history form. Outcome measures included the distribution of failed M-CHAT items among groups classified according to cerebral palsy diagnosis, gross motor function, BSID-II scores and vision or hearing impairments. M-CHAT items were failed more frequently by children with concurrently identified impairments (motor, cognitive, vision and hearing). In addition, the frequency of item failure increased with the severity of impairment. The failed M-CHAT items were often, but not consistently, related to children's specific impairments. Importantly, four of the six M-CHAT 'critical items' were commonly affected by presence and severity of concurrent impairments. The strong association between impaired sensory or motor function and M-CHAT results among extremely low gestational age children suggests that such impairments might give rise to false positive M-CHAT screening. © 2011 Blackwell Publishing Ltd.

Contribution of 32 GWAS-Identified Common Variants to Severe Obesity in European Adults Referred for Bariatric Surgery

PubMed Central

Yousseif, Ahmed; Pucci, Andrea; Santini, Ferruccio; Karra, Efthimia; Querci, Giorgia; Pelosini, Caterina; McCarthy, Mark I.; Lindgren, Cecilia M.; Batterham, Rachel L.

2013-01-01

The prevalence of severe obesity, defined as body mass index (BMI) ≥35.0 kg/m2, is rising rapidly. Given the disproportionately high health burden and healthcare costs associated with this condition, understanding the underlying aetiology, including predisposing genetic factors, is a biomedical research priority. Previous studies have suggested that severe obesity represents an extreme tail of the population BMI variation, reflecting shared genetic factors operating across the spectrum. Here, we sought to determine whether a panel of 32 known common obesity-susceptibility variants contribute to severe obesity in patients (n = 1,003, mean BMI 48.4±8.1 kg/m2) attending bariatric surgery clinics in two European centres. We examined the effects of these 32 common variants on obesity risk and BMI, both as individual markers and in combination as a genetic risk score, in a comparison with normal-weight controls (n = 1,809, BMI 18.0–24.9 kg/m2); an approach which, to our knowledge, has not been previously undertaken in the setting of a bariatric clinic. We found strong associations with severe obesity for SNP rs9939609 within the FTO gene (P = 9.3×10−8) and SNP rs2815752 near the NEGR1 gene (P = 3.6×10−4), and directionally consistent nominal associations (P<0.05) for 12 other SNPs. The genetic risk score associated with severe obesity (P = 8.3×10−11) but, within the bariatric cohort, this score did not associate with BMI itself (P = 0.264). Our results show significant effects of individual BMI-associated common variants within a relatively small sample size of bariatric patients. Furthermore, the burden of such low-penetrant risk alleles contributes to severe obesity in this population. Our findings support that severe obesity observed in bariatric patients represents an extreme tail of the population BMI variation. Moreover, future genetic studies focused on bariatric patients may provide valuable insights into the pathogenesis of obesity at a population level. PMID:23950990

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

Identifying clinically meaningful symptom response cut-off values on the SANS in predominant negative symptoms.

PubMed

Levine, Stephen Z; Leucht, Stefan

2013-04-01

The treatment and measurement of negative symptoms are currently at issue in schizophrenia, but the clinical meaning of symptom severity and change is unclear. To offer a clinically meaningful interpretation of severity and change scores on the Scale for the Assessment of Negative Symptoms (SANS). Patients were intention-to-treat participants (n=383) in two double-blind randomized placebo-controlled clinical trials that compared amisulpride with placebo for the treatment of predominant negative symptoms. Equipercentile linking was used to examine extrapolation from (a) CGI-S to SANS severity ratings, and (b) CGI-I to SANS percentage change (n=383). Linking was conducted at baseline, 8-14 days, 28-30 days, and 56-60 days of the trials. Across visits, CGI-S ratings of 'not ill' linked to SANS scores of 0-13, and ranged to 'extreme' ratings that linked to SANS scores of 102-105. The relationship between the CGI-S and the SANS severity scores assumed a linear trend (1=0-13, 2=15-56, 3=37-61, 4=49-66, 5=63-75, 6=79-89, 7=102-105). Similarly the relationship between CGI-I ratings and SANS percentage change followed a linear trend. For instance, CGI-I ratings of 'very much improved' were linked to SANS percent changes of -90 to -67, 'much improved' to -50 to -42, and 'minimally improved' to -21 to -13. The current results uniquely contribute to the debate surrounding negative symptoms by providing clinical meaning to SANS severity and change scores and so offer direction regarding clinically meaningful response cut-off scores to guide treatment targets of predominant negative symptoms. Copyright © 2013 Elsevier B.V. All rights reserved.

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

The relationship between physical and psychological complaints and quality of life in severely injured patients.

PubMed

van Delft-Schreurs, C C H M; van Son, M A C; de Jongh, M A C; Lansink, K W W; de Vries, J; Verhofstad, M H J

2017-09-01

The purpose of this study was two-fold. The first goal was to investigate which variables were associated with the remaining physical limitations of severely injured patients after the initial rehabilitation phase. Second, we investigated whether physical limitations were attributable to the association between psychological complaints and quality of life in this patient group. Patients who were 18 years or older and who had an injury severity score (ISS)>15 completed a set of questionnaires at one time-point after their rehabilitation phase (15-53 months after their trauma). The Short Musculoskeletal Function Assessment (SMFA) questionnaire was used to determine physical limitations. The Hospital Anxiety and Depression Scale, the Dutch Impact of Event Scale and the Cognitive Failure Questionnaire were used to determine psychological complaints, and the World Health Organization Quality of Life assessment instrument-BREF was used to measure general Quality of Life (QOL). Differences in physical limitations were investigated for several trauma- and patient-related variables using non-parametric independent-sample Mann-Whitney U tests. Multiple linear regression was performed to investigate whether the decreased QOL of severely injured patients with psychological complaints could be explained by their physical limitations. Older patients, patients with physical complaints before the injury, patients with higher ISS scores, and patients who had an injury of the spine or of the lower extremities reported significantly more physical problems. Additionally, patients with a low education level, patients who were living alone, and those who were unemployed reported significantly more long-term physical problems. Severely injured patients without psychological complaints reported significantly less physical limitations than those with psychological complaints. The SMFA factor of Lower extremity dysfunction was a confounder of the association between psychological complaints and QOL in all QOL domains. Long-term physical limitations were mainly reported by patients with psychological complaints. The decreased QOL of severely injured patients with psychological complaints can partially be explained by physical limitations, particularly those involving lower extremity function. Experienced physical limitations were significantly different for some trauma and patient characteristics. These characteristics may be used to select patients for whom a rehabilitation programme would be useful. Copyright © 2017. Published by Elsevier Ltd.

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.

Use of Ganga Hospital Open Injury Severity Scoring for determination of salvage versus amputation in open type IIIB injuries of lower limbs in children-An analysis of 52 type IIIB open fractures.

PubMed

Venkatadass, K; Grandhi, Tarani Sai Prasanth; Rajasekaran, S

2017-11-01

Open injuries in children are rare compared to adults. In children with major open injuries, there is no specific scoring system to guide when to amputate or salvage the limb. The use of available adult scoring systems may lead to errors in management. The role of Ganga Hospital Open Injury Severity Scoring (GHOISS) for open injuries in adults is well established and its applicability for pediatric open injuries has not been studied. This study was done to analyse the usefulness of GHOISS in pediatric open injuries and to compare it with MESS(Mangled Extremity Severity Score). All children (0-18 years) who were admitted with Open type IIIB injuries of lower limbs between January 2008 and March 2015 were included. MESS and GHOISS were calculated for all the patients. There were 50 children with 52 type IIIB Open injuries of which 39 had open tibial fractures and 13 had open femur fractures. Out of 52 type IIIB open injuries, 48 were salvaged and 4 were amputated. A MESS score of 7 and above had sensitivity of 25% for amputation while GHOISS of 17 and above was found to be more accurate for determining amputation with sensitivity of 75% and specificity of 93.75%. GHOISS is a reliable predictor of injury severity in type IIIB open fractures in children and can be used as a guide for decision-making. The use of MESS score in children has a lower predictive value compared to GHOISS in deciding amputation versus salvage. A GHOISS of 17 or more has the highest sensitivity and specificity to predict amputation. Copyright © 2017 Elsevier Ltd. All rights reserved.

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.

Absence of left ventricular concentric hypertrophy: a prerequisite for zero coronary calcium score.

PubMed

Ehara, Shoichi; Shirai, Nobuyuki; Okuyama, Takuhiro; Matsumoto, Kenji; Matsumura, Yoshiki; Yoshiyama, Minoru

2011-09-01

The identification and intervention of factors associated with a coronary artery calcification (CAC) score of zero, suggesting the absence of significant coronary artery disease (CAD) with high probability, would be meaningful in the clinical setting. Thus far, the relationship between CAC and left ventricular (LV) hypertrophy has not been documented. We identified factors associated with a CAC score of zero and evaluated the relationship between this score and LV concentric hypertrophy in 309 consecutive patients with suspected CAD who were clinically indicated to undergo multislice computed tomography angiography for coronary artery evaluation. The quantitative CAC score was calculated according to Agatston's method. The total coronary calcium score (TCS) was defined as the sum of the scores for each lesion. Four absolute TCS categories were considered: zero, mild (0-100), moderate (100-400), and severe (>400). LV hypertrophy was classified into concentric (LV mass index >104 g/m(2) in women or >116 g/m(2) in men; LV end-diastolic volume index ≤109.2 mL/m(2)) and eccentric (LV end-diastolic volume index >109.2 mL/m(2)) patterns. In the zero-TCS group, the frequency of LV concentric hypertrophy was extremely low (zero 6%, mild 17%, moderate 26%, severe 19%). Multivariate analysis revealed that age, hypercholesterolemia, diabetes mellitus, LV concentric hypertrophy, and LV mass index, but not hypertension, were the independent factors associated with a CAC score of zero. The present study demonstrated that the absence of LV concentric hypertrophy was a prerequisite for a CAC score of zero. That is, the presence of LV concentric hypertrophy, which indicated more severe underlying hypertension, long duration, or poor control of blood pressure, implicates the presence of CAC.

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.

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.

Tranexamic acid administration to pediatric trauma patients in a combat setting: the pediatric trauma and tranexamic acid study (PED-TRAX).

PubMed

Eckert, Matthew J; Wertin, Thomas M; Tyner, Stuart D; Nelson, Daniel W; Izenberg, Seth; Martin, Matthew J

2014-12-01

Early administration of tranexamic acid (TXA) has been associated with a reduction in mortality and blood product requirements in severely injured adults. It has also shown significantly reduced blood loss and transfusion requirements in major elective pediatric surgery, but no published data have examined the use of TXA in pediatric trauma. This is a retrospective review of all pediatric trauma admissions to the North Atlantic Treaty Organization Role 3 hospital, Camp Bastion, Afghanistan, from 2008 to 2012. Univariate and logistic regression analyses of all patients and select subgroups were performed to identify factors associated with TXA use and mortality. Standard adult dosing of TXA was used in all patients. There were 766 injured patients 18 years or younger (mean [SD] age, 11 [5] years; 88% male; 73% penetrating injury; mean [SD], Injury Severity Score [ISS], 10 [9]; mean [SD] Glasgow Coma Scale [GCS] score, 12 [4]). Of these patients, 35% required transfusion in the first 24 hours, 10% received massive transfusion, and 76% required surgery. Overall mortality was 9%. Of the 766 patients, 66 (9%) received TXA. The only independent predictors of TXA use were severe abdominal or extremity injury (Abbreviated Injury Scale [AIS] score ≥ 3) and a base deficit of greater than 5 (all p < 0.05). Patients who received TXA had greater injury severity, hypotension, acidosis, and coagulopathy versus the patients in the no-TXA group. After correction for demographics, injury type and severity, vitals, and laboratory parameters, TXA use was independently associated with decreased mortality among all patients (odds ratio, 0.3; p = 0.03) and showed similar trends for subgroups of severely injured (ISS > 15) and transfused patients. There was no significant difference in thromboembolic complications or other cardiovascular events. Propensity analysis confirmed the TXA-associated survival advantage and suggested significant improvements in discharge neurologic status as well as decreased ventilator dependence. TXA was used in approximately 10% of pediatric combat trauma patients, typically in the setting of severe abdominal or extremity trauma and metabolic acidosis. TXA administration was independently associated with decreased mortality. There were no adverse safety- or medication-related complications identified. Therapeutic study, level IV.

Effects of Clinical Pilates Exercises on Patients Developing Lymphedema after Breast Cancer Treatment: A Randomized Clinical Trial.

PubMed

Şener, Hülya Özlem; Malkoç, Mehtap; Ergin, Gülbin; Karadibak, Didem; Yavuzşen, Tuğba

2017-01-01

The aim of the present study was to compare the effects of clinical Pilates exercises with those of the standard lymphedema exercises on lymphedema developing after breast cancer treatment. The study comprised 60 female patients with a mean age of 53.2±7.7 years who developed lymphedema after having breast cancer treatment. The patients were randomized into two groups: the clinical Pilates exercise group (n=30), and the control group (n=30). Before, and at the 8th week of treatment, the following parameters were measured: the severity of lymphedema, limb circumferences, body image using the Social Appearance Anxiety Scale, quality of life with the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-BR23), and upper extremity function using the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure. Both groups performed one-hour exercises three days a week for 8 weeks. After treatment, the symptoms recovered significantly in both groups. Reductions in the severity of lymphedema, improvements in the social appearance anxiety scale scores, quality of life scores, and upper extremity functions scores in the clinical Pilates exercise group were greater than those in the control group. Clinical Pilates exercises were determined to be more effective on the symptoms of patients with lymphedema than were standard lymphedema exercises. Clinical Pilates exercises could be considered a safe model and would contribute to treatment programs.

Effects of Clinical Pilates Exercises on Patients Developing Lymphedema after Breast Cancer Treatment: A Randomized Clinical Trial

PubMed Central

Şener, Hülya Özlem; Malkoç, Mehtap; Ergin, Gülbin; Karadibak, Didem; Yavuzşen, Tuğba

2017-01-01

Objective The aim of the present study was to compare the effects of clinical Pilates exercises with those of the standard lymphedema exercises on lymphedema developing after breast cancer treatment. Materials and Methods The study comprised 60 female patients with a mean age of 53.2±7.7 years who developed lymphedema after having breast cancer treatment. The patients were randomized into two groups: the clinical Pilates exercise group (n=30), and the control group (n=30). Before, and at the 8th week of treatment, the following parameters were measured: the severity of lymphedema, limb circumferences, body image using the Social Appearance Anxiety Scale, quality of life with the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-BR23), and upper extremity function using the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure. Both groups performed one-hour exercises three days a week for 8 weeks. Results After treatment, the symptoms recovered significantly in both groups. Reductions in the severity of lymphedema, improvements in the social appearance anxiety scale scores, quality of life scores, and upper extremity functions scores in the clinical Pilates exercise group were greater than those in the control group. Clinical Pilates exercises were determined to be more effective on the symptoms of patients with lymphedema than were standard lymphedema exercises. Conclusions Clinical Pilates exercises could be considered a safe model and would contribute to treatment programs. PMID:28331763

Thoracic Trauma Severity score on admission allows to determine the risk of delayed ARDS in trauma patients with pulmonary contusion.

PubMed

Daurat, Aurélien; Millet, Ingrid; Roustan, Jean-Paul; Maury, Camille; Taourel, Patrice; Jaber, Samir; Capdevila, Xavier; Charbit, Jonathan

2016-01-01

Pulmonary contusion is a major risk factor of acute respiratory distress syndrome (ARDS) in trauma patients. As this complication may appear after a free interval of 24-48 h, detection of patients at risk is essential. The main objective of this study was to assess the performance of the Thoracic Trauma Severity (TTS) score upon admission in predicting delayed ARDS in blunt trauma patients with pulmonary contusion. All blunt thoracic trauma patients admitted consecutively to our trauma centre between January 2005 and December 2009 were retrospectively included if they presented a pulmonary contusion on the admission chest computed tomography scan. Main outcome measure was the presence of moderate or severe ARDS (PaO2/FiO2 ratio≤200) for 48 h or more. The global ability of the TTS score to predict ARDS was studied by ROC curves with a threshold analysis using a grey zone approach. Of 329 patients studied (75% men, mean age 36.9 years [SD 17.8 years], mean Injury Severity Score 21.7 [SD 16.0]), 82 (25%) presented with ARDS (mean lowest PaO2/FiO2 ratio of 131 [SD 34]). The area under the ROC curves for the TTS score in predicting ARDS was 0.82 (95% CI 0.78-0.86) in the overall population. TTS scores between 8 and 12 belonged to the inconclusive grey zone. A TTS score of 13-25 was found to be independent risk factors of ARDS (OR 25.8 [95% CI 6.7-99.6] P<0.001). An extreme TTS score on admission accurately predicts the occurrence of delayed ARDS in blunt thoracic trauma patients affected by pulmonary contusion. This simple score could guide early decision making and management for a non-negligible proportion of this specific population. Copyright © 2015. Published by Elsevier Ltd.

Recovery-related indicators of motor network plasticity according to impairment severity after stroke.

PubMed

Lee, J; Park, E; Lee, A; Chang, W H; Kim, D-S; Kim, Y-H

2017-10-01

Brain connectivity analysis has been widely used to investigate brain plasticity and recovery-related indicators of patients with stroke. However, results remain controversial because of interindividual variability of initial impairment and subsequent recovery of function. In this study, we aimed to investigate the differences in network plasticity and motor recovery-related indicators according to initial severity. We divided participants (16 males and 14 females, aged 54.2 ± 12.0 years) into groups of different severity by Fugl-Mayer Assessment score, i.e. moderate (50-84), severe (20-49) and extremely severe (<20) impairment groups. Longitudinal resting-state functional magnetic resonance imaging data were acquired at 2 weeks and 3 months after onset. The differences in network plasticity and recovery-related indicators between groups were investigated using network distance and graph measurements. As the level of impairment increased, the network balance was more disrupted. Network balance, interhemispheric connectivity and network efficiency were recovered at 3 months only in the moderate impairment group. However, this was not the case in the extremely severe impairment group. A single connection strength between the ipsilesional primary motor cortex and ventral premotor cortex was implicated in the recovery of motor function for the extremely severe impairment group. The connections of the ipsilesional primary motor cortex-ventral premotor cortex were positively associated with motor recovery as the patients were more severely impaired. Differences in plasticity and recovery-related indicators of motor networks were noted according to impairment severity. Our results may suggest meaningful implications for recovery prediction and treatment strategies in future stroke research. © 2017 EAN.

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.

Investigating histological aspects of scars in children.

PubMed

Westra, I; Verhaegen, P D H M; Ibrahim Korkmaz, H; Braam, K I; Kaspers, G J L; Niessen, H W M; Niessen, F B

2017-05-02

Very little is known about histological aspects of paediatric scars and the possible role of the immune system during their formation. In this study, the histology thoracic scars caused by the placement of an implantable central venous access device in children who underwent treatment for cancer was assessed. The amount and type of collagen, the collagen orientation, the type of elastic fibres, the vascularsation, and the count of neutrophils, macrophages, and lymphocytes were analysed. The severity of scarring was assessed using the Vancouver scar scale (VSS). To evaluate the role of the immune system on scar severity and histology, the scars of children suffering from acute lymphoblastic leukaemia (ALL) were compared with the scars of children suffering from other types of childhood cancer. Our results showed an extremely random orientation of the collagen fibres of the paediatric scars with a mean collagen orientation index of 0.22 (standard deviation (SD) 0.10, zero indicating a perfectly random orientation and a perfectly parallel orientation). A lower collagen orientation index was seen in scars with a lower VSS score (VSS score <3: 0.19 versus VSS score ≥3 0.29, p=0.037). A higher total VSS score, resembling a worse scar, was assessed to the scars in the non-ALL group compared with the children with ALL (mean ALL: 0.91 (0-3) versus mean non-ALL: 2.50 (0-6), p=0.037). To our knowledge, this is the first study investigating a wide array of histological aspects in paediatric scars. Compared with adult scars, an extremely random collagen orientation was found (0.22 in children versus 0.41 and 0.46 adult normotrophic and hypertrophic scars, respectively). A lower collagen orientation index was found in scars with a lower VSS score. In addition, less severe scarring was measured in children suffering from ALL compared with children suffering from other types of childhood cancer. This suggests that the immune system could play a role in the development of aberrant scarring and should be a target for future research.

Joint health and functional ability in children with haemophilia who receive intensive replacement therapy.

PubMed

Groen, W; van der Net, J; Bos, K; Abad, A; Bergstrom, B-M; Blanchette, V S; Feldman, B M; Funk, S; Helders, P; Hilliard, P; Manco-Johnson, M; Petrini, P; Zourikian, N; Fischer, K

2011-09-01

Joint physical examination is an important outcome in haemophilia; however its relationship with functional ability is not well established in children with intensive replacement therapy. Boys aged 4-16 years were recruited from two European and three North American treatment centres. Joint physical structure and function was measured with the Haemophilia Joint Health Score (HJHS) while functional ability was measured with the revised Childhood Health Assessment Questionnaire (CHAQ₃₈. Two haemophilia-specific domains were created by selecting items of the CHAQ₃₈ that cover haemophilia-specific problems. Associations between CHAQ, HJHS, cumulative number of haemarthroses and age were assessed. A total of 226 subjects - mean 10.8 years old (SD 3.8) - participated; the majority (68%) had severe haemophilia. Most severe patients (91%) were on prophylactic treatment. Lifetime number of haemarthroses [median=5; interquartile range (IQR)=1-12] and total HJHS (median = 5; IQR=1-12) correlated strongly (ρ = 0.51). Total HJHS did not correlate with age and only weakly (ρ=-0.19) with functional ability scores (median=0; IQR=-0.06-0). Overall, haemarthroses were reported most frequently in the ankles. Detailed analysis of ankle joint health scores revealed moderate associations (ρ=0.3-0.5) of strength, gait and atrophy with lower extremity tasks (e.g. stair climbing). In this population, HJHS summating six joints did not perform as well as individual joint scores, however, certain elements of ankle impairment, specifically muscle strength, atrophy and gait associated significantly with functional loss in lower extremity activities. Mild abnormalities in ankle assessment by HJHS may lead to functional loss. Therefore, ankle joints may warrant special attention in the follow up of these children. © 2011 Blackwell Publishing Ltd.

Amputation: Not a failure for severe lower extremity combat injury.

PubMed

van Dongen, Thijs T C F; Huizinga, Eelco P; de Kruijff, Loes G M; van der Krans, Arie C; Hoogendoorn, Jochem M; Leenen, Luke P H; Hoencamp, Rigo

2017-02-01

The use of improvised explosive devices is a frequent method of insurgents to inflict harm on deployed military personnel. Consequently, lower extremity injuries make up the majority of combat related trauma. The wounding pattern of an explosion is not often encountered in a civilian population and can lead to substantial disability. It is therefore important to study the impact of these lower extremity injuries and their treatment (limb salvage versus amputation) on functional outcome and quality of life. All Dutch repatriated service members receiving treatment for wounds on the lower extremity sustained in the Afghan theater between august 2005 and August 2014, were invited to participate in this observational cohort study. We conducted a survey regarding their physical and mental health using the Short Form health survey 36, EuroQoL 6 dimensions and Lower Extremity Functional Scale questionnaires. Results were collated in a specifically designed electronic database combined with epidemiology and hospital statistics gathered from the archive of the Central Military Hospital. Statistical analyses were performed to identify differences between combat and non-combat related injuries and between limb salvage treatment and amputation. In comparison with non-battle injury patients, battle casualties were significantly younger of age, sustained more severe injuries, needed more frequent operations and clinical rehabilitation. Their long-term outcome scores in areas concerning well-being, social and cognitive functioning, were significantly lower. Regarding treatment, amputees experienced higher physical well-being and less pain compared to those treated with limb salvage surgery. Sustaining a combat injury to the lower extremity can lead to partial or permanent dysfunction. However, wounded service members, amputees included, are able to achieve high levels of activity and participation in society, proving a remarkable resilience. These long-term results demonstrate that amputation is not a failure for casualty and surgeon, and strengthen a life before limb (damage control surgery) mindset in the initial phase. For future research, we recommend the use of adequate coding and injury scoring systems to predict outcome and give insight in the attributes that are supportive for the resilience that is needed to cope with a serious battle injury. Copyright © 2016 Elsevier Ltd. All rights reserved.

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.

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.

Incorporating yoga into an intense physical therapy program in someone with Parkinson's disease: a case report.

PubMed

Moriello, Gabriele; Denio, Christopher; Abraham, Megan; DeFrancesco, Danielle; Townsley, Jill

2013-10-01

The purpose of this case report was to document outcomes following an intense exercise program integrating yoga with physical therapy exercise in a male with Parkinson's disease. The participant performed an intense 1½-hour program (Phase A) incorporating strengthening, balance, agility and yoga exercises twice weekly for 12 weeks. He then completed a new home exercise program developed by the researchers (Phase B) for 12 weeks. His score on the Parkinson's Disease Questionnaire improved 16 points while his score on the High Level Mobility Assessment tool improved 11 points. There were also improvements in muscle length of several lower extremity muscles, in upper and lower extremity muscle strength, in dynamic balance and he continues to work full time 29 months later. There were no improvements in thoracic posture or aerobic power. This intense program was an effective dose of exercise for someone with Parkinson's disease and allowed him to continue to participate in work, leisure, and community activities. Copyright © 2013 Elsevier Ltd. All rights reserved.

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.

Comparison of Depressive Symptom Severity Scores in Low-Income Women

PubMed Central

Kneipp, Shawn M.; Kairalla, John A.; Stacciarini, Jeanne Marie R.; Pereira, Deidre; Miller, M. David

2010-01-01

Background The Beck Depression Inventory-II (BDI-II) and the Patient Health Questionnaire-9 (PHQ-9) are considered reliable and valid for measuring depressive symptom severity and screening for a depressive disorder. Few studies have examined the convergent or divergent validity of these two measures, and none have been conducted among low-income women – even though rates of depression in this group are extremely high. Moreover, variation in within-subject scores suggests these measures may be less comparable in select subgroups. Objective We sought to compare these two measures in terms of construct validity, and examine whether within-subject differences in depressive symptom severity scores could be accounted for by select characteristics in low-income women. Method In a sample of 308 low-income women, construct validity was assessed using a multitrait-monomethod matrix approach, between-instrument differences in continuous symptom severity scores were regressed on select characteristics using backward stepwise selection, and differences in depressive symptom classification were assessed using the Mantel-Haenszel test. Results Convergent validity was high (rs = 0.80, p < .001). Among predictors that included age, race, education, number of chronic health conditions, history of depression, perceived stress, anxiety, and/or the number of generalized symptoms, none explained within-subject differences in depressive symptom scores between the BDI-II and PHQ-9 (p > .05, R2 < 0.04). Similarly, there was consistency in depressive symptom classification (X2 = 172 and 172.6, p < .0001). Discussion These findings demonstrate the BDI-II and PHQ-9 perform similarly among low-income women in terms of depressive symptom severity measurement and classifying levels of depressive symptoms, and do not vary across subgroups based on select demographics. PMID:21048482

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.

Locomotor Training Restores Walking in a Nonambulatory Child With Chronic, Severe, Incomplete Cervical Spinal Cord Injury

PubMed Central

Behrman, Andrea L; Nair, Preeti M; Bowden, Mark G; Dauser, Robert C; Herget, Benjamin R; Martin, Jennifer B; Phadke, Chetan P; Reier, Paul J; Senesac, Claudia R; Thompson, Floyd J; Howland, Dena R

2008-01-01

Background and Purpose: Locomotor training (LT) enhances walking in adult experimental animals and humans with mild-to-moderate spinal cord injuries (SCIs). The animal literature suggests that the effects of LT may be greater on an immature nervous system than on a mature nervous system. The purpose of this study was to evaluate the effects of LT in a child with chronic, incomplete SCI. Subject: The subject was a nonambulatory 4½-year-old boy with an American Spinal Injury Association Impairment Scale (AIS) C Lower Extremity Motor Score (LEMS) of 4/50 who was deemed permanently wheelchair-dependent and was enrolled in an LT program 16 months after a severe cervical SCI. Methods: A pretest-posttest design was used in the study. Over 16 weeks, the child received 76 LT sessions using both treadmill and over-ground settings in which graded sensory cues were provided. The outcome measures were ASIA Impairment Scale score, gait speed, walking independence, and number of steps. Result: One month into LT, voluntary stepping began, and the child progressed from having no ability to use his legs to community ambulation with a rolling walker. By the end of LT, his walking independence score had increased from 0 to 13/20, despite no change in LEMS. The child's final self-selected gait speed was 0.29 m/s, with an average of 2,488 community-based steps per day and a maximum speed of 0.48 m/s. He then attended kindergarten using a walker full-time. Discussion and Conclusion: A simple, context-dependent stepping pattern sufficient for community ambulation was recovered in the absence of substantial voluntary isolated lower-extremity movement in a child with chronic, severe SCI. These novel data suggest that some children with severe, incomplete SCI may recover community ambulation after undergoing LT and that the LEMS cannot identify this subpopulation. PMID:18326054

External-beam radiation therapy combined with limb-sparing surgery in elderly patients (>70 years) with primary soft tissue sarcomas of the extremities : A retrospective analysis.

PubMed

Andrä, Claudia; Klein, Alexander; Dürr, Hans Roland; Rauch, Josefine; Lindner, Lars Hartwin; Knoesel, Thomas; Angele, Martin; Baur-Melnyk, Andrea; Belka, Claus; Roeder, Falk

2017-08-01

To report our experience with EBRT combined with limb-sparing surgery in elderly patients (>70 years) with primary extremity soft tissue sarcomas (STS). Retrospectively analyzed were 35 patients (m:f 18:17, median 78 years) who all presented in primary situation without nodal/distant metastases (Charlson score 0/1 in 18 patients; ≥2 in 17 patients). Median tumor size was 10 cm, mainly located in lower limb (83%). Stage at presentation (UICC7th) was Ib:3%, 2a:20%, 2b:20%, and 3:57%. Most lesions were high grade (97%), predominantly leiomyosarcoma (26%) and undifferentiated pleomorphic/malignant fibrous histiocytoma (23%). Limb-sparing surgery was preceded (median 50 Gy) or followed (median 66 Gy) by EBRT. Median follow-up was 37 months (range 1-128 months). Margins were free in 26 patients (74%) and microscopically positive in 9 (26%). Actuarial 3‑ and 5‑year local control rates were 88 and 81% (4 local recurrences). Corresponding rates for distant control, disease-specific survival, and overall survival were 57/52%, 76/60%, and 72/41%. The 30-day mortality was 0%. Severe postoperative complications were scored in 8 patients (23%). Severe acute radiation-related toxicity was observed in 2 patients (6%). Patients with Charlson score ≥2 had a significantly increased risk for severe postoperative complications and acute radiation-related side effects. Severe late toxicities were found in 7 patients (20%), including fractures in 3 (8.6%). Final limb preservation rate was 97%. Combination of EBRT and limb-sparing surgery is feasible in elderly patients with acceptable toxicities and encouraging but slightly inferior outcome compared to younger patients. Comorbidity correlated with postoperative complications and acute toxicities. Late fracture risk seems slightly increased.

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)

Quality improvement activity for improving pain management in acute extremity injuries in the emergency department.

PubMed

Chang, Hyung Lan; Jung, Jin Hee; Kwak, Young Ho; Kim, Do Kyun; Lee, Jin Hee; Jung, Jae Yun; Kwon, Hyuksool; Paek, So Hyun; Park, Joong Wan; Shin, Jonghwan

2018-03-01

The aim of this study was to investigate the effectiveness of a quality improvement activity for pain management in patients with extremity injury in the emergency department (ED). This was a retrospective interventional study. The patient group consisted of those at least 19 years of age who visited the ED and were diagnosed with International Classification of Diseases codes S40-S99 (extremity injuries). The quality improvement activity consisted of three measures: a survey regarding activities, education, and the triage nurse's pain assessment, including change of pain documentation on electronic medical records. The intervention was conducted from January to April in 2014 and outcome was compared between May and August in 2013 and 2014. The primary outcome was the rate of analgesic prescription, and the secondary outcome was the time to analgesic prescription. A total of 1,739 patients were included, and 20.3% of 867 patients in the pre-intervention period, and 28.8% of 872 patients in the post-intervention period received analgesics (P< 0.001). The prescription rate of analgesics for moderate-to-severe injuries was 36.4% in 2013 and 44.5% in 2014 (P=0.026). The time to analgesics prescription was 116.6 minutes (standard deviation 225.6) in 2013 and 64 minutes (standard deviation 75.5) in 2014 for all extremity injuries. The pain scoring increased from 1.4% to 51.6%. ED-based quality improvement activities including education and change of pain score documentation can improve the rate of analgesic prescription and time to prescription for patients with extremity injury in the ED.

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.

Root resorption of maxillary incisors retracted with and without skeletal anchorage.

PubMed

Barros, Sérgio Estelita; Janson, Guilherme; Chiqueto, Kelly; Baldo, Vitor Oliveira; Baldo, Taiana Oliveira

2017-02-01

Our objective was to compare root resorption degree of the maxillary central incisors retracted with and without skeletal anchorage. This nonrandomized historical control study included 37 patients requiring maximum anterior retraction and treated with extraction of 2 maxillary premolars. Group 1 consisted of 22 patients (11 male, 11 female) in whom anterior retraction was performed without skeletal anchorage, and group 2 included 15 patients (3 male, 12 female) treated with skeletally anchored anterior retraction. Periapical radiographs were used to evaluate root resorption degree by a scoring system. The groups were compared regarding the resorption score and resorption degree distribution with the Mann-Whitney U test, chi-square test, and Z test on proportions. There was no statistically significant intergroup difference regarding root resorption, but the number of patients with severe and extreme root resorption degrees was significantly greater in group 2. Although the root resorption degree of the skeletal anchorage group was not significantly different from the group without skeletal anchorage, the number of patients with severe to extreme resorption in the first group was significantly greater. Therefore, careful clinical monitoring of skeletally anchored anterior retraction is needed, especially when there are known root resorption predisposing factors. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

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.

Transcatheter aortic valve replacement in patients with severe mitral or tricuspid regurgitation at extreme risk for surgery.

PubMed

Little, Stephen H; Popma, Jeffrey J; Kleiman, Neal S; Deeb, G Michael; Gleason, Thomas G; Yakubov, Steven J; Checuti, Stan; O'Hair, Daniel; Bajwa, Tanvir; Mumtaz, Mubashir; Maini, Brijeshwar; Hartman, Alan; Katz, Stanley; Robinson, Newell; Petrossian, George; Heiser, John; Merhi, William; Moore, B Jane; Li, Shuzhen; Adams, David H; Reardon, Michael J

2018-05-01

Patients with symptomatic severe aortic stenosis and severe mitral regurgitation or severe tricuspid regurgitation were excluded from the major transcatheter aortic valve replacement trials. We studied these 2 subgroups in patients at extreme risk for surgery in the prospective, nonrandomized, single-arm CoreValve US Expanded Use Study. The primary end point was all-cause mortality or major stroke at 1 year. A favorable medical benefit was defined as a Kansas City Cardiomyopathy Questionnaire overall summary score greater than 45 at 6 months and greater than 60 at 1 year and with a less than 10-point decrease from baseline. There were 53 patients in each group. Baseline characteristics for the severe mitral regurgitation and severe tricuspid regurgitation cohorts were age 84.2 ± 6.4 years and 84.9 ± 6.5 years; male, 29 (54.7%) and 22 (41.5%), and mean Society of Thoracic Surgeons score 9.9% ± 5.0% and 9.2% ± 4.0%, respectively. Improvement in valve regurgitation from baseline to 1 year occurred in 72.7% of the patients with severe mitral regurgitation and in 61.8% of patients with severe tricuspid regurgitation. A favorable medical benefit occurred in 31 of 47 patients (66.0%) with severe mitral regurgitation and 33 of 47 patients (70.2%) with severe tricuspid regurgitation at 6 months, and in 25 of 44 patients (56.8%) with severe mitral regurgitation and 24 of 45 patients (53.3%) with severe tricuspid regurgitation at 1 year. All-cause mortality or major stroke for the severe mitral regurgitation and severe tricuspid regurgitation cohorts were 11.3% and 3.8% at 30 days and 21.0% and 19.2% at 1 year, respectively. There were no major strokes in either group at 1 year. Transcatheter aortic valve replacement in patients with severe mitral regurgitation or severe tricuspid regurgitation is reasonable and safe and leads to improvement in atrioventricular valve regurgitation. Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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.

Burden Assessment, Psychiatric Morbidity, and Their Correlates in Caregivers of Patients with Intellectual Disability.

PubMed

Bhatia, M S; Srivastava, S; Gautam, P; Saha, R; Kaur, J

2015-12-01

Intellectual disability in a child places great stress on a family and caregiver and this leads to significant socio-occupational dysfunction and impaired quality of life for caregivers. This study aimed to assess socio-demographic characteristics, burden, and psychiatric morbidity of the caregivers of persons with intellectual disability, as well as to determine the variables that correlated with burden and psychiatric morbidity. An observational study was carried out in an outpatient psychiatric unit of a tertiary care teaching hospital in India from October 2014 to April 2015. A total of 100 caregivers of intellectually impaired individuals were assessed for burden and psychiatric morbidity. In all, 39% of the caregivers had a high burden score, 46% perceived mild-to-moderate burden severity, and 15% perceived no to mild burden. Mild-to-moderate depressive symptoms were present in 23% and 16% had severe-to-extremely severe depressive symptoms. Mild-to-moderate anxiety symptoms were evident in 19% of caregivers and a further 19% had severe-to-extremely severe anxiety symptoms. Routine assessment of burden and psychiatric morbidity in the caregiver will help to reduce their burden and thus help them care for their children more appropriately and efficiently.

[Occupational injuries among construction workers in Hong Kong].

PubMed

Huang, Zihui; Chen, Weiqing

2002-02-01

To explore the nature and severity of occupational injuries among construction workers and its risk factors in Hong Kong. One hundred and twenty-two injured construction workers in a public hospital and an equal number of workmate controls were studied. Contents included socio -demographic characteristics, the availability and use of safety equipment, smoking and alcohol consumption, etc. Abbreviated injury scale (AIS) and injury severity score (ISS) were employed for describing the nature, pattern and severity of injuries. Single injuries were seen in 80% of cases. Of 149 injuries classified by body region, 49% were external, 26% involved either the upper or lower extremities, and 11% were spinal injuries. Working at height was associated with the injury severity score. Safety hazards were identified in the work environment in 68% of the cases. Significant odds ratios for accidents were obtained for 'no formal education', 'non safety training' and 'current smokers'. The results implicated that construction was a hazardous occupation in Hong Kong. Improving the work environment and promoting safety education among construction workers would be helpful for minimizing or eliminating occupational injuries in construction occupation in Hong Kong.

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.

A novel, simple scale for assessing the symptom severity of atrial fibrillation at the bedside: the CCS-SAF scale.

PubMed

Dorian, Paul; Cvitkovic, Suzan S; Kerr, Charles R; Crystal, Eugene; Gillis, Anne M; Guerra, Peter G; Mitchell, L Brent; Roy, Denis; Skanes, Allan C; Wyse, D George

2006-04-01

The severity of symptoms caused by atrial fibrillation (AF) is extremely variable. Quantifying the effect of AF on patient well-being is important but there is no simple, commonly accepted measure of the effect of AF on quality of life (QoL). Current QoL measures are cumbersome and impractical for clinical use. To create a simple, concise and readily usable AF severity score to facilitate treatment decisions and physician communication. The Canadian Cardiovascular Society (CCS) Severity of Atrial Fibrillation (SAF) Scale is analogous to the CCS Angina Functional Class. The CCS-SAF score is determined using three steps: documentation of possible AF-related symptoms (palpitations, dyspnea, dizziness/syncope, chest pain, weakness/fatigue); determination of symptom-rhythm correlation; and assessment of the effect of these symptoms on patient daily function and QoL. CCS-SAF scores range from 0 (asymptomatic) to 4 (severe impact of symptoms on QoL and activities of daily living). Patients are also categorized by type of AF (paroxysmal versus persistent/permanent). The CCS-SAF Scale will be validated using accepted measures of patient-perceived severity of symptoms and impairment of QoL and will require 'field testing' to ensure its applicability and reproducibility in the clinical setting. This type of symptom severity scale, like the New York Heart Association Functional Class for heart failure symptoms and the CCS Functional Class for angina symptoms, trades precision and comprehensiveness for simplicity and ease of use at the bedside. A common language to quantify AF severity may help to improve patient care.

Motorcycle-related hospitalization of adolescents in a Level I trauma center in southern Taiwan: a cross-sectional study.

PubMed

Liang, Chi-Cheng; Liu, Hang-Tsung; Rau, Cheng-Shyuan; Hsu, Shiun-Yuan; Hsieh, Hsiao-Yun; Hsieh, Ching-Hua

2015-08-28

The aim of this study was to investigate and compare the injury pattern, mechanisms, severity, and mortality of adolescents and adults hospitalized for treatment of trauma following motorcycle accidents in a Level I trauma center. Detailed data regarding patients aged 13-19 years (adolescents) and aged 30-50 years (adults) who had sustained trauma due to a motorcycle accident were retrieved from the Trauma Registry System between January 1, 2009 and December 31, 2012. The Pearson's chi-squared test, Fisher's exact test, or the independent Student's t-test were performed to compare the adolescent and adult motorcyclists and to compare the motorcycle drivers and motorcycle pillion. Analysis of Abbreviated Injury Scale (AIS) scores revealed that the adolescent patients had sustained higher rates of facial, abdominal, and hepatic injury and of cranial, mandibular, and femoral fracture but lower rates of thorax and extremity injury; hemothorax; and rib, scapular, clavicle, and humeral fracture compared to the adults. No significant differences were found between the adolescents and adults regarding Injury Severity Score (ISS), New Injury Severity Score (NISS), Trauma-Injury Severity Score (TRISS), mortality, length of hospital stay, or intensive care unit (ICU) admission rate. A significantly greater percentage of adolescents compared to adults were found not to have worn a helmet. Motorcycle riders who had not worn a helmet were found to have a significantly lower first Glasgow Coma Scale (GCS) score, and a significantly higher percentage was found to present with unconscious status, head and neck injury, and cranial fracture compared to those who had worn a helmet. Adolescent motorcycle riders comprise a major population of patients hospitalized for treatment of trauma. This population tends to present with a higher injury severity compared to other hospitalized trauma patients and a bodily injury pattern differing from that of adult motorcycle riders, indicating the need to emphasize use of protective equipment, especially helmets, to reduce their rate and severity of injury.

Reducing robotic guidance during robot-assisted gait training improves gait function: a case report on a stroke survivor.

PubMed

Krishnan, Chandramouli; Kotsapouikis, Despina; Dhaher, Yasin Y; Rymer, William Z

2013-06-01

To test the feasibility of patient-cooperative robotic gait training for improving locomotor function of a chronic stroke survivor with severe lower-extremity motor impairments. Single-subject crossover design. Performed in a controlled laboratory setting. A 62-year-old man with right temporal lobe ischemic stroke was recruited for this study. The baseline lower-extremity Fugl-Meyer score of the subject was 10 on a scale of 34, which represented severe impairment in the paretic leg. However, the subject had a good ambulation level (community walker with the aid of a stick cane and ankle-foot orthosis) and showed no signs of sensory or cognitive impairments. The subject underwent 12 sessions (3 times per week for 4wk) of conventional robotic training with the Lokomat, where the robot provided full assistance to leg movements while walking, followed by 12 sessions (3 times per week for 4wk) of patient-cooperative robotic control training, where the robot provided minimal guidance to leg movements during walking. Clinical outcomes were evaluated before the start of the intervention, immediately after 4 weeks of conventional robotic training, and immediately after 4 weeks of cooperative control robotic training. These included: (1) self-selected and fast walking speed, (2) 6-minute walk test, (3) Timed Up & Go test, and (4) lower-extremity Fugl-Meyer score. Results showed that clinical outcomes changed minimally after full guidance robotic training, but improved considerably after 4 weeks of reduced guidance robotic training. The findings from this case study suggest that cooperative control robotic training is superior to conventional robotic training and is a feasible option to restoring locomotor function in ambulatory stroke survivors with severe motor impairments. A larger trial is needed to verify the efficacy of this advanced robotic control strategy in facilitating gait recovery after stroke. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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.

Evaluation of intra-subject difference in hamstring flexibility in patients with low back pain: An exploratory study.

PubMed

Radwan, Ahmed; Bigney, Kyle A; Buonomo, Haily N; Jarmak, Michael W; Moats, Shannon M; Ross, Jaimie K; Tatarevic, Enida; Tomko, Mary Anne

2014-06-24

To evaluate the extent of intra-subject difference in hamstring flexibility and its possible relationship to the severity of Low Back Pain (LBP). A secondary purpose was to evaluate the extent of intra-rater reliability using both electrogoniometer and conventional goniometer for measuring hamstring tightness. Potential correlations between muscle impairments and LBP may lead to more effective treatments and prevention strategies. Seventy two participants with mechanical LBP were recruited for this study. The sample included; 41 females, 31 males with a mean age of 33.69 ± (11.04) years, height of 170 ± (9) cm, and weight of 79.5 ± (1.6) kg. Hamstring length was detected indirectly using the Active Knee Extension method in the 90/90 position from supine. The amount of extension was measured using both electro-goniometer (EG)and a standard goniometer (SG). Right lower extremities of these patients were significantly more flexible than left ones at α = 0.025 (t_{72}= 3.14, p=0.002). Similarly, dominant lower extremities of these patients were significantly more flexible than the non dominant ones at α=0.025 (t _{72}=2.56, p=0.013). Additionally, Oswestry scores of the patients were significantly and positively correlated with the amount of hamstring tightness of the right lower extremities (r=0.244, p=0.039), left lower extremities (r=0.225, p=0.048) and the average of both sides (r=0.24, p=0.039). However, the Oswestry scores were negatively, but insignificantly correlated to the absolute difference between right and left extremities at (r=-0.156, p=0.091). Finally, the extent of intrasubject reliability in measuring hamstring tightness using EG and SG was found to be high (ICC=0.93).CONCLUSION: There is a possible relation between mild mechanical LBP and hamstrings tightness. It was found that the more the tightness, the higher the severity of LBP that patient experienced. Also, these patients had one of their lower extremities significantly tighter than the other. Such tightness was successfully detected utilizing both EG and SG. These findings and their possible pathomechanical consequences should be considered while constructing effective rehabilitation protocols for patients with mechanical LBP.

The relationship between extreme weather events and crop losses in central Taiwan

NASA Astrophysics Data System (ADS)

Lai, Li-Wei

2017-09-01

The frequency of extreme weather events, which cause severe crop losses, is increasing. This study investigates the relationship between crop losses and extreme weather events in central Taiwan from 2003 to 2015 and determines the main factors influencing crop losses. Data regarding the crop loss area and meteorological information were obtained from government agencies. The crops were categorised into the following five groups: `grains', `vegetables', `fruits', `flowers' and `other crops'. The extreme weather events and their synoptic weather patterns were categorised into six and five groups, respectively. The data were analysed using the z score, correlation coefficient and stepwise regression model. The results show that typhoons had the highest frequency of all extreme weather events (58.3%). The largest crop loss area (4.09%) was caused by two typhoons and foehn wind in succession. Extreme wind speed coupled with heavy rainfall is an important factor affecting the losses in the grain and vegetable groups. Extreme wind speed is a common variable that affects the loss of `grains', `vegetables', `fruits' and `flowers'. Consecutive extreme weather events caused greater crop losses than individual events. Crops with long production times suffered greater losses than those with short production times. This suggests that crops with physical structures that can be easily damaged and long production times would benefit from protected cultivation to maintain food security.

[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.

Railway train versus motor vehicle collisions: a comparative study of injury severity and patterns.

PubMed

Kligman, M D; Knotts, F B; Buderer, N M; Kerwin, A J; Rodgers, J F

1999-11-01

This study compares the demographics, injury severity, resource use, and injury patterns of patients involved in railway train-motor vehicle (RT-MV) to motor vehicle-motor vehicle (MV-MV) collisions. Retrospective trauma registry review of 74 RT-MV and 1,931 MV-MV consecutive patients, age more than 14 years, presenting to two Level I trauma centers, January of 1991 to May of 1998. Compared with MV-MV, RT-MV had significantly more males (72% vs. 54%), higher mortality (15% vs. 7%), higher Injury Severity Score (median, 20 vs. 9), longer intensive care unit length of stay (1.7 vs. 0.04 days), and longer hospital length of stay (7.5 vs. 4 days). RT-MV patients had a higher percentage of scalp/facial lacerations; intracranial hemorrhage; hemothorax and pneumothorax; fractures of the rib/sternum, upper extremity, skull, and face; and lung, splenic, and renal injuries. After adjusting for the difference in Injury Severity Score between groups, the only remaining significant group difference was the odds of a scalp/facial laceration. RT-MV collisions are a marker for more severe injuries, but not a different pattern of injury, compared with MV-MV collisions.

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

Hip pain while using lower extremity joints and sleep disturbances in elderly white women: results from a cross-sectional analysis.

PubMed

Parimi, Neeta; Blackwell, Terri; Stone, Katie L; Lui, Li-Yung; Ancoli-Israel, Sonia; Tranah, Gregory J; Hillier, Teresa A; Nevitt, Michael E; Lane, Nancy E

2012-07-01

To evaluate sleep quality in women with hip pain due to daily activities involving the lower extremity joints. We evaluated the association of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) hip pain severity score with objective sleep measures obtained by wrist actigraphy in 2,225 white women ≥ 65 years of age enrolled in the Study of Osteoporotic Fractures. Women had an increased odds of spending ≥ 90 minutes awake after sleep onset (odds ratio [OR] 1.28, 95% confidence interval [95% CI] 1.11-1.50) for every 5-point increase in hip pain score after adjustment for all covariates. Hip pain when sitting or lying was the strongest predictor of sleep fragmentation (OR 2.0, 95% CI 1.47-2.73); however, standing pain was associated with a higher number of awake minutes in bed scored from sleep onset to the end of the last sleep episode, independent of pain while in bed (OR 1.41, 95% CI 1.07-2.01). Sleep disturbances increased significantly after the first 2 hours of sleep in women with severe hip pain compared to those without hip pain (mean ± SD 1.4 ± 0.47 minutes per hour of sleep; P < 0.003). Similar associations were observed for long wake episodes >5 minutes. There were no associations between daytime napping, sleep latency, sleep efficiency, and total sleep minutes and WOMAC hip pain. Fragmented sleep was greater in women with hip pain compared to those without hip pain; however, fragmented sleep in women with severe hip pain compared to those without hip pain was unchanged until after the first 2 hours of sleep. Further investigations into pain medications wearing off over time or the prolonged periods of inactivity decreasing the pain threshold are warranted. Copyright © 2012 by the American College of Rheumatology.

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.

Relationship between levels of thyroid stimulating hormone, age, and gender, with symptoms of depression among patients with thyroid disorders as measured by the Depression Anxiety Stress Scale 21 (DASS-21).

PubMed

Saidi, Sanisah; Iliani Jaafar, Siti Nur; Daud, Azlina; Musa, Ramli; Nik Ahmad, Nik Noor Fatnoon

2018-02-01

The aim of this study was to investigate the correlation between levels of depression symptoms and age, thyroid-stimulating hormone levels, and stressful life events of the participants. Patients above 18 years old, with any thyroid disorders, and without psychiatric disorders were included in this study. All participants completed the Depression Anxiety Stress Scale 21 (DASS-21). The depression symptom score was calculated and interpreted as follows: less than 9: no depression; between 10 and 13: mild depression; between 14 and 20: moderate depression; between 21 and 27: severe depression, and more than 28: extremely severe depression. The total number of participants in this study was 199. There was no correlation between age, thyroid stimulating hormone, and the DASS score. There was also no significant difference in the DASS-21 score between genders. However, there was a positive correlation between depression symptoms and stressful life events (r=0.201, n=199, p < 0.05). These findings would suggest that increased depression symptom scores correlate with increased stressful life events. A larger study should be undertaken to confirm these findings. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

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

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.

Lower-extremity rotational profile and toe-walking in preschool children with autism spectrum disorder.

PubMed

Arik, Atilla; Aksoy, Cemalettin; Aysev, Ayla; Akçakin, Melda

2018-04-24

The aim of this study was to establish the torsional and toe-walking profiles of children with autism spectrum disorder (ASD), and to analyze the correlations between torsion, toe-walking, autism severity score, and age. In total, 79 consecutive children with autism were examined to determine their hip rotations, thigh-foot angle, degree of toe-walking, and autism severity. Femoral and tibial torsion values, of the preschool patients, were compared statistically with age-matched controls. The hip rotation profile of the patients was similar to the normal group. Nearly a half of the patients with ASD present excessive external tibial torsion. The difference in the tibial torsion between patients and normal children was statistically significant. A weak correlation was found only between tibial torsion and the autism severity score, but no correlation was found between the other parameters. External tibial torsion is the cardinal and persistent orthopedic manifestation among patients with ASD. Toe-walking is the second most common such manifestation and is an independent orthopedic feature in these patients. External tibial torsion may potentially contribute toward the described gait abnormalities in patients with ASD.

PAI-1 4G/5G and MTHFR C677T polymorphisms increased the accuracy of two prediction scores for the risk of acute lower extremity deep vein thrombosis.

PubMed

Pop, Tudor Radu; Vesa, Ştefan Cristian; Trifa, Adrian Pavel; Crişan, Sorin; Buzoianu, Anca Dana

2014-01-01

This study investigates the accuracy of two scores in predicting the risk of acute lower extremity deep vein thrombosis. The study included 170 patients [85 (50%) women and 85 (50%) men] who were diagnosed with acute lower extremity deep vein thrombosis (DVT) with duplex ultrasonography. Median age was 62 (52.75; 72) years. The control group consisted of 166 subjects [96 (57.8%) women and 70 (42.2%) men], without DVT, matched for age (± one year) to those in the group with DVT. The patients and controls were selected from those admitted to the internal medicine, cardiology and geriatrics wards within the Municipal Hospital of Cluj-Napoca, Romania, between October 2009 and June 2011. Clinical, demographic and lab data were recorded for each patient. For each patient we calculated the prior risk of DVT using two prediction scores: Caprini and Padua. According to the Padua score only 93 (54.7%) patients with DVT had been at high risk of developing DVT, while 48 (28.9%) of controls were at high risk of developing DVT. When Padua score included PAI-1 4G/5G and MTHFR C677T polymorphisms, the sensitivity increased at 71.7%. Using the Caprini score, we determined that 147 (86.4%) patients with DVT had been at high risk of developing DVT, while 103 (62%) controls were at high risk of developing DVT. A Caprini score higher than 5 was the strongest predictor of acute lower extremity DVT risk. The Caprini prediction score was more sensitive than the Padua score in assessing the high risk of DVT in medical patients. PAI-1 4G/5G and MTHFR C677T polymorphisms increased the sensitivity of Padua score.

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

Consistent etiology of severe, frequent psychotic experiences and milder, less frequent manifestations: a twin study of specific psychotic experiences in adolescence.

PubMed

Zavos, Helena M S; Freeman, Daniel; Haworth, Claire M A; McGuire, Philip; Plomin, Robert; Cardno, Alastair G; Ronald, Angelica

2014-09-01

The onset of psychosis is usually preceded by psychotic experiences (PE). Little is known about the etiology of PE and whether the degree of genetic and environmental influences varies across different levels of severity. A recognized challenge is to identify individuals at high risk of developing psychotic disorders prior to disease onset. To investigate the degree of genetic and environmental influences on specific PE, assessed dimensionally, in adolescents in the community and in those who have many, frequent experiences (defined using quantitative cutoffs). We also assessed the degree of overlap in etiological influences between specific PE. Structural equation model-fitting, including univariate and bivariate twin models, liability threshold models, DeFries-Fulker extremes analysis, and the Cherny method, was used to analyze a representative community sample of 5059 adolescent twin pairs (mean [SD] age, 16.31 [0.68] years) from England and Wales. Psychotic experiences assessed as quantitative traits (self-rated paranoia, hallucinations, cognitive disorganization, grandiosity, and anhedonia, as well as parent-rated negative symptoms). Genetic influences were apparent for all PE (15%-59%), with modest shared environment for hallucinations and negative symptoms (17%-24%) and significant nonshared environment (49%-64%) for the self-rated scales and 17% for parent-rated negative symptoms. Three empirical approaches converged to suggest that the etiology in extreme-scoring groups (most extreme scoring: 5%, 10%, and 15%) did not differ significantly from that of the whole distribution. There was no linear change in heritability across the distribution of PE, with the exception of a modest increase in heritability for increasing severity of parent-rated negative symptoms. Of the PE that showed covariation, this appeared to be due to shared genetic influences (bivariate heritabilities, 0.54-0.71). These findings are consistent with the concept of a psychosis continuum, suggesting that the same genetic and environmental factors influence both extreme, frequent PE and milder, less frequent manifestations in adolescents. Individual PE in adolescence, assessed quantitatively, have lower heritability estimates and higher estimates of nonshared environment than those for the liability to schizophrenia. Heritability varies by type of PE, being highest for paranoia and parent-rated negative symptoms and lowest for hallucinations.

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.

An Improved Correction for Range Restricted Correlations Under Extreme, Monotonic Quadratic Nonlinearity and Heteroscedasticity.

PubMed

Culpepper, Steven Andrew

2016-06-01

Standardized tests are frequently used for selection decisions, and the validation of test scores remains an important area of research. This paper builds upon prior literature about the effect of nonlinearity and heteroscedasticity on the accuracy of standard formulas for correcting correlations in restricted samples. Existing formulas for direct range restriction require three assumptions: (1) the criterion variable is missing at random; (2) a linear relationship between independent and dependent variables; and (3) constant error variance or homoscedasticity. The results in this paper demonstrate that the standard approach for correcting restricted correlations is severely biased in cases of extreme monotone quadratic nonlinearity and heteroscedasticity. This paper offers at least three significant contributions to the existing literature. First, a method from the econometrics literature is adapted to provide more accurate estimates of unrestricted correlations. Second, derivations establish bounds on the degree of bias attributed to quadratic functions under the assumption of a monotonic relationship between test scores and criterion measurements. New results are presented on the bias associated with using the standard range restriction correction formula, and the results show that the standard correction formula yields estimates of unrestricted correlations that deviate by as much as 0.2 for high to moderate selectivity. Third, Monte Carlo simulation results demonstrate that the new procedure for correcting restricted correlations provides more accurate estimates in the presence of quadratic and heteroscedastic test score and criterion relationships.

Association of activities of daily living with the load during step ascent motion in nursing home-residing elderly individuals.

PubMed

Masaki, Mitsuhiro; Ikezoe, Tome; Kamiya, Midori; Araki, Kojiro; Isono, Ryo; Kato, Takehiro; Kusano, Ken; Tanaka, Masayo; Sato, Syunsuke; Hirono, Tetsuya; Kita, Kiyoshi; Tsuboyama, Tadao; Ichihashi, Noriaki

2018-04-19

This study aimed to examine the association of independence in ADL with the loads during step ascent motion and other motor functions in 32 nursing home-residing elderly individuals. Independence in ADL was assessed by using the functional independence measure (FIM). The loads at the upper (i.e., pulling up) and lower (i.e., pushing up) levels during step ascent task was measured on a step ascent platform. Hip extensor, knee extensor, plantar flexor muscle, and quadriceps setting strengths; lower extremity agility using the stepping test; and hip and knee joint pain severities were measured. One-legged stance and functional reach distance for balance, and maximal walking speed, timed up-and-go (TUG) time, five-chair-stand time, and step ascent time were also measured to assess mobility. Stepwise regression analysis revealed that the load at pushing up during step ascent motion and TUG time were significant and independent determinants of FIM score. FIM score decreased with decreased the load at pushing up and increased TUG time. The study results suggest that depending on task specificity, both one step up task's push up peak load during step ascent motion and TUG, can partially explain ADL's FIM score in the nursing home-residing elderly individuals. Lower extremity muscle strength, agility, pain or balance measures did not add to the prediction.

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.

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.

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.

Design, Implementation, and Evaluation of a Simulation-Based Clinical Correlation Curriculum as an Adjunctive Pedagogy in an Anatomy Course.

PubMed

Coombs, Carmen M; Shields, Ryan Y; Hunt, Elizabeth A; Lum, Ying Wei; Sosnay, Patrick R; Perretta, Julianne S; Lieberman, Rhett H; Shilkofski, Nicole A

2017-04-01

Because reported use of simulation in preclinical basic science courses is limited, the authors describe the design, implementation, and preliminary evaluation of a simulation-based clinical correlation curriculum in an anatomy course for first-year medical students at Perdana University Graduate School of Medicine (in collaboration with Johns Hopkins University School of Medicine). The simulation curriculum, with five weekly modules, was a component of a noncadaveric human anatomy course for three classes (n = 81 students) from September 2011 to November 2013. The modules were designed around major anatomical regions (thorax; abdomen and pelvis; lower extremities and back; upper extremities; and head and neck) and used various types of simulation (standardized patients, high-fidelity simulators, and task trainers). Several methods were used to evaluate the curriculum's efficacy, including comparing pre- versus posttest scores and comparing posttest scores against the score on 15 clinical correlation final exam questions. A total of 81 students (response rate: 100%) completed all pre- and posttests and consented to participate. Posttest scores suggest significant knowledge acquisition and better consistency of performance after participation in the curriculum. The comparison of performance on the posttests and final exam suggests that using simulation as an adjunctive pedagogy can lead to excellent short-term knowledge retention. Simulation-based medical education may prove useful in preclinical basic science curricula. Next steps should be to validate the use of this approach, demonstrate cost-efficacy or the "return on investment" for educational and institutional leadership, and examine longer-term knowledge retention.

Discontinuity in the genetic and environmental causes of the intellectual disability spectrum.

PubMed

Reichenberg, Abraham; Cederlöf, Martin; McMillan, Andrew; Trzaskowski, Maciej; Kapra, Ori; Fruchter, Eyal; Ginat, Karen; Davidson, Michael; Weiser, Mark; Larsson, Henrik; Plomin, Robert; Lichtenstein, Paul

2016-01-26

Intellectual disability (ID) occurs in almost 3% of newborns. Despite substantial research, a fundamental question about its origin and links to intelligence (IQ) still remains. ID has been shown to be inherited and has been accepted as the extreme low of the normal IQ distribution. However, ID displays a complex pattern of inheritance. Previously, noninherited rare mutations were shown to contribute to severe ID risk in individual families, but in the majority of cases causes remain unknown. Common variants associated with ID risk in the population have not been systematically established. Here we evaluate the hypothesis, originally proposed almost 1 century ago, that most ID is caused by the same genetic and environmental influences responsible for the normal distribution of IQ, but that severe ID is not. We studied more than 1,000,000 sibling pairs and 9,000 twin pairs assessed for IQ and for the presence of ID. We evaluated whether genetic and environmental influences at the extremes of the distribution are different from those operating in the normal range. Here we show that factors influencing mild ID (lowest 3% of IQ distribution) were similar to those influencing IQ in the normal range. In contrast, the factors influencing severe ID (lowest 0.5% of IQ distribution) differ from those influencing mild ID or IQ scores in the normal range. Taken together, our results suggest that most severe ID is a distinct condition, qualitatively different from the preponderance of ID, which, in turn, represents the low extreme of the normal distribution of intelligence.

Discontinuity in the genetic and environmental causes of the intellectual disability spectrum

PubMed Central

Reichenberg, Abraham; Cederlöf, Martin; McMillan, Andrew; Trzaskowski, Maciej; Kapra, Ori; Fruchter, Eyal; Ginat, Karen; Davidson, Michael; Weiser, Mark; Larsson, Henrik; Plomin, Robert; Lichtenstein, Paul

2016-01-01

Intellectual disability (ID) occurs in almost 3% of newborns. Despite substantial research, a fundamental question about its origin and links to intelligence (IQ) still remains. ID has been shown to be inherited and has been accepted as the extreme low of the normal IQ distribution. However, ID displays a complex pattern of inheritance. Previously, noninherited rare mutations were shown to contribute to severe ID risk in individual families, but in the majority of cases causes remain unknown. Common variants associated with ID risk in the population have not been systematically established. Here we evaluate the hypothesis, originally proposed almost 1 century ago, that most ID is caused by the same genetic and environmental influences responsible for the normal distribution of IQ, but that severe ID is not. We studied more than 1,000,000 sibling pairs and 9,000 twin pairs assessed for IQ and for the presence of ID. We evaluated whether genetic and environmental influences at the extremes of the distribution are different from those operating in the normal range. Here we show that factors influencing mild ID (lowest 3% of IQ distribution) were similar to those influencing IQ in the normal range. In contrast, the factors influencing severe ID (lowest 0.5% of IQ distribution) differ from those influencing mild ID or IQ scores in the normal range. Taken together, our results suggest that most severe ID is a distinct condition, qualitatively different from the preponderance of ID, which, in turn, represents the low extreme of the normal distribution of intelligence. PMID:26711998

Muscle Mass Loss Is a Potential Predictor of 90-Day Mortality in Older Adults with Aspiration Pneumonia.

PubMed

Maeda, Keisuke; Akagi, Junji

2017-01-01

To investigate the association between loss of muscle mass and aspiration pneumonia (AP). Prospective observational cohort. Acute geriatric hospital. Individuals admitted to the hospital for AP (N = 151; mean age 85.9; 49.7% male). Appendicular skeletal muscle index (ASMI; appendicular skeletal muscle mass divided by height squared) was used to evaluate muscle mass. Data on age, sex, body mass index, Mini Nutritional Assessment-Short Form score, Barthel Index score, Charlson Comorbidity Index score, and pneumonia severity (Japanese version of the CURB-65 (C (confusion), U (blood urea nitrogen ≥20 mg/dL), R (respiratory rate ≥30 breaths/min), B (systolic blood pressure <90 mmHg or diastolic blood pressure ≤60 mmHg), 65 (aged ≥65) severity score (A-DROP)) were obtained. Outcomes included 30- and 90-day mortality. Mild, moderate, severe, and extremely severe AP were observed in 1.3%, 70.2%, 25.8%, and 2.6% of participants, respectively. On Kaplan-Meier analysis, participants in the lowest ASMI quartile for each sex were more likely to die than those in the other quartiles (log-lank test P = .005). Multivariate logistic analyses showed that ASMI and A-DROP were independent predictors of 90-day mortality; only A-DROP was a significant predictor of 30-day mortality (P < .001). Cox regression analysis also showed that the first ASMI quartile was independently associated with mortality (hazard ratio = 2.19; 95% confidence interval = 1.06-4.52; P = .03). Low muscle mass is a potential predictor of long-term mortality in individuals with AP. Prospectively preventing muscle mass deterioration may be beneficial for recovery from AP in older adults. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

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.

Item response theory analysis to evaluate reliability and minimal clinically important change of the Roland-Morris Disability Questionnaire in patients with severe disability due to back pain from vertebral compression fractures.

PubMed

Lee, Minji K; Yost, Kathleen J; McDonald, Jennifer S; Dougherty, Ryne W; Vine, Roanna L; Kallmes, David F

2017-06-01

The majority of validation done on the Roland-Morris Disability Questionnaire (RMDQ) has been in patients with mild or moderate disability. There is paucity of research focusing on the psychometric quality of the RMDQ in patients with severe disability. To evaluate the psychometric quality of the RMDQ in patients with severe disability. Observational clinical study. The sample consisted of 214 patients with painful vertebral compression fractures who underwent vertebroplasty or kyphoplasty. The 23-item version of the RMDQ was completed at two time points: baseline and 30-day postintervention follow-up. With the two-parameter logistic unidimensional item response theory (IRT) analyses, we derived the range of scores that produced reliable measurement and investigated the minimal clinically important difference (MCID). Scores for 214 (100%) patients at baseline and 108 (50%) patients at follow-up did not meet the reliability criterion of 0.90 or higher, with the majority of patients having disability due to back pain that was too severe to be reliably measured by the RMDQ. Depending on methodology, MCID estimates ranged from 2 to 8 points and the proportion of patients classified as having experienced meaningful improvement ranged from 26% to 68%. A greater change in score was needed at the extreme ends of the score scale to be classified as having achieved MCID using IRT methods. Replacing items measuring moderate disability with items measuring severe disability could yield a version of the RMDQ that better targets patients with severe disability due to back pain. Improved precision in measuring disability would be valuable to clinicians who treat patients with greater functional impairments. Caution is needed when choosing criteria for interpreting meaningful change using the RMDQ. Copyright © 2017 Elsevier Inc. All rights reserved.

Defining the nature of the cerebral abnormalities in the premature infant: a qualitative magnetic resonance imaging study.

PubMed

Inder, Terrie E; Wells, Scott J; Mogridge, Nina B; Spencer, Carole; Volpe, Joseph J

2003-08-01

The aim of this study was to define qualitatively the nature and extent of white and gray matter abnormalities in a longitudinal population-based study of infants with very low birth weight. Perinatal factors were then related to the presence and severity of magnetic resonance imaging (MRI) abnormalities. From November 1998 to December 2000, 100 consecutive premature infants admitted to the neonatal intensive care unit at Christchurch Women's Hospital were recruited (98% eligible) after informed parental consent to undergo an MRI scan at term equivalent. The scans were analyzed by a single neuroradiologist experienced in pediatric MRI, with a second independent scoring of the MRI using a combination of criteria for white matter (cysts, signal abnormality, loss of volume, ventriculomegaly, corpus callosal thinning, myelination) and gray matter (gray matter signal abnormality, gyration, subarachnoid space). Results were analyzed against individual item scores as well as the presence of moderate-severe white matter score, total gray matter score, and total brain score. The mean gestational age was 27.9+/-2.4 weeks (range, 23-32 weeks), and mean birth weight was 1063+/-292 g. The greatest univariate predictors for moderate-severe white matter abnormality were lower gestational age (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.7; P<.01), maternal fever (OR, 2.2; 95% CI, 1.1-4.6; P<.04), proven sepsis in the infant at delivery (OR, 1.8; 95% CI, 1.1-3.6; P=0.03), inotropic support (OR, 2.7; 95% CI, 1.5-4.5; P<.001), patent ductus arteriosus (OR, 2.2; 95% CI, 1.2-3.8; P=.01), grade III/IV intraventricular hemorrhage (P=.015), and the occurrence of a pneumothorax (P=.05). There was a significant protective effect of intrauterine growth restriction (OR, 0.51; 95% CI, 0.23-0.99; P=.04). Gray matter abnormality was highly related to the presence and severity of white matter abnormality. A unique pattern of cerebral abnormality consisting of significant diffuse white matter atrophy, ventriculomegaly, immature gyral development, and enlarged subarachnoid space was found in 10 of 11 infants with birth gestation <26 weeks. Given the later outcome of these infants, this pattern may have very high risk for later global neurodevelopmental disability. This MRI study confirms a high incidence of cerebral white matter abnormality at term in an unselected population of premature infants, which is predominantly a result of noncystic injury in the extremely immature infant. We confirm that the major perinatal risk factors for white matter abnormality are related to perinatal infection, particularly maternal fever and infant sepsis, and hypotension with inotrope use. We have defined a distinct pattern of diffuse white and gray matter abnormality in the extremely immature infant.

Bone disease in primary hyperparathyroidism

PubMed Central

Bandeira, Francisco; Cusano, Natalie E.; Silva, Barbara C.; Cassibba, Sara; Almeida, Clarissa Beatriz; Machado, Vanessa Caroline Costa; Bilezikian, John P.

2015-01-01

Bone disease in severe primary hyperparathyroidism (PHPT) is described classically as osteitis fibrosa cystica (OFC). Bone pain, skeletal deformities and pathological fractures are features of OFC. Bone mineral density is usually extremely low in OFC, but it is reversible after surgical cure. The signs and symptoms of severe bone disease include bone pain, pathologic fractures, proximal muscle weakness with hyperreflexia. Bone involvement is typically characterized as salt-and-pepper appearance in the skull, bone erosions and bone resorption of the phalanges, brown tumors and cysts. In the radiography, diffuse demineralization is observed, along with pathological fractures, particularly in the long bones of the extremities. In severe, symptomatic PHPT, marked elevation of the serum calcium and PTH concentrations are seen and renal involvement is manifested by nephrolithiasis and nephrocalcinosis. A new technology, recently approved for clinical use in the United States and Europe, is likely to become more widely available because it is an adaptation of the lumbar spine DXA image. Trabecular bone score (TBS) is a gray-level textural analysis that provides an indirect index of trabecular microarchitecture. Newer technologies, such as high-resolution peripheral quantitative computed tomography (HR-pQCT), have provided further understanding of the microstructural skeletal features in PHPT. PMID:25166047

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

Polygenic Versus Monogenic Causes of Hypercholesterolemia Ascertained Clinically.

PubMed

Wang, Jian; Dron, Jacqueline S; Ban, Matthew R; Robinson, John F; McIntyre, Adam D; Alazzam, Maher; Zhao, Pei Jun; Dilliott, Allison A; Cao, Henian; Huff, Murray W; Rhainds, David; Low-Kam, Cécile; Dubé, Marie-Pierre; Lettre, Guillaume; Tardif, Jean-Claude; Hegele, Robert A

2016-12-01

Next-generation sequencing technology is transforming our understanding of heterozygous familial hypercholesterolemia, including revision of prevalence estimates and attribution of polygenic effects. Here, we examined the contributions of monogenic and polygenic factors in patients with severe hypercholesterolemia referred to a specialty clinic. We applied targeted next-generation sequencing with custom annotation, coupled with evaluation of large-scale copy number variation and polygenic scores for raised low-density lipoprotein cholesterol in a cohort of 313 individuals with severe hypercholesterolemia, defined as low-density lipoprotein cholesterol >5.0 mmol/L (>194 mg/dL). We found that (1) monogenic familial hypercholesterolemia-causing mutations detected by targeted next-generation sequencing were present in 47.3% of individuals; (2) the percentage of individuals with monogenic mutations increased to 53.7% when copy number variations were included; (3) the percentage further increased to 67.1% when individuals with extreme polygenic scores were included; and (4) the percentage of individuals with an identified genetic component increased from 57.0% to 92.0% as low-density lipoprotein cholesterol level increased from 5.0 to >8.0 mmol/L (194 to >310 mg/dL). In a clinically ascertained sample with severe hypercholesterolemia, we found that most patients had a discrete genetic basis detected using a comprehensive screening approach that includes targeted next-generation sequencing, an assay for copy number variations, and polygenic trait scores. © 2016 American Heart Association, Inc.

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.

Importance of electromyography and the electrophysiological severity scale in forensic reports.

PubMed

Bilgin, Nursel Gamsiz; Ozge, Aynur; Mert, Ertan; Yalçinkaya, Deniz E; Kar, Hakan

2007-05-01

Forensic reports on traumatic peripheral nerve injuries include dysfunction degrees of extremities, which are arranged according to the Turkish Penalty Code. The aim of this study is to discuss the role and importance of electromyography while preparing forensic reports in the cases of traumatic peripheral nerve injuries and the usefulness of scoring systems. A modified global scale, recommended by Mondelli et al., was used to assess the electrophysiological impairment of each peripheral nerve. Forensic reports of 106 patients, reported between 2002 and 2004, were evaluated. Thirty-four percent of the cases were reported as "total loss of function," 41.5% were reported as "functional disability," and there were no dysfunctions in the other cases in forensic reports that were prepared based on Council of Social Insurance Regulations of Health Processes and Guide prepared by the Council of Forensic Medicine and profession associations of forensic medicine. When we rearranged these forensic reports based on the electrophysiological severity scale (ESS), it was clearly found that all of the score 2 cases and 86.7% of the score 3 cases corresponded to "functional disability" and 91.4% of the score 4 cases correspond to "total loss of function." We found a significant correlation between the ESS and functional evaluation in peripheral nerve injury cases. Evaluation of functional disabilities in peripheral nerve injuries with the ESS represents a standardized and objective method used for forensic reports.

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.

Test anxiety in mathematics among early undergraduate students in a British university in Malaysia

NASA Astrophysics Data System (ADS)

Karjanto, Natanael; Yong, Su Ting

2013-03-01

The level of test anxiety in mathematics subjects among early undergraduate students at the University of Nottingham Malaysia Campus is studied in this article. The sample consists of 206 students taking several mathematics modules who completed the questionnaires on test anxiety just before they entered the venue for midterm examinations. The sample data include the differences in the context of academic levels, gender groups and nationality backgrounds. The level of test anxiety in mathematics is measured using seven Likert questionnaire statements adapted from the Test Anxiety Inventory describing one's emotional feeling before the start of an examination. In general, the result shows that the students who had a lower score expectation were more anxious than those who had a higher score expectation, but that they obtained a better score than the expected score. In the context of academic levels, gender groups and nationality backgrounds, there were no significant correlations between the level of test anxiety and the students' academic performance. The effect size of the correlation values ranged from extremely small to moderate.

Persistent Polyuria in a Rat Spinal Contusion Model

PubMed Central

Ward, Patricia J.

2012-01-01

Abstract Polyuria contributes to bladder overdistention, which confounds both lower and upper urinary tract management in individuals having a spinal cord injury (SCI). Bladder overdistention post-SCI is one of the most common triggers for autonomic dysreflexia, a potentially life-threatening condition. Post-SCI polyuria is thought to result from loss of vascular tone in the lower extremities, leading to edema and subsequent excess fluid, resulting in polyuria. Mild SCIs that have near complete recovery would therefore be expected to have little to no polyuria, while severe injuries resulting in flaccid limbs and lower extremity edema would be expected to exhibit severe polyuria. Since interventions that may decrease lower extremity edema are recommended to lessen the severity of polyuria, step training (which promotes vascular circulation) was evaluated as a therapy to reduce post-SCI polyuria. In the present study, polyuria was evaluated in mild, moderate, and severe contusive SCI in adult male rats. The animals were housed in metabolic cages for 24-hour periods pre- and post-SCI (to 6 weeks). Urine, feces, food, water, and body weights were collected. Other assessments included residual expressed urine volumes, locomotor scoring, in-cage activity, and lesion histology. SCI produced an immediate increase in 24-hour urine collection, as early as 3 days post-SCI. Approximately 2.6-fold increases in urine collection occurred from weeks 1–6 post-SCI for all injury severities. Even with substantial gains in locomotor and bladder function following a mild SCI, polyuria remained severe. Step training (30 min/day, 6 days/week) did not alleviate polyuria in the moderate SCI contusion group. These results indicate that (1) mild injuries retaining weight-bearing locomotion that should have mild, if any, edema/loss of vascular tone still exhibit severe polyuria, and (2) step training was unable to reduce post-SCI polyuria. Taken together, these results indicate that the current mechanistic hypothesis of post-SCI polyuria may be incomplete. PMID:22708983

Persistent polyuria in a rat spinal contusion model.

PubMed

Ward, Patricia J; Hubscher, Charles H

2012-10-10

Polyuria contributes to bladder overdistention, which confounds both lower and upper urinary tract management in individuals having a spinal cord injury (SCI). Bladder overdistention post-SCI is one of the most common triggers for autonomic dysreflexia, a potentially life-threatening condition. Post-SCI polyuria is thought to result from loss of vascular tone in the lower extremities, leading to edema and subsequent excess fluid, resulting in polyuria. Mild SCIs that have near complete recovery would therefore be expected to have little to no polyuria, while severe injuries resulting in flaccid limbs and lower extremity edema would be expected to exhibit severe polyuria. Since interventions that may decrease lower extremity edema are recommended to lessen the severity of polyuria, step training (which promotes vascular circulation) was evaluated as a therapy to reduce post-SCI polyuria. In the present study, polyuria was evaluated in mild, moderate, and severe contusive SCI in adult male rats. The animals were housed in metabolic cages for 24-hour periods pre- and post-SCI (to 6 weeks). Urine, feces, food, water, and body weights were collected. Other assessments included residual expressed urine volumes, locomotor scoring, in-cage activity, and lesion histology. SCI produced an immediate increase in 24-hour urine collection, as early as 3 days post-SCI. Approximately 2.6-fold increases in urine collection occurred from weeks 1-6 post-SCI for all injury severities. Even with substantial gains in locomotor and bladder function following a mild SCI, polyuria remained severe. Step training (30 min/day, 6 days/week) did not alleviate polyuria in the moderate SCI contusion group. These results indicate that (1) mild injuries retaining weight-bearing locomotion that should have mild, if any, edema/loss of vascular tone still exhibit severe polyuria, and (2) step training was unable to reduce post-SCI polyuria. Taken together, these results indicate that the current mechanistic hypothesis of post-SCI polyuria may be incomplete.

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

Pulmonary function and dysfunction in multiple sclerosis.

PubMed

Smeltzer, S C; Utell, M J; Rudick, R A; Herndon, R M

1988-11-01

Pulmonary function was studied in 25 patients with clinically definite multiple sclerosis with a range of motor impairment. Forced vital capacity (FVC), maximal voluntary ventilation (MVV), and maximal expiratory pressure (MEP) were normal in the ambulatory patients (mean greater than or equal to 80% predicted) but reduced in bedridden patients (mean, 38.5%, 31.6%, and 36.3% predicted; FCV, MVV, and MEP, respectively) and wheelchair-bound patients with upper extremity involvement (mean, 69.4%, 50.4%, and 62.6% predicted; FVC, MVV, and MEP, respectively). Forced vital capacity, MVV, and MEP correlated with Kurtzke Expanded Disability Status scores (tau = -0.72, -0.70, and -0.65) and expiratory muscle weakness occurred most frequently. These findings demonstrate that marked expiratory weakness develops in severely paraparetic patients with multiple sclerosis and the weakness increases as the upper extremities become increasingly involved.

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.

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.

Functional electrical stimulation enhancement of upper extremity functional recovery during stroke rehabilitation: a pilot study.

PubMed

Alon, Gad; Levitt, Alan F; McCarthy, Patricia A

2007-01-01

To test if functional electrical stimulation (FES) can enhance the recovery of upper extremity function during early stroke rehabilitation. Open-label block-randomized trial, begun during inpatient rehabilitation and continued at the patients' home. Patients were assigned to either FES combined with task-specific upper extremity rehabilitation (n = 7) or a control group that received task-specific therapy alone (n = 8) over 12 weeks. Outcome measures . Hand function (Box & Blocks, B & B; Jebsen-Taylor light object lift, J-T) and motor control (modified Fugl-Meyer, mF-M) were video-recorded for both upper extremities at baseline, 4, 8, and 12 weeks. B&B mean score at 12 weeks favored (P = .049) the FES group (42.3 +/- 16.6 blocks) over the control group (26.3 +/- 11.0 blocks). The FES group J-T task was 6.7 +/- 2.9 seconds and faster (P = .049) than the 11.8 +/- 5.4 seconds of the control group. Mean mF-M score of the FES group at 12 weeks was 49.3 +/- 5.1 points out of 54, compared to the control group that scored 40.6 +/- 8.2 points (P = .042). All patients regained hand function. Upper extremity task-oriented training that begins soon after stroke that incorporates FES may improve upper extremity functional use in patients with mild/moderate paresis more than task-oriented training without FES.

Spectrum of gross motor function in extremely low birth weight children with cerebral palsy at 18 months of age.

PubMed

Vohr, Betty R; Msall, Michael E; Wilson, Dee; Wright, Linda L; McDonald, Scott; Poole, W Kenneth

2005-07-01

The purpose of this study was to evaluate the relationship between cerebral palsy (CP) diagnoses as measured by the topographic distribution of the tone abnormality with level of function on the Gross Motor Function Classification System (GMFCS) and developmental performance on the Bayley Scales of Infant Development II (BSID-II). It was hypothesized that (1) the greater the number of limbs involved, the higher the GMFCS and the lower the BSID-II Motor Scores and (2) there would be a spectrum of function and skill achievement on the GMFCS and BSID-II Motor Scores for children in each of the CP categories. A multicenter, longitudinal cohort study was conducted of 1860 extremely low birth weight (ELBW) infants who were born between August 1, 1995 and February 1, 1998, and evaluated at 18 to 22 months' corrected age. Children were categorized into impairment groups on the basis of the typography of neurologic findings: spastic quadriplegia, triplegia, diplegia, hemiplegia, monoplegia, hypotonic and/or athetotic CP, other abnormal neurologic findings, and normal. The neurologic category then was compared with GMFCS level and BSID-II Motor Scores. A total of 282 (15.2%) of the 1860 children evaluated had CP. Children with more limbs involved had more abnormal GMFCS levels and lower BSID-II scores, reflecting more severe functional limitations. However, for each CP diagnostic category, there was a spectrum of gross motor functional levels and BSID-II scores. Although more than 1 (26.6%) in 4 of the children with CP had moderate to severe gross motor functional impairment, 1 (27.6%) in 4 had motor functional skills that allowed for ambulation. Given the range of gross motor skill outcomes for specific types of CP, the GMFCS is a better indicator of gross motor functional impairment than the traditional categorization of CP that specifies the number of limbs with neurologic impairment. The neurodevelopmental assessment of young children is optimized by combining a standard neurologic examination with measures of gross and fine motor function (GMFCS and Bayley Psychomotor Developmental Index). Additional studies to examine longer term functional motor and adaptive-functional developmental skills are required to devise strategies that delineate therapies to optimize functional performance.

MRI assessment of the thigh musculature in dermatomyositis and healthy subjects using diffusion tensor imaging, intravoxel incoherent motion and dynamic DTI.

PubMed

Sigmund, E E; Baete, S H; Luo, T; Patel, K; Wang, D; Rossi, I; Duarte, A; Bruno, M; Mossa, D; Femia, A; Ramachandran, S; Stoffel, D; Babb, J S; Franks, A; Bencardino, J

2018-06-04

Dermatomyositis (DM) is an idiopathic inflammatory myopathy involving severe debilitation in need of diagnostics. We evaluated the proximal lower extremity musculature with diffusion tensor imaging (DTI), intravoxel incoherent motion (IVIM) and dynamic DTI in DM patients and controls and compared with standard clinical workup.  METHODS: In this IRB-approved, HIPAA-compliant study with written informed consent, anatomical, Dixon fat/water and diffusion imaging were collected in bilateral thigh MRI of 22 controls and 27 DM patients in a 3T scanner. Compartments were scored on T1/T2 scales. Single voxel dynamic DTI metrics in quadriceps before and after 3-min leg exercise were measured. Spearman rank correlation and mixed model analysis of variance/covariance (ANOVA/ANCOVA) were used to correlate with T1 and T2 scores and to compare patients with controls. DM patients showed significantly lower pseudo-diffusion and volume in quadriceps than controls. All subjects showed significant correlation between T1 score and signal-weighted fat fraction; tissue diffusion and pseudo-diffusion varied significantly with T1 and T2 score in patients. Radial and mean diffusion exercise response in patients was significantly higher than controls. Static and dynamic diffusion imaging metrics show correlation with conventional imaging scores, reveal spatial heterogeneity, and provide means to differentiate dermatomyositis patients from controls. • Diffusion imaging shows regional differences between thigh muscles of dermatomyositis patients and controls. • Signal-weighted fat fraction and diffusion metrics correlate with T1/T2 scores of disease severity. • Dermatomyositis patients show significantly higher radial diffusion exercise response than controls.

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.

The suicidality continuum in a large sample of obsessive-compulsive disorder (OCD) patients.

PubMed

Velloso, P; Piccinato, C; Ferrão, Y; Aliende Perin, E; Cesar, R; Fontenelle, L; Hounie, A G; do Rosário, M C

2016-10-01

Obsessive-compulsive disorder (OCD) has a chronic course leading to huge impact in the patient's functioning. Suicidal thoughts and attempts are much more frequent in OCD subjects than once thought before. To empirically investigate whether the suicidal phenomena could be analyzed as a suicidality severity continuum and its association with obsessive-compulsive (OC) symptom dimensions and quality of life (QoL), in a large OCD sample. Cross-sectional study with 548 patients diagnosed with OCD according to the DSM-IV criteria, interviewed in the Brazilian OCD Consortium (C-TOC) sites. Patients were evaluated by OCD experts using standardized instruments including: Yale-Brown Obsessive-Compulsive Scale (YBOCS); Dimensional Yale-Brown Obsessive-Compulsive Scale (DYBOCS); Beck Depression and Anxiety Inventories; Structured Clinical Interview for DSM-IV (SCID); and the SF-36 QoL Health Survey. There were extremely high correlations between all the suicidal phenomena. OCD patients with suicidality had significantly lower QoL, higher severity in the "sexual/religious", "aggression" and "symmetry/ordering" OC symptom dimensions, higher BDI and BA scores and a higher frequency of suicide attempts in a family member. In the regression analysis, the factors that most impacted suicidality were the sexual dimension severity, the SF-36 QoL Mental Health domain, the severity of depressive symptoms and a relative with an attempted suicide history. Suicidality could be analyzed as a severity continuum and patients should be carefully monitored since they present with suicidal ideation. Lower QoL scores, higher scores on the sexual dimension and a family history of suicide attempts should be considered as risk factors for suicidality among OCD patients. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Preoperative spinal cord damage affects the characteristics and prognosis of segmental motor paralysis after cervical decompression surgery.

PubMed

Ikegami, Shota; Tsutsumimoto, Takahiro; Ohta, Hiroshi; Yui, Mutsuki; Kosaku, Hidemi; Uehara, Masashi; Misawa, Hiromichi

2014-03-15

Retrospective analysis. To test the hypothesis that preoperative spinal cord damage affects postoperative segmental motor paralysis (SMP). SMP is an enigmatic complication after cervical decompression surgery. The cause of this complication remains controversial. We particularly focused on preoperative T2-weighted high signal change (T2HSC) on magnetic resonance imaging in the spinal cord, and assessed the influence of preoperative T2HSC on SMP after cervical decompression surgery. A retrospective review of 181 consecutive patients (130 males and 51 females) who underwent cervical decompression surgery was conducted. SMP was defined as development of postoperative motor palsy of the upper extremities by at least 1 grade in manual muscle testing without impairment of the lower extremities. The relationship between the locations of T2HSC in preoperative magnetic resonance imaging and SMP and Japanese Orthopedic Association score was investigated. Preoperative T2HSC was detected in 78% (142/181) of the patients. SMP occurred in 9% (17/181) of the patients. Preoperative T2HSC was not a significant risk factor for the occurrence of SMP (P = 0.682). However, T2HSC significantly influenced the severity of SMP: the number of paralyzed segments increased with an incidence rate ratio of 2.2 (P = 0.026), the manual muscle score deteriorated with an odds ratio of 8.4 (P = 0.032), and the recovery period was extended with a hazard ratio of 4.0 (P = 0.035). In patients with preoperative T2HSC, Japanese Orthopaedic Association scores remained lower than those in patients without T2HSC throughout the entire period including pre- and postoperative periods (P < 0.001). Preoperative T2HSC was associated with worse severity of SMP in patients who underwent cervical decompression surgery, suggesting that preoperative spinal cord damage is one of the pathomechanisms of SMP after cervical decompression surgery. 3.

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

Validity of Self-reported Sleep Bruxism among Myofascial Temporomandibular Disorder Patients and Controls

PubMed Central

Raphael, Karen G.; Janal, Malvin N.; Sirois, David A.; Dubrovsky, Boris; Klausner, Jack J.; Krieger, Ana C.; Lavigne, Gilles J.

2015-01-01

Sleep bruxism (SB), primarily involving rhythmic grinding of the teeth during sleep, has been advanced as a causal or maintenance factor for a variety of orofacial problems, including temporomandibular disorders (TMD). Since laboratory polysomnographic (PSG) assessment is extremely expensive and time-consuming, most research testing this belief has relied on patient self-report of SB. The current case-control study examined the accuracy of those self-reports relative to laboratory-based PSG assessment of SB in a large sample of women suffering from chronic myofascial TMD (n=124) and a demographically matched control group without TMD (n=46). A clinical research coordinator administered a structured questionnaire to assess self-reported SB. Participants then spent two consecutive nights in a sleep laboratory. Audiovisual and electromyographic data from the second night were scored to assess whether participants met criteria for presence of 2 or more (2+) rhythmic masticatory muscle activity episodes accompanied by grinding sounds, moderate SB, or severe SB, using previously validated research scoring standards. Contingency tables were constructed to assess positive and negative predictive values, sensitivity and specificity, and 95% confidence intervals surrounding the point estimates. Results showed that self-report significantly predicted 2+ grinding sounds during sleep for TMD cases. However, self-reported SB failed to significantly predict presence or absence of either moderate or severe SB as assessed by PSG, for both cases and controls. These data show that self-report of tooth grinding awareness is highly unlikely to be a valid indicator of true SB. Studies relying on self-report to assess SB must be viewed with extreme caution. PMID:26010126

Analyses of demographical and injury characteristics of adult and pediatric patients injured in Syrian civil war.

PubMed

Er, Erhan; Çorbacıoğlu, Şeref Kerem; Güler, Sertaç; Aslan, Şahin; Seviner, Meltem; Aksel, Gökhan; Bekgöz, Burak

2017-01-01

Aimed to analyze demographical data and injury characteristics of patients who were injured in the Syrian Civil War (SCW) and to define differences in injury characteristics between adult and pediatric patients. Patients who were injured in the SCW and transferred to our emergency department were retrospectively analyzed in this study during the 15-month period between July 2013 and October 2014. During the study period, 1591 patients who were the victims of the SCW and admitted to our emergency department due to war injury enrolled in the study. Of these patients, 285 were children (18%). The median of the injury severity score was 16 (interquartile range [IQR]: 9-25) in all patients. The most frequent mechanism of injury was blunt trauma (899 cases, 55%), and the most frequently-injured region of the body was the head (676 cases, 42.5%). Head injury rates among the children's group were higher than those of the adult group (P < .001). In contrast, injury rates for the abdomen and extremities in the children's group were lower than those in the adult group (P < .001, P < .001). The majority of patients were adults, and the most frequent mechanism of injury was blunt trauma. Similarly, the children were substantially affected by war. Although the injury severity score values and mortality rates of the child and adult groups were similar, it was determined that the number of head injuries was higher, but the number of abdomen and extremity injuries was lower in the children's group than in the adult group. Copyright © 2016 Elsevier Inc. All rights reserved.

A Novel Lung Disease Phenotype Adjusted for Mortality Attrition for Cystic Fibrosis Genetic Modifier Studies

PubMed Central

Taylor, Chelsea; Commander, Clayton W.; Collaco, Joseph M.; Strug, Lisa J.; Li, Weili; Wright, Fred A.; Webel, Aaron D.; Pace, Rhonda G.; Stonebraker, Jaclyn R.; Naughton, Kathleen; Dorfman, Ruslan; Sandford, Andrew; Blackman, Scott M.; Berthiaume, Yves; Paré, Peter; Drumm, Mitchell L.; Zielenski, Julian; Durie, Peter; Cutting, Garry R.; Knowles, Michael R.; Corey, Mary

2011-01-01

SUMMARY Genetic studies of lung disease in Cystic Fibrosis are hampered by the lack of a severity measure that accounts for chronic disease progression and mortality attrition. Further, combining analyses across studies requires common phenotypes that are robust to study design and patient ascertainment. Using data from the North American Cystic Fibrosis Modifier Consortium (Canadian Consortium for CF Genetic Studies, Johns Hopkins University CF Twin and Sibling Study, and University of North Carolina/Case Western Reserve University Gene Modifier Study), the authors calculated age-specific CF percentile values of FEV1 which were adjusted for CF age-specific mortality data. The phenotype was computed for 2061 patients representing the Canadian CF population, 1137 extreme phenotype patients in the UNC/Case Western study, and 1323 patients from multiple CF sib families in the CF Twin and Sibling Study. Despite differences in ascertainment and median age, our phenotype score was distributed in all three samples in a manner consistent with ascertainment differences, reflecting the lung disease severity of each individual in the underlying population. The new phenotype score was highly correlated with the previously recommended complex phenotype, but the new phenotype is more robust for shorter follow-up and for extreme ages. A disease progression and mortality adjusted phenotype reduces the need for stratification or additional covariates, increasing statistical power and avoiding possible distortions. This approach will facilitate large scale genetic and environmental epidemiological studies which will provide targeted therapeutic pathways for the clinical benefit of patients with CF. PMID:21462361

Sporadic Inclusion Body Myositis: MRI Findings and Correlation With Clinical and Functional Parameters.

PubMed

Guimaraes, Julio Brandao; Zanoteli, Edmar; Link, Thomas M; de Camargo, Leonardo V; Facchetti, Luca; Nardo, Lorenzo; Fernandes, Artur da Rocha Correa

2017-12-01

The purpose of this prospective study is to assess MRI findings in patients with sporadic inclusion body myositis (IBM) and correlate them with clinical and functional parameters. This study included 12 patients with biopsy-proven sporadic IBM. All patients underwent MRI of the bilateral upper and lower extremities. The images were scored for muscle atrophy, fatty infiltration, and edema pattern. Clinical data included onset and duration of disease. Muscle strength was measured using the Medical Research Council (MRC) scale, and functional status was assessed using the Modified Rankin Scale. Correlation between MRI and different clinical and functional parameters was calculated using the Spearman rank test and Pearson correlation. All patients showed MRI abnormalities, which were more severe within the lower limbs and the distal segments. The most prevalent MRI finding was fat infiltration. There was a statistically significant correlation between disease duration and number of muscles infiltrated by fat (r = 0.65; p = 0.04). The number of muscles with fat infiltration correlated with the sum of the scores of MRC (r = -0.60; p = 0.04) and with the Modified Rankin Scale (r = 0.48; p = 0.03). Our findings suggest that most patients with biopsy-proven sporadic IBM present with a typical pattern of muscle involvement at MRI, more extensively in the lower extremities. Moreover, MRI findings strongly correlated with clinical and functional parameters, because both the extent and severity of muscle involvement assessed by MRI and clinical and functional parameters are associated with the early onset of the disease and its duration.

Survey Criteria for Fibromyalgia Independently Predict Increased Postoperative Opioid Consumption after Lower Extremity Joint Arthroplasty: A Prospective, Observational Cohort Study

PubMed Central

Brummett, Chad M.; Janda, Allison M.; Schueller, Christa M.; Tsodikov, Alex; Morris, Michelle; Williams, David A.; Clauw, Daniel J.

2013-01-01

Background Variance in pain following total knee and hip arthroplasty may be due to a number of procedural and peripheral factors but also, in some individuals, to aberrant central pain processing as is described in conditions like fibromyalgia. To test this hypothesis, we conducted a prospective, observational cohort study of patients undergoing lower extremity joint arthroplasty. Methods 519 patients were preoperatively phenotyped using validated self-reported pain questionnaires, psychological measures, and health information. In addition to assessing factors previously found to be associated with poor outcomes in arthroplasty, participants also completed the American College of Rheumatology survey criteria for fibromyalgia. Previous studies have suggested that rather than being “present” or “absent,” features of fibromyalgia as measured by this instrument, occur over a wide continuum. Postoperative pain control was assessed by total postoperative opioid consumption. Results Preoperatively, patients with higher fibromyalgia survey scores were younger, more likely to be female, taking more opioids, reported higher pain severity, and had a more negative psychological profile. In the multivariate analysis, the fibromyalgia survey score, younger age, preoperative opioid use, knee (vs. hip), pain severity at baseline, and the anesthetic technique were all predictive of increased postoperative opioid consumption. Conclusions Using the survey criteria for fibromyalgia distinct phenotypic differences were found, and the measure was independently predictive of opioid consumption. This self-report measure may provide an additional simple means of predicting postoperative pain outcomes and analgesic requirements. Future studies are needed to determine whether tailored therapies can improve postoperative pain control in this population. PMID:24343289

Crash scene photography in motor vehicle crashes without air bag deployment.

PubMed

Newgard, Craig D; Martens, Katherine A; Lyons, Evelyn M

2002-09-01

To determine whether vehicle characteristics, measured using crash scene photography, are associated with anatomic patterns of injury and severity of injury sustained in motor vehicle crashes (MVCs) without air bag deployment. A prospective observational study was conducted over 22 months, using 12 fire departments serving two hospitals. Two vehicle photographs (exterior and interior) were taken at each MVC. Vehicular variables were assigned by grading the photographs with a standardized scoring system, and outcome information on each patient was collected by chart review. Five hundred fifty-nine patients were entered into the study. Frontal crashes and increasing passenger space intrusion (PSI) were associated with head, facial, and lower-extremity injuries, while rear crashes were associated with spinal injuries. Restraint use had a protective effect in head, facial, and upper and lower extremity injuries, yet was associated with higher odds of spinal injury. Lack of restraint use, increasing PSI, and steering wheel deformity were associated with an increased hospital length of stay and hospital charges, yet only steering wheel deformity was associated with increasing injury severity when adjusting for other crash variables. Out-of-hospital variables, as obtained from crash vehicle photography, are associated with injury site, injury severity, hospital length of stay, and hospital charges in patients involved in MVCs without air bag deployment.

The impact of major earthquakes on the psychological functioning of medical students: a Christchurch, New Zealand study.

PubMed

Carter, Frances A; Bell, Caroline J; Ali, Anthony N; McKenzie, Janice; Wilkinson, Timothy J

2014-07-18

No previous studies have systematically assessed the psychological functioning of medical students following a major disaster. To describe the psychological functioning of medical students following the earthquakes in Canterbury, New Zealand, and identify predictors of adverse psychological functioning. 7 months following the most severe earthquake, medical students completed the Depression, Anxiety and Stress Scale (DASS), the Post-Traumatic Stress Disorder Checklist, the Eysenck Personality Questionnaire, the Connor Davidson Resilience Scale, the Work and Adjustment Scale, and Likert scales assessing psychological functioning at worst and currently. A substantial minority of medical students reported moderate-extreme difficulties on the DASS subscales 7 months following the most severe earthquake (Depression =12%; Anxiety =9%; Stress =10%). Multiple linear modelling produced a model that predicted 27% of the variance in total scores on the DASS. Variables contributing significantly to the model were: year of medical course, presence of mental health problems prior to the earthquakes, not being New Zealand European, and being higher on retrospectively rated neuroticism prior to the earthquakes. Around 10% of medical students experienced moderate-extreme psychological difficulties 7 months following the most severe earthquake on 22 February 2011. Specific groups at high risk for ongoing psychological symptomatology were able to be identified.

Polygenic influences on dyslipidemias.

PubMed

Dron, Jacqueline S; Hegele, Robert A

2018-04-01

Rare large-effect genetic variants underlie monogenic dyslipidemias, whereas common small-effect genetic variants - single nucleotide polymorphisms (SNPs) - have modest influences on lipid traits. Over the past decade, these small-effect SNPs have been shown to cumulatively exert consistent effects on lipid phenotypes under a polygenic framework, which is the focus of this review. Several groups have reported polygenic risk scores assembled from lipid-associated SNPs, and have applied them to their respective phenotypes. For lipid traits in the normal population distribution, polygenic effects quantified by a score that integrates several common polymorphisms account for about 20-30% of genetic variation. Among individuals at the extremes of the distribution, that is, those with clinical dyslipidemia, the polygenic component includes both rare variants with large effects and common polymorphisms: depending on the trait, 20-50% of susceptibility can be accounted for by this assortment of genetic variants. Accounting for polygenic effects increases the numbers of dyslipidemic individuals who can be explained genetically, but a substantial proportion of susceptibility remains unexplained. Whether documenting the polygenic basis of dyslipidemia will affect outcomes in clinical trials or prospective observational studies remains to be determined.

Assessment of Musculoskeletal Function and its Correlation with Radiological Joint Score in Children with Hemophilia A.

PubMed

Gupta, Samriti; Garg, Kapil; Singh, Jagdish

2015-12-01

To evaluate the functional independence of children with hemophilia A and its correlation to radiological joint score. The present cross sectional study was conducted at SPMCHI, SMS Medical College, Jaipur, India. Children in the age group of 4-18 y affected with severe, moderate and mild hemophilia A and with a history of hemarthrosis who attended the OPD, emergency or got admitted in wards of SPMCHI, SMS Medical College were examined. Musculoskeletal function was measured in 98 patients using Functional Independence Score in Hemophilia (FISH) and index joints (joints most commonly affected with repeated bleeding) were assessed radiologically with plain X rays using Pettersson score. The mean FISH score was 28.07 ± 3.90 (range 17-32) with squatting, running and step climbing as most affected tasks. The mean Pettersson score was 3.8 ± 3.2. A significant correlation was found between mean Pettersson score and FISH (r = -0.875, P < 0.001) with knee and elbow having r = -0.810 and -0.861 respectively, but not in case of ankle with r = -0.420 (P 0.174). The FISH and radiological joint (Pettersson's) scores may be extremely useful in the clinical practice in the absence of magnetic resonance imaging (MRI), which is considered very sensitive to detect early joint damage, but at a cost that makes it relatively inaccessible. FISH seems to be a reliable tool for assessment of functional independence in patients with hemophilia A.

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.

Ganga hospital open injury score in management of open injuries.

PubMed

Rajasekaran, S; Sabapathy, S R; Dheenadhayalan, J; Sundararajan, S R; Venkatramani, H; Devendra, A; Ramesh, P; Srikanth, K P

2015-02-01

Open injuries of the limbs offer challenges in management as there are still many grey zones in decision making regarding salvage, timing and type of reconstruction. As a result, there is still an unacceptable rate of secondary amputations which lead to tremendous waste of resources and psychological devastation of the patient and his family. Gustilo Anderson's classification was a major milestone in grading the severity of injury but however suffers from the disadvantages of imprecise definition, a poor interobserver correlation, inability to address the issue of salvage and inclusion of a wide spectrum of injuries in Type IIIb category. Numerous scores such as Mangled Extremity Severity Score, the Predictive Salvage Index, the Limb Salvage Index, Hannover Fracture Scale-97 etc have been proposed but all have the disadvantage of retrospective evaluation, inadequate sample sizes and poor sensitivity and specificity to amputation, especially in IIIb injuries. The Ganga Hospital Open Injury Score (GHOIS) was proposed in 2004 and is designed to specifically address the outcome in IIIb injuries of the tibia without vascular deficit. It evaluates the severity of injury to the three components of the limb--the skin, the bone and the musculotendinous structures separately on a grade from 0 to 5. Seven comorbid factors which influence the treatment and the outcome are included in the score with two marks each. The application of the total score and the individual tissue scores in management of IIIB injuries is discussed. The total score was shown to predict salvage when the value was 14 or less; amputation when the score was 17 and more. A grey zone of 15 and 16 is provided where the decision making had to be made on a case to case basis. The additional value of GHOIS was its ability to guide the timing and type of reconstruction. A skin score of more than 3 always required a flap and hence it indicated the need for an orthoplastic approach from the index procedure. Bone score of 4 and 5 will require complex reconstruction procedures like bone transport, extensive bone grafting or free fibular graft. Regarding the timing of reconstruction, injuries with a score of 9 or less indicated a low violence trauma and were amenable for early soft tissue reconstruction whereas injuries with a score of 10 or more indicated high violence injuries where a staged reconstruction policy must be followed. Ganga Hospital Open Injury Score was found to be highly useful in decision making regarding salvage in IIIB injuries. The individual tissue scores were also useful to provide guidance regarding the timing and type of bone and soft tissue reconstruction.

Changing to AIS 2005 and agreement of injury severity scores in a trauma registry with scores based on manual chart review.

PubMed

Stewart, Kenneth E; Cowan, Linda D; Thompson, David M

2011-09-01

The Abbreviated Injury Scale (AIS) recently underwent a major revision from AIS 98 to AIS 05. AIS injury codes form the basis of widely used injury severity scores such as the injury severity score (ISS). ISS thresholds are often used in trauma case definitions and ISS is widely used in injury research to adjust for injury severity. This study evaluated changes from AIS 98 to AIS 05, the changes' effect on ISS distributions, and presents an application of the results. Injury descriptions from medical records of 137 randomly selected patients in the Oklahoma Trauma Registry (OTR) were obtained. A single trained coder used AIS 98 and AIS 05 to code each injury. ISS values were calculated and grouped into 4 categories: 1-8, 9-14, 16-24, >24. Paired ISS was compared using Kappa statistics and tests of symmetry. We identified common injury diagnoses for which AIS severity changed between versions. Estimates of the proportion of patients changing ISS groups were applied to the entire OTR to assess the impact on reporting and on a model for reimbursement. OTR AIS 98 and manual AIS 98-based ISS values had a weighted Kappa of 0.71. OTR AIS 98 and manual AIS 05-based ISS values had a Kappa of 0.58. Manual AIS 98 and manual AIS 05 ISS had the highest Kappa of 0.81, however, though the scores differed by only 1 ISS category, there were 30 discordant pairs. The distribution of these discordant pairs was not symmetrical (Bowker's S=30; df=6; p<0.0001) with AIS 05-based ISS values consistently shifted to a lower ISS category. Reductions in AIS severity and ISS values using AIS 05 were common for extremity fractures and thorax injuries. The results suggest fewer patients would be reported to the OTR or be eligible for reimbursement. Changing from AIS 98 to AIS 05 injury coding resulted in systematic changes in AIS codes and ISS. Specific injuries and body regions were differentially affected. Trauma registries and injury researchers that use AIS based injury coding can use this information to evaluate the potential impact of changes in AIS 2005. Copyright © 2010 Elsevier Ltd. All rights reserved.

N-terminal pro-brain natriuretic peptide and cardiac troponin I for the prognostic utility in elderly patients with severe sepsis or septic shock in intensive care unit: A retrospective study.

PubMed

Cheng, Hui; Fan, Wei-Ze; Wang, Sheng-Chi; Liu, Zhao-Hui; Zang, Hui-Ling; Wang, Li-Zhong; Liu, Hong-Juan; Shen, Xiao-Hui; Liang, Shao-Qing

2015-06-01

Using biomarkers to predict mortality in patient with severe sepsis or septic shock is of importance, as these patients frequently have high mortality and unsatisfied outcome. N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) play extremely important roles in prognostic value in the mortality of severe sepsis and septic shock. The present study was retrospectively designed to evaluate the predicting mortality of NT-proBNP and cTnI in elderly patients with severe sepsis or septic shock administered in the intensive care unit (ICU) and also to evaluate whether the predicting ability of Acute Physiology and Chronic Health Evaluation II (APACHE-II) score or C-reactive protein (CRP) was increased in combination with the biomarkers. A cohort of 430 patients (aged ≥65 years) with severe sepsis or septic shock admitted to our ICU between October 2011 and December 2013 was included in the study. Patient data including clinical, laboratory, and survival and mortality were collected. All patients were examined with NT-proBNP, cTnI, CRP, and APACHE-II score and were categorized as the survived and deceased groups according to the outcome 30 days after ICU treatment. The levels of NT-proBNP and cTnI (P < .01) or CRP (P < .05) were significantly higher in the deceased group than those in the survived group. The predicting mortality of APACHE-II score alone was low but largely improved, when it was combined with both NT-proBNP and cTnI (P < .05). The alteration of NT-proBNP and cTnI levels strongly predicated the ICU prognosis in elderly patients with severe sepsis or septic shock. N-terminal pro-brain natriuretic peptide and cTnI were superior to CRP in predicting mortality. The predicting ability of APACHE-II score was improved only when combined with NT-proBNP and cTnI. Copyright © 2014 Elsevier Inc. All rights reserved.

The post-stroke depression and its impact on functioning in young and adult stroke patients of a rehabilitation unit.

PubMed

Amaricai, Elena; Poenaru, Dan V

2016-01-01

Stroke is a leading cause of disability and a major public health problem. To determine frequency and degree of post-stroke depression (PSD) and its impact on functioning in young and adult stroke patients in a rehabilitation unit. The study included 72 stroke patients (aged 29-59 years) who were attending rehabilitation. The patients were assessed for depressive symptoms by Beck Depression Inventory (BDI), and their functioning by using the Stroke Impact Scale (SIS) and the Barthel Index of Activities of Daily Living (ADL). Forty-eight patients had different degrees of depression: borderline clinical depression (13.8%), moderate depression (34.7%), severe depression (15.2%) or extreme depression (2.9%). There were no significant differences of BDI scores in 30-39, 40-49 and 50-59 years groups. Statistically significant correlations were between BDI score and SIS score, between BDI score and ADL index, and between SIS score and ADL index in men, women and total study patients. More than half of the PSD patients had a moderate degree of depression. Significant correlations were noticed between depressive symptoms and functional status evaluated both by an instrument of assessing stroke impact upon general health and an instrument for assessing the everyday activities.

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.

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.

Lawn mower injuries to children in Pennsylvania, 1989 to 1993.

PubMed

Bernardo, L M; Gardner, M J

1996-01-01

Lawn mowers pose a significant risk of morbidity and mortality to children. The purpose of this study was to identify the characteristics of children injured by lawn mowers admitted to accredited trauma centers in Pennsylvania from 1989 to 1993. Data were available on 177 children who sustained 504 injuries. The majority of children were less than 5 years old, male, injured by a power mower, during the summer, at home, and with an injury to an extremity. Four cases that represent patients with a low injury Severity Score but a long hospitalization are discussed.

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

The Functional Arm Scale for Throwers (FAST)-Part II: Reliability and Validity of an Upper Extremity Region-Specific and Population-Specific Patient-Reported Outcome Scale for Throwing Athletes.

PubMed

Huxel Bliven, Kellie C; Snyder Valier, Alison R; Bay, R Curtis; Sauers, Eric L

2017-04-01

The Functional Arm Scale for Throwers (FAST) is an upper extremity (UE) region-specific and population-specific patient-reported outcome (PRO) scale developed to measure health-related quality of life in throwers with UE injuries. Stages I and II, described in a companion paper, of FAST development produced a 22-item scale and a 9-item pitcher module. Stage III of scale development, establishing reliability and validity of the FAST, is reported herein. To describe stage III of scale development: reliability and validity of the FAST. Cohort study (diagnosis); Level of evidence, 2. Data from throwing athletes collected over 5 studies were pooled to assess reliability and validity of the FAST. Reliability was estimated using FAST scores from 162 throwing athletes who were injured (n = 23) and uninjured (n = 139). Concurrent validity was estimated using FAST scores and Disabilities of the Arm, Shoulder, and Hand (DASH) and Kerlan-Jobe Orthopaedic Clinic (KJOC) scores from 106 healthy, uninjured throwing athletes. Known-groups validity was estimated using FAST scores from 557 throwing athletes who were injured (n = 142) and uninjured (n = 415). Reliability and validity were assessed using intraclass correlation coefficients (ICCs), and measurement error was assessed using standard error of measurement (SEM) and minimum detectable change (MDC). Receiver operating characteristic curves and sensitivity/specificity values were estimated for known-groups validity. Data from a separate group (n = 18) of postsurgical and nonoperative/conservative rehabilitation patients were analyzed to report responsiveness of the FAST. The FAST total, subscales, and pitcher module scores demonstrated excellent test-retest reliability (ICC, 0.91-0.98). The SEM 95 and MDC 95 for the FAST total score were 3.8 and 10.5 points, respectively. The SEM 95 and MDC 95 for the pitcher module score were 5.7 and 15.7 points, respectively. The FAST scores showed acceptable correlation with DASH (ICC, 0.49-0.82) and KJOC (ICC, 0.62-0.81) scores. The FAST total score classified 85.1% of players into the correct injury group. For predicting UE injury status, a FAST total cutoff score of 10.0 out of 100.0 was 91% sensitive and 75% specific, and a pitcher module score of 10.0 out of 100.0 was 87% sensitive and 78% specific. The FAST total score demonstrated responsiveness on several indices between intake and discharge time points. The FAST is a reliable, valid, and responsive UE region-specific and population-specific PRO scale for measuring patient-reported health care outcomes in throwing athletes with injury.

The Functional Arm Scale for Throwers (FAST)—Part II: Reliability and Validity of an Upper Extremity Region-Specific and Population-Specific Patient-Reported Outcome Scale for Throwing Athletes

PubMed Central

Huxel Bliven, Kellie C.; Snyder Valier, Alison R.; Bay, R. Curtis; Sauers, Eric L.

2017-01-01

Background: The Functional Arm Scale for Throwers (FAST) is an upper extremity (UE) region-specific and population-specific patient-reported outcome (PRO) scale developed to measure health-related quality of life in throwers with UE injuries. Stages I and II, described in a companion paper, of FAST development produced a 22-item scale and a 9-item pitcher module. Stage III of scale development, establishing reliability and validity of the FAST, is reported herein. Purpose: To describe stage III of scale development: reliability and validity of the FAST. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Data from throwing athletes collected over 5 studies were pooled to assess reliability and validity of the FAST. Reliability was estimated using FAST scores from 162 throwing athletes who were injured (n = 23) and uninjured (n = 139). Concurrent validity was estimated using FAST scores and Disabilities of the Arm, Shoulder, and Hand (DASH) and Kerlan-Jobe Orthopaedic Clinic (KJOC) scores from 106 healthy, uninjured throwing athletes. Known-groups validity was estimated using FAST scores from 557 throwing athletes who were injured (n = 142) and uninjured (n = 415). Reliability and validity were assessed using intraclass correlation coefficients (ICCs), and measurement error was assessed using standard error of measurement (SEM) and minimum detectable change (MDC). Receiver operating characteristic curves and sensitivity/specificity values were estimated for known-groups validity. Data from a separate group (n = 18) of postsurgical and nonoperative/conservative rehabilitation patients were analyzed to report responsiveness of the FAST. Results: The FAST total, subscales, and pitcher module scores demonstrated excellent test-retest reliability (ICC, 0.91-0.98). The SEM95 and MDC95 for the FAST total score were 3.8 and 10.5 points, respectively. The SEM95 and MDC95 for the pitcher module score were 5.7 and 15.7 points, respectively. The FAST scores showed acceptable correlation with DASH (ICC, 0.49-0.82) and KJOC (ICC, 0.62-0.81) scores. The FAST total score classified 85.1% of players into the correct injury group. For predicting UE injury status, a FAST total cutoff score of 10.0 out of 100.0 was 91% sensitive and 75% specific, and a pitcher module score of 10.0 out of 100.0 was 87% sensitive and 78% specific. The FAST total score demonstrated responsiveness on several indices between intake and discharge time points. Conclusion: The FAST is a reliable, valid, and responsive UE region-specific and population-specific PRO scale for measuring patient-reported health care outcomes in throwing athletes with injury. PMID:28451614

Location and severity of spasticity in the first 1-2 weeks and at 3 and 18 months after stroke.

PubMed

Welmer, A-K; Widén Holmqvist, L; Sommerfeld, D K

2010-05-01

There is no consensus concerning the location or severity of spasticity, or how this changes with time after stroke. The purpose was to describe: the location and severity of spasticity, in different muscle groups, during the first 1-2 weeks and at 3 and 18 months after stroke; the association between the severity of spasticity and control of voluntary movements; and the occurrence of spasticity in younger versus older patients. In a cohort of consecutive patients, the following parameters were assessed during the first 1-2 weeks (n = 109) and at 3 (n = 95) and 18 (n = 66) months after first-ever stroke: spasticity, by the Modified Ashworth Scale in different muscle groups; plantar-flexor clonus, by physical examination; and movement function, by the Lindmark Motor Assessment Scale. During the first 1-2 weeks and at 3 months after stroke, spasticity was most common in the anti-gravity muscles. The severity of upper extremity spasticity increased over time (P < 0.05). Upper extremity spasticity and movement scores were moderately associated (r = -0.61, P < 0.05). At 3 months, spasticity was more common amongst the younger patients (P < 0.05). The results confirm that spasticity is most common in the anti-gravity muscles and is associated with the control of voluntary movements. As the severity of spasticity also increased after 3 months, when neurally mediated spasticity is expected to have passed its peak, intrinsic muscle changes may play a larger role than neural components with the passage of time after stroke.

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.

Objective Assessment of the Interfrontal Angle for Severity Grading and Operative Decision-Making in Metopic Synostosis.

PubMed

Anolik, Rachel A; Allori, Alexander C; Pourtaheri, Navid; Rogers, Gary F; Marcus, Jeffrey R

2016-05-01

The purpose of this study was to evaluate the utility of a previously validated interfrontal angle for classification of severity of metopic synostosis and as an aid to operative decision-making. An expert panel was asked to study 30 cases ranging from minor to severe metopic synostosis. Based on computed tomographic images of the skull and clinical photographs, they classified the severity of trigonocephaly (1 = normal, 2 = mild, 3 = moderate, and 4 = severe) and management (0 = nonoperative and 1 = operative). The severity scores and management reported by experts were then pooled and matched with the interfrontal angle computed from each respective computed tomographic scan. A threshold was identified at which most experts agree on operative management. Expert severity scores were higher for more acute interfrontal angles. There was a high concordance at the extremes of classifications, severe (4) and normal (1) (p < 0.0001); however, between interfrontal angles of 114.3 and 136.1 degrees, there exists a "gray zone," with severe discordance in expert rankings. An operative threshold of 118.2 degrees was identified, with the interfrontal angle able to predict the expert panel's decision to proceed with surgery 87.6 percent of the time. The interfrontal angle has been previously validated as a simple, accurate, and reproducible means for diagnosing trigonocephaly, but must be obtained from computed tomographic data. In this article, the authors demonstrate that the interfrontal angle can be used to further characterize the severity of trigonocephaly. It also correlated with expert decision-making for operative versus nonoperative management. This tool may be used as an adjunct to clinical decision-making when the decision to proceed with surgery may not be straightforward. Diagnostic, V.

Overweight children: are they at increased risk for severe injury in motor vehicle collisions?

PubMed

Zaveri, Pavan P; Morris, Danielle M; Freishtat, Robert J; Brown, Kathleen

2009-09-01

Obesity is an epidemic in the United States. The relationship between traumatic injury and obesity in children is not well-studied. We hypothesized that overweight children suffer more severe injuries, different distributions of injuries and improper use of restraints in motor vehicle collisions. We conducted a secondary analysis of the CIREN database of motor vehicle collisions of subjects 2-17 years old. Overweight was defined as a BMI percentile for age >85%. Significant injury was an Injury Severity Score (ISS) >15 or an Abbreviated Injury Scale (AIS) score greater than one. Further analysis looked at injuries classified as head, trunk, or extremities and appropriateness of restraints. Odds ratios compared the overweight to lean groups. 335 subjects met inclusion criteria with 35.5% of cases being overweight. For significant injury, overweight cases had an odds ratio of 1.2 [95% CI: 0.8-1.9]. Analysis by AIS for overall significant injury and to specific body regions also did not show any significant associations. Overweight versus lean subjects had an odds ratio of 1.3 [95% CI: 0.8-2.1] for improper use of restraints. We found no significant relationship between pediatric injury severity, distribution of injuries, or restraint use and being overweight. Limitations of this study were the small sample size in this database and the large number of unrestrained subjects.

Current Concepts in the Management of Necrotizing Fasciitis

PubMed Central

Misiakos, Evangelos P.; Bagias, George; Patapis, Paul; Sotiropoulos, Dimitrios; Kanavidis, Prodromos; Machairas, Anastasios

2014-01-01

Necrotizing fasciitis (NF) is a severe, rare, potentially lethal soft tissue infection that develops in the scrotum and perineum, the abdominal wall, or the extremities. The infection progresses rapidly, and septic shock may ensue; hence, the mortality rate is high (median mortality 32.2%). Prognosis becomes poorer in the presence of co-morbidities, such as diabetes mellitus, immunosuppression, chronic alcohol disease, chronic renal failure, and liver cirrhosis. NF is classified into four types, depending on microbiological findings. Most cases are polymicrobial, classed as type I. The clinical status of the patient varies from erythema, swelling, and tenderness in the early stage to skin ischemia with blisters and bullae in the advanced stage of infection. In its fulminant form, the patient is critically ill with signs and symptoms of severe septic shock and multiple organ dysfunction. The clinical condition is the most important clue for diagnosis. However, in equivocal cases, the diagnosis and severity of the infection can be secured with laboratory-based scoring systems, such as the laboratory risk indicator for necrotizing fasciitis score or Fournier’s gangrene severity index score, especially in regard to Fournier’s gangrene. Computed tomography or ultrasonography can be helpful, but definitive diagnosis is attained by exploratory surgery at the infected sites. Management of the infection begins with broad-spectrum antibiotics, but early and aggressive drainage and meticulous debridement constitute the mainstay of treatment. Postoperative management of the surgical wound is also important for the patient’s survival, along with proper nutrition. The vacuum-assisted closure system has proved to be helpful in wound management, with its combined benefits of continuous cleansing of the wound and the formation of granulation tissue. PMID:25593960

Evaluation of severe and fatal injuries in extreme and contact sports: an international multicenter analysis.

PubMed

Weber, Christian D; Horst, Klemens; Nguyen, Anthony R; Lefering, Rolf; Pape, Hans-Christoph; Hildebrand, Frank

2018-04-19

The participation in extreme and contact sports has grown internationally, despite the significant risk for major and multiple injuries. We conducted this multicenter study to evaluate sport-specific injury patterns and mechanisms, to characterize individuals at risk and to identify possible approaches for prevention. We compared demographic data, severity and patterns of injuries; and the pre- and in-hospital management from an international population-based prospective trauma database (TraumaRegister DGU®). The registry was screened for sport-related injuries, and only patients with major injuries [Injury Severity Score (ISS) ≥ 9 points] related to extreme or contact sports activities were included (January 1, 2002, to December 31, 2012). Parameters were compared for different types of sports activities: (1) Airborne sports, (2) Climbing, (3) Skateboarding/Skating, (4) Contact sports. The following countries participated: Germany, Austria, Switzerland, Finland, Slovenia, Belgium, Luxembourg, and The Netherlands. Statistical analyses were performed with SPSS (Version 22, IBM Inc., Armonk, New York). A total of 278 athletes were identified within the study period and classified into four groups: Airborne sports (n = 105) were associated with the highest injury severity (ISS 22.4 ± 14.6), followed by climbing (n = 35, ISS 16.5 ± 12), skating (n = 67, ISS 15.2 ± 10.3) and contact sports (n = 71, ISS 10.4 ± 9.2). Especially high falls resulted in a significant rate of spinal injuries in airborne activities (68.6%, p < 0.001) and in climbing accidents (45.7%). Skating was associated with the highest rate of loss of consciousness (LOC) at scene (27.1%), the highest pre-hospital intubation rate (33.3%), and also the highest in-hospital mortality (15.2%, p < 0.001), related to major head injuries. Extreme and contact sports related major injuries predominantly affect young male athletes. Especially skaters are at risk for debilitating and lethal head injuries. Individuals recognizing sport-specific hazards might modify their risk behavior. Descriptive Epidemiologic Study, Level II.

Personality assessment of homeless adults as a tool for service planning.

PubMed

Tolomiczenko, G S; Sota, T; Goering, P N

2000-01-01

The psychiatric status of homeless adults has been described primarily in terms of Axis I disorders. By adding a subset of the Personality Assessment Inventory, this study tests the feasibility and usefulness of a brief, self-administered questionnaire to obtain scores on several dimensions of personality. Cluster analysis sorted 112 tested subjects into four groups characterized by distinct profiles. Two of these were characterized by extreme scores on pathological dimensions of personality (borderline features, antisocial traits, and aggressivity) and differed primarily on the dimension of suicidality. The third reflected moderate levels of personality dysfunction and the fourth did not deviate from adult nonclinical norms. The validity of the clusters was supported by demographic, background, and diagnostic subgroup differences. Brief personality assessment can be a cost-effective approach to matching services with clinical needs of homeless adults by attending to interpersonal dimensions that will likely affect service provision.

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.

Impact of malocclusion on the quality of life of children aged 8 to 10 years.

PubMed

Dutra, Sônia Rodrigues; Pretti, Henrique; Martins, Milene Torres; Bendo, Cristiane Baccin; Vale, Miriam Pimenta

2018-01-01

The aim of the present cross-sectional study was to assess the impact of malocclusion on the quality of life of children aged 8 to 10 years attending public elementary schools in Belo Horizonte, State of Minas Gerais, Brazil. The Brazilian version of the Child Perceptions Questionnaire 8-10 (CPQ8-10) was used to evaluate oral health-related quality of life. The children were examined for the diagnosis of malocclusion using the Dental Aesthetic Index (DAI). The data were analyzed by bivariate and multivariate descriptive statistics using Poisson regression at a 5% significance level. A total of 270 children participated in the study. Children with normal occlusion or mild malocclusion (DAI ≤ 25) were 56% less likely (95%CI: 0.258-0.758; p= 0.003) to have their quality of life affected compared with children diagnosed with extremely severe malocclusion (DAI ≥ 36). Children with a maxillary anterior overjet ≥ 3 mm had higher CPQ8-10 mean scores (19.4; SD = 17.1) than those with an overjet < 3 mm (13.6; SD = 11.7; p= 0.038). Extremely severe malocclusion and pronounced maxillary anterior overjet were associated with a negative impact on quality of life.

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.

Landing Kinematics in Elite Male Youth Soccer Players of Different Chronologic Ages and Stages of Maturation.

PubMed

Read, Paul J; Oliver, Jon L; De Ste Croix, Mark B A; Myer, Gregory D; Lloyd, Rhodri S

2018-04-01

  Despite the high frequency of knee injuries in athletes, few researchers have studied the effects of chronologic age and stage of maturation on knee-joint kinematics in male youth soccer players.   To use a coach-friendly screening tool to examine knee-valgus scores for players of different ages and at different stages of maturation.   Cross-sectional study.   Academy soccer clubs.   A total of 400 elite male youth soccer players aged 10 to 18 years categorized by chronologic age and stage of maturation based on their years from peak height velocity (PHV).   Knee valgus was evaluated during the tuck-jump assessment via 2-dimensional analysis. Frontal-plane projection angles were subjectively classified as minor (<10°), moderate (10°-20°), or severe (>20°), and using these classifications, we scored knee valgus in the tuck jump as 0 ( no valgus), 1 ( minor), 2 ( moderate), or 3 ( severe).   A trend toward higher valgus scores was observed in the younger age groups and the pre-PHV group. The lowest frequency of no valgus occurred in the U18 and post-PHV groups. The highest percentages of severe scores were in the U13 and pre-PHV groups for the right limb. Knee-valgus scores were lower for both lower extremities in the U18 group than in all other age groups ( P < .001) except the U16 group. Scores were lower for the post-PHV than the pre-PHV group for the right limb ( P < .001) and both pre-PHV and circa-PHV groups for the left limb ( P < .001). Noteworthy interlimb asymmetries were evident in the U14, U15, and circa-PHV groups.   Reductions in knee valgus with incremental age and during the later stages of maturation indicated that this risk factor was more prevalent in younger players. Interlimb asymmetry may also emerge around the time of the peak growth spurt and early adolescence, potentially increasing the risk of traumatic injury.

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.

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…

Extreme Fire Severity Patterns in Topographic, Convective and Wind-Driven Historical Wildfires of Mediterranean Pine Forests

PubMed Central

Lecina-Diaz, Judit; Alvarez, Albert; Retana, Javier

2014-01-01

Crown fires associated with extreme fire severity are extremely difficult to control. We have assessed fire severity using differenced Normalized Burn Ratio (dNBR) from Landsat imagery in 15 historical wildfires of Pinus halepensis Mill. We have considered a wide range of innovative topographic, fuel and fire behavior variables with the purposes of (1) determining the variables that influence fire severity patterns among fires (considering the 15 wildfires together) and (2) ascertaining whether different variables affect extreme fire severity within the three fire types (topographic, convective and wind-driven fires). The among-fires analysis showed that fires in less arid climates and with steeper slopes had more extreme severity. In less arid conditions there was more crown fuel accumulation and closer forest structures, promoting high vertical and horizontal fuel continuity and extreme fire severity. The analyses carried out for each fire separately (within fires) showed more extreme fire severity in areas in northern aspects, with steeper slopes, with high crown biomass and in climates with more water availability. In northern aspects solar radiation was lower and fuels had less water limitation to growth which, combined with steeper slopes, produced more extreme severity. In topographic fires there was more extreme severity in northern aspects with steeper slopes and in areas with more water availability and high crown biomass; in convection-dominated fires there was also more extreme fire severity in northern aspects with high biomass; while in wind-driven fires there was only a slight interaction between biomass and water availability. This latter pattern could be related to the fact that wind-driven fires spread with high wind speed, which could have minimized the effect of other variables. In the future, and as a consequence of climate change, new zones with high crown biomass accumulated in non-common drought areas will be available to burn as extreme severity wildfires. PMID:24465492

Extreme fire severity patterns in topographic, convective and wind-driven historical wildfires of Mediterranean pine forests.

PubMed

Lecina-Diaz, Judit; Alvarez, Albert; Retana, Javier

2014-01-01

Crown fires associated with extreme fire severity are extremely difficult to control. We have assessed fire severity using differenced Normalized Burn Ratio (dNBR) from Landsat imagery in 15 historical wildfires of Pinus halepensis Mill. We have considered a wide range of innovative topographic, fuel and fire behavior variables with the purposes of (1) determining the variables that influence fire severity patterns among fires (considering the 15 wildfires together) and (2) ascertaining whether different variables affect extreme fire severity within the three fire types (topographic, convective and wind-driven fires). The among-fires analysis showed that fires in less arid climates and with steeper slopes had more extreme severity. In less arid conditions there was more crown fuel accumulation and closer forest structures, promoting high vertical and horizontal fuel continuity and extreme fire severity. The analyses carried out for each fire separately (within fires) showed more extreme fire severity in areas in northern aspects, with steeper slopes, with high crown biomass and in climates with more water availability. In northern aspects solar radiation was lower and fuels had less water limitation to growth which, combined with steeper slopes, produced more extreme severity. In topographic fires there was more extreme severity in northern aspects with steeper slopes and in areas with more water availability and high crown biomass; in convection-dominated fires there was also more extreme fire severity in northern aspects with high biomass; while in wind-driven fires there was only a slight interaction between biomass and water availability. This latter pattern could be related to the fact that wind-driven fires spread with high wind speed, which could have minimized the effect of other variables. In the future, and as a consequence of climate change, new zones with high crown biomass accumulated in non-common drought areas will be available to burn as extreme severity wildfires.

The fibromyalgia survey score correlates with preoperative pain phenotypes but does not predict pain outcomes after shoulder arthroscopy

PubMed Central

Cheng, Jennifer; Kahn, Richard L.; YaDeau, Jacques T.; Tsodikov, Alexander; Goytizolo, Enrique A.; Guheen, Carrie R.; Haskins, Stephen C.; Oxendine, Joseph A.; Allen, Answorth A.; Gulotta, Lawrence V.; Dines, David M.; Brummett, Chad M.

2015-01-01

Objectives Fibromyalgia characteristics can be evaluated using a simple, self-reported measure, which correlates with postoperative opioid consumption following lower-extremity joint arthroplasty. The purpose of this study was to determine if preoperative pain history and/or the fibromyalgia survey score can predict postoperative outcomes following shoulder arthroscopy, which may cause moderate-to-severe pain. Methods In this prospective study, 100 shoulder arthroscopy patients completed preoperative validated self-report measures to assess baseline quality of recovery score, physical functioning, depression/anxiety, and neuropathic pain. Fibromyalgia characteristics were evaluated using a validated measure of widespread pain and comorbid symptoms on a 0–31 scale. Outcomes were assessed on postoperative days 2 (opioid consumption [primary], pain, physical functioning, quality of recovery score) and 14 (opioid consumption, pain). Results Fibromyalgia survey scores ranged from 0–13. The cohort was divided into tertiles for univariate analyses. Preoperative depression/anxiety (p<0.001) and neuropathic pain (p=0.008) were higher, and physical functioning was lower (p<0.001), in higher fibromyalgia survey score groups. The fibromyalgia survey score was not associated with postoperative pain or opioid consumption; however, it was independently associated with poorer quality of recovery scores (p=0.001). The only independent predictor of postoperative opioid use was preoperative opioid use (p=0.038). Discussion Fibromyalgia survey scores were lower than those in a previous study of joint arthroplasty. Although they distinguished a negative preoperative pain phenotype, fibromyalgia scores were not independently associated with postoperative opioid consumption. Further research is needed to elucidate the impact of a fibromyalgia-like phenotype on postoperative analgesic outcomes. PMID:26626295

Epidemiology of distal radius fractures in polytrauma patients and the influence of high traumatic energy transfer.

PubMed

Ferree, Steven; van der Vliet, Quirine M J; Nawijn, Femke; Bhashyam, Abhiram R; Houwert, Roderick M; Leenen, Luke P H; Hietbrink, Falco

2018-03-01

For several extremity fractures differences in morphology, incidence rate and functional outcome were found when polytrauma patients were compared to patients with an isolated injury. This is not proven for distal radius fractures (DRF). Therefore, this study aimed to analyse fracture morphology in relation to energy transfer in both poly- and mono-trauma patients with a DRF. This was a retrospective cohort study. All patients aged 16 years and older with a DRF were included. Patients with an Injury Severity Score of 16 or higher were classified as polytrauma patients. Injuries were defined as high or low energy. All DRFs were classified using the AO/OTA fracture classification system. A total of 830 patients with a DRF were included, 12% were polytrauma. The incidence rate of DRF in polytrauma patients was 3.5%. Ipsilateral upper extremity injury was found in >30% of polytrauma and high-energy monotrauma patients, compared to 5% in low-energy monotrauma patients. More type C DRF were found in polytrauma and high-energy monotrauma patients versus low-energy monotrauma patients. Operative intervention rates for all types of DRF were similar for polytrauma and high-energy monotrauma patients. Non-union rates were higher in polytrauma patients. Higher energy mechanisms of injury, in polytrauma and high-energy monotrauma patients, were associated with more severe complex articular distal radius fractures and more ipsilateral upper extremity injuries. Polytrauma and high-energy monotrauma patient have a similar fracture morphology. However, polytrauma patients have in addition to more injured body regions also more non-union related interventions than high-energy monotrauma patients. Copyright © 2018 Elsevier Ltd. All rights reserved.

Closed-Loop Neuroprosthesis for Reach-to-Grasp Assistance: Combining Adaptive Multi-channel Neuromuscular Stimulation with a Multi-joint Arm Exoskeleton.

PubMed

Grimm, Florian; Gharabaghi, Alireza

2016-01-01

Stroke patients with severe motor deficits cannot execute task-oriented rehabilitation exercises with their affected upper extremity. Advanced rehabilitation technology may support them in performing such reach-to-grasp movements. The challenge is, however, to provide assistance as needed, while maintaining the participants' commitment during the exercises. In this feasibility study, we introduced a closed-loop neuroprosthesis for reach-to-grasp assistance which combines adaptive multi-channel neuromuscular stimulation with a multi-joint arm exoskeleton. Eighteen severely affected chronic stroke patients were assisted by a gravity-compensating, seven-degree-of-freedom exoskeleton which was attached to the paretic arm for performing reach-to-grasp exercises resembling activities of daily living in a virtual environment. During the exercises, adaptive electrical stimulation was applied to seven different muscles of the upper extremity in a performance-dependent way to enhance the task-oriented movement trajectory. The stimulation intensity was individualized for each targeted muscle and remained subthreshold, i.e., induced no overt support. Closed-loop neuromuscular stimulation could be well integrated into the exoskeleton-based training, and increased the task-related range of motion (p = 0.0004) and movement velocity (p = 0.015), while preserving accuracy. The highest relative stimulation intensity was required to facilitate the grasping function. The facilitated range of motion correlated with the upper extremity Fugl-Meyer Assessment score of the patients (p = 0.028). Combining adaptive multi-channel neuromuscular stimulation with antigravity assistance amplifies the residual motor capabilities of severely affected stroke patients during rehabilitation exercises and may thus provide a customized training environment for patient-tailored support while preserving the participants' engagement.

Closed-Loop Neuroprosthesis for Reach-to-Grasp Assistance: Combining Adaptive Multi-channel Neuromuscular Stimulation with a Multi-joint Arm Exoskeleton

PubMed Central

Grimm, Florian; Gharabaghi, Alireza

2016-01-01

Stroke patients with severe motor deficits cannot execute task-oriented rehabilitation exercises with their affected upper extremity. Advanced rehabilitation technology may support them in performing such reach-to-grasp movements. The challenge is, however, to provide assistance as needed, while maintaining the participants' commitment during the exercises. In this feasibility study, we introduced a closed-loop neuroprosthesis for reach-to-grasp assistance which combines adaptive multi-channel neuromuscular stimulation with a multi-joint arm exoskeleton. Eighteen severely affected chronic stroke patients were assisted by a gravity-compensating, seven-degree-of-freedom exoskeleton which was attached to the paretic arm for performing reach-to-grasp exercises resembling activities of daily living in a virtual environment. During the exercises, adaptive electrical stimulation was applied to seven different muscles of the upper extremity in a performance-dependent way to enhance the task-oriented movement trajectory. The stimulation intensity was individualized for each targeted muscle and remained subthreshold, i.e., induced no overt support. Closed-loop neuromuscular stimulation could be well integrated into the exoskeleton-based training, and increased the task-related range of motion (p = 0.0004) and movement velocity (p = 0.015), while preserving accuracy. The highest relative stimulation intensity was required to facilitate the grasping function. The facilitated range of motion correlated with the upper extremity Fugl-Meyer Assessment score of the patients (p = 0.028). Combining adaptive multi-channel neuromuscular stimulation with antigravity assistance amplifies the residual motor capabilities of severely affected stroke patients during rehabilitation exercises and may thus provide a customized training environment for patient-tailored support while preserving the participants' engagement. PMID:27445658

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.

Decision trees for the analysis of genes involved in Alzheimer's disease pathology.

PubMed

Mestizo Gutiérrez, Sonia L; Herrera Rivero, Marisol; Cruz Ramírez, Nicandro; Hernández, Elena; Aranda-Abreu, Gonzalo E

2014-09-21

Alzheimer's disease (AD) is characterized by a gradual loss of memory, orientation, judgement and language. There is still no cure for this disorder. AD pathogenesis remains fairly unknown and its underlying molecular mechanisms are not yet fully understood. Several studies have shown that the abnormal accumulation of beta-amyloid and tau proteins occurs 10 to 20 years before the onset of symptoms of the disease, so it is extremely important to identify changes in the brain before the first symptoms. We used decision trees to classify 31 individuals (9 healthy controls and 22 AD patients in three different stages of disease) according to the expression of 69 genes previously reported in a meta-analysis, plus the expression levels of APP, APOE, BACE1, NCSTN, PSEN1, PSEN2 and MAPT. We also included in our analysis the MMSE (Mini-Mental State Examination) scores and number of NFT (neurofibrillary tangles). Results allowed us to generate a model of classification values for different AD stages of severity, according to MMSE scores, and achieve the identification of the expression level of protein tau that may possibly determine the onset (incipient stage) of AD. We used decision trees to model the different stages of AD (severe, moderate, incipient and control) based on the meta-analysis of gene expression levels plus MMSE and NFT scores. Both classifiers reported the variable MMSE as most informative, however it we were found that the protein tau also an important role in the onset of AD. Copyright © 2014 Elsevier Ltd. All rights reserved.

Functional outcomes and life satisfaction in long-term survivors of pediatric sarcomas.

PubMed

Gerber, Lynn H; Hoffman, Karen; Chaudhry, Usha; Augustine, Elizabeth; Parks, Rebecca; Bernad, Martha; Mackall, Crystal; Steinberg, Seth; Mansky, Patrick

2006-12-01

To describe the inter-relationships among impairments, performance, and disabilities in survivors of pediatric sarcoma and to identify measurements that profile survivors at risk for functional loss. Prospective, cross-sectional. Research facility. Thirty-two participants in National Cancer Institute clinical trials. Not applicable. Range of motion (ROM), strength, limb volume, grip strength, walk velocity, Assessment of Motor and Process Skills (AMPS); Human Activity Profile (HAP), Sickness Impact Profile (SIP), standard form of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36); and vocational attitudes and leisure satisfaction. Twenty of 30 survivors tested had moderate or severe loss of ROM; 13 of 31 tested had 90% or less of predicted walk velocity; all of whom had trunk or lower-extremity lesions. Women with decreased ROM (r=.50, P=.06) or strength (r=.74, P=.002) had slow gait velocity. Sixteen of 31 tested were more than 1 standard deviation below normal grip strength. Eighteen had increased limb volume. These 18 had low physical competence (SF-36) (r=-.70, P=.001) and high SIP scores (r=.73, P=.005). AMPS scores were lower than those of the matched normed sample (P<.001). HAP identified 15 of 30 who had moderately or severely reduced activity. Leisure satisfaction was higher in the subjects (P<.001). Eight reported cancer had negatively impacted work and 17 reported that it negatively impacted vocational plans. Survivors with lower-extremity or truncal lesions and women with decreased ROM and strength likely have slow walk velocity, low exercise tolerance, and high risk for functional loss. They should be identified using ROM, strength, limb volume, and walk time measures.

Validity of self-reported sleep bruxism among myofascial temporomandibular disorder patients and controls.

PubMed

Raphael, K G; Janal, M N; Sirois, D A; Dubrovsky, B; Klausner, J J; Krieger, A C; Lavigne, G J

2015-10-01

Sleep bruxism (SB), primarily involving rhythmic grinding of the teeth during sleep, has been advanced as a causal or maintenance factor for a variety of oro-facial problems, including temporomandibular disorders (TMD). As laboratory polysomnographic (PSG) assessment is extremely expensive and time-consuming, most research testing this belief has relied on patient self-report of SB. The current case-control study examined the accuracy of those self-reports relative to laboratory-based PSG assessment of SB in a large sample of women suffering from chronic myofascial TMD (n = 124) and a demographically matched control group without TMD (n = 46). A clinical research coordinator administered a structured questionnaire to assess self-reported SB. Participants then spent two consecutive nights in a sleep laboratory. Audiovisual and electromyographic data from the second night were scored to assess whether participants met criteria for the presence of 2 or more (2+) rhythmic masticatory muscle activity episodes accompanied by grinding sounds, moderate SB, or severe SB, using previously validated research scoring standards. Contingency tables were constructed to assess positive and negative predictive values, sensitivity and specificity, and 95% confidence intervals surrounding the point estimates. Results showed that self-report significantly predicted 2+ grinding sounds during sleep for TMD cases. However, self-reported SB failed to significantly predict the presence or absence of either moderate or severe SB as assessed by PSG, for both cases and controls. These data show that self-report of tooth grinding awareness is highly unlikely to be a valid indicator of true SB. Studies relying on self-report to assess SB must be viewed with extreme caution. © 2015 John Wiley & Sons Ltd.

Comparing the predictive value of the pelvic ring injury classification systems by Tile and by Young and Burgess.

PubMed

Osterhoff, Georg; Scheyerer, Max J; Fritz, Yannick; Bouaicha, Samy; Wanner, Guido A; Simmen, Hans-Peter; Werner, Clément M L

2014-04-01

Radiology-based classifications of pelvic ring injuries and their relevance for the prognosis of morbidity and mortality are disputed in the literature. The purpose of this study was to evaluate potential differences between the pelvic ring injury classification systems by Tile and by Young and Burgess with regard to their predictive value on mortality, transfusion/infusion requirement and concomitant injuries. Two-hundred-and-eighty-five consecutive patients with pelvic ring fractures were analyzed for mortality within 30 days after admission, number of blood units and total volume of fluid infused during the first 24h after trauma, the Abbreviated Injury Severity (AIS) scores for head, chest, spine, abdomen and extremities as a function of the Tile and the Young-Burgess classifications. There was no significant relationship between occurrence of death and fracture pattern but a significant relationship between fracture pattern and need for blood units/total fluid volume for Tile (p<.001/p<.001) and Young-Burgess (p<.001/p<.001). In both classifications, open book fractures were associated with more fluid requirement and more severe injuries of the abdomen, spine and extremities (p<.05). When divided into the larger subgroups "partially stable" and "unstable", unstable fractures were associated with a higher mortality rate in the Young-Burgess system (p=.036). In both classifications, patients with unstable fractures required significantly more blood transfusions (p<.001) and total fluid infusion (p<.001) and higher AIS scores. In this first direct comparison of both classifications, we found no clinical relevant differences with regard to their predictive value on mortality, transfusion/infusion requirement and concomitant injuries. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

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 ankle brachial index and change in lower extremity functioning over time: the Women's Health and Aging Study.

PubMed

McDermott, Mary McGrae; Ferrucci, Luigi; Simonsick, Eleanor M; Balfour, Jennifer; Fried, Linda; Ling, Shari; Gibson, Daniel; Guralnik, Jack M

2002-02-01

To define the association between baseline ankle brachial index (ABI) level and subsequent onset of severe disability. Prospective cohort study. Baltimore community. Eight hundred forty-seven disabled women aged 65 and older participating in the Women's Health and Aging Study. At baseline, participants underwent measurement of ABI and lower extremity functioning. Measures of lower extremity functioning included patient's report of their ability to walk one-quarter of a mile, number of city blocks walked last week, number of stair flights climbed last week, and performance-based measures including walking speed over 4 meters, five repeated chair stands, and a summary performance score. Functioning was remeasured every 6 months for 3 years. Definitions of severe disability were developed a priori, and participants who met these definitions at baseline were excluded from subsequent analyses. Participants with an ABI of less than 0.60 at baseline had significantly higher cumulative probabilities of developing severe disability than participants with a baseline ABI of 0.90 to 1.50 for walking-specific outcomes (ability to walk a quarter of a mile, number of city blocks walked last week, and walking velocity) but not for the remaining functional outcomes. In age-adjusted Cox proportional hazards analyses, hazard ratios for participants with a baseline ABI of less than 0.60 were 1.63 for becoming unable to walk a quarter of a mile (P = .044), 2.00 for developing severe disability in the number of blocks walked last week (P = .004), and 1.61 for developing severe disability in walking speed (P = .041), compared with participants with a baseline ABI of 0.90 to 1.50. Adjusting for age, race, baseline performance, and comorbidities, an ABI of less than 0.60 remained associated with becoming severely disabled in the number of blocks walked last week (hazard ratio = 1.97, P = .009) and nearly significantly associated with becoming unable to walk a quarter of a mile (hazard ratio = 1.54, P = .09). In fully adjusted random effects models, a baseline ABI of less than 0.60 was associated with significantly greater decline in walking speed per year (P = .019) and nearly significantly greater decline in number of blocks walked last week per year (P = .053) compared with a baseline ABI of 0.90 to 1.50. In community-dwelling disabled older women, a low ABI is associated with a greater incidence of severe disability in walking-specific but not other lower extremity functional outcomes, compared with persons with a normal ABI over 3 years.

Impact of whole-body rehabilitation in patients receiving chronic mechanical ventilation.

PubMed

Martin, Ubaldo J; Hincapie, Luis; Nimchuk, Mark; Gaughan, John; Criner, Gerard J

2005-10-01

To evaluate the prevalence and magnitude of weakness in patients receiving chronic mechanical ventilation and the impact of providing aggressive whole-body rehabilitation on conventional weaning variables, muscle strength, and overall functional status. Retrospective analysis of 49 consecutive patients. Multidisciplinary ventilatory rehabilitation unit in an academic medical center. Forty-nine consecutive chronic ventilator-dependent patients referred to a tertiary care hospital ventilator rehabilitation unit. None. Patients were 58 +/- 7 yrs old with multiple etiologies for respiratory failure. On admission, all patients were bedridden and had severe weakness of upper and lower extremities measured by a 5-point muscle strength score and a 7-point Functional Independence Measurement. Postrehabilitation, patients had increases in upper and lower extremity strength (p < .05) and were able to stand and ambulate. All weaned from mechanical ventilation, but three required subsequent intermittent support. Six patients died before hospital discharge. Upper extremity strength on admission inversely correlated with time to wean from mechanical ventilation (R = .72, p < .001). : Patients receiving chronic ventilation are weak and deconditioned but respond to aggressive whole-body and respiratory muscle training with an improvement in strength, weaning outcome, and functional status. Whole-body rehabilitation should be considered a significant component of their therapy.

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.

Mortality and morbidity risks vary with birth weight standard deviation score in growth restricted extremely preterm infants.

PubMed

Yamakawa, Takuji; Itabashi, Kazuo; Kusuda, Satoshi

2016-01-01

To assess whether the mortality and morbidity risks vary with birth weight standard deviation score (BWSDS) in growth restricted extremely preterm infants. This was a multicenter retrospective cohort study using the database of the Neonatal Research Network of Japan and including 9149 infants born between 2003 and 2010 at <28 weeks gestation. According to the BWSDSs, the infants were classified as: <-2.0, -2.0 to -1.5, -1.5 to -1.0, -1.0 to -0.5, and ≥-0.5. Infants with BWSDS≥-0.5 were defined as non-growth restricted group. After adjusting for covariates, the risks of mortality and some morbidities were different among the BWSDS groups. Compared with non-growth restricted group, the adjusted odds ratio (aOR) for mortality [aOR, 1.69; 95% confidence interval (CI), 1.35-2.12] and chronic lung disease (CLD) (aOR, 1.28; 95% CI, 1.07-1.54) were higher among the infants with BWSDS -1.5 to <-1.0. The aOR for severe retinopathy of prematurity (ROP) (aOR, 1.36; 95% CI, 1.09-1.71) and sepsis (aOR, 1.72; 95% CI, 1.32-2.24) were higher among the infants with BWSDS -2.0 to <-1.5. The aOR for necrotizing enterocolitis (NEC) (aOR, 2.41; 95% CI, 1.64-3.55) was increased at a BWSDS<-2.0. Being growth restricted extremely preterm infants confer additional risks for mortality and morbidities such as CLD, ROP, sepsis and NEC, and these risks may vary with BWSDS. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Safety, Feasibility, and Efficacy of Vagus Nerve Stimulation Paired With Upper-Limb Rehabilitation After Ischemic Stroke.

PubMed

Dawson, Jesse; Pierce, David; Dixit, Anand; Kimberley, Teresa J; Robertson, Michele; Tarver, Brent; Hilmi, Omar; McLean, John; Forbes, Kirsten; Kilgard, Michael P; Rennaker, Robert L; Cramer, Steven C; Walters, Matthew; Engineer, Navzer

2016-01-01

Recent animal studies demonstrate that vagus nerve stimulation (VNS) paired with movement induces movement-specific plasticity in motor cortex and improves forelimb function after stroke. We conducted a randomized controlled clinical pilot study of VNS paired with rehabilitation on upper-limb function after ischemic stroke. Twenty-one participants with ischemic stroke >6 months before and moderate to severe upper-limb impairment were randomized to VNS plus rehabilitation or rehabilitation alone. Rehabilitation consisted of three 2-hour sessions per week for 6 weeks, each involving >400 movement trials. In the VNS group, movements were paired with 0.5-second VNS. The primary objective was to assess safety and feasibility. Secondary end points included change in upper-limb measures (including the Fugl-Meyer Assessment-Upper Extremity). Nine participants were randomized to VNS plus rehabilitation and 11 to rehabilitation alone. There were no serious adverse device effects. One patient had transient vocal cord palsy and dysphagia after implantation. Five had minor adverse device effects including nausea and taste disturbance on the evening of therapy. In the intention-to-treat analysis, the change in Fugl-Meyer Assessment-Upper Extremity scores was not significantly different (between-group difference, 5.7 points; 95% confidence interval, -0.4 to 11.8). In the per-protocol analysis, there was a significant difference in change in Fugl-Meyer Assessment-Upper Extremity score (between-group difference, 6.5 points; 95% confidence interval, 0.4 to 12.6). This study suggests that VNS paired with rehabilitation is feasible and has not raised safety concerns. Additional studies of VNS in adults with chronic stroke will now be performed. URL: https://www.clinicaltrials.gov. Unique identifier: NCT01669161. © 2015 The Authors.

Safety, Feasibility, and Efficacy of Vagus Nerve Stimulation Paired With Upper-Limb Rehabilitation After Ischemic Stroke

PubMed Central

Pierce, David; Dixit, Anand; Kimberley, Teresa J.; Robertson, Michele; Tarver, Brent; Hilmi, Omar; McLean, John; Forbes, Kirsten; Kilgard, Michael P.; Rennaker, Robert L.; Cramer, Steven C.; Walters, Matthew; Engineer, Navzer

2016-01-01

Background and Purpose— Recent animal studies demonstrate that vagus nerve stimulation (VNS) paired with movement induces movement-specific plasticity in motor cortex and improves forelimb function after stroke. We conducted a randomized controlled clinical pilot study of VNS paired with rehabilitation on upper-limb function after ischemic stroke. Methods— Twenty-one participants with ischemic stroke >6 months before and moderate to severe upper-limb impairment were randomized to VNS plus rehabilitation or rehabilitation alone. Rehabilitation consisted of three 2-hour sessions per week for 6 weeks, each involving >400 movement trials. In the VNS group, movements were paired with 0.5-second VNS. The primary objective was to assess safety and feasibility. Secondary end points included change in upper-limb measures (including the Fugl–Meyer Assessment-Upper Extremity). Results— Nine participants were randomized to VNS plus rehabilitation and 11 to rehabilitation alone. There were no serious adverse device effects. One patient had transient vocal cord palsy and dysphagia after implantation. Five had minor adverse device effects including nausea and taste disturbance on the evening of therapy. In the intention-to-treat analysis, the change in Fugl–Meyer Assessment-Upper Extremity scores was not significantly different (between-group difference, 5.7 points; 95% confidence interval, −0.4 to 11.8). In the per-protocol analysis, there was a significant difference in change in Fugl–Meyer Assessment-Upper Extremity score (between-group difference, 6.5 points; 95% confidence interval, 0.4 to 12.6). Conclusions— This study suggests that VNS paired with rehabilitation is feasible and has not raised safety concerns. Additional studies of VNS in adults with chronic stroke will now be performed. Clinical Trial Registration— URL: https://www.clinicaltrials.gov. Unique identifier: NCT01669161. PMID:26645257

Use of the Central Sensitization Inventory (CSI) as a treatment outcome measure for patients with chronic spinal pain disorder in a functional restoration program.

PubMed

Neblett, Randy; Hartzell, Meredith M; Williams, Mark; Bevers, Kelley R; Mayer, Tom G; Gatchel, Robert J

2017-12-01

The Central Sensitization Inventory (CSI) is a valid and reliable patient-reported instrument designed to identify patients whose presenting symptoms may be related to central sensitization (CS). Part A of the CSI measures a full array of 25 somatic and emotional symptoms associated with CS, and Part B asks if patients have previously been diagnosed with one or more specific central sensitivity syndromes (CSSs) and related disorders. The CSI has previously been validated in a group of patients with chronic pain who were screened by a trained psychiatrist for specific CSS diagnoses. It is currently unknown if the CSI can be a useful treatment-outcome assessment tool for patients with chronic spinal pain disorder (CSPD) who are not screened for comorbid CSSs. It is known, however, that previous studies have identified CS-related symptoms, and comorbid CSSs, in subsets of patients with CSPDs. Studies have also shown that CS-related symptoms can be influenced by cognitive and psychosocial factors, including abuse history in both childhood and adulthood, sleep disturbance, catastrophic and fear-avoidant cognitions, and symptoms of depression and anxiety. This study aimed to evaluate CSI scores, and their associations with other clinically relevant psychosocial variables, in a cohort of patients with CSPD who entered and completed a functional restoration program. A retrospective study of prospectively collected data from a cohort study of patients with CSPD, who completed the CSI at admission to, and discharge from, an interdisciplinary function restoration program (FRP) was carried out. A cohort of 763 patients with CSPD comprised the study sample. Clinical interviews evaluated mood disorders and abuse history. A series of self-reported measures evaluated comorbid psychosocial symptoms, including pain intensity, pain-related anxiety, depressive symptoms, somatization symptoms, perceived disability, and sleep disturbance, at FRP admission and discharge. Patients were grouped into five severity level groups, from mild to extreme, based on total CSI scores, at FRP admission, and then again at discharge. The FRP included a quantitatively directed and medically supervised exercise process, as well as a multimodal psychosocial disability management component. The CSI severity groups were strongly associated with Major Depressive Disorder and previous abuse history (p<.01), which are known risk factors for CS-related symptoms and diagnoses. The CSI scores were also strongly associated with patient-reported CSS diagnoses on CSI Part B. The percentage of patients who reported a comorbid CSS diagnosis increased in each higher CSI-severity group, from 11% in the Subclinical group, to 56% in the Extreme group. The CSI severity groups were significantly related to other CS-related patient-reported symptoms, including pain intensity, pain-related anxiety, depressive symptoms, somatization symptoms, perceived disability, and sleep disturbance (p's<.001). The CSI scores, along with all other psychosocial measures, decreased at treatment discharge. In the present study, admission CSI scores were highly associated with previous CSS diagnoses, CS-related symptoms, and clinically relevant patient-reported psychosocial variables. All psychosocial variables, as well as scores on the CSI, were significantly improved at FRP discharge. The CSI may have important clinical utility, as a screener and as a treatment outcome measure, for patients with CSPD participating in an interdisciplinary FRP. Copyright © 2017 Elsevier Inc. All rights reserved.

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

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.

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.

The bothersomeness of sciatica: patients' self-report of paresthesia, weakness and leg pain.

PubMed

Grøvle, Lars; Haugen, Anne Julsrud; Keller, Anne; Natvig, Bård; Brox, Jens Ivar; Grotle, Margreth

2010-02-01

The objective of the study was to investigate how patients with sciatica due to disc herniation rate the bothersomeness of paresthesia and weakness as compared to leg pain, and how these symptoms are associated with socio-demographic and clinical characteristics. A cross-sectional study was conducted on 411 patients with clinical signs of radiculopathy. Items from the Sciatica Bothersomeness Index (0 = none to 6 = extremely) were used to establish values for paresthesia, weakness and leg pain. Associations with socio-demographic and clinical variables were analyzed by multiple linear regression. Mean scores (SD) were 4.5 (1.5) for leg pain, 3.4 (1.8) for paresthesia and 2.6 (2.0) for weakness. Women reported higher levels of bothersomeness for all three symptoms with mean scores approximately 10% higher than men. In the multivariate models, more severe symptoms were associated with lower physical function and higher emotional distress. Muscular paresis explained 19% of the variability in self-reported weakness, sensory findings explained 10% of the variability in paresthesia, and straight leg raising test explained 9% of the variability in leg pain. In addition to leg pain, paresthesia and weakness should be assessed when measuring symptom severity in sciatica.

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

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.

Gaining the Patient Reported Outcomes Measurement Information System (PROMIS) Perspective in Chronic Kidney Disease: a Midwest Pediatric Nephrology Consortium study

PubMed Central

Selewski, David T.; Massengill, Susan F.; Troost, Jonathan P.; Wickman, Larysa; Messer, Kassandra L.; Herreshoff, Emily; Bowers, Corinna; Ferris, Maria E.; Mahan, John D.; Greenbaum, Larry A.; MacHardy, Jackie; Kapur, Gaurav; Chand, Deepa H.; Goebel, Jens; Barletta, Gina Marie; Geary, Denis; Kershaw, David B.; Pan, Cynthia G.; Gbadegesin, Rasheed; Hidalgo, Guillermo; Lane, Jerome C.; Leiser, Jeffrey D.; Song, Peter X.; Thissen, David; Liu, Yang; Gross, Heather E.; DeWalt, Darren A.; Gipson, Debbie S.

2014-01-01

Background and Objectives Chronic kidney disease is a persistent chronic health condition commonly seen in pediatric nephrology programs. Our study aims to evaluate the sensitivity of the Patient Reported Outcomes Measurement Information System (PROMIS) pediatric instrument to indicators of disease severity and activity in pediatric chronic kidney disease. Methods This cross sectional study included 233 children 8–17 years old with chronic kidney disease from 16 participating institutions in North America. Disease activity indicators, including hospitalization in the previous 6 months, edema, and number of medications consumed daily, as well as disease severity indicators of kidney function and coexisting medical conditions were captured. PROMIS domains, including depression, anxiety, social-peer relationships, pain interference, fatigue, mobility, and upper extremity function, were administered via web-based questionnaires. Absolute effect sizes (AES) were generated to demonstrate the impact of disease on domain scores. Four children were excluded because of missing GFR estimations. Results 221 of the 229 children included in the final analysis completed the entire PROMIS questionnaire. Unadjusted PROMIS domains were responsive to chronic kidney disease activity indicators and number of coexisting conditions. PROMIS domain scores were worse in the presence of recent hospitalizations (depression AES 0.33, anxiety AES 0.42, pain interference AES 0.46, fatigue AES 0.50, mobility AES 0.49), edema (depression AES 0.50, anxiety AES 0.60, pain interference AES 0.77, mobility AES 0.54) and coexisting medical conditions (social peer-relationships AES 0.66, fatigue AES 0.83, mobility AES 0.60, upper extremity function AES 0.48). Conclusions The PROMIS pediatric domains of depression, anxiety, social-peer relationships, pain interference, and mobility were sensitive to the clinical status of children with chronic kidney disease in this multi-center cross sectional study. We demonstrated that a number of important clinical characteristics including recent history of hospitalization and edema affected patient perceptions of depression, anxiety, pain interference, fatigue and mobility. The PROMIS instruments provide a potentially valuable tool to study the impact of chronic kidney disease. Additional studies will be required to assess responsiveness in PROMIS score with changes in disease status over time. PMID:24908324

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.

Motor function domains in alternating hemiplegia of childhood.

PubMed

Masoud, Melanie; Gordon, Kelly; Hall, Amanda; Jasien, Joan; Lardinois, Kara; Uchitel, Julie; Mclean, Melissa; Prange, Lyndsey; Wuchich, Jeffrey; Mikati, Mohamad A

2017-08-01

To characterize motor function profiles in alternating hemiplegia of childhood, and to investigate interrelationships between these domains and with age. We studied a cohort of 23 patients (9 males, 14 females; mean age 9y 4mo, range 4mo-43y) who underwent standardized tests to assess gross motor, upper extremity motor control, motor speech, and dysphagia functions. Gross Motor Function Classification System (GMFCS), Gross Motor Function Measure-88 (GMFM-88), Manual Ability Classification System (MACS), and Revised Melbourne Assessment (MA2) scales manifested predominantly mild impairments; motor speech, moderate to severe; Modified Dysphagia Outcome and Severity Scale (M-DOSS), mild-to moderate deficits. GMFCS correlated with GMFM-88 scores (Pearson's correlation, p=0.002), MACS (p=0.038), and MA2 fluency (p=0.005) and accuracy (p=0.038) scores. GMFCS did not correlate with motor speech (p=0.399), MA2 dexterity (p=0.247), range of motion (p=0.063), or M-DOSS (p=0.856). Motor speech was more severely impaired than the GMFCS (p<0.013). There was no correlation between any of the assessment tools and age (p=0.210-0.798). Our data establish a detailed profile of motor function in alternating hemiplegia of childhood, argue against the presence of worse motor function in older patients, identify tools helpful in evaluating this population, and identify oropharyngeal function as the more severely affected domain, suggesting that brain areas controlling this function are more affected than others. © 2017 Mac Keith Press.

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.

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.

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.

A scoring system predicting the clinical course of CLPB defect based on the foetal and neonatal presentation of 31 patients.

PubMed

Pronicka, Ewa; Ropacka-Lesiak, Mariola; Trubicka, Joanna; Pajdowska, Magdalena; Linke, Markus; Ostergaard, Elsebet; Saunders, Carol; Horsch, Sandra; van Karnebeek, Clara; Yaplito-Lee, Joy; Distelmaier, Felix; Õunap, Katrin; Rahman, Shamima; Castelle, Martin; Kelleher, John; Baris, Safa; Iwanicka-Pronicka, Katarzyna; Steward, Colin G; Ciara, Elżbieta; Wortmann, Saskia B

2017-11-01

Recently, CLPB deficiency has been shown to cause a genetic syndrome with cataracts, neutropenia, and 3-methylglutaconic aciduria. Surprisingly, the neurological presentation ranges from completely unaffected to patients with virtual absence of development. Muscular hypo- and hypertonia, movement disorder and progressive brain atrophy are frequently reported. We present the foetal, peri- and neonatal features of 31 patients, of which five are previously unreported, using a newly developed clinical severity scoring system rating the clinical, metabolic, imaging and other findings weighted by the age of onset. Our data are illustrated by foetal and neonatal videos. The patients were classified as having a mild (n = 4), moderate (n = 13) or severe (n = 14) disease phenotype. The most striking feature of the severe subtype was the neonatal absence of voluntary movements in combination with ventilator dependency and hyperexcitability. The foetal and neonatal presentation mirrored the course of disease with respect to survival (current median age 17.5 years in the mild group, median age of death 35 days in the severe group), severity and age of onset of all findings evaluated. CLPB deficiency should be considered in neonates with absence of voluntary movements, respiratory insufficiency and swallowing problems, especially if associated with 3-methylglutaconic aciduria, neutropenia and cataracts. Being an important differential diagnosis of hyperekplexia (exaggerated startle responses), we advise performing urinary organic acid analysis, blood cell counts and ophthalmological examination in these patients. The neonatal presentation of CLPB deficiency predicts the course of disease in later life, which is extremely important for counselling.

Neurodevelopmental and Behavioral Outcomes in Extremely Premature Neonates With Ventriculomegaly in the Absence of Periventricular-Intraventricular Hemorrhage.

PubMed

Pappas, Athina; Adams-Chapman, Ira; Shankaran, Seetha; McDonald, Scott A; Stoll, Barbara J; Laptook, Abbot R; Carlo, Waldemar A; Van Meurs, Krisa P; Hintz, Susan R; Carlson, Martha D; Brumbaugh, Jane E; Walsh, Michele C; Wyckoff, Myra H; Das, Abhik; Higgins, Rosemary D

2018-01-01

Studies of cranial ultrasonography and early childhood outcomes among cohorts of extremely preterm neonates have linked periventricular-intraventricular hemorrhage and cystic periventricular leukomalacia with adverse neurodevelopmental outcomes. However, the association between nonhemorrhagic ventriculomegaly and neurodevelopmental and behavioral outcomes is not fully understood. To characterize the outcomes of extremely preterm neonates younger than 27 weeks' gestational age who experienced nonhemorrhagic ventriculomegaly that was detected prior to 36 weeks' postmenstrual age. This longitudinal observational study was conducted at 16 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Infants born prior to 27 weeks' gestational age in any network facility between July 1, 2006, and June 30, 2011, were included if they had a cranial ultrasonogram performed prior to 36 weeks' postmenstrual age. Comparisons were made between those with ventriculomegaly and those with normal cranial sonograms. Data analysis was completed from August 2013 to August 2017. The main outcome was neurodevelopmental impairment, defined as a Bayley Scales of Infant and Toddler Development III cognitive score less than 70, moderate/severe cerebral palsy, a Gross Motor Function Classification System score of level 2 or more, vision impairment, or hearing impairment. Secondary outcomes included Bayley Scales of Infant and Toddler Development III subscores, components of neurodevelopmental impairment, behavioral outcomes, and death/neurodevelopmental impairment. Logistic regression was used to evaluate the association of ventriculomegaly with adverse outcomes while controlling for potentially confounding variables and center differences as a random effect. Linear regression was used similarly for continuous outcomes. Of 4193 neonates with ultrasonography data, 300 had nonhemorrhagic ventriculomegaly (7%); 3045 had normal cranial ultrasonograms (73%), 775 had periventricular-intraventricular hemorrhage (18.5%), and 73 had cystic periventricular leukomalacia (1.7%). Outcomes were available for 3008 of 3345 neonates with ventriculomegaly or normal scans (90%). Compared with normal cranial ultrasonograms, ventriculomegaly was associated with lower gestational age, male sex, and bronchopulmonary dysplasia, late-onset sepsis, meningitis, necrotizing enterocolitis, and stage 3 retinopathy of prematurity. After adjustment, neonates with ventriculomegaly had higher odds of neurodevelopmental impairment (odds ratio [OR], 3.07; 95% CI, 2.13-4.43), cognitive impairment (OR, 3.23; 95% CI, 2.09-4.99), moderate/severe cerebral palsy (OR, 3.68; 95% CI, 2.08-6.51), death/neurodevelopmental impairment (OR, 2.17; 95% CI, 1.62-2.91), but not death alone (OR, 1.09; 95% CI, 0.76-1.57). Behavioral outcomes did not differ. Nonhemorrhagic ventriculomegaly is associated with increased odds of neurodevelopmental impairment among extremely preterm neonates.

Neurodevelopmental, health, and growth status at age 6 years of children with birth weights less than 1001 grams.

PubMed

Teplin, S W; Burchinal, M; Johnson-Martin, N; Humphry, R A; Kraybill, E N

1991-05-01

The neurodevelopmental, health, and growth outcomes for 28 six-year-old extremely low birth weight (ELBW) (birth weight less than 1001 gm) children were compared with those of 26 control children born at term. The two groups did not differ in mean weight or height, but the ELBW group had smaller head circumferences (p = 0.015). Kaufman mental processing scores correlated with head circumference (p = 0.0003). Significantly more of the ELBW children (61%) had mild or moderate to severe neurologic problems compared with control children (23%) (p = 0.003). Three ELBW children had mild spastic diplegia; one was blind. Eighteen (64%) of the ELBW children had required rehospitalization versus five (20%) of the comparison group. The mean Kaufman Mental Processing Composite was lower for the ELBW group, but when the data were analyzed by maternal education, only those children whose mothers had a twelfth-grade education had significantly lower scores (p = 0.0001). A similar pattern of group differences was seen for scores on visual-motor function (p = 0.0045), visual-perceptual abilities (p = 0.003), and attention span (p = 0.0001). No group differences were seen regarding hyperactivity or parental stress. Overall functional disability among the ELBW children was considered absent in 46%, mild in 36%, and moderate to severe in 18%. There was a significant association (p = 0.029) between classification of handicap at 12 to 34 months and classification at 6 years. No neonatal factors correlated with 6-year outcome. A significant proportion of ELBW children had no severe disabilities, but many had dysfunctions likely to affect learning and behavior in school.

Pediatric outcomes data collection instrument scores in ambulatory children with cerebral palsy: an analysis by age groups and severity level.

PubMed

Barnes, Douglas; Linton, Judith L; Sullivan, Elroy; Bagley, Anita; Oeffinger, Donna; Abel, Mark; Damiano, Diane; Gorton, George; Nicholson, Diane; Romness, Mark; Rogers, Sarah; Tylkowski, Chester

2008-01-01

The Pediatric Outcomes Data Collection Instrument (PODCI) was developed in 1994 as a patient-based tool for use across a broad age range and wide array of musculoskeletal disorders, including children with cerebral palsy (CP). The purpose of this study was to establish means and SDs of the Parent PODCI measures by age groups and Gross Motor Function Classification System (GMFCS) levels for ambulatory children with CP. This instrument was one of several studied in a prospective, multicenter project of ambulatory patients with CP between the aged 4 and 18 years and GMFCS levels I through III. Participants included 338 boys and 221 girls at a mean age of 11.1 years, with 370 diplegic, 162 hemiplegic, and 27 quadriplegic. Both baseline and follow-up data sets of the completed Parent PODCI responses were statistically analyzed. Age was identified as a significant predictor of the PODCI measures of Upper Extremity Function, Transfers and Basic Mobility, Global Function, and Happiness With Physical Condition. Gross Motor Function Classification System levels was a significant predictor of Transfers and Basic Mobility, Sports and Physical Function, and Global Function. Pattern of involvement, sex, and prior orthopaedic surgery were not statistically significant predictors for any of the Parent PODCI measures. Mean and SD scores were calculated for age groups stratified by GMFCS levels. Analysis of the follow-up data set validated the findings derived from the baseline data. Linear regression equations were derived, with age as a continuous variable and GMFCS levels as a categorical variable, to be used for Parent PODCI predicted scores. The results of this study provide clinicians and researchers with a set of Parent PODCI values for comparison to age- and severity-matched populations of ambulatory patients with CP.

Caregiver burden and coping strategies in caregivers of patients with Alzheimer’s disease

PubMed Central

Iavarone, Alessandro; Ziello, Antonio Rosario; Pastore, Francesca; Fasanaro, Angiola Maria; Poderico, Carla

2014-01-01

Background Alzheimer’s disease (AD) causes considerable distress in caregivers who are continuously required to deal with requests from patients. Coping strategies play a fundamental role in modulating the psychologic impact of the disease, although their role is still debated. The present study aims to evaluate the burden and anxiety experienced by caregivers, the effectiveness of adopted coping strategies, and their relationships with burden and anxiety. Methods Eighty-six caregivers received the Caregiver Burden Inventory (CBI) and the State-Trait Anxiety Inventory (STAI Y-1 and Y-2). The coping strategies were assessed by means of the Coping Inventory for Stressful Situations (CISS), according to the model proposed by Endler and Parker in 1990. Results The CBI scores (overall and single sections) were extremely high and correlated with dementia severity. Women, as well as older caregivers, showed higher scores. The trait anxiety (STAI-Y-2) correlated with the CBI overall score. The CISS showed that caregivers mainly adopted task-focused strategies. Women mainly adopted emotion-focused strategies and this style was related to a higher level of distress. Conclusion AD is associated with high distress among caregivers. The burden strongly correlates with dementia severity and is higher in women and in elderly subjects. Chronic anxiety affects caregivers who mainly rely on emotion-oriented coping strategies. The findings suggest providing support to families of patients with AD through tailored strategies aimed to reshape the dysfunctional coping styles. PMID:25114532

The association of body mass index with complications and functional outcomes after surgery for closed ankle fractures.

PubMed

Stavem, K; Naumann, M G; Sigurdsen, U; Utvåg, S E

2017-10-01

This study assessed the association of classes of body mass index in kg/m 2 (classified as normal weight 18.5 kg/m 2 to 24.9 kg/m 2 , overweight 25.0 kg/m 2 to 29.9 kg/m 2 , and obese ≥ 30.0 kg/m 2 ) with short-term complications and functional outcomes three to six years post-operatively for closed ankle fractures. We performed a historical cohort study with chart review of 1011 patients who were treated for ankle fractures by open reduction and internal fixation in two hospitals, with a follow-up postal survey of 959 of the patients using three functional outcome scores. Obese patients had more severe overall complications and higher odds of any complication than the normal weight group, with adjusted odds ratio 1.67 (95% confidence interval (CI) 1.08 to 2.59; p = 0.021) and 1.71 (95% CI 1.10 to 2.65; p = 0.016), respectively. In total 479 patients (54.6%) responded to the questionnaire. Obese patients had worse scores on the Olerud and Molander Ankle Score (p < 0.001), Self-Reported Foot and Ankle Questionnaire (p = 0.003) and Lower Extremity Functional Scale (p = 0.01) than those with normal weight. In contrast, overweight patients did not have worse functional scores than those with normal weight. Obese patients had more complications, more severe complications, and worse functional outcomes three to six years after ankle surgery compared with those with normal weight. Cite this article: Bone Joint J 2017;99-B:1389-98. ©2017 The British Editorial Society of Bone & Joint Surgery.

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.

[EFFECTIVENESS OF BILATERAL TOTAL HIP AND KNEE ARTHROPLASTY FOR SEVERE INFLAMMATORY ARTHROPATHIES].

PubMed

Li, Xin; Li, Heng; Ni, Ming; Li, Xiang; Song, Xinggui; Kong, Xiangpeng; Li, Yucong; Chen, Jiying

2016-11-08

To evaluate the application and effectiveness of bilateral total hip arthroplasty and total knee arthroplasty in the treatment of severe inflammatory arthropathies. Between September 2008 and September 2015, 31 patients with severe inflammatory arthropathies were treated with bilateral total hip arthroplasty and total knee arthroplasty. Of 31 cases, 22 were male and 9 were female with an average age of 30 years (range, 20 to 41 years); there were 15 cases of rheumatoid arthritis and 16 cases of ankylosing spondylitis with an average onset age of 14 years (range, 5-28 years); all 4 ankylosed joints were observed in 11 cases, 3 ankylosed joints in 2 cases, 2 ankylosed joints in 6 cases, 1 ankylosed joint in 1 case, and no ankylosed joint in 11 cases. Before operation, the hip range of motion (ROM) value was (17.82±28.18)°, and the knee ROM value score was (26.45±30.18)°; the hip Harris score was 29.64±11.58, and the hospital for special surgery (HSS) score was 27.07±11.04. The patients were grouped and compared in accordance with etiology and ankylosed joint. One-stage arthroplasty was performed in 1 case, two-stage arthroplasty in 22 cases, three-stage arthroplasty in 7 cases, and four-stage arthroplasty in 1 case. The total operation time was 325-776 minutes; the total blood loss was 900-3 900 mL; the total transfusion volume was 2 220-8 070 mL; and the total hospitalization time was 21-65 days. The patients were followed up 12-94 months (mean, 51 months). The hip and knee ROM values, Harris score and HSS score at last follow-up were significantly improved when compared with preoperative ones ( P <0.05). The subjective satisfaction degree was good in 16 cases, moderate in 10 cases, and poor in 5 cases. Periprosthetic infection occurred in 2 cases (3 knees), joint stiffness in 3 cases (6 knees), joint instability in 1 case (1 knee), leg length discrepancy of >2 cm in 2 cases, and flexion deformity of 10° in 1 case (1 knee). The hip and knee ROM values, Harris score and HSS score showed no significant difference between patients with ankylosing spondylitis and patients rheumatoid arthritis at last follow-up ( P >0.05). The hip and knee ROM values of the patients with ankylosed joint were significantly lower than those of patients with no ankylosed joint ( P <0.05); the Harris score and HSS score of the patients with ankylosed joint were lower than those of patients with no ankylosed joint, but no significant difference was found ( P >0.05). A combination of bilateral hip and knee arthroplasty is an efficient treatment for severe lower extremities deformity, arthralgia and poor quality of life caused by inflammatory arthropathies. However, the postoperative periprosthetic infection and stiffness of knee are important complications influencing the effectiveness of operation.

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

Role of contralesional hemisphere in paretic arm reaching in patients with severe arm paresis due to stroke: A preliminary report.

PubMed

Mohapatra, Sambit; Harrington, Rachael; Chan, Evan; Dromerick, Alexander W; Breceda, Erika Y; Harris-Love, Michelle

2016-03-23

Stroke is highly prevalent and a leading cause of serious, long-term disability among American adults. Impaired movement (i.e. paresis) of the stroke-affected arm is a major contributor to post-stroke disability, yet the mechanisms of upper extremity motor recovery are poorly understood, particularly in severely impaired patients who lack hand function. To address this problem, we examined the functional relevance of the contralesional hemisphere in paretic arm motor performance in individuals with severe arm paresis. Twelve individuals with severe stroke-induced arm paresis (Upper Extremity Fugl-Meyer Assessment=17.1 ± 8.5; maximum score=66) participated in the study. Participants performed a reaching response time task with their paretic arm. At varying time intervals following a 'Go' cue, a pair of transcranial magnetic stimulation (TMS) pulses were delivered to contralesional hemisphere primary motor (M1) or dorsal pre-motor cortex (PMd) to momentarily disrupt the pattern of neural firing. Response time components and hand-path characteristics were compared across the 2 sites for trials with and without TMS disruption. There was no significant effect of TMS disruption on overall Response time or Reaction time, but Movement time was significantly longer (i.e. slower) with disruption of the contralesional hemisphere (p=0.015), regardless of which area was stimulated. Peak hand-path velocity and hand-path smoothness were also significantly lower (p=0.005 and p<0.0001, respectively) with TMS disruption of the contralesional hemisphere. The data from this study provide evidence supporting a functionally relevant role of contralesional hemisphere motor areas in paretic arm reaching movements in individuals with severe post-stroke arm impairment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Age independency of mobility decrease assessed using the Locomotive Syndrome Risk Test in elderly with disability: a cross-sectional study.

PubMed

Yamada, Keiko; Muranaga, Shingo; Shinozaki, Tomohiro; Nakamura, Kozo; Tanaka, Sakae; Ogata, Toru

2018-01-26

Mobility decrease is reportedly age-dependent in community dwelling elderly, and a major factor of disability in the geriatric population. The purpose of this study is to examine whether mobility decrease, as assessed using a set of tests, is similarly age-dependent in elderly adults who already have disability. One hundred thirty-five community-dwelling elderly (54 men, 81 women) with disability and 1469 independent community dwellers (1009 men, 460 women) were analyzed. Disability was defined having a certified need for care under the long-term care insurance system in Japan. Lower extremity mobility decrease was quantified using the Locomotive Syndrome Risk Test, which comprises the two-step test, stand-up test, and 25-Question Geriatric Locomotive Function Scale (GLFS-25). Multivariable regression analyses indicated no age-related decrease in the three test scores among elderly with disability, whereas these scores all decreased with age among independent community dwellers. All the test scores decreased as care level increased. Mobility decrease among elderly adults with disability is unrelated to age. However, the severity of care level is associated with mobility decrease.

Key features of hip hop dance motions affect evaluation by judges.

PubMed

Sato, Nahoko; Nunome, Hiroyuki; Ikegami, Yasuo

2014-06-01

The evaluation of hip hop dancers presently lacks clearly defined criteria and is often dependent on the subjective impressions of judges. Our study objective was to extract hidden motion characteristics that could potentially distinguish the skill levels of hip hop dancers and to examine the relationship between performance kinematics and judging scores. Eleven expert, six nonexpert, and nine novice dancers participated in the study, where each performed the "wave" motion as an experimental task. The movements of their upper extremities were captured by a motion capture system, and several kinematic parameters including the propagation velocity of the wave were calculated. Twelve judges evaluated the performances of the dancers, and we compared the kinematic parameters of the three groups and examined the relationship between the judging scores and the kinematic parameters. We found the coefficient of variation of the propagation velocity to be significantly different among the groups (P < .01) and highly correlated with the judging scores (r = -0.800, P < .01). This revealed that the variation of propagation velocity was the most dominant variable representing the skill level of the dancers and that the smooth propagation of the wave was most closely related to the evaluation by judges.

Association between increased blood interleukin-6 levels on emergency department arrival and prolonged length of intensive care unit stay for blunt trauma.

PubMed

Taniguchi, Masashi; Nakada, Taka-Aki; Shinozaki, Koichiro; Mizushima, Yasuaki; Matsuoka, Tetsuya

2016-01-01

Systemic immune response to injury plays a key role in the pathophysiological mechanism of blunt trauma. We tested the hypothesis that increased blood interleukin-6 (IL-6) levels of blunt trauma patients on emergency department (ED) arrival are associated with poor clinical outcomes, and investigated the utility of rapid measurement of the blood IL-6 level. We enrolled 208 consecutive trauma patients who were transferred from the scene of an accident to a level I trauma centre in Japan and admitted to the intensive care unit (ICU). Blood IL-6 levels on ED arrival were measured by using a rapid measurement assay. The primary outcome variable was prolonged ICU stay (length of ICU stay > 7 days). The secondary outcomes were 28-day mortality, probability of survival and Abbreviated Injury Scale (AIS) scores. Patients with prolonged ICU stay had significantly higher blood IL-6 levels on ED arrival than the patients without prolonged ICU stay (P < 0.0001). The receiver-operating characteristic curves produced an area under the curve of 0.75 (95 % confidence interval [CI], 0.66-0.84; P < 0.0001) for prolonged ICU stay. The patients who had increased blood IL-6 levels on ED arrival had increased 28-day mortality (P = 0.021) and decreased probability of survival (P < 0.0001). The AIS scores for the thorax, abdomen, extremity, and external body regions independently correlated with blood IL-6 levels (unstandardized coefficients [95 % CI] for the thorax: 23.8 [12.6-35.1]; P < 0.0001; abdomen: 42.7 [23.8-61.7]; P < 0.0001; extremity: 19.0 [5.5-32.4]; P = 0.0060; external body regions: 62.9 [13.2-112.7]; P = 0.030); the standardized coefficients for the thorax (0.27) and abdomen (0.28) were larger than those for the extremity (0.18) and external body regions (0.15). Increased blood IL-6 level on ED arrival was significantly associated with prolonged length of ICU stay. Blood IL-6 level on ED arrival independently correlated with the AIS scores for the abdomen and thorax, and, to a lesser extent, those for the extremity and external body regions. The rapid measurement of blood IL-6 level on ED arrival can be utilized as a fast screening tool to improve assessment of injury severity and prediction of clinical outcomes in the initial phase of trauma care.

PTSD and key somatic complaints and cultural syndromes among rural Cambodians: the results of a needs assessment survey.

PubMed

Hinton, Devon E; Hinton, Alexander L; Eng, Kok-Thay; Choung, Sophearith

2012-09-01

This article describes a culturally sensitive assessment tool for traumatized Cambodians, the Cambodian "Somatic Symptom and Syndrome Inventory" (SSI), and reports the outcome of a needs assessment conducted in rural Cambodia using the instrument. Villagers locally identified (N = 139) as still suffering the effects of the Pol Pot genocide were evaluated. All 139 had post-traumatic stress disorder (PTSD) as assessed by the PTSD Checklist (PCL), and they had elevated SSI scores. The severity of the SSI items varied by level of PTSD severity, and several items--for example, dizziness, dizziness on standing, khyâl (a windlike substance) attacks, and "thinking a lot"--were extremely elevated in those participants with higher levels of PTSD. The SSI was more highly correlated to self-perceived health (Short Form Health Survey-3) and past trauma events (Harvard Trauma Questionnaire) than was the PCL. The study shows the SSI items to be a core aspect of the Cambodian trauma ontology.

Cognitive functioning in bilateral perisylvian polymicrogyria (BPP): clinical and radiological correlations.

PubMed

Jansen, An C; Leonard, Gabriel; Bastos, Alexandre C; Esposito-Festen, Josée E; Tampieri, Donatella; Watkins, Kate; Andermann, Frederick; Andermann, Eva

2005-05-01

Bilateral perisylvian polymicrogyria (BPP) is a malformation of cortical development, frequently associated with severe dysarthria or anarthria. BPP patients are therefore often labeled as severely retarded, but a detailed neuropsychological profile has not been reported to date. In a series of 14 patients, we demonstrated that only a minority had extremely low intelligence, and that some aspects of cognitive function correlated with the extent of the cortical disorganization. Early age at seizure onset correlated positively with Performance IQ scores (P<0.05) and negatively with the extent of the lesion (P<0.01), reflecting that patients with more severe BPP are more likely to have early seizure onset, resulting in greater interference with ongoing cognitive development. Receptive and expressive language skills were found to be equally poor. Frontal lobe function and memory abilities were relatively well preserved, suggesting that the observed cognitive profiles were related, at least in part, to specific areas of cortical dysfunction and not only to global dysfunction.

Cementless total hip arthroplasty for severely dislocated hips previously treated with Schanz osteotomy of the proximal femur.

PubMed

Akman, Yunus Emre; Yavuz, Umut; Çetinkaya, Engin; Gür, Volkan; Gül, Murat; Demir, Bilal

2018-03-01

We report the short-term outcomes of total hip arthroplasty(THA) in patients previously treated with Schanz osteotomy (SO). Eighteen patients [2 male, 16 female; mean age, 55.4 (range, 50-66) years] who had undergone THA after SO were retrospectively evaluated. Clinical evaluation was performed based on the Harris hip score. Radiological evaluation was performed using full-length radiographs of the lower extremities, pelvis, and hip. The mean follow-up period was 30.8 (range, 18-56) months. Mean femoral shortening was 3.7 (range, 2-5) cm. Perioperative complications occurred in 4 (22.2%) patients. Nonunion was not found at the osteotomy sites. No dislocation was observed. The Trendelenburg sign was positive for five (27.7%) patients, postoperatively. The mean Harris hip score improved from 42.7 to 78.7 (p < 0.05). THA for hips previously treated with SO is technically demanding. If careful preoperative planning is performed, successful treatment can be achieved.

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.

Imaging features of blast injuries: experience from 2015 Ankara bombing in Turkey.

PubMed

Yazgan, Cisel; Aksu, Nalan M

2016-06-01

To present the radiological features of blast-related injuries in the victims of the 10 October 2015 Ankara bombing and emphasize the importance of imaging. This retrospective descriptive study included a total of 28 patients who underwent CT scan or radiographic imaging within 6 h after the bombing on 10 October 2015. CT scans and plain radiographs were evaluated regarding mechanisms of injuries. Injuries were categorized as primary, secondary, tertiary and quaternary. The number of shrapnel and distribution of injuries were noted. Injury Severity Score (ISS) was used to rank the severity of the injury. Primary blast injuries consisted of only tympanic membrane rupture. A high rate of patients (21/28 patients) in the study group suffered from secondary blast injuries. Tertiary injuries were detected in only three patients. Of the severely injured patients, five had abdominal injuries, three had thoracic injuries and six had extremity injuries. ISS was significantly higher in patients with thoracic and abdominal injuries. Our results after the suicide bomb attacks showed that the most common injury pattern was secondary blast injury. The torso was the most commonly injured body region, followed by the extremities. This specific injury pattern requires the use of immense radiological imaging. Hence, radiologists should be aware of the mechanisms and spectrums of blast-related injuries. Both the unique injury pattern and the following chaos make blast-related injuries a challenge in terms of triage, diagnosis and management. Radiologists should be familiar with the wide spectrum of these unique injuries.

Investigating the DSM-5 severity specifiers based on thinness for adults with anorexia nervosa.

PubMed

Reas, Deborah Lynn; Rø, Øyvind

2017-08-01

The DSM-5 severity classification scheme for adults with anorexia nervosa (AN) is based upon current body mass index (BMI; kg/m 2 ). This study examined the utility of the DSM-5 severity specifiers for adults with AN in relation to core cognitive and behavioral features of eating pathology and associated psychosocial impairment. A clinical sample of 146 adult AN patients (140 women, 6 men) were categorized using DSM-5 current BMI severity specifiers and assessed with the Eating Disorder Examination-Questionnaire (EDE-Q) and Clinical Impairment Assessment (CIA). A total of 34 (23.3%) patients were categorized as mild (>=17.0 BMI), 35 (24.0%) as moderate (16-16.99 BMI), 32 (21.9%) as severe (15-15.99 BMI), and 45 (30.8%) as extreme (<15 BMI). No significant group differences were found for age, CIA and EDE-Q global or subscale scores, frequency of laxative use, self-induced vomiting, binge eating, or excessive exercise. This study found little empirical evidence to support the utility of DSM-5 severity rating scheme to differentiate adults with AN in terms of core eating disorder pathology or associated psychosocial impairment. © 2017 Wiley Periodicals, Inc.

The Role of Scoring Systems and Urine Dipstick in Prediction of Rhabdomyolysis-induced Acute Kidney Injury: a Systematic Review.

PubMed

Safari, Saeed; Yousefifard, Mahmoud; Hashemi, Behrooz; Baratloo, Alireza; Forouzanfar, Mohammad Mehdi; Rahmati, Farhad; Motamedi, Maryam; Najafi, Iraj

2016-05-01

During the past decade, using serum biomarkers and clinical decision rules for early prediction of rhabdomyolysis-induced acute kidney injury (AKI) has received much attention from researchers. This study aimed to broadly review the value of scoring systems and urine dipstick in prediction of rhabdomyolysis-induced AKI. The study was designed based on the guidelines of the Meta-analysis of Observational Studies in Epidemiology statement. Search was done in electronic databases of MEDLINE, EMBASE, Cochrane Library, Scopus, and Google Scholar by 2 independent reviewers. Studies evaluating AKI risk factors in rhabdomyolysis patients with the aim of developing a scoring model as well as those assessing the role of urine dipstick in these patients were included. Of the 5997 articles found, 143 were potentially relevant studies. After studying their full texts, 6 articles were entered into the systematic review. Two studies had developed or validated scoring systems of the "rule of thumb," and the AKI index, and the Mangled Extremity Severity Score. Four studies were on the predictive value of urine dipstick in risk prediction of rhabdomyolysis-induced AKI, with favorable results. The findings of this systematic review showed that based on the available resources, using the prediction rules and urine dipstick could be considered as valuable screening tools for detection of patients at risk for AKI following rhabdomyolysis. Yet, the external validity of the mentioned tools should be assessed before their general application in routine practice.

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…

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/.

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.

Upper-extremity functional electric stimulation-assisted exercises on a workstation in the subacute phase of stroke recovery.

PubMed

Kowalczewski, Jan; Gritsenko, Valeriya; Ashworth, Nigel; Ellaway, Peter; Prochazka, Arthur

2007-07-01

To test the efficacy of functional electric stimulation (FES)-assisted exercise therapy (FES-ET) on a workstation in the subacute phase of recovery from a stroke. Single-blind, randomly controlled comparison of high- and low-intensity treatment. Laboratory in a rehabilitation hospital. Nineteen stroke survivors (10 men, 9 women; mean age +/- standard deviation, 60.6+/-5.8y), with upper-extremity hemiplegia (mean poststroke time, 48+/-17d). The main inclusion criteria were: stroke occurred within 3 months of onset of trial and resulted in severe upper-limb dysfunction, and FES produced adequate hand opening. An FES stimulator and an exercise workstation with instrumented objects were used by 2 groups to perform specific motor tasks with their affected upper extremity. Ten subjects in the high-intensity FES-ET group received FES-ET for 1 hour a day on 15 to 20 consecutive workdays. Nine subjects in the low-intensity FES-ET group received 15 minutes of sensory electric stimulation 4 days a week and on the fifth day they received 1 hour of FES-ET. Primary outcome measure included the Wolf Motor Function Test (WMFT). Secondary outcome measures included the Motor Activity Log (MAL), the upper-extremity portion of the Fugl-Meyer Assessment (FMA), and the combined kinematic score (CKS) derived from workstation measurements. The WMFT, MAL, and FMA were used to assess function in the absence of FES whereas CKS was used to evaluate function assisted by FES. Improvements in the WMFT and CKS were significantly greater in the high-intensity group (post-treatment effect size, .95) than the low-intensity group (post-treatment effect size, 1.3). The differences in MAL and FMA were not statistically significant. Subjects performing high-intensity FES-ET showed significantly greater improvements on the WMFT than those performing low-intensity FES-ET. However, this was not reflected in subjects' self-assessments (MAL) or in their FMA scores, so the clinical significance of the result is open to debate. The CKS data suggest that high-intensity FES-ET may be advantageous in neuroprosthetic applications.

The role of categorization and scale endpoint comparisons in numerical information processing: A two-process model.

PubMed

Tao, Tao; Wyer, Robert S; Zheng, Yuhuang

2017-03-01

We propose a two-process conceptualization of numerical information processing to describe how people form impressions of a score that is described along a bounded scale. According to the model, people spontaneously categorize a score as high or low. Furthermore, they compare the numerical discrepancy between the score and the endpoint of the scale to which it is closer, if they are not confident of their categorization, and use implications of this comparison as a basis for judgment. As a result, their evaluation of the score is less extreme when the range of numbers along the scale is large (e.g., from 0 to 100) than when it is small (from 0 to 10). Six experiments support this two-process model and demonstrate its generalizability. Specifically, the magnitude of numbers composing the scale has less impact on judgments (a) when the score being evaluated is extreme, (b) when individuals are unmotivated to engage in endpoint comparison processes (i.e., they are low in need for cognition), and (c) when they are unable to do so (i.e., they are under cognitive load). Moreover, the endpoint to which individuals compare the score can depend on their regulatory focus. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

N-Acetylcysteine in the Treatment of Excoriation Disorder: A Randomized Clinical Trial.

PubMed

Grant, Jon E; Chamberlain, Samuel R; Redden, Sarah A; Leppink, Eric W; Odlaug, Brian L; Kim, Suck Won

2016-05-01

Excoriation (skin-picking) disorder (SPD) is a disabling, underrecognized condition in which individuals repeatedly pick at their skin, leading to noticeable tissue damage. To date, there has been no clearly effective pharmacologic or psychological treatment for SPD. To determine whether N-acetylcysteine, an amino acid that appears to restore extracellular glutamate concentration in the nucleus accumbens, will be more effective than placebo in reducing compulsive picking behavior. A randomized, double-blind trial was conducted at ambulatory care centers at the University of Minnesota (September 12, 2011, to June 15, 2012) and the University of Chicago (December 17, 2012, to June 26, 2015) and included 66 adults with SPD. Data analysis was performed from July 16 to September 9, 2015. N-acetylcysteine (dosing range, 1200-3000 mg/d) or placebo was administered for 12 weeks. Participants were assessed using measures of skin-picking severity, including the modified Yale-Brown Obsessive Compulsive Scale (NE-YBOCS); total scores range from 0 to 40, with higher scores reflective of greater symptom severity. Another measure of skin-picking severity was the Clinical Global Impression-Severity Scale; total scores range from 1 (normal) to 7 (among the most extremely ill patients), and improvement ratings range from 7 (very much worse) to 1 (very much improved). Selected cognitive tasks included the Intra-dimensional/Extra-dimensional Shift Task to examine cognitive flexibility, with the key outcome measures being the number of errors, and Stop-Signal Reaction Time task, which evaluates motor inhibition. Outcomes were examined using a linear mixed-effects model. Of the 66 participants (31 randomized to placebo and 35 to N-acetylcysteine) included in the analysis, 59 (89%) were women; mean (SD) age was 34.8 (11.0) years. Compared with placebo, N-acetylcysteine treatment was associated with significant improvements in the NE-YBOCS. At baseline, NE-YBOCS scores were 18.9 and 17.9 for the treatment and placebo groups, respectively, and at 12 weeks, the scores were 11.5 and 14.1 for the treatment and placebo groups, respectively (P = .048). For the Clinical Global Impression-Severity scale, baseline scores were 3.5 and 4.0 and 12-week scores were 3.0 and 4.2, respectively (P = .003). These effects were significant both in terms of treatment by time interactions and post hoc tests at 1 or more individual time points. At the study's end point, of the 53 participants who completed the study, 15 of the 32 participants (47%) receiving N-acetylcysteine were much or very much improved compared with 4 of the 21 participants (19%) receiving placebo (P = .03). There were no significant differences between the active and placebo arms in terms of psychosocial functioning. N-acetylcysteine treatment resulted in significant reductions in skin-picking symptoms and was well tolerated. The glutamate system may prove a beneficial target in treating SPD and other compulsive behaviors. clinicaltrials.gov Identifier: NCT01063348.

Race and insurance status as risk factors for trauma mortality.

PubMed

Haider, Adil H; Chang, David C; Efron, David T; Haut, Elliott R; Crandall, Marie; Cornwell, Edward E

2008-10-01

To determine the effect of race and insurance status on trauma mortality. Review of patients (aged 18-64 years; Injury Severity Score > or = 9) included in the National Trauma Data Bank (2001-2005). African American and Hispanic patients were each compared with white patients and insured patients were compared with uninsured patients. Multiple logistic regression analyses determined differences in survival rates after adjusting for demographics, injury severity (Injury Severity Score and revised Trauma Score), severity of head and/or extremity injury, and injury mechanism. A total of 429 751 patients met inclusion criteria. African American (n = 72,249) and Hispanic (n = 41,770) patients were less likely to be insured and more likely to sustain penetrating trauma than white patients (n = 262,878). African American and Hispanic patients had higher unadjusted mortality rates (white, 5.7%; African American, 8.2%; Hispanic, 9.1%; P = .05 for African American and Hispanic patients) and an increased adjusted odds ratio (OR) of death compared with white patients (African American OR, 1.17; 95% confidence interval [CI], 1.10-1.23; Hispanic OR, 1.47; 95% CI, 1.39-1.57). Insured patients (47%) had lower crude mortality rates than uninsured patients (4.4% vs 8.6%; P = .05). Insured African American and Hispanic patients had increased mortality rates compared with insured white patients. This effect worsened for uninsured patients across groups (insured African American OR, 1.2; 95% CI, 1.08-1.33; insured Hispanic OR, 1.51; 95% CI, 1.36-1.64; uninsured white OR, 1.55; 95% CI, 1.46-1.64; uninsured African American OR, 1.78; 95% CI, 1.65-1.90; uninsured Hispanic OR, 2.30; 95% CI, 2.13-2.49). The reference group was insured white patients. Race and insurance status each independently predicts outcome disparities after trauma. African American, Hispanic, and uninsured patients have worse outcomes, but insurance status appears to have the stronger association with mortality after trauma.

Psychological, Relational, and Biological Correlates of Ego-Dystonic Masturbation in a Clinical Setting.

PubMed

Castellini, Giovanni; Fanni, Egidia; Corona, Giovanni; Maseroli, Elisa; Ricca, Valdo; Maggi, Mario

2016-09-01

Attitudes toward masturbation are extremely varied, and this practice is often perceived with a sense of guilt. To evaluate the prevalence of ego-dystonic masturbation (EM), defined as masturbation activity followed by a sense of guilt, in a clinical setting of sexual medicine and the impact of EM on psychological and relational well-being. A series of 4,211 men attending an andrology and sexual medicine outpatient clinic was studied retrospectively. The presence and severity of EM were defined according to ANDROTEST items related to masturbation, determined by the mathematical product of the frequency of masturbation and the sense of guilt after masturbation. Clinical, biochemical, and psychological parameters were studied using the Structured Interview on Erectile Dysfunction, ANDROTEST, and modified Middlesex Hospital Questionnaire. Three hundred fifty-two subjects (8.4%) reported any sense of guilt after masturbation. Subjects with EM were younger than the remaining sample (mean age ± SD = 51.27 ± 13.43 vs 48.31 ± 12.04 years, P < .0001) and had more psychiatric comorbidities. EM severity was positively associated with higher free-floating (Wald = 35.94, P < .001) and depressive (Wald = 16.85, P < .001) symptoms, and subjects with a higher EM score reported less phobic anxiety (Wald = 4.02, P < .05) and obsessive-compulsive symptoms (Wald = 7.6, P < .01). A higher EM score was associated with a higher alcohol intake. Subjects with EM more often reported the partner's lower frequency of climax and more problems achieving an erection during sexual intercourse. EM severity was positively associated with worse relational and intrapsychic domain scores. Clinicians should consider that some subjects seeking treatment in a sexual medicine setting might report compulsive sexual behaviors. EM represents a clinically relevant cause of disability, given the high level of psychological distress reported by subjects with this condition, and the severe impact on quality of life in interpersonal relationships. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Specific abbreviated injury scale values are responsible for the underestimation of mortality in penetrating trauma patients by the injury severity score.

PubMed

Rowell, Susan E; Barbosa, Ronald R; Diggs, Brian S; Schreiber, Martin A; Holcomb, J B; Wade, C E; Brasel, K J; Vercruysse, G; MacLeod, J; Dutton, R P; Hess, J R; Duchesne, J C; McSwain, N E; Muskat, P; Johannigamn, J; Cryer, H M; Tillou, A; Cohen, M J; Pittet, J F; Knudson, P; De Moya, M A; Schreiber, M A; Tieu, B; Brundage, S; Napolitano, L M; Brunsvold, M; Sihler, K C; Beilman, G; Peitzman, A B; Zenait, M S; Sperry, J; Alarcon, L; Croce, M A; Minei, J P; Kozar, R; Gonzalez, E A; Stewart, R M; Cohn, S M; Mickalek, J E; Bulger, E M; Cotton, B A; Nunez, T C; Ivatury, R; Meredith, J W; Miller, P; Pomper, J; Marin, B

2011-08-01

The Injury Severity Score (ISS) is widely used as a method for rating severity of injury. The ISS is the sum of the squares of the three worst Abbreviated Injury Scale (AIS) values from three body regions. Patients with penetrating injuries tend to have higher mortality rates for a given ISS than patients with blunt injuries. This is thought to be secondary to the increased prevalence of multiple severe injuries in the same body region in patients with penetrating injuries, which the ISS does not account for. We hypothesized that the mechanism-based difference in mortality could be attributed to certain ISS ranges and specific AIS values by body region. Outcome and injury scoring data were obtained from transfused patients admitted to 23 Level I trauma centers. ISS values were grouped into categories, and a logistic regression model was created. Mortality for each ISS category was determined and compared with the ISS 1 to 15 group. An interaction term was added to evaluate the effect of mechanism. Additional logistic regression models were created to examine each AIS category individually. There were 2,292 patients in the cohort. An overall interaction between ISS and mechanism was observed (p = 0.049). Mortality rates between blunt and penetrating patients with an ISS between 25 and 40 were significantly different (23.6 vs. 36.1%; p = 0.022). Within this range, the magnitude of the difference in mortality was far higher for penetrating patients with head injuries (75% vs. 37% for blunt) than truncal injuries (26% vs. 17% for blunt). Penetrating trauma patients with an AIS head of 4 or 5, AIS abdomen of 3, or AIS extremity of 3 all had adjusted mortality rates higher than blunt trauma patients with those values. Significant differences in mortality between blunt and penetrating trauma patients exist at certain ISS and AIS category values. The mortality difference is greatest for head injured patients.

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).

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.

Development of a questionnaire to measure quality of life in adolescents with food allergy: the FAQL-teen.

PubMed

Resnick, Elena S; Pieretti, Mariah M; Maloney, Jennifer; Noone, Sally; Muñoz-Furlong, Anne; Sicherer, Scott H

2010-11-01

Living with food allergies affects quality of life (QOL) and may be particularly problematic for teenagers. To develop a validated food allergy QOL assessment tool for US adolescents (FAQL-teen). Initial items were developed through expert opinion, literature review, and adolescent focus groups, resulting in an 88-question impact assessment questionnaire. This questionnaire was completed by 52 adolescents for effect scoring; final instrument questions were determined through analysis of effect scores. The final 17-item instrument was completed by 203 participants aged 13 to 19 years via an Internet link on the Food Allergy & Anaphylaxis Network Web site and via paper surveys distributed at a Food Allergy & Anaphylaxis Network conference. Items were scored on a 7-point Likert scale: 0 corresponded to "not troubled/limited," 3 to "moderately troubled/limited," and 6 to "extremely troubled/limited." Areas most troubling included limitations on social activities (score, 2.7), not being able to eat what others were eating (score, 2.7), and limited choice of restaurants (score, 3.9). Instrument validation steps showed strong internal validity (Cronbach α = .9). The instrument discriminated by disease severity: adolescents with a history of anaphylaxis had significantly lower QOL (higher scores) than did those without a history of anaphylaxis (P = .003). While developing a food allergy QOL assessment tool for US adolescents (FAQL-teen), we identified multiple social and emotional concerns that could be targeted for adolescent counseling. This instrument is internally valid and has the ability to discriminate, making it a useful tool in adolescent food allergy studies. Copyright © 2010 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

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

Tibiofemoral osteoarthritis affects quality of life and function in elderly Koreans, with women more adversely affected than men.

PubMed

Kim, Inje; Kim, Hyun Ah; Seo, Young-Il; Song, Yeong Wook; Hunter, David J; Jeong, Jin Young; Kim, Dong Hyun

2010-06-22

The prevalence of knee osteoarthritis(OA) in East Asia is as common for men and even higher for women than that reported in the Caucasian population. Since both population aging and economic growth have taken place at a much faster pace in Asian countries, such as South Korea, one would expect knee OA to become a major public health problem. However, few studies have examined the influence of knee OA on the quality of life (QoL) and physical function in Asia. The aim of this cross-sectional study is to investigate the influence of knee osteoarthritis (OA) on the quality of life (QoL), function and lower extremity physical performance and the gender difference in its influence in elderly community residents in Korea. Participants were from the population-based Hallym Aging Study (HAS). The mean age of the 504 study subjects was 70.2 years and 274 (54%) were women. Demographic information was obtained by questionnaire, and radiographic evaluations consisted of weight-bearing semi-flexed knee radiographs. Self-reported QoL and function were assessed using Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index and Short Form 12-item (SF-12). Performance-based lower extremity function was assessed using the tests consisting of standing balance, usual walk and chair stands. The odds ratios(ORs) for belonging to the worst quartile of WOMAC and physical performance test were calculated by logistic regression analysis in radiographic knee OA compared to non-OA after adjustment of confounders. Scores for SF-12 items were analyzed using general linear models and means adjusted for age, BMI and OA severity were compared. Subjects with radiographic knee OA had significantly increased OR for belonging to the worst WOMAC quartile(for pain, 2.13,95% confidence interval[CI], 1.33-3.40, for stiffness, 2.94,95% CI,1.78-4.86, and for function, 2.97, 95% CI,1.83-4.81) and significantly worse SF-12 scores compared to non-OA after adjustment of age, BMI and sex. Women had worse WOMAC and SF-12 scores compared to men, regardless of the presence of radiographic knee OA after adjustment of age, BMI and OA severity. OA subjects had significantly worse performance score for usual walk and chair stands compared to non-OA subjects, but the ORs were no more significant after adjustment of sex. Knee OA negatively affects the QoL and physical function in both genders, but women are more adversely affected than men.

Musculoskeletal Pain, Self-reported Physical Function, and Quality of Life in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Cohort.

PubMed

Bout-Tabaku, Sharon; Michalsky, Marc P; Jenkins, Todd M; Baughcum, Amy; Zeller, Meg H; Brandt, Mary L; Courcoulas, Anita; Buncher, Ralph; Helmrath, Michael; Harmon, Carroll M; Chen, Mike K; Inge, Thomas H

2015-06-01

Obesity is associated with chronic musculoskeletal pain and is a risk factor for disability and osteoarthritis. To describe the prevalence, sites, and intensity of musculoskeletal pain in adolescents with severe obesity; to evaluate associations between musculoskeletal pain and self-reported physical function as well as weight-related quality of life; and to evaluate the association between musculoskeletal pain and high-sensitivity C-reactive protein level. Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) is a prospective, observational study that collects standardized data on adolescents undergoing weight loss surgery at 5 US centers. We examined baseline data from this cohort between February 28, 2007, and December 30, 2011. We excluded adolescents with Blount disease and slipped capital femoral epiphyses. A total of 233 participants were included in these analyses. We assessed musculoskeletal pain and pain intensity of the lower back, hips, knees, and ankles/feet using the visual analog scale, categorizing musculoskeletal pain into lower back pain, lower extremity (hips, knees, and feet/ankles combined) pain, and no pain. We assessed self-reported physical function status with the Health Assessment Questionnaire Disability Index and assessed weight-related quality of life with the Impact of Weight on Quality of Life-Kids measure. We adjusted for sex, race, age at surgery, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and clinical depressive symptoms in regression analyses. Among the 233 participants, the mean (SD) age at surgery was 17.1 (1.56) years and the median BMI was 50.4. Participants were predominantly female (77%), white (73%), and non-Hispanic (93%). Among the participants, 49% had poor functional status and 76% had musculoskeletal pain. Lower back pain was prevalent (63%), followed by ankle/foot (53%), knee (49%), and hip (31%) pain; 26% had pain at all 4 sites. In adjusted analyses, compared with pain-free participants, those reporting lower extremity pain had greater odds of having poor physical function according to scores on the Health Assessment Questionnaire Disability Index (odds ratio = 2.82; 95% CI, 1.35 to 5.88; P < .01). Compared with pain-free participants, those reporting lower extremity pain had significantly lower Impact of Weight on Quality of Life-Kids total scores (β = -9.42; 95% CI, -14.15 to -4.69; P < .01) and physical comfort scores (β = -17.29; 95% CI, -23.32 to -11.25; P < .01). After adjustment, no significant relationship was observed between musculoskeletal pain and high-sensitivity C-reactive protein level. Adolescents with severe obesity have musculoskeletal pain that limits their physical function and quality of life. Longitudinal follow-up will reveal whether weight loss surgery reverses pain and physical functional limitations and improves quality of life.

The bothersomeness of sciatica: patients’ self-report of paresthesia, weakness and leg pain

PubMed Central

Haugen, Anne Julsrud; Keller, Anne; Natvig, Bård; Brox, Jens Ivar; Grotle, Margreth

2009-01-01

The objective of the study was to investigate how patients with sciatica due to disc herniation rate the bothersomeness of paresthesia and weakness as compared to leg pain, and how these symptoms are associated with socio-demographic and clinical characteristics. A cross-sectional study was conducted on 411 patients with clinical signs of radiculopathy. Items from the Sciatica Bothersomeness Index (0 = none to 6 = extremely) were used to establish values for paresthesia, weakness and leg pain. Associations with socio-demographic and clinical variables were analyzed by multiple linear regression. Mean scores (SD) were 4.5 (1.5) for leg pain, 3.4 (1.8) for paresthesia and 2.6 (2.0) for weakness. Women reported higher levels of bothersomeness for all three symptoms with mean scores approximately 10% higher than men. In the multivariate models, more severe symptoms were associated with lower physical function and higher emotional distress. Muscular paresis explained 19% of the variability in self-reported weakness, sensory findings explained 10% of the variability in paresthesia, and straight leg raising test explained 9% of the variability in leg pain. In addition to leg pain, paresthesia and weakness should be assessed when measuring symptom severity in sciatica. PMID:19488793

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

PROSPECTIVE FUNCTIONAL PERFORMANCE TESTING AND RELATIONSHIP TO LOWER EXTREMITY INJURY INCIDENCE IN ADOLESCENT SPORTS PARTICIPANTS

PubMed Central

DePhillipo, Nick; Kimura, Iris; Kocher, Morgan; Hetzler, Ronald

2017-01-01

Background Due to the high number of adolescent athletes and subsequent lower extremity injuries, improvements of injury prevention strategies with emphasis on clinic-based and practical assessments are warranted. Purpose The purpose of this study was to prospectively investigate if a battery of functional performance tests (FPT) could be used as a preseason-screening tool to identify adolescent athletes at risk for sports-related acute lower extremity injury via comparison of injured and uninjured subjects. Methods One hundred adolescent volleyball, basketball and soccer athletes (female, n=62; male, n=38; mean age = 14.4 ± 1.6) participated. The FPT assessment included: triple hop for distance, star excursion balance test, double leg lowering maneuver, drop jump video test, and multi-stage fitness test. Composite scores were calculated using a derived equation. Subjects were monitored throughout their designated sport season(s), which consisted of a six-month surveillance period. The schools certified athletic trainer (ATC) recorded all injuries. Subjects were categorized into groups according to sex and injury incidence (acute lower extremity injury vs. uninjured) for analysis. Results Mean FPT composite scores were significantly lower for the injured compared to the uninjured groups in both sexes (males: 19.06 ± 3.59 vs. 21.90 ± 2.44; females: 19.48 ± 3.35 vs. 22.10 ± 3.06 injured and uninjured, respectively)(p < .05). The receiver-operator characteristic analysis determined the cut-off score at ≤ 20 for both genders (sensitivity=.71, specificity=.81, for males; sensitivity=.67, specificity=.69, for females)(p<.05) for acute noncontact lower extremity injuries. Significant positive correlations were found between the FPT composite score and the multi-stage fitness test in male subjects (r=.474, p=.003), suggesting a relationship between functional performance, aerobic capacity, and potential injury risk. Conclusion A comprehensive assessment of functional performance tests may be beneficial to identify high-injury risk adolescents prior to athletic participation. PMID:28515975

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.

Severe contrast reaction emergencies high-fidelity simulation training for radiology residents and technologists in a children's hospital.

PubMed

Tofil, Nancy M; White, Marjorie Lee; Grant, Matthew; Zinkan, J Lynn; Patel, Bhavik; Jenkins, Lynsey; Youngblood, Amber Q; Royal, Stuart A

2010-07-01

Severe reactions to radiographic contrast agents can be life threatening, and although they are rare, effective recognition and management are essential to improving outcomes. A high-fidelity radiology simulation course for radiology residents and technologists focusing on severe contrast reactions and immediate treatments was designed to test the hypothesis that knowledge would improve with this educational intervention. A prospective pretest and posttest study design was used. Residents and technologists worked in teams of three to five members. Learning objectives focused on demonstrating when and how to use basic life support skills and epinephrine auto-injectors. Each resident and technologist was administered a pretest prior to the start of the case scenarios and a posttest following the debriefing session. Scores from the pretest and posttest for the residents and technologists were compared using a paired-samples t test. Nineteen radiology residents and 11 radiology technologists participated. The average test scores were higher and improved significantly following the simulation experience for both the radiology residents (57% vs 82%, P < .001) and technologists (47% vs 72%, P = .006). Anonymous evaluations demonstrated that the experience was well received by residents and technologists, with 97% of learners (29 of 30) rating the experience as extremely or very helpful. Important learning themes included the knowledge of epinephrine auto-injector use and basic life support skills. High-fidelity simulation for radiology residents and technologists focusing on epinephrine auto-injector use and basic life support skills during the first 5 minutes of a severe contrast reaction can significantly improve recognition and knowledge in treating patients having severe contrast reactions. 2010 AUR. Published by Elsevier Inc. All rights reserved.

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

Validation of the Neuro-QoL measurement system in children with epilepsy.

PubMed

Lai, Jin-Shei; Nowinski, Cindy J; Zelko, Frank; Wortman, Katy; Burns, James; Nordli, Douglas R; Cella, David

2015-05-01

Children with epilepsy often face complex psychosocial consequences that are not fully captured by existing patient-reported outcome (PRO) measures. The Neurology Quality of Life Measurement System "Neuro-QoL" was developed to provide a set of common PRO measures that address issues important to people with neurologic disorders. This paper reports Neuro-QoL (anxiety, depression, interaction with peers, fatigue, pain, cognitive function, stigma, and upper and lower extremity functions) validation in children with epilepsy. Patients (aged 10-18years) diagnosed with epilepsy completed Neuro-QoL and legacy measures at time 1 (initial study visit) and 6-month follow-up. Internal consistency reliability was also evaluated. Concurrent validity was assessed by comparing Neuro-QoL measures with more established "legacy" measures of the same concepts. Clinical validity was evaluated by comparing mean Neuro-QoL scores of patients grouped by clinical anchors such as disease severity. Responsiveness of the Neuro-QoL from time 1 (initial study visit) to 6months was evaluated using self-reported change as the primary anchor. Sixty-one patients (mean age=13.4years; 62.3% male, 75.9% white) participated. Most patients (64.2%) had been seizure-free in the 3months prior to participation, and seizure frequency was otherwise described as follows: 17.8% daily, 13.3% weekly, 35.6% monthly, and 33.3% yearly. All patients were taking antiepileptic drugs. Patients reported better function/less symptoms compared to the reference groups. Internal consistency (alpha) coefficients ranged from 0.76 to 0.87. Patients with different seizure frequencies differed on anxiety (p<.01) and cognitive function (p<.05). Compared to patients on polytherapy, those on monotherapy had better upper extremity scores (p<.05). Compared to those with localized seizures, those experiencing generalized seizures reported worse stigma (p<.05). Depression, anxiety, lower extremity, fatigue, pain, interaction with peers, and stigma also significantly discriminated patients with different levels of quality of life (p≤.05). All Neuro-QoL measures were significantly correlated with other measures assessing similar domains. Stigma was related to self-reported change in several areas of functioning but in sometimes unexpected directions. The Neurology Quality of Life Measurement System is a valid and reliable assessment tool for children with epilepsy and can be used in research and clinical settings. Copyright © 2015 Elsevier Inc. All rights reserved.

Validation of the Neuro-QoL Measurement System in Children with Epilepsy

PubMed Central

Lai, Jin-Shei; Nowinski, Cindy J.; Zelko, Frank; Wortman, Katy; Burns, James; Nordli, Douglas R.; Cella, David

2015-01-01

OBJECTIVE Children with epilepsy often face complex psychosocial consequences that are not fully captured by existing patient-reported outcome (PRO) measures. The Neurology Quality of Life Measurement System “Neuro-QoL” was developed to provide a set of common PRO measures that address issues important to people with neurologic disorders. This paper reports Neuro-QoL (Anxiety, Depression, Interaction with peers, Fatigue, Pain, Cognition, Stigma, and Upper and Lower Extremity Function) validation in children with epilepsy. METHOD Patients (aged 10–18 years) diagnosed with epilepsy completed Neuro-QoL and legacy measures at time-1 and 6-month follow-up. Internal consistency reliability was also evaluated. Concurrent validity was assessed by comparing Neuro-QoL measures with more established “legacy” measures of the same concepts. Clinical validity was evaluated by comparing mean Neuro-QoL scores of patients grouped by clinical anchors such as disease severity. Responsiveness of the Neuro-QoL from time-1 to 6-month was evaluated using self-reported change as the primary anchor. RESULTS 61 patients (mean age=13.4 years; 62.3% male, 75.9% white) participated. Most patients (64.2%) had been seizure free in the 3 months prior to participation, and seizure frequency was otherwise described as follows: 17.8% daily, 13.3% weekly, 35.6% monthly and 33.3% yearly. All patients were taking anti-epileptic drugs. Patients reported better function/less symptoms compared to the reference groups. Internal consistency (alpha) coefficients ranged from 0.76 – 0.87. Patients with different seizure frequency differed on Anxiety (p<.01) and Cognition (p<.05). Compared to patients on polytherapy, those on monotherapy had better Upper Extremity scores (p<.05). Compared to those with localized seizures, those experiencing generalized seizures reported worse stigma (p<.05). Depression, Anxiety, Lower Extremity, Fatigue, Pain, Interaction with peers, and Stigma also significantly discriminated patients with different levels of quality of life, p<=.05. All Neuro-QoL measures were significantly correlated with other measures assessing similar domains. Stigma was related to self-reported change in several areas of functioning, but in sometimes unexpected directions. SIGNIFICANCE Neuro-QoL is a valid and reliable assessment tool for children with epilepsy and can be used in research and clinical settings. PMID:25862469

EVALUATION OF PROGNOSTIC FACTORS IN DECOMPENSATED LIVER CIRRHOSIS WITH ASCITES AND SPONTANEOUS BACTERIAL PERITONITIS.

PubMed

Dănulescu, Răzvana Munteanu; Stanciu, Carol; Trifan, Anca

2015-01-01

Mortality in spontaneous bacterial peritonitis (SBP) decreased significantly from 90% in 1970 to 10-30% today, but SBP still remains a complication with a poor prognosis. Although there are new preventive measures, such as early diagnosis and treatment with albumin, the introduction of new antibiotics, the prognosis of patients with decompensated cirrhosis and SBP remains poor, with a mortality rate of 20-40%. The installation of an episode of spontaneous bacterial peritonitis reduces the survival rate at 1 year to 30% and to 20% at 2 years. In this context, the identification of patients with increased risk of death is extremely important in order to improve prognosis. The prospective study included 153 patients with cirrhosis admitted to the Institute of Gastroenterology and Hepatology Iaşi from 1 January to 31 December 2010, reevaluated during 2 years. Criteria for the diagnosis of SBP were the presence of a number > 250 PMN / mmc. The presence of ascites and/or upper gastrointestinal bleeding (UGB) marks the decompensated cirrhosis. To assess the severity of cirrhosis, there were used Child-Pugh and MELD scores. Diagnostic paracentesis and ascites fluid cultures were performed in all hospitalized patients with ascites and also in case of signs and symptoms of SBP, before and after antibiotic treatment. Lack of response to empirical therapy was considered in those cases with a decrease in the number of neutrophils < 25% from baseline. Identification of patients with increased risk of death is extremely important to improve prognosis. In peripheral leukocytosis and in the ascites fluid, low hemoglobin can be considered predictors of mortality in patients with PBS. Child-Pugh score, increased levels of bilirubin and creatinine and hyponatremia are independent risk factors of mortality in patients with SBP. Bacteremia and lack of therapeutic response are independent risk factors of mortality associated with SBP. Recent history of variceal bleeding, severity of infection and the degree of hepatic and renal impairment influence short-term prognosis of patients with SBP. Identification of patients with increased risk of death is extremely important to improve prognosis. Therefore, it is important to identify prognostic factors in patients with bacterial infection and cirrhosis, in order to identify high risk patients and to prevent complications and death.

Predicting in-hospital mortality of traffic victims: A comparison between AIS-and ICD-9-CM-related injury severity scales when only ICD-9-CM is reported.

PubMed

Van Belleghem, Griet; Devos, Stefanie; De Wit, Liesbet; Hubloue, Ives; Lauwaert, Door; Pien, Karen; Putman, Koen

2016-01-01

Injury severity scores are important in the context of developing European and national goals on traffic safety, health-care benchmarking and improving patient communication. Various severity scores are available and are mostly based on Abbreviated Injury Scale (AIS) or International Classification of Diseases (ICD). The aim of this paper is to compare the predictive value for in-hospital mortality between the various severity scores if only International Classification of Diseases, 9th revision, Clinical Modification ICD-9-CM is reported. To estimate severity scores based on the AIS lexicon, ICD-9-CM codes were converted with ICD Programmes for Injury Categorization (ICDPIC) and four AIS-based severity scores were derived: Maximum AIS (MaxAIS), Injury Severity Score (ISS), New Injury Severity Score (NISS) and Exponential Injury Severity Score (EISS). Based on ICD-9-CM, six severity scores were calculated. Determined by the number of injuries taken into account and the means by which survival risk ratios (SRRs) were calculated, four different approaches were used to calculate the ICD-9-based Injury Severity Scores (ICISS). The Trauma Mortality Prediction Model (TMPM) was calculated with the ICD-9-CM-based model averaged regression coefficients (MARC) for both the single worst injury and multiple injuries. Severity scores were compared via model discrimination and calibration. Model comparisons were performed separately for the severity scores based on the single worst injury and multiple injuries. For ICD-9-based scales, estimation of area under the receiver operating characteristic curve (AUROC) ranges between 0.94 and 0.96, while AIS-based scales range between 0.72 and 0.76, respectively. The intercept in the calibration plots is not significantly different from 0 for MaxAIS, ICISS and TMPM. When only ICD-9-CM codes are reported, ICD-9-CM-based severity scores perform better than severity scores based on the conversion to AIS. Copyright © 2015 Elsevier Ltd. All rights reserved.

Long-term outcomes after severe shock.

PubMed

Pratt, Cristina M; Hirshberg, Eliotte L; Jones, Jason P; Kuttler, Kathryn G; Lanspa, Michael J; Wilson, Emily L; Hopkins, Ramona O; Brown, Samuel M

2015-02-01

Severe shock is a life-threatening condition with very high short-term mortality. Whether the long-term outcomes among survivors of severe shock are similar to long-term outcomes of other critical illness survivors is unknown. We therefore sought to assess long-term survival and functional outcomes among 90-day survivors of severe shock and determine whether clinical predictors were associated with outcomes. Seventy-six patients who were alive 90 days after severe shock (received ≥1 μg/kg per minute of norepinephrine equivalent) were eligible for the study. We measured 3-year survival and long-term functional outcomes using the Medical Outcomes Study 36-Item Short-Form Health Survey, the EuroQOL 5-D-3L, the Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised, and an employment instrument. We also assessed the relationship between in-hospital predictors and long-term outcomes. The mean long-term survival was 5.1 years; 82% (62 of 76) of patients survived, of whom 49 were eligible for follow-up. Patients who died were older than patients who survived. Thirty-six patients completed a telephone interview a mean of 5 years after hospital admission. The patients' Physical Functioning scores were below U.S. population norms (P < 0.001), whereas mental health scores were similar to population norms. Nineteen percent of the patients had symptoms of depression, 39% had symptoms of anxiety, and 8% had symptoms of posttraumatic stress disorder. Thirty-six percent were disabled, and 17% were working full-time. Early survivors of severe shock had a high 3-year survival rate. Patients' long-term physical and psychological outcomes were similar to those reported for cohorts of less severely ill intensive care unit survivors. Anxiety and depression were relatively common, but only a few patients had symptoms of posttraumatic stress disorder. This study supports the observation that acute illness severity does not determine long-term outcomes. Even extremely critically ill patients have similar outcomes to general intensive care unit survivor populations.

Is trauma in Switzerland any different? epidemiology and patterns of injury in major trauma - a 5-year review from a Swiss trauma centre.

PubMed

Heim, C; Bosisio, F; Roth, A; Bloch, J; Borens, O; Daniel, R T; Denys, A; Oddo, M; Pasquier, M; Schmidt, S; Schoettker, P; Zingg, T; Wasserfallen, J B

2014-01-01

Switzerland, the country with the highest health expenditure per capita, is lacking data on trauma care and system planning. Recently, 12 trauma centres were designated to be reassessed through a future national trauma registry by 2015. Lausanne University Hospital launched the first Swiss trauma registry in 2008, which contains the largest database on trauma activity nationwide. Prospective analysis of data from consecutively admitted shock room patients from 1 January 2008 to 31 December 2012. Shock room admission is based on physiology and mechanism of injury, assessed by prehospital physicians. Management follows a surgeon-led multidisciplinary approach. Injuries are coded by Association for the Advancement of Automotive Medicine (AAAM) certified coders. Over the 5 years, 1,599 trauma patients were admitted, predominantly males with a median age of 41.4 years and median injury severity score (ISS) of 13. Rate of ISS >15 was 42%. Principal mechanisms of injury were road traffic (40.4%) and falls (34.4%), with 91.5% blunt trauma. Principal patterns were brain (64.4%), chest (59.8%) and extremity/pelvic girdle (52.9%) injuries. Severe (abbreviated injury scale [AIS] score ≥ 3) orthopaedic injuries, defined as extremity and spine injuries together, accounted for 67.1%. Overall, 29.1% underwent immediate intervention, mainly by orthopaedics (27.3%), neurosurgeons (26.3 %) and visceral surgeons (13.9%); 43.8% underwent a surgical intervention within the first 24 hours and 59.1% during their hospitalisation. In-hospital mortality for patients with ISS >15 was 26.2%. This is the first 5-year report on trauma in Switzerland. Trauma workload was similar to other European countries. Despite high levels of healthcare, mortality exceeds published rates by >50%. Regardless of the importance of a multidisciplinary approach, trauma remains a surgical disease and needs dedicated surgical resources.

Association of Enterococcus spp. with Severe Combat Extremity Injury, Intensive Care, and Polymicrobial Wound Infection.

PubMed

Heitkamp, Rae A; Li, Ping; Mende, Katrin; Demons, Samandra T; Tribble, David R; Tyner, Stuart D

2018-01-01

Combat-related extremity wound infections can complicate the recovery of injured military personnel. The Enterococcus genus contains both commensal and pathogenic bacteria found in many combat wounds. We describe the patient population susceptible to Enterococcus infection, the characteristics of Enterococcus spp. isolated from combat-related wounds, and the microbiological profile of Enterococcus-positive wounds. Patient and culture data were obtained from the Trauma Infectious Disease Outcomes Study. Subjects were divided into a case group with enterococcal extremity wound infections and a comparator group with wound infections caused by other micro-organisms. Case and comparator subjects had similar patterns of injury and infection. Case subjects had higher Injury Severity Scores (33 vs. 30; p < 0.001), longer hospitalization at U.S. facilities (55 vs. 40 days; p = 0.004), and required more large-volume blood transfusions (>20 units) within 24 h post-injury (53% vs. 30%; p < 0.001). Approximately 60% of case subjects had three or more infections, and 91% had one or more polymicrobial infections, compared with 43% and 50%, respectively, in the comparator group. The thigh was the most common site of Enterococcus spp. isolation, contributing 50% of isolates. Enterococcus faecium was the predominant species isolated from case-group infections overall (66%), as well as in polymicrobial infections (74%). Frequent co-colonizing microbes in polymicrobial wound infections with Enterococcus were other ESKAPE pathogens (64%) (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae [and Escherichia coli], Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) and fungi (35%). The specific pathogenicity of Enterococcus relative to other pathogens in polymicrobial wounds is unknown. Identifying strain-specific outcomes and investigating the interactions of Enterococcus strains with other wound pathogens could provide additional tools and strategies for infection mitigation in combat-related wounds.

Lack of association between vitamin D receptor genotypes and osteoporosis in Koreans

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

Lim, Sung Kil; Park, Young Suk; Park, Jae Min

To evaluate whether common allelic variants in the gene encoding the vitamin D receptor (VDR) were useful in predicting differences in bone mineral density (BMD) and bone turnover rate in Koreans, we analyzed the restriction pattern of the polymerase chain reaction product of the VDR gene with the Bsm1 enzyme and serum osteocalcin in patients with osteoporosis. The prevalence of the BB genotype in the controls was extremely low when compared with that in other reports: the BB, Bb, and bb genotypes accounted for 1.4%, 12.9%, and 85.7%, respectively. Only 2.8% of those patients with osteoporosis had the BB genotype.more » In contrast, 12.5% had the Bb genotype, and 84.7% had the bb genotype. The prevalence of the BB genotype in patients with severe osteoporosis was also extremely low: the BB, Bb and bb genotypes accounted for 0%, 12.4%, and 87.6%, respectively. Compared with the mean serum osteocalcin level of the pre- and post-menopausal controls, the levels in patients with severe osteoporosis was higher, and this was statistically significant. As expected, a negative correlation was observed between the serum osteocalcin levels and the age-matched Z scores for spinal BMD. However, no correlation was found in the femoral neck BMD. These results suggest that restriction fragment length polymorphism analysis of the VDR gene with a Bsm1 restriction enzyme in Koreans is not helpful for early detection of patients at risk of developing osteoporosis. This is true even in patients with a high rate of bone turnover. Our data suggest extreme ethnic differences in the pattern of prevalence of the VDR allele. 19 refs., 5 figs., 2 tabs.« less

Population-based study shows improved postnatal growth in preterm very-low-birthweight infants between 1995 and 2010.

PubMed

Ofek Shlomai, Noa; Reichman, Brian; Lerner-Geva, Liat; Boyko, Valentina; Bar-Oz, Benjamin

2014-05-01

To assess whether the postnatal growth of preterm very-low-birthweight (VLBW) infants, as determined by measures of postnatal growth failure (PNGF), improved during the period 1995-2010 and to evaluate postnatal growth by gestational age (GA) and intrauterine growth groups. The study was based on the Israel national VLBW infant database and comprised 13 531 VLBW infants of 24-32 weeks' GA, discharged at a postmenstrual age of ≤40 weeks. Z-scores were determined for weight at birth and discharge. Severe and mild PNGF was defined as a decrease >2 and 1-2 z-scores, respectively. Three time periods were considered: 1995-2000, 2001-2005 and 2006-2010. Multinomial logistic regression was used to assess the independent effect of time period on PNGF. Severe PNGF decreased from 11.7% in 1995-2000 to 7.2% in 2001-2005 and 5.2% in 2006-2010. Infants born in 2006-2010 had sixfold lower odds for severe PNGF than babies born in 1995-2000 (adjusted odds ratio 0.17, 95% confidence interval 0.14-0.21) and

A quality-of-life study of cutaneous lupus erythematosus.

PubMed

Batalla, A; García-Doval, I; Peón, G; de la Torre, C

2013-11-01

The study of quality of life in patients with skin disorders has become more important in recent decades. In the case of lupus erythematosus, most quality-of-life studies have focused on the systemic form of the disease, with less attention being paid to the cutaneous form. The main objective of this study was to evaluate quality of life in patients with cutaneous lupus erythematosus (CLE) using a dermatology-specific questionnaire: the Dermatology Life Quality Index (DLQI). Our secondary objective was to investigate associations between DLQI scores and other aspects of the disease. Thirty-six patients with CLE completed the DLQI questionnaire. Other factors assessed were disease severity (measured using the Cutaneous Lupus Erythematosus Disease Area and Severity Index), time since diagnosis, body surface area affected, previous and current treatments, and the presence of criteria for systemic lupus erythematosus (SLE). According to the DLQI, CLE had a moderate, very large, or extremely large effect on quality of life in 50% of the patients analyzed (18/36). No significant associations were found between DLQI scores and disease severity, time since diagnosis, body surface area affected, number, type, or duration of pharmacologic treatments, or the presence or absence of SLE criteria. CLE has a significant and lasting effect on patient quality of life. This effect is probably primarily due to multiple factors, including the chronic nature of the disease, the visibility of the lesions, and the fact that they can cause disfigurement. Copyright © 2012 Elsevier España, S.L. and AEDV. All rights reserved.

Peritraumatic tonic immobility is associated with posttraumatic stress symptoms in undergraduate Brazilian students.

PubMed

Portugal, Liana Catarina L; Pereira, Mirtes Garcia; Alves, Rita de Cássia S; Tavares, Gisella; Lobo, Isabela; Rocha-Rego, Vanessa; Marques-Portella, Carla; Mendlowicz, Mauro V; Coutinho, Evandro S; Fiszman, Adriana; Volchan, Eliane; Figueira, Ivan; Oliveira, Letícia de

2012-03-01

Tonic immobility is a defensive reaction occurring under extreme life threats. Patients with posttraumatic stress disorder (PTSD) reporting peritraumatic tonic immobility show the most severe symptoms and a poorer response to treatment. This study investigated the predictive value of tonic immobility for posttraumatic stress symptoms in a non-clinical sample. One hundred and ninety-eight college students exposed to various life threatening events were selected to participate. The Posttraumatic Stress Disorder Checklist - Civilian Version (PCL-C) and tonic immobility questions were used. Linear regression models were fitted to investigate the association between peritraumatic tonic immobility and PCL-C scores. Peritraumatic dissociation, peritraumatic panic reactions, negative affect, gender, type of trauma, and time since trauma were considered as confounding variables. We found significant association between peritraumatic tonic immobility and PTSD symptoms in a non-clinical sample exposed to various traumas, even after regression controlled for confounding variables (β = 1.99, p = 0.017). This automatic reaction under extreme life threatening stress, although adaptive for defense, may have pathological consequences as implied by its association with PTSD symptoms.

Effects of interactive visual feedback training on post-stroke pusher syndrome: a pilot randomized controlled study.

PubMed

Yang, Yea-Ru; Chen, Yi-Hua; Chang, Heng-Chih; Chan, Rai-Chi; Wei, Shun-Hwa; Wang, Ray-Yau

2015-10-01

We investigated the effects of a computer-generated interactive visual feedback training program on the recovery from pusher syndrome in stroke patients. Assessor-blinded, pilot randomized controlled study. A total of 12 stroke patients with pusher syndrome were randomly assigned to either the experimental group (N = 7, computer-generated interactive visual feedback training) or control group (N = 5, mirror visual feedback training). The scale for contraversive pushing for severity of pusher syndrome, the Berg Balance Scale for balance performance, and the Fugl-Meyer assessment scale for motor control were the outcome measures. Patients were assessed pre- and posttraining. A comparison of pre- and posttraining assessment results revealed that both training programs led to the following significant changes: decreased severity of pusher syndrome scores (decreases of 4.0 ± 1.1 and 1.4 ± 1.0 in the experimental and control groups, respectively); improved balance scores (increases of 14.7 ± 4.3 and 7.2 ± 1.6 in the experimental and control groups, respectively); and higher scores for lower extremity motor control (increases of 8.4 ± 2.2 and 5.6 ± 3.3 in the experimental and control groups, respectively). Furthermore, the computer-generated interactive visual feedback training program produced significantly better outcomes in the improvement of pusher syndrome (p < 0.01) and balance (p < 0.05) compared with the mirror visual feedback training program. Although both training programs were beneficial, the computer-generated interactive visual feedback training program more effectively aided recovery from pusher syndrome compared with mirror visual feedback training. © The Author(s) 2014.

Strength changes induced by extreme dieting and exercise in severely obese females.

PubMed

Pronk, N P; Donnelly, J E; Pronk, S J

1992-04-01

Strength changes, induced by very low-calorie diet (VLCD, 520 kcal/day) alone and in combination with exercise, were determined in 109 severely obese females (46.8 +/- 4.69% fat). Experimental treatments included VLCD alone (LC, n = 40), VLCD with endurance exercise (EE, n = 23), VLCD with endurance exercise and resistance strength training (EERST, n = 23), and VLCD with resistance strength training (RST, n = 23). All subjects participated in the study for 90 days while EE, EERST, and RST exercised four times/week according to specified schedules. Results indicated significant differences for the change scores (baseline to 90 days) for bench press, knee flexion, upper body and lower body composite strength scores between RST and all other groups. RST was the only treatment that increased upper and lower body strength. No differences between groups were found for body mass losses, decrease in percent fat and fat mass. In contrast, these variables showed significant change scores for all groups. Decreases in fat-free mass (FFM) were 5.18 +/- 3.40 kg, 4.79 +/- 4.15 kg (p = 0.001), 4.64 +/- 4.23 kg, and 3.26 +/- 2.67 kg for EE, LC, RST, and EERST, respectively. These data suggest that the combination of resistance strength training and VLCD increases strength despite a loss of FFM. However, endurance exercise and VLCD do not seem to affect body mass loss or FFM loss per se. Moreover, it seems that these increases in strength may represent a training effect which might imply improved central neuromuscular function rather than muscular hypertrophy since FFM decreased in all groups.

Report from a quality assurance program on patients undergoing the MILD procedure.

PubMed

Durkin, Brian; Romeiser, Jamie; Shroyer, A Laurie W; Schiller, Robin; Bae, Jin; Davis, Raphael P; Peyster, Robert; Benveniste, Helene

2013-05-01

To characterize trends in pain and functional outcomes and identify risk factors in patients with lumbar spinal stenosis (LSS) and neurogenic claudication undergoing the "Minimally Invasive Lumbar Decompression" (MILD) procedure. Retrospective observational cohort study. Academic multidisciplinary pain center at Stony Brook Medicine. Patients undergoing the MILD procedure from October 2010 to November 2012. De-identified perioperative, pain and function related data for 50 patients undergoing MILD were extracted from the Center for Pain Management's quality assessment database. Data included numerical rating scale (NRS), symptom severity and physical function (Zurich Claudication Questionnaire), functional status (Oswestry Disability Index [ODI]), pain interference scores (National Institutes of Health Patient-Reported Outcomes Measurement Information System [PROMIS]), and patients' self-reported low back and lower extremity pain distribution. No MILD patient incurred procedure-related complications. Average NRS scores decreased postoperatively and 64.3% of patients reported less pain at 3 months. Clinically meaningful functional ODI improvements of at least 20% from baseline were present in 25% of the patients at 6 months. Preliminary analysis of changes in PROMIS scores at 3 months revealed that pre-MILD "severe" lumbar canal stenosis may be associated with high risk of "no improvement." No such impact was observed for NRS or ODI outcomes. Overall, pain is reduced and functional status improved in LSS patients following the MILD procedure at 3 and 6 months. Given the small sample size, it is not yet possible to identify patient subgroups at risk for "no improvement." Continued follow-up of longer-term outcomes appears warranted to develop evidence-based patient selection criteria. Wiley Periodicals, Inc.

Gun-shot injuries in UK military casualties - Features associated with wound severity.

PubMed

Penn-Barwell, Jowan G; Sargeant, Ian D

2016-05-01

Surgical treatment of high-energy gun-shot wounds (GSWs) to the extremities is challenging. Recent surgical doctrine states that wound tracts from high-energy GSWs should be laid open, however the experience from previous conflicts suggests that some of these injuries can be managed more conservatively. The aim of this study is to firstly characterise the GSW injuries sustained by UK forces, and secondly test the hypothesis that the likely severity of GSWs can be predicted by features of the wound. The UK Military trauma registry was searched for cases injured by GSW in the five years between 01 January 2009 and 31 December 2013: only UK personnel were included. Clinical notes and radiographs were then reviewed. Features associated with energy transfer in extremity wounds in survivors were further examined with number of wound debridements used as a surrogate marker of wound severity. There were 450 cases who met the inclusion criteria. 96 (21%) were fatally injured, with 354 (79%) surviving their injuries. Casualties in the fatality group had a median New Injury Severity Score (NISS) of 75 (IQR 75-75), while the median NISS of the survivors was 12 (IQR 4-48) with 10 survivors having a NISS of 75. In survivors the limbs were most commonly injured (56%). 'Through and through' wounds, where the bullet passes intact through the body, were strongly associated with less requirement for debridement (p<0.0001). When a bullet fragmented there was a significant association with a requirement for a greater number of wound debridements (p=0.0002), as there was if a bullet fractured a bone (p=0.0006). More complex wounds, as indicated by the requirement for repeated debridements, are associated with injuries where the bullet does not pass straight through the body, or where a bone is fractured. Gunshot wounds should be assessed according to the likely energy transferred, extremity wounds without features of high energy transfer do not require extensive exploration. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Are rheumatoid arthritis patients discernible from other early arthritis patients using 1.5T extremity magnetic resonance imaging? a large cross-sectional study.

PubMed

Stomp, Wouter; Krabben, Annemarie; van der Heijde, Désirée; Huizinga, Tom W J; Bloem, Johan L; van der Helm-van Mil, Annette H M; Reijnierse, Monique

2014-08-01

Magnetic resonance imaging (MRI) is increasingly used in rheumatoid arthritis (RA) research. A European League Against Rheumatism (EULAR) task force recently suggested that MRI can improve the certainty of RA diagnosis. Because this recommendation may reflect a tendency to use MRI in daily practice, thorough studies on the value of MRI are required. Thus far no large studies have evaluated the accuracy of MRI to differentiate early RA from other patients with early arthritis. We performed a large cross-sectional study to determine whether patients who are clinically classified with RA differ in MRI features compared to patients with other diagnoses. In our study, 179 patients presenting with early arthritis (median symptom duration 15.4 weeks) underwent 1.5T extremity MRI of unilateral wrist, metacarpophalangeal, and metatarsophalangeal joints according to our arthritis protocol, the foot without contrast. Images were scored according to OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) by 2 independent readers. Tenosynovitis was also assessed. The main outcome was fulfilling the 1987 American College of Rheumatology (ACR) criteria for RA. Test characteristics and areas under the receiver-operator-characteristic curves (AUC) were evaluated. In subanalyses, the 2010 ACR/EULAR criteria were used as outcome, and analyses were stratified for anticitrullinated protein antibodies (ACPA). The ACR 1987 criteria were fulfilled in 43 patients (24.0%). Patients with RA had higher scores for synovitis, tenosynovitis, and bone marrow edema (BME) than patients without RA (p < 0.05). ACPA-positive patients had more BME (median scores 6.5 vs. 4.25, p = 0.016) than ACPA-negative patients. For all MRI features, the predictive value for the presence of RA was low (< 50%). For all MRI features the AUC were < 0.70. Patients who fulfilled ACR/EULAR 2010 criteria but not ACR87 criteria for RA had less synovitis than patients who were positive for RA according to both sets of criteria (p = 0.029). Although patients with RA had higher scores of MRI inflammation and ACPA-positive patients had more BME, the severity of MRI inflammation assessed according to RAMRIS does not accurately differentiate patients with RA from other early arthritis 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 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.

Comparison of an expert system with other clinical scores for the evaluation of severity of asthma.

PubMed

Gautier, V; Rédier, H; Pujol, J L; Bousquet, J; Proudhon, H; Michel, C; Daurès, J P; Michel, F B; Godard, P

1996-01-01

"Asthmaexpert" was produced at the special request of several clinicians in order to obtain a better understanding of the medical decisions taken by clinical experts in the management of asthmatic patients. In order to assess the severity of asthma, a new score called Artificial Intelligence score (AI score), produced by Asthmaexpert, was compared with three other scores (Aas, Hargreave and Brooks). One hundred patients were enrolled prospectively in the study during their first consultation in the out-patient clinic. Distribution of severity level according to the different scores was studied, and the reliability between AI and other scores was evaluated by Kappa and MacNemar tests. Correlations with functional parameters were performed. The AI score assessed higher levels of severity than the other scores (Kappa = 18, 28 and 10% for Aas, Hargreave and Brooks, respectively) with significant MacNemar test in all cases. There was a significant correlation between AI score and forced expiratory volume in one second (FEV1) (r = 0.73). These data indicate that the AI score is a severity score which defines higher levels of severity than the chosen scores. Correlations for functional parameters are good. This score appears easy to use for the first consultation of an asthmatic patient.

Composite selection signals can localize the trait specific genomic regions in multi-breed populations of cattle and sheep

PubMed Central

2014-01-01

Background Discerning the traits evolving under neutral conditions from those traits evolving rapidly because of various selection pressures is a great challenge. We propose a new method, composite selection signals (CSS), which unifies the multiple pieces of selection evidence from the rank distribution of its diverse constituent tests. The extreme CSS scores capture highly differentiated loci and underlying common variants hauling excess haplotype homozygosity in the samples of a target population. Results The data on high-density genotypes were analyzed for evidence of an association with either polledness or double muscling in various cohorts of cattle and sheep. In cattle, extreme CSS scores were found in the candidate regions on autosome BTA-1 and BTA-2, flanking the POLL locus and MSTN gene, for polledness and double muscling, respectively. In sheep, the regions with extreme scores were localized on autosome OAR-2 harbouring the MSTN gene for double muscling and on OAR-10 harbouring the RXFP2 gene for polledness. In comparison to the constituent tests, there was a partial agreement between the signals at the four candidate loci; however, they consistently identified additional genomic regions harbouring no known genes. Persuasively, our list of all the additional significant CSS regions contains genes that have been successfully implicated to secondary phenotypic diversity among several subpopulations in our data. For example, the method identified a strong selection signature for stature in cattle capturing selective sweeps harbouring UQCC-GDF5 and PLAG1-CHCHD7 gene regions on BTA-13 and BTA-14, respectively. Both gene pairs have been previously associated with height in humans, while PLAG1-CHCHD7 has also been reported for stature in cattle. In the additional analysis, CSS identified significant regions harbouring multiple genes for various traits under selection in European cattle including polledness, adaptation, metabolism, growth rate, stature, immunity, reproduction traits and some other candidate genes for dairy and beef production. Conclusions CSS successfully localized the candidate regions in validation datasets as well as identified previously known and novel regions for various traits experiencing selection pressure. Together, the results demonstrate the utility of CSS by its improved power, reduced false positives and high-resolution of selection signals as compared to individual constituent tests. PMID:24636660

Investigating NWP initialization sensitivities in heavy precipitation events

NASA Astrophysics Data System (ADS)

Frediani, M. E. B.; Anagnostou, E. N.; Papadopoulos, A.

2010-09-01

This study aims to investigate the effect of different types of model initialization applied to extreme storms simulations. Storms with extreme precipitation can usually produce flash floods that cause several damages to the society. Lives and property are destroyed from the landslides when they could be speared if forecasted a few hours in advance. The forecasts depend on several factors; among them the initialization fields play an important role. These fields are the starting point for the simulation and therefore it controls the quality of the forecast. This study evaluates the sensitivities of WRF to the initialization from two perspectives, (1) resolution and (2) initial atmospheric fields. Two storms that lead to flash flood are simulated. The first one happened in Northeast Italy in 04/09/2009 (NI), and the second in Germany, in 02/06/2008 (GE). These storms present contrasting characteristics, NI was a maritime originated storm enhanced by local orography while GE was a typical summer convection. Three different sources of atmospheric fields defining the initial conditions are applied: (a) ECMWF operational analysis at resolution of 0.25 deg, (b) GFS operational analysis at 0.5deg and (c) LAPS analysis at ~15km, produced operationally at HCMR. The rainfall forecasted is compared against in situ ground radar and surface rain gauges observations through a set of quantitative precipitation forecast scores.

The effectiveness of a clinical and home-based physical activity program and simple lymphatic drainage in the prevention of breast cancer-related lymphedema: A prospective randomized controlled study.

PubMed

Dönmez, Ayşe Arıkan; Kapucu, Sevgisun

2017-12-01

To investigate the effectiveness of a clinical and home-based, nurse-led physical activity program (PAP) and simple lymphatic drainage (SLD) in the prevention of breast cancer-related lymphedema. A total of 52 breast cancer patients were randomized to either a PAP and SLD program (n = 25) or a control group (n = 27). Patients in both groups were also provided training for lymphedema. The PAP and SLD were administered through home visits by the investigators, twice a week for six weeks, in the intervention group. The control group did not undergo intervention. The circumference of the upper extremity, symptom severity, and physical function were measured in both groups. The upper extremity circumference increased by about two times from the baseline, in the control group, especially in the sixth week (p < 0.05). Lymphedema-related symptom severity scores were found to decrease significantly in the intervention group, compared to those at the baseline (p < 0.05). It was recommended that PAP and SLD, with a follow-up program, be used for patients who planned to undergo breast cancer surgery, starting from before surgery and continuing until after, to prevent breast cancer-related lymphedema. Copyright © 2017 Elsevier Ltd. All rights reserved.

Using multiclass classification to automate the identification of patient safety incident reports by type and severity.

PubMed

Wang, Ying; Coiera, Enrico; Runciman, William; Magrabi, Farah

2017-06-12

Approximately 10% of admissions to acute-care hospitals are associated with an adverse event. Analysis of incident reports helps to understand how and why incidents occur and can inform policy and practice for safer care. Unfortunately our capacity to monitor and respond to incident reports in a timely manner is limited by the sheer volumes of data collected. In this study, we aim to evaluate the feasibility of using multiclass classification to automate the identification of patient safety incidents in hospitals. Text based classifiers were applied to identify 10 incident types and 4 severity levels. Using the one-versus-one (OvsO) and one-versus-all (OvsA) ensemble strategies, we evaluated regularized logistic regression, linear support vector machine (SVM) and SVM with a radial-basis function (RBF) kernel. Classifiers were trained and tested with "balanced" datasets (n_ Type  = 2860, n_ SeverityLevel  = 1160) from a state-wide incident reporting system. Testing was also undertaken with imbalanced "stratified" datasets (n_ Type  = 6000, n_ SeverityLevel =5950) from the state-wide system and an independent hospital reporting system. Classifier performance was evaluated using a confusion matrix, as well as F-score, precision and recall. The most effective combination was a OvsO ensemble of binary SVM RBF classifiers with binary count feature extraction. For incident type, classifiers performed well on balanced and stratified datasets (F-score: 78.3, 73.9%), but were worse on independent datasets (68.5%). Reports about falls, medications, pressure injury, aggression and blood products were identified with high recall and precision. "Documentation" was the hardest type to identify. For severity level, F-score for severity assessment code (SAC) 1 (extreme risk) was 87.3 and 64% for SAC4 (low risk) on balanced data. With stratified data, high recall was achieved for SAC1 (82.8-84%) but precision was poor (6.8-11.2%). High risk incidents (SAC2) were confused with medium risk incidents (SAC3). Binary classifier ensembles appear to be a feasible method for identifying incidents by type and severity level. Automated identification should enable safety problems to be detected and addressed in a more timely manner. Multi-label classifiers may be necessary for reports that relate to more than one incident type.

Insufficient access to harm reduction measures in prisons in 5 countries (PRIDE Europe): a shared European public health concern.

PubMed

Michel, Laurent; Lions, Caroline; Van Malderen, Sara; Schiltz, Julie; Vanderplasschen, Wouter; Holm, Karina; Kolind, Torsten; Nava, Felice; Weltzien, Nadja; Moser, Andrea; Jauffret-Roustide, Marie; Maguet, Olivier; Carrieri, Patrizia M; Brentari, Cinzia; Stöver, Heino

2015-10-27

Prisoners constitute a high-risk population, particularly for infectious diseases. The aim of this study was to estimate the level of infectious risk in the prisons of five different European countries by measuring to what extent the prison system adheres to WHO/UNODC recommendations. Following the methodology used in a previous French survey, a postal/electronic questionnaire was sent to all prisons in Austria, Belgium, Denmark and Italy to collect data on the availability of several recommended HIV-HCV prevention interventions and HBV vaccination for prisoners. A score was built to compare adherence to WHO/UNODC recommendations (considered a proxy of environmental infectious risk) in those 4 countries. It ranged from 0 (no adherence) to 12 (full adherence). A second score (0 to 9) was built to include data from a previous French survey, thereby creating a 5-country comparison. A majority of prisons answered in Austria (100 %), France (66 %) and Denmark (58 %), half in Belgium (50 %) and few in Italy (17 %), representing 100, 74, 89, 47 and 23 % coverage of the prison populations, respectively. Availability of prevention measures was low, with median adherence scores ranging from 3.5 to 4.5 at the national level. These results were confirmed when using the second score which included France in the inter-country comparison. Overall, the adherence score was inversely associated with prison overpopulation rates (p = 0.08). Using a score of adherence to WHO/UNODC recommendations, the estimated environmental infectious risk remains extremely high in the prisons of the 5 European countries assessed. Public health strategies should be adjusted to comply with the principle of equivalence of care and prevention with the general community.

Effects of Mirror Therapy in Stroke Patients With Complex Regional Pain Syndrome Type 1: A Randomized Controlled Study.

PubMed

Pervane Vural, Secil; Nakipoglu Yuzer, Guldal Funda; Sezgin Ozcan, Didem; Demir Ozbudak, Sibel; Ozgirgin, Nese

2016-04-01

To investigate the effects of mirror therapy on upper limb motor functions, spasticity, and pain intensity in patients with hemiplegia accompanied by complex regional pain syndrome type 1. Randomized controlled trial. Training and research hospital. Adult patients with first-time stroke and simultaneous complex regional pain syndrome type 1 of the upper extremity at the dystrophic stage (N=30). Both groups received a patient-specific conventional stroke rehabilitation program for 4 weeks, 5 d/wk, for 2 to 4 h/d. The mirror therapy group received an additional mirror therapy program for 30 min/d. We evaluated the scores of the Brunnstrom recovery stages of the arm and hand for motor recovery, wrist and hand subsections of the Fugl-Meyer Assessment (FMA) and motor items of the FIM-motor for functional status, Modified Ashworth Scale (MAS) for spasticity, and visual analog scale (VAS) for pain severity. After 4 weeks of rehabilitation, both groups had significant improvements in the FIM-motor and VAS scores compared with baseline scores. However, the scores improved more in the mirror therapy group than the control group (P<.001 and P=.03, respectively). Besides, the patients in the mirror therapy arm showed significant improvement in the Brunnstrom recovery stages and FMA scores (P<.05). No significant difference was found for MAS scores. In patients with stroke and simultaneous complex regional pain syndrome type 1, addition of mirror therapy to a conventional stroke rehabilitation program provides more improvement in motor functions of the upper limb and pain perception than conventional therapy without mirror therapy. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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.

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…

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.

Development of a novel score for the prediction of hospital mortality in patients with severe sepsis: the use of electronic healthcare records with LASSO regression.

PubMed

Zhang, Zhongheng; Hong, Yucai

2017-07-25

There are several disease severity scores being used for the prediction of mortality in critically ill patients. However, none of them was developed and validated specifically for patients with severe sepsis. The present study aimed to develop a novel prediction score for severe sepsis. A total of 3206 patients with severe sepsis were enrolled, including 1054 non-survivors and 2152 survivors. The LASSO score showed the best discrimination (area under curve: 0.772; 95% confidence interval: 0.735-0.810) in the validation cohort as compared with other scores such as simplified acute physiology score II, acute physiological score III, Logistic organ dysfunction system, sequential organ failure assessment score, and Oxford Acute Severity of Illness Score. The calibration slope was 0.889 and Brier value was 0.173. The study employed a single center database called Medical Information Mart for Intensive Care-III) MIMIC-III for analysis. Severe sepsis was defined as infection and acute organ dysfunction. Clinical and laboratory variables used in clinical routines were included for screening. Subjects without missing values were included, and the whole dataset was split into training and validation cohorts. The score was coined LASSO score because variable selection was performed using the least absolute shrinkage and selection operator (LASSO) technique. Finally, the LASSO score was evaluated for its discrimination and calibration in the validation cohort. The study developed the LASSO score for mortality prediction in patients with severe sepsis. Although the score had good discrimination and calibration in a randomly selected subsample, external validations are still required.

[Analysis of the pediatric trauma score in patients wounded with shrapnel; the effect of explosives with high kinetic energy: results of the first intervention center].

PubMed

Taş, Hüseyin; Mesci, Ayhan; Demirbağ, Suzi; Eryılmaz, Mehmet; Yiğit, Taner; Peker, Yusuf

2013-03-01

We aimed to assess the pediatric trauma score analysis in pediatric trauma cases due to shrapnel effect of explosives material with high kinetic energy. The data of 17 pediatric injuries were reviewed retrospectively between February 2002 and August 2005. The information about age, gender, trauma-hospital interval, trauma mechanism, the injured organs, pediatric Glasgow coma score (PGCS), pediatric trauma score (PTS), hemodynamic parameters, blood transfusion, interventions and length of hospital stay (LHS) were investigated. While all patients suffered from trauma to the extremities, only four patients had traumatic lower-limb amputation. Transportation time was <=1 hour in 35% of cases, and >1 hour in 65% of cases. While PTS was found as <=8 in 35.3% of cases (n=6), the score was found to be higher than 8 in 64.7% of them (n=11). Median heart rate in patients with PTS <=8 was 94 beats/min. This value was 70 beats/min in those with PTS >8 (p=0.007). Morbidity rates of PTS <=8 cases and PTS >8 cases were 29.4% and 5.9%, respectively (p=0.026). While LHS was 22.8 days in PTS <=8 cases, LHS was found to be only 4 days in PTS >8 cases. This difference was found to be statistically significant (p=0.001). PTS is very efficient and a time-saving procedure to assess the severity of trauma caused by the shrapnel effect. The median heart rate, morbidity, and LHS increased significantly in patients with PTS <=8.

The relationship between agitation and impairments of orientation and memory during the PTA period after traumatic brain injury.

PubMed

McKay, Adam; Love, Jasmine; Trevena-Peters, Jessica; Gracey, Jacinta; Ponsford, Jennie

2018-06-03

Agitation is common during the post-traumatic amnesia (PTA) period after traumatic brain injury (TBI), although our knowledge of what causes or predicts agitation is limited. The current study aimed to examine the association of agitation in PTA with the concurrent impairments in orientation and memory while controlling for covariates of agitation. Participants were 125 patients in PTA following moderate to extremely severe TBI recruited from an inpatient brain injury rehabilitation service who were assessed throughout PTA on the Agitated Behavior Scale (ABS) and the Westmead PTA Scale (WPTAS). Agitation was observed in 42.4% of participants (ABS score > 21), with disinhibited behaviours (e.g., distractibility and impulsivity) most common. Multilevel modelling found daily ABS scores to be associated with daily scores on the WPTAS but in a non-linear pattern. Analysis of covariates found that shorter time post-admission, younger age, presence of infection and higher antipsychotic doses were associated with higher ABS scores. These results support a relationship between agitation and the concurrent cognitive impairment during PTA. While a causal link cannot yet be inferred, management strategies that can potentially interfere with cognition (e.g., sedating medications, environmental changes) should be used cautiously in case they exacerbate agitation.

Executive functions and psychiatric symptoms in drug-refractory juvenile myoclonic epilepsy.

PubMed

Walsh, Jordana; Thomas, Rhys H; Church, Carla; Rees, Mark I; Marson, Anthony G; Baker, Gus A

2014-06-01

The pattern of executive dysfunction reported in juvenile myoclonic epilepsy (JME) resembles that of patients with cluster B personality disorders. This study examined whether executive dysfunction and maladaptive behavior reported in patients with JME are related. Sixty patients with drug-refractory JME were administered tests of intellect, memory, and executive dysfunction. Anxiety, depression, personality traits, impact of epilepsy, and perceived cognitive effects of antiepileptic drugs were measured. Half of the cohort exhibited moderate to severe anxiety symptoms. The patients performed most poorly on naming ability and inhibition switching. Duration of epilepsy exacerbated poor performance on inhibition switching. Females presented with pathological scores for neurotic and introvert traits and males for introvert traits. Abnormal personality traits and psychiatric disorders were associated with worse intellectual and executive functioning. People with extreme Eysenck Personality Scale - Brief Version (EPQ-BV) scores demonstrated the greatest level of executive impairment. Furthermore, the same degree of dysfunction was not seen in any individual with unremarkable EPQ-BV scores. This study indicates that specific patterns of executive dysfunction are related to maladaptive behavior in JME. Distinct behavioral patterns may be used to identify functional and anatomical differences between people with JME and for stratification to enable gene discovery. Copyright © 2014. Published by Elsevier Inc.

Enzymatic debridement for the treatment of severely burned upper extremities - early single center experiences.

PubMed

Cordts, Tomke; Horter, Johannes; Vogelpohl, Julian; Kremer, Thomas; Kneser, Ulrich; Hernekamp, Jochen-Frederick

2016-06-24

Severe burns of hands and arms are complex and challenging injuries. The Standard of care (SOC) - necrosectomy with skin grafting - is often associated with poor functional or aesthetic outcome. Enzymatic debridement (ED) is considered one promising alternative but, until recently, results proved to be highly variable. Between 04/2014 and 04/2015, 16 patients with deep partial- to full-thickness burns of the upper extremities underwent enzymatic debridement (ED) in our Burn Center and were evaluated for extent of additional surgery, wound healing, pain management and functional parameters. Following ED, no further surgical intervention was required in 53.8 % of the study population. In patients who required surgical treatment, the the skin-grafted area could be reduced by 37.0 % when compared to initial assessment. Time from injury to ED was 24.4 h and patients were able to start physical therapy after 2.0 days but suffered from prolonged wound closure (28.0 days). Regionally administered anesthesia proved to be superior to pain medication alone as pain levels and consumed morphine-equivalent were lower. Post-demission follow-up showed good functional results and pain levels with low scores in two self-report questionnaires (DASH, PRWE-G) but 3 patients reported increased susceptibility to shear stress. Based on these early experiences, we developed a 3-step algorithm for consecutive patients allowing appropriate and individualized treatment selection. We see a potential benefit for ED in the treatment of severely burned hands and forearms but further investigations and proper prospective, randomized controlled trials are needed to statistically support any outlined assumptions.

Distributions of Autocorrelated First-Order Kinetic Outcomes: Illness Severity

PubMed Central

Englehardt, James D.

2015-01-01

Many complex systems produce outcomes having recurring, power law-like distributions over wide ranges. However, the form necessarily breaks down at extremes, whereas the Weibull distribution has been demonstrated over the full observed range. Here the Weibull distribution is derived as the asymptotic distribution of generalized first-order kinetic processes, with convergence driven by autocorrelation, and entropy maximization subject to finite positive mean, of the incremental compounding rates. Process increments represent multiplicative causes. In particular, illness severities are modeled as such, occurring in proportion to products of, e.g., chronic toxicant fractions passed by organs along a pathway, or rates of interacting oncogenic mutations. The Weibull form is also argued theoretically and by simulation to be robust to the onset of saturation kinetics. The Weibull exponential parameter is shown to indicate the number and widths of the first-order compounding increments, the extent of rate autocorrelation, and the degree to which process increments are distributed exponential. In contrast with the Gaussian result in linear independent systems, the form is driven not by independence and multiplicity of process increments, but by increment autocorrelation and entropy. In some physical systems the form may be attracting, due to multiplicative evolution of outcome magnitudes towards extreme values potentially much larger and smaller than control mechanisms can contain. The Weibull distribution is demonstrated in preference to the lognormal and Pareto I for illness severities versus (a) toxicokinetic models, (b) biologically-based network models, (c) scholastic and psychological test score data for children with prenatal mercury exposure, and (d) time-to-tumor data of the ED01 study. PMID:26061263

Imaging features of blast injuries: experience from 2015 Ankara bombing in Turkey

PubMed Central

Aksu, Nalan M

2016-01-01

Objective: To present the radiological features of blast-related injuries in the victims of the 10 October 2015 Ankara bombing and emphasize the importance of imaging. Methods: This retrospective descriptive study included a total of 28 patients who underwent CT scan or radiographic imaging within 6 h after the bombing on 10 October 2015. CT scans and plain radiographs were evaluated regarding mechanisms of injuries. Injuries were categorized as primary, secondary, tertiary and quaternary. The number of shrapnel and distribution of injuries were noted. Injury Severity Score (ISS) was used to rank the severity of the injury. Results: Primary blast injuries consisted of only tympanic membrane rupture. A high rate of patients (21/28 patients) in the study group suffered from secondary blast injuries. Tertiary injuries were detected in only three patients. Of the severely injured patients, five had abdominal injuries, three had thoracic injuries and six had extremity injuries. ISS was significantly higher in patients with thoracic and abdominal injuries. Conclusion: Our results after the suicide bomb attacks showed that the most common injury pattern was secondary blast injury. The torso was the most commonly injured body region, followed by the extremities. This specific injury pattern requires the use of immense radiological imaging. Hence, radiologists should be aware of the mechanisms and spectrums of blast-related injuries. Advances in knowledge: Both the unique injury pattern and the following chaos make blast-related injuries a challenge in terms of triage, diagnosis and management. Radiologists should be familiar with the wide spectrum of these unique injuries. PMID:26959613

Urinary Incontinence Symptoms and Impact on Quality of Life in Patients Seeking Outpatient Physical Therapy Services

PubMed Central

Alappattu, Meryl; Neville, Cynthia; Beneciuk, Jason; Bishop, Mark

2016-01-01

Objective The objective of this study was to examine the frequency and types of urinary incontinence (UI) in patients seeking outpatient physical therapy for neuro-musculoskeletal conditions. Design Retrospective cross-sectional analysis. Patients A convenience sample of patients that positively responded to a UI screening question were included in this study. Methods Data were collected for age, sex, and primary treatment condition classified into one of the following (i.e. urinary dysfunction; fecal dysfunction; pelvic pain; spine; neurological disorders; or extremity disorders); UI type (i.e. mixed, urge, stress, or insensible); UI symptom severity; and quality of life impact. Main Outcome Measures Frequency of UI type, symptom severity, health-related quality of life (HRQoL) impact, and pad use were compared between treatment groups. Results The mean age of the sample (n=599) was 49.8 years (SD=18.5) and 94.7% were female. The urinary dysfunction group comprised 44.2% of the total sample, followed by the spine group with 25.7%, and pelvic pain with 17.2%. The urinary dysfunction group scored significantly higher on UI symptom severity and impact on quality of life compared to the pelvic pain and spine groups, but not compared to the extremity disorders, fecal dysfunction, or neurological disorders group. Conclusion These preliminary data indicate that UI is a condition afflicting many individuals who present to outpatient physical therapy beyond those seeking care for UI. We recommend using a simple screening measure for UI and its impact on HRQoL as part of a routine initial evaluation in outpatient physical therapy settings. PMID:26863987

Urinary incontinence symptoms and impact on quality of life in patients seeking outpatient physical therapy services.

PubMed

Alappattu, Meryl; Neville, Cynthia; Beneciuk, Jason; Bishop, Mark

2016-01-01

The objective of this study was to examine the frequency and types of urinary incontinence (UI) in patients seeking outpatient physical therapy for neuro-musculoskeletal conditions. Retrospective cross-sectional analysis. A convenience sample of patients that positively responded to a UI screening question was included in this study. Data were collected for age, sex, and primary treatment condition classified into one of the following (i.e., urinary dysfunction, fecal dysfunction, pelvic pain, spine, neurological disorders, or extremity disorders); UI type (i.e., mixed, urge, stress, or insensible); UI symptom severity; and quality of life (QoL) impact. Frequency of UI type, symptom severity, health-related quality of life (HRQoL) impact, and pad use were compared between treatment groups. The mean age of the sample (n = 599) was 49.8 years (SD = 18.5) and 94.7% were female. The urinary dysfunction group comprised 44.2% of the total sample, followed by the spine group with 25.7% and pelvic pain with 17.2%. The urinary dysfunction group scored significantly higher on UI symptom severity and impact on QoL compared to the pelvic pain and spine groups, but not compared to the extremity disorders, fecal dysfunction, or neurological disorder group. These preliminary data indicate that UI is a condition afflicting many individuals who present to outpatient physical therapy beyond those seeking care for UI. We recommend using a simple screening measure for UI and its impact on HRQoL as part of a routine initial evaluation in outpatient physical therapy settings.

Projected timing of perceivable changes in climate extremes for terrestrial and marine ecosystems.

PubMed

Tan, Xuezhi; Gan, Thian Yew; Horton, Daniel E

2018-05-26

Human and natural systems have adapted to and evolved within historical climatic conditions. Anthropogenic climate change has the potential to alter these conditions such that onset of unprecedented climatic extremes will outpace evolutionary and adaptive capabilities. To assess whether and when future climate extremes exceed their historical windows of variability within impact-relevant socioeconomic, geopolitical, and ecological domains, we investigate the timing of perceivable changes (time of emergence; TOE) for 18 magnitude-, frequency-, and severity-based extreme temperature (10) and precipitation (8) indices using both multimodel and single-model multirealization ensembles. Under a high-emission scenario, we find that the signal of frequency- and severity-based temperature extremes is projected to rise above historical noise earliest in midlatitudes, whereas magnitude-based temperature extremes emerge first in low and high latitudes. Precipitation extremes demonstrate different emergence patterns, with severity-based indices first emerging over midlatitudes, and magnitude- and frequency-based indices emerging earliest in low and high latitudes. Applied to impact-relevant domains, simulated TOE patterns suggest (a) unprecedented consecutive dry day occurrence in >50% of 14 terrestrial biomes and 12 marine realms prior to 2100, (b) earlier perceivable changes in climate extremes in countries with lower per capita GDP, and (c) emergence of severe and frequent heat extremes well-before 2030 for the 590 most populous urban centers. Elucidating extreme-metric and domain-type TOE heterogeneities highlights the challenges adaptation planners face in confronting the consequences of elevated twenty-first century radiative forcing. © 2018 John Wiley & Sons Ltd.

Progression, Symptoms and Psychosocial Concerns among Those Severely Affected by Multiple Sclerosis: A Mixed-Methods Cross-Sectional Study of Black Caribbean and White British People

PubMed Central

Koffman, Jonathan; Gao, Wei; Goddard, Cassie; Burman, Rachel; Jackson, Diana; Shaw, Pauline; Barnes, Fiona; Silber, Eli; Higginson, Irene J.

2013-01-01

Objective Multiple sclerosis is now more common among minority ethnic groups in the UK but little is known about their experiences, especially in advanced stages. We examine disease progression, symptoms and psychosocial concerns among Black Caribbean (BC) and White British (WB) people severely affected by MS. Design Mixed methods study of 43 BC and 43 WB people with MS (PwMS) with an Expanded Disability Status Scale (EDSS) ≥6 involving data from in clinical records, face-to-face structured interviews and a nested-qualitative component. Progression Index (PI) and Multiple Sclerosis Severity Score (MSSS) were calculated. To control for selection bias, propensity scores were derived for each patient and adjusted for in the comparative statistical analysis; qualitative data were analysed using the framework approach. Results Median EDSS for both groups was (6.5; range: 6.0–9.0). Progression Index (PI) and Multiple Sclerosis Severity Score (MSSS) based on neurological assessment of current EDSS scores identified BC PwMS were more likely to have aggressive disease (PI F = 4.04, p = 0.048, MSSS F = 10.30, p<0.001). Patients’ reports of the time required to reach levels of functional decline equivalent to different EDSS levels varied by group; EDSS 4: BC 2.7 years v/s WB 10.2 years (U = 258.50, p = 0.013), EDSS 6∶6.1 years BC v/s WB 12.7 years (U = 535.500, p = 0.011), EDSS 8: BC 8.7 years v/s WB 10.2 years. Both groups reported high symptom burden. BC PwMS were more cognitively impaired than WB PwMS (F = 9.65, p = 0.003). Thematic analysis of qualitative interviews provides correspondence with quantitative findings; more BC than WB PwMS referred to feelings of extreme frustration and unresolved loss/confusion associated with their rapidly advancing disease. The interviews also reveal the centrality, meanings and impact of common MS-related symptoms. Conclusions Delays in diagnosis should be avoided and more frequent reviews may be justified by healthcare services. Culturally acceptable interventions to better support people who perceive MS as an assault on identity should be developed to help them achieve normalisation and enhance self-identity. PMID:24098384

Progression, symptoms and psychosocial concerns among those severely affected by multiple sclerosis: a mixed-methods cross-sectional study of Black Caribbean and White British people.

PubMed

Koffman, Jonathan; Gao, Wei; Goddard, Cassie; Burman, Rachel; Jackson, Diana; Shaw, Pauline; Barnes, Fiona; Silber, Eli; Higginson, Irene J

2013-01-01

Multiple sclerosis is now more common among minority ethnic groups in the UK but little is known about their experiences, especially in advanced stages. We examine disease progression, symptoms and psychosocial concerns among Black Caribbean (BC) and White British (WB) people severely affected by MS. Mixed methods study of 43 BC and 43 WB people with MS (PwMS) with an Expanded Disability Status Scale (EDSS) ≥6 involving data from in clinical records, face-to-face structured interviews and a nested-qualitative component. Progression Index (PI) and Multiple Sclerosis Severity Score (MSSS) were calculated. To control for selection bias, propensity scores were derived for each patient and adjusted for in the comparative statistical analysis; qualitative data were analysed using the framework approach. Median EDSS for both groups was (6.5; range: 6.0-9.0). Progression Index (PI) and Multiple Sclerosis Severity Score (MSSS) based on neurological assessment of current EDSS scores identified BC PwMS were more likely to have aggressive disease (PI F = 4.04, p = 0.048, MSSS F = 10.30, p<0.001). Patients' reports of the time required to reach levels of functional decline equivalent to different EDSS levels varied by group; EDSS 4: BC 2.7 years v/s WB 10.2 years (U = 258.50, p = 0.013), EDSS 6∶6.1 years BC v/s WB 12.7 years (U = 535.500, p = 0.011), EDSS 8: BC 8.7 years v/s WB 10.2 years. Both groups reported high symptom burden. BC PwMS were more cognitively impaired than WB PwMS (F = 9.65, p = 0.003). Thematic analysis of qualitative interviews provides correspondence with quantitative findings; more BC than WB PwMS referred to feelings of extreme frustration and unresolved loss/confusion associated with their rapidly advancing disease. The interviews also reveal the centrality, meanings and impact of common MS-related symptoms. Delays in diagnosis should be avoided and more frequent reviews may be justified by healthcare services. Culturally acceptable interventions to better support people who perceive MS as an assault on identity should be developed to help them achieve normalisation and enhance self-identity.

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

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.

Bicyclists injured by automobiles: relationship of age to injury type and severity--a national trauma databank analysis.

PubMed

Lustenberger, Thomas; Inaba, Kenji; Talving, Peep; Barmparas, Galinos; Schnüriger, Beat; Green, Donald; Plurad, David; Demetriades, Demetrios

2010-11-01

Bicycle riding is a popular recreational activity and a common mode of transportation. Impact with a motor vehicle, however, has the potential to result in significant injury to the rider. The magnitude of this problem, the incidence and types of injuries, and the effect of age on these variables are poorly defined in the literature. This was a National Trauma Databank study during a 5-year period. Injury Severity Score (ISS), specific injuries sustained by riders, and outcomes were analyzed according to age groups (≤ 14 years, 15-35 years, 36-55 years, 56-65 years, and >65 years). During the study period, there were 12,429 admissions as a result of bicycle-related injuries involving motor vehicles (0.7% of all trauma admissions). There were 4,095 patients (32.9%) ≤ 14 years, 3,806 (30.7%) 15 to 35 years, 3,413 (27.5%) 36 to 55 years, 688 (5.5%) 56 to 65 years, and 427 (3.4%) >65 years. The incidence of severe or critical trauma (ISS ≥ 16) in the five age strata was 20.3%, 19.2%, 26.4%, 33.4%, and 38.2%, respectively (p < 0.001). The most commonly encountered injuries consisted of extremity fractures (34.9%). Patients ≤ 14 years old were significantly more likely to suffer fractures to the lower extremity and less likely to sustain fractures to the upper extremity. The overall incidence of head injury was 28.3% and increased in a stepwise fashion with increasing age, ranging from 26.5% in the age stratum 15 to 35 years to 38.6% in the age stratum >65 years, p < 0.001. The overall mortality was 3.7% and ranged from 2.4% in the age stratum ≤ 14 years, to 12.2% in the stratum >65 years. After adjusting for differences in age groups, there was a stepwise increase in the risk of death for bicyclists >65 years old who were 10-fold more likely to die than those ≤ 14 years old (adj. p < 0.001). Bicycle-related injuries involving motor vehicles are associated with a high incidence of head injuries and extremity fractures. Age plays a critical role in the severity and anatomic distribution of injuries sustained, with a stepwise increase in mortality with increasing age. Further evaluation of specific preventative measures, especially for elderly bicyclists is warranted.

Changing Neurodevelopment at 8 Years in Children Born Extremely Preterm Since the 1990s.

PubMed

Cheong, Jeanie L Y; Anderson, Peter J; Burnett, Alice C; Roberts, Gehan; Davis, Noni; Hickey, Leah; Carse, Elizabeth; Doyle, Lex W

2017-06-01

Survival of extremely preterm (EP; <28 weeks' gestation) infants has increased over the last 2 decades. Equivalent reductions in developmental morbidity in early childhood have not been consistently reported. The aim of this study was to determine trends in neurodevelopmental outcomes at 8 years of age of children born EP (22-27 completed weeks' gestation) over the past 2 decades. Population-based cohorts of all EP survivors born in the state of Victoria, Australia in 1991-1992, 1997, and 2005 were recruited at birth. At 8 years of age, general intelligence (IQ), academic achievement, and neurosensory status were assessed. Major neurosensory disability was defined as any of moderate or severe cerebral palsy, IQ <-2 SD relative to term controls, blindness, or deafness. Rates of major neurosensory disability were similar in all eras (1991-1992, 18%; 1997, 15%; 2005, 18%), as were rates of IQ <-2 SD, cerebral palsy, blindness, and deafness. Mean z scores for IQ were similar across eras, but there was some evidence that scores for academic achievement were lower in 2005 than in 1997, and the odds of having academic problems were higher in 2005 than in both earlier eras. These outcomes were not explained by differences in known perinatal care or sociodemographic variables between eras. Contrary to expectations, rates of major neurosensory disability have not improved, and academic performance is poorer at early school age in 2005 than in earlier eras for EP children born in the state of Victoria, Australia. Copyright © 2017 by the American Academy of Pediatrics.

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

Evaluation of WRF-based convection-permitting multi-physics ensemble forecasts over China for an extreme rainfall event on 21 July 2012 in Beijing

NASA Astrophysics Data System (ADS)

Zhu, Kefeng; Xue, Ming

2016-11-01

On 21 July 2012, an extreme rainfall event that recorded a maximum rainfall amount over 24 hours of 460 mm, occurred in Beijing, China. Most operational models failed to predict such an extreme amount. In this study, a convective-permitting ensemble forecast system (CEFS), at 4-km grid spacing, covering the entire mainland of China, is applied to this extreme rainfall case. CEFS consists of 22 members and uses multiple physics parameterizations. For the event, the predicted maximum is 415 mm d-1 in the probability-matched ensemble mean. The predicted high-probability heavy rain region is located in southwest Beijing, as was observed. Ensemble-based verification scores are then investigated. For a small verification domain covering Beijing and its surrounding areas, the precipitation rank histogram of CEFS is much flatter than that of a reference global ensemble. CEFS has a lower (higher) Brier score and a higher resolution than the global ensemble for precipitation, indicating more reliable probabilistic forecasting by CEFS. Additionally, forecasts of different ensemble members are compared and discussed. Most of the extreme rainfall comes from convection in the warm sector east of an approaching cold front. A few members of CEFS successfully reproduce such precipitation, and orographic lift of highly moist low-level flows with a significantly southeasterly component is suggested to have played important roles in producing the initial convection. Comparisons between good and bad forecast members indicate a strong sensitivity of the extreme rainfall to the mesoscale environmental conditions, and, to less of an extent, the model physics.

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

Representing Extremes in Agricultural Models

NASA Technical Reports Server (NTRS)

Ruane, Alex

2015-01-01

AgMIP and related projects are conducting several activities to understand and improve crop model response to extreme events. This involves crop model studies as well as the generation of climate datasets and scenarios more capable of capturing extremes. Models are typically less responsive to extreme events than we observe, and miss several forms of extreme events. Models also can capture interactive effects between climate change and climate extremes. Additional work is needed to understand response of markets and economic systems to food shocks. AgMIP is planning a Coordinated Global and Regional Assessment of Climate Change Impacts on Agricultural Production and Food Security with an aim to inform the IPCC Sixth Assessment Report.

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.

The impact of tics, obsessive-compulsive symptoms, and impulsivity on global functioning in Tourette syndrome.

PubMed

Kano, Yukiko; Kono, Toshiaki; Matsuda, Natsumi; Nonaka, Maiko; Kuwabara, Hitoshi; Shimada, Takafumi; Shishikura, Kurie; Konno, Chizue; Ohta, Masataka

2015-03-30

This study investigated the relationships between tics, obsessive-compulsive symptoms (OCS), and impulsivity, and their effects on global functioning in Japanese patients with Tourette syndrome (TS), using the dimensional approach for OCS. Fifty-three TS patients were assessed using the Yale Global Tic Severity Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Impulsivity Rating Scale, and the Global Assessment of Functioning Scale. Although tic severity scores were significantly and positively correlated with OCS severity scores, impulsivity severity scores were not significantly correlated with either. The global functioning score was significantly and negatively correlated with tic and OCS severity scores. Of the 6 dimensional OCS scores, only aggression scores had a significant negative correlation with global functioning scores. A stepwise multiple regression analysis showed that only OCS severity scores were significantly associated with global functioning scores. Despite a moderate correlation between tic severity and OCS severity, the impact of OCS on global functioning was greater than that of tics. Of the OCS dimensions, only aggression had a significant impact on global functioning. Our findings suggest that it is important to examine OCS using a dimensional approach when analyzing global functioning in TS patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Evaluation of the DSM-5 Severity Indicator for Bulimia Nervosa

PubMed Central

Grilo, Carlos M.; Ivezaj, Valentina; White, Marney A.

2015-01-01

This study examined the DSM-5 severity criterion for bulimia nervosa (BN) based on the frequency of inappropriate weight compensatory behaviors. 199 community volunteers classified with BN were categorized using DSM-5 severity levels and compared on demographic and clinical variables. 77 (39%) participants were categorized as mild, 68 (34%) as moderate, 32 (16%) as severe, and 22 (11%) as extreme. The severity groups did not differ significantly in demographic variables or body mass index. Shape and Weight concerns did not differ significantly across severity groups. Binge eating differed with the extreme group having higher frequency than the severe, moderate, and mild groups, which did not differ from each other. Restraint differed with the extreme group having significantly higher levels than the mild group. Eating concerns differed with the extreme group having higher levels than moderate and mild groups. Depression differed with the extreme group having higher levels than severe, moderate, and mild groups, which did not differ from each other. Findings from this non-clinical group provide new, albeit modest, support for DSM-5 severity rating for BN based on frequency of inappropriate weight compensatory behaviors. Statistical findings indicate that differences in collateral clinical variables associated with the DSM-5 severity ratings reflect small effect sizes. Further research is needed with treatment-seeking patient groups with BN to establish the validity of the DSM-5 severity specifier and should include broader clinical and functional validators. PMID:25744910

Evaluation of the DSM-5 severity indicator for bulimia nervosa.

PubMed

Grilo, Carlos M; Ivezaj, Valentina; White, Marney A

2015-04-01

This study examined the DSM-5 severity criterion for bulimia nervosa (BN) based on the frequency of inappropriate weight compensatory behaviors. 199 community volunteers classified with BN were categorized using DSM-5 severity levels and compared on demographic and clinical variables. 77 (39%) participants were categorized as mild, 68 (34%) as moderate, 32 (16%) as severe, and 22 (11%) as extreme. The severity groups did not differ significantly in demographic variables or body mass index. Shape and Weight concerns did not differ significantly across severity groups. Binge eating differed with the extreme group having significantly higher frequency than the severe, moderate, and mild groups, which did not differ from each other. Restraint differed with the extreme group having significantly higher levels than the mild group. Eating concerns differed with the extreme group having significantly higher levels than moderate and mild groups. Depression differed with the extreme group having significantly higher levels than severe, moderate, and mild groups, which did not differ from each other. Findings from this non-clinical group provide new, albeit modest, support for DSM-5 severity rating for BN based on frequency of inappropriate weight compensatory behaviors. Statistical findings indicate that differences in collateral clinical variables associated with the DSM-5 severity ratings reflect small effect sizes. Further research is needed with treatment-seeking patient groups with BN to establish the validity of the DSM-5 severity specifier and should include broader clinical and functional validators. Copyright © 2015 Elsevier Ltd. All rights reserved.

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.

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.

More tornadoes in the most extreme U.S. tornado outbreaks

NASA Astrophysics Data System (ADS)

Tippett, Michael K.; Lepore, Chiara; Cohen, Joel E.

2016-12-01

Tornadoes and severe thunderstorms kill people and damage property every year. Estimated U.S. insured losses due to severe thunderstorms in the first half of 2016 were $8.5 billion (US). The largest U.S. effects of tornadoes result from tornado outbreaks, which are sequences of tornadoes that occur in close succession. Here, using extreme value analysis, we find that the frequency of U.S. outbreaks with many tornadoes is increasing and that it is increasing faster for more extreme outbreaks. We model this behavior by extreme value distributions with parameters that are linear functions of time or of some indicators of multidecadal climatic variability. Extreme meteorological environments associated with severe thunderstorms show consistent upward trends, but the trends do not resemble those currently expected to result from global warming.

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.

Dynamic balance performance and noncontact lower extremity injury in college football players: an initial study.

PubMed

Butler, Robert J; Lehr, Michael E; Fink, Michael L; Kiesel, Kyle B; Plisky, Phillip J

2013-09-01

Field expedient screening tools that can identify individuals at an elevated risk for injury are needed to minimize time loss in American football players. Previous research has suggested that poor dynamic balance may be associated with an elevated risk for injury in athletes; however, this has yet to be examined in college football players. To determine if dynamic balance deficits are associated with an elevated risk of injury in collegiate football players. It was hypothesized that football players with lower performance and increased asymmetry in dynamic balance would be at an elevated risk for sustaining a noncontact lower extremity injury. Prospective cohort study. Fifty-nine collegiate American football players volunteered for this study. Demographic information, injury history, and dynamic balance testing performance were collected, and noncontact lower extremity injuries were recorded over the course of the season. Receiver operator characteristic curves were calculated based on performance on the Star Excursion Balance Test (SEBT), including composite score and asymmetry, to determine the population-specific risk cut-off point. Relative risk was then calculated based on these variables, as well as previous injury. A cut-off point of 89.6% composite score on the SEBT optimized the sensitivity (100%) and specificity (71.7%). A college football player who scored below 89.6% was 3.5 times more likely to get injured. Poor performance on the SEBT may be related to an increased risk for sustaining a noncontact lower extremity injury over the course of a competitive American football season. College football players should be screened preseason using the SEBT to identify those at an elevated risk for injury based upon dynamic balance performance to implement injury mitigation strategies to this specific subgroup of athletes.

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.

Musculoskeletal Pain, Self-reported Physical Function, and Quality of Life in the Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Cohort

PubMed Central

Bout-Tabaku, Sharon; Michalsky, Marc P.; Jenkins, Todd M.; Baughcum, Amy; Zeller, Meg H.; Brandt, Mary L.; Courcoulas, Anita; Buncher, Ralph; Helmrath, Michael; Harmon, Carroll M.; Chen, Mike K.; Inge, Thomas H.

2015-01-01

IMPORTANCE Obesity is associated with chronic musculoskeletal pain and is a risk factor for disability and osteoarthritis. OBJECTIVES To describe the prevalence, sites, and intensity of musculoskeletal pain in adolescents with severe obesity; to evaluate associations between musculoskeletal pain and self-reported physical function as well as weight-related quality of life; and to evaluate the association between musculoskeletal pain and high-sensitivity C-reactive protein level. DESIGN, SETTING, AND PARTICIPANTS Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS) is a prospective, observational study that collects standardized data on adolescents undergoing weight loss surgery at 5 US centers. We examined baseline data from this cohort between February 28, 2007, and December 30, 2011. We excluded adolescents with Blount disease and slipped capital femoral epiphyses. A total of 233 participants were included in these analyses. MAIN OUTCOMES AND MEASURES We assessed musculoskeletal pain and pain intensity of the lower back, hips, knees, and ankles/feet using the visual analog scale, categorizing musculoskeletal pain into lower back pain, lower extremity (hips, knees, and feet/ankles combined) pain, and no pain. We assessed self-reported physical function status with the Health Assessment Questionnaire Disability Index and assessed weight-related quality of life with the Impact of Weight on Quality of Life–Kids measure. We adjusted for sex, race, age at surgery, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and clinical depressive symptoms in regression analyses. RESULTS Among the 233 participants, the mean (SD) age at surgery was 17.1 (1.56) years and the median BMI was 50.4. Participants were predominantly female (77%), white (73%), and non-Hispanic (93%). Among the participants, 49% had poor functional status and 76% had musculoskeletal pain. Lower back pain was prevalent (63%), followed by ankle/foot (53%), knee (49%), and hip (31%) pain; 26% had pain at all 4 sites. In adjusted analyses, compared with pain-free participants, those reporting lower extremity pain had greater odds of having poor physical function according to scores on the Health Assessment Questionnaire Disability Index (odds ratio = 2.82; 95% CI, 1.35 to 5.88; P < .01). Compared with pain-free participants, those reporting lower extremity pain had significantly lower Impact of Weight on Quality of Life–Kids total scores (β = −9.42; 95% CI, −14.15 to −4.69; P < .01) and physical comfort scores (β = −17.29; 95% CI, −23.32 to −11.25; P < .01). After adjustment, no significant relationship was observed between musculoskeletal pain and high-sensitivity C-reactive protein level. CONCLUSIONS AND RELEVANCE Adolescents with severe obesity have musculoskeletal pain that limits their physical function and quality of life. Longitudinal follow-up will reveal whether weight loss surgery reverses pain and physical functional limitations and improves quality of life. PMID:25915190

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.

Malnutrition Has No Effect on the Timing of Human Tooth Formation

PubMed Central

Elamin, Fadil; Liversidge, Helen M.

2013-01-01

The effect of nutrition on the timing of human tooth formation is poorly understood. Delays and advancements in dental maturation have all been reported as well as no effect. We investigated the effect of severe malnutrition on the timing of human tooth formation in a large representative sample of North Sudanese children. The sample (1102 males, 1013 females) consisted of stratified randomly selected healthy individuals in Khartoum, Sudan, aged 2-22 years using a cross-sectional design following the STROBE statement. Nutritional status was defined using WHO criteria of height and weight. Body mass index Z-scores and height for age Z-scores of ≤−2 (cut-off) were used to identify the malnourished group (N = 474) while the normal was defined by Z-scores of ≥0 (N = 799). Clinical and radiographic examination of individuals, with known ages of birth was performed including height and weight measurements. Mandibular left permanent teeth were assessed using eight crown and seven root established tooth formation stages. Mean age at entry and mean age within tooth stages were calculated for each available tooth stage in each group and compared using a t-test. Results show the mean age at entry and mean age within tooth stages were not significantly different between groups affected by severe malnutrition and normal children (p>0.05). This remarkable finding was evident across the span of dental development. We demonstrate that there is little measurable effect of sustained malnutrition on the average timing of tooth formation. This noteworthy finding supports the notion that teeth have substantial biological stability and are insulated from extreme nutritional conditions compared to other maturing body systems. PMID:24023614

Modification of a sonographic enthesitis score to differentiate between psoriatic arthritis and young healthy volunteers.

PubMed

Wervers, K; Vis, M; Rasappu, N; van der Ven, M; Tchetverikov, I; Kok, M R; Gerards, A H; Hazes, Jmw; Luime, J J

2018-01-02

We aimed to describe sonographic structural and inflammatory changes in entheses of patients with recently diagnosed psoriatic arthritis (PsA), patients with established PsA, and young healthy volunteers, and to investigate whether the MAdrid Sonographic Enthesitis Index (MASEI) enables us to distinguish these groups in an extreme comparison. New and established PsA patients and healthy volunteers (aged 20-30 years) were recruited. The triceps, quadriceps, patellar, Achilles and elbow extensor tendon insertion, and plantar fascia entheses were investigated sonographically for structural changes, erosions, calcifications, increased thickness, bursitis, and power Doppler (PD) signal according to the MASEI. The study included 25 new and 25 established PsA patients, and 25 healthy volunteers. Increased thickness and PD signal in knee entheses were common for patients and healthy volunteers, while changes at other locations predominantly occurred in patients only. PD was recoded (1, one spot; 1.5, two or three spots; 2, confluent signal; 3, severe confluent signal) and thickness of knee entheses excluded. This resulted in different modified MASEI scores between PsA patients and young healthy controls: median (interquartile range) modified MASEI of 13 (10-22.5) in new PsA, 13.5 (9.5-18) in established PsA, and 3 (1-8.5) in healthy volunteers (p = 0.002). Structural ultrasound changes and PD in entheses are common in both new and established PsA and healthy controls. MASEI score did not differentiate PsA patients from young healthy volunteers. After recoding of PD severity and excluding thickness of knee entheses, marked differences between PsA patients and healthy controls were observed.

Development and validation of a clinically applicable score to classify cachexia stages in advanced cancer patients

PubMed Central

Zhou, Ting; Wang, Bangyan; Liu, Huiquan; Yang, Kaixiang; Thapa, Sudip; Zhang, Haowen; Li, Lu

2018-01-01

Abstract Background Cachexia is a multifactorial syndrome that is highly prevalent in advanced cancer patients and leads to progressive functional impairments. The classification of cachexia stages is essential for diagnosing and treating cachexia. However, there is a lack of simple tools with good discrimination for classifying cachexia stages. Therefore, our study aimed to develop a clinically applicable cachexia staging score (CSS) and validate its discrimination of clinical outcomes for different cachexia stages. Methods Advanced cancer patients were enrolled in our study. A CSS comprising the following five components was developed: weight loss, a simple questionnaire of sarcopenia (SARC‐F), Eastern Cooperative Oncology Group, appetite loss, and abnormal biochemistry. According to the CSS, patients were classified into non‐cachexia, pre‐cachexia, cachexia, and refractory cachexia stages, and clinical outcomes were compared among the four groups. Results Of the 297 participating patients, data from 259 patients were ultimately included. Based on the CSS, patients were classified into non‐cachexia (n = 69), pre‐cachexia (n = 68), cachexia (n = 103), and refractory cachexia (n = 19) stages. Patients with more severe cachexia stages had lower skeletal muscle indexes (P = 0.002 and P = 0.004 in male and female patients, respectively), higher prevalence of sarcopenia (P = 0.017 and P = 0.027 in male and female patients, respectively), more severe symptom burden (P < 0.001), poorer quality of life (P < 0.001 for all subscales except social well‐being), and shorter survival times (P < 0.001). Conclusions The CSS is a simple and clinically applicable tool with excellent discrimination for classifying cachexia stages. This score is extremely useful for the clinical treatment and prognosis of cachexia and for designing clinical trials. PMID:29372594

Reliability, Validity, and Sensitivity to Change Overtime of the Modified Melasma Area and Severity Index Score.

PubMed

Abou-Taleb, Doaa A E; Ibrahim, Ahmed K; Youssef, Eman M K; Moubasher, Alaa E A

2017-02-01

The new modified Melasma Area and Severity Index (mMASI) score, the recently used outcome measure for melasma, has not been tested to determine its sensitivity to change in melasma. To determine the reliability, validity, and sensitivity to change overtime of the mMASI score in assessment of the severity of melasma. Pearson correlation, Cronbach alpha, and intraclass correlation coefficient were calculated to assess the reliability of the mMASI score. Validity of the mMASI scale was carried out using Spearman correlation between mMASI total score (before and after treatment), clinical data, and patient's responses. The mMASI score showed excellent reliability and good validity for assessment of the severity of melasma. The authors also determined that the mMASI score demonstrated sensitivity to change over time. An excellent degree of agreement between the mMSAI and MASI scores was revealed. The mMASI score is reliable, valid, and responsive to change in the assessment of severity of melasma. Moreover, the mMASI score was found to be easier to learn and perform and simpler in calculation compared with the MASI score. Overall, the mMASI score can effectively replace the MASI score.

''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.

Influence of manual lymphatic drainage on health-related quality of life and symptoms of chronic venous insufficiency: a randomized controlled trial.

PubMed

dos Santos Crisóstomo, Rute Sofia; Costa, Daniela Sofia Albino; de Luz Belo Martins, Catarina; Fernandes, Tânia Isabel Russo; Armada-da-Silva, Paulo A

2015-02-01

To evaluate the efficacy of manual lymphatic drainage (MLD) in improving health-related quality of life (HRQOL), symptomatology, and physical status in patients with chronic venous insufficiency (CVI). Single-blind randomized controlled trial. Health community attendant service. Subjects with CVI (N=41) were randomly assigned to an experimental group (n=20; mean age, 54.6±11.3y) or control group (n=21; mean age, 46.8±11.1y). The experimental group completed 10 lower extremity MLD sessions over 4 weeks and 1 educational session. The control group only attended the educational session. Outcome measures were taken at baseline (t0), at the end of 4 weeks (t1), and after 2 months for follow-up (t2). HRQOL was assessed with the Chronic Venous Insufficiency Quality of Life Questionnaire-20, symptoms (fatigue, heaviness) were assessed with a visual analog scale, severity of the disease was assessed with the Venous Clinical Severity Score (VCSS) (total score, score for each item), leg volumetry was assessed with perimeters, and plantar/dorsiflexion strength and ankle range of motion (ROM) were assessed with dynamometry. A significant interaction group×time effect was found for pain on HRQOL (F2,78=3.507; P=.035; partial η2=.087), clinical severity (F2,78=5.231; P=.007; partial η2=.118), especially for venous edema (assessed with the VCSS), fatigue (F1.67,65.21=4.690; P=.012; partial η2=.107), and heaviness (F1.57,61.32=9.702; P=.001; partial η2=.199), with the experimental group improving from t0 to t1 and t0 to t2 in all of these outcomes. No effect of MLD treatment could be found for ankle muscle strength, ankle ROM, and leg volume. Short-term MLD treatment ameliorates CVI severity and related edema, symptoms, and pain HRQOL in patients with CVI. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

A comparison of EuroQol 5-Dimension health-related utilities using Italian, UK, and US preference weights in a patient sample.

PubMed

Mozzi, Adelaide; Meregaglia, Michela; Lazzaro, Carlo; Tornatore, Valentina; Belfiglio, Maurizio; Fattore, Giovanni

2016-01-01

Weights associated with the EuroQol 5-Dimension 3-Level (EQ-5D-3L) instrument represent preferences for health states elicited from general population's samples. Weights have not been calculated for every country; however, empirical research shows that cross-country differences exist. This empirical study aims at investigating the impact of recently developed Italian weights in comparison with UK and US scores on health-related utility calculation using a sample of patients with Crohn's disease. The study is based on a survey on health-related quality of life in patients (n=552) affected by active Crohn's disease conducted in Italy from 2012 to 2013. Utilities computed through the Italian algorithm (mean: 0.76; SD: 0.20; median: 0.81) are generally higher than US (mean: 0.69; SD: 0.22; median: 0.77) and UK (mean: 0.57; SD: 0.32; median: 0.69) utilities, except for extremely severe health states where US values outweigh the Italian ones. UK preference weights generate the highest number of negative results. All the three value distributions are left-skewed due to very low scores associated with the most serious health states (ie, three or four levels equal to 3). As expected, despite the tariff set considered, more severe disease (Harvey Bradshaw Index >16) reduces the mean conditional EQ-5D-3L index (P<0.0001). Kendall's rank correlation between EQ Visual Analog Scale score and EQ-5D-3L index is positive (P<0.0001), even though patients tend to value their health-related quality of life more when responding to EQ-5D-3L questions than on EQ Visual Analog Scale. Regardless of the tariff set considered, ordinary least-square results highlight that more severe disease (Harvey Bradshaw Index >16) reduces the mean conditional EQ-5D-3L index (P<0.0001). Results reveal remarkable differences among the three national tariff sets and especially when severe health states occur, suggesting the need for country-specific preference weights when evaluating utilities, which can be problematic since they have not been calculated for every country yet.

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.

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.

Scores on Riley's stuttering severity instrument versions three and four for samples of different length and for different types of speech material.

PubMed

Todd, Helena; Mirawdeli, Avin; Costelloe, Sarah; Cavenagh, Penny; Davis, Stephen; Howell, Peter

2014-12-01

Riley stated that the minimum speech sample length necessary to compute his stuttering severity estimates was 200 syllables. This was investigated. Procedures supplied for the assessment of readers and non-readers were examined to see whether they give equivalent scores. Recordings of spontaneous speech samples from 23 young children (aged between 2 years 8 months and 6 years 3 months) and 31 older children (aged between 10 years 0 months and 14 years 7 months) were made. Riley's severity estimates were scored on extracts of different lengths. The older children provided spontaneous and read samples, which were scored for severity according to reader and non-reader procedures. Analysis of variance supported the use of 200-syllable-long samples as the minimum necessary for obtaining severity scores. There was no significant difference in SSI-3 scores for the older children when the reader and non-reader procedures were used. Samples that are 200-syllables long are the minimum that is appropriate for obtaining stable Riley's severity scores. The procedural variants provide similar severity scores.

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

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.

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.

More tornadoes in the most extreme U.S. tornado outbreaks.

PubMed

Tippett, Michael K; Lepore, Chiara; Cohen, Joel E

2016-12-16

Tornadoes and severe thunderstorms kill people and damage property every year. Estimated U.S. insured losses due to severe thunderstorms in the first half of 2016 were $8.5 billion (US). The largest U.S. effects of tornadoes result from tornado outbreaks, which are sequences of tornadoes that occur in close succession. Here, using extreme value analysis, we find that the frequency of U.S. outbreaks with many tornadoes is increasing and that it is increasing faster for more extreme outbreaks. We model this behavior by extreme value distributions with parameters that are linear functions of time or of some indicators of multidecadal climatic variability. Extreme meteorological environments associated with severe thunderstorms show consistent upward trends, but the trends do not resemble those currently expected to result from global warming. Copyright © 2016, American Association for the Advancement of Science.

Increasing comorbidity is associated with worsening physical function and pain after primary total knee arthroplasty.

PubMed

Hilton, Maren E; Gioe, Terence; Noorbaloochi, Siamak; Singh, Jasvinder A

2016-10-07

Previous studies suggested that pre-operative comorbidity was a risk factor for worse outcomes after TKA. To our knowledge, studies have not examined whether postoperative changes in comorbidity impact pain and function outcomes longitudinally. Our objective was to examine if increasing comorbidity postoperatively is associated with worsening physical function and pain after primary total knee arthroplasty (TKA). We performed a retrospective chart review of veterans who had completed Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form-36 (SF36) surveys at regular intervals after primary TKA. Comorbidity was assessed using a variety of scales: validated Charlson comorbidity index score, and a novel Arthroplasty Comorbidity Severity Index score (Including medical index, local musculoskeletal index [including lower extremity and spine] and TKA-related index subscales; higher scores are worse ), at multiple time-points post-TKA. We used mixed model linear regression to examine the association of worsening comorbidity post-TKA with change in WOMAC and SF-36 scores in the subsequent follow-up periods, controlling for age, length of follow-up, and repeated observations. The study cohort consisted of 124 patients with a mean age of 71.7 years (range 58.6-89.2, standard deviation (SD) 6.9) followed for a mean of 4.9 years post-operatively (range 1.3-11.4; SD 2.8). We found that post-operative worsening of the Charlson Index score was significantly associated with worsening SF-36 Physical Function (PF) (beta coefficient (ß) = -0.07; p < 0.0001), SF-36 Bodily Pain (BP) (ß = -0.06; p = 0.002), and WOMAC PF subscale (ß = 0.08; p < 0.001; higher scores are worse) scores, in the subsequent periods. Worsening novel medical index subscale scores were significantly associated with worsening SF-36 PF scores (ß = -0.03; p = 0.002), SF-36 BP (ß = -0.04; p < 0.001) and showed a non-significant trend for worse WOMAC PF scores (ß = 0.02; p = 0.11) subsequently. Local musculoskeletal index subscale scores were significantly associated with worsening SF-36 PF (ß = -0.05; p = 0.001), SF-36 BP (ß = -0.04; p = 0.03) and WOMAC PF (ß = 0.06; p = 0.01) subsequently. None of the novel index subscale scores were significantly associated with WOMAC pain scores. TKA complications, as assessed by TKA-related index subscale,  were not significantly associated with SF-36 or WOMAC domain scores. Increasing Charlson index as well as novel medical and local musculoskeletal index subscale scores (from novel Arthroplasty  Comorbidity Severity Index) post-TKA correlated with subsequent worsening of physical function and pain outcomes post-TKA. Further studies should examine which comorbidity management could have the greatest impact on these outcomes.

Deletion 2q37 syndrome: Cognitive-behavioral trajectories and autistic features related to breakpoint and deletion size.

PubMed

Fisch, Gene S; Falk, Rena E; Carey, John C; Imitola, Jaime; Sederberg, Maria; Caravalho, Karen S; South, Sarah

2016-09-01

Subtelomeric deletions have been reported in ∼2.5% of individuals with developmental disabilities. Subtelomeric deletion 2q37 has been detected in many individuals diagnosed with intellectual disabilities (ID) and autism spectrum disorders (ASD). Previously, genotype-phenotype correspondences were examined for their relationship to breakpoints 37.1, 37.2, or 37.3. Our purpose was to ascertain whether there were phenotypic differences at these breakpoints, elucidate the cognitive-behavioral phenotype in del2q37, and examine the genotype-phenotype association in the deletion with respect to cognitive-behavioral profiles and ASD. We administered a comprehensive cognitive-behavioral battery to nine children diagnosed with del 2q37, ages 3.9-17.75 years. ID for five tested with the Stanford-Binet (4th Edition) (SBFE) ranged from severe to mild [IQ Range: 36-59]. Adaptive behavior scores from the Vineland Adaptive Behavior Scale (VABS) were much below adequate levels (DQ Range: floor value ["19"] to 55). Autism scores from the Child Autism Rating Scale (CARS) ranged from 22 [non-autistic] to 56 [extremely autistic]; 5/8 [63%] children received scores on the autism spectrum. Participants with the largest deletions, 10.1 and 9.5 Mb, attained the highest IQ and DQ scores while those with the smallest deletions, 7.9 and 6.6 Mb, made the lowest IQ and DQ scores. No association between deletion breakpoint and phenotype were found. Assessment of the various deleted regions suggested histone deacetylase 4 gene (HDAC4) was a likely candidate gene for ASD in our sample. However, two earlier reports found no association between HDAC4 haploinsufficiency and ASD. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Association of Neurodevelopmental Outcomes and Neonatal Morbidities of Extremely Premature Infants With Differential Exposure to Antenatal Steroids.

PubMed

Chawla, Sanjay; Natarajan, Girija; Shankaran, Seetha; Pappas, Athina; Stoll, Barbara J; Carlo, Waldemar A; Saha, Shampa; Das, Abhik; Laptook, Abbot R; Higgins, Rosemary D

2016-12-01

Many premature infants are born without exposure to antenatal steroids (ANS) or with incomplete courses. This study evaluates the dose-dependent effect of ANS on rates of neonatal morbidities and early childhood neurodevelopmental outcomes of extremely premature infants. To compare rates of neonatal morbidities and 18- to 22-month neurodevelopmental outcomes of extremely premature infants exposed to no ANS or partial or complete courses of ANS. In this observational cohort study, participants were extremely premature infants (birth weight range, 401-1000 g; gestational age, 22-27 weeks) who were born at participating centers of the National Institute of Child Health and Human Development Neonatal Research Network between January 2006 and December 2011. Data were analyzed between October 2013 and May 2016. Rates of death or neurodevelopmental impairment at 18 to 22 months' corrected age. Neurodevelopmental impairment was defined as the presence of any of the following: moderate to severe cerebral palsy, a cognitive score less than 85 on the Bayley Scales of Infant and Toddler Development III, blindness, or deafness. There were 848 infants in the no ANS group, 1581 in the partial ANS group, and 3692 in the complete ANS group; the mean (SD) birth weights were 725 (169), 760 (173), and 753 (170) g, respectively, and the mean (SD) gestational ages were 24.5 (1.4), 24.9 (2), and 25.1 (1.1) weeks. Of 6121 eligible infants, 4284 (70.0%) survived to 18- to 22-month follow-up, and data were available for 3892 of 4284 infants (90.8%). Among the no, partial, and complete ANS groups, there were significant differences in the rates of mortality (43.1%, 29.6%, and 25.2%, respectively), severe intracranial hemorrhage among survivors (23.3%, 19.1%, and 11.7%), death or necrotizing enterocolitis (48.1%, 37.1%, and 32.5%), and death or bronchopulmonary dysplasia (74.9%, 68.9%, and 65.5%). Additionally, death or neurodevelopmental impairment occurred in 68.1%, 54.4%, and 48.1% of patients in the no, partial, and complete ANS groups, respectively. Logistic regression analysis revealed that complete (odds ratio, 0.63; 95% CI, 0.53-0.76) and partial (odds ratio, 0.77; 95% CI, 0.63-0.95) ANS courses were associated with lower rates of death or neurodevelopmental impairment compared with the no ANS group. The reduction in the rate of death or neurodevelopmental impairment associated with exposure to a complete ANS course may be mediated through a reduction in rates of severe intracranial hemorrhage and/or cystic periventricular leukomalacia in the neonatal period. Antenatal steroid exposure was associated with a dose-dependent protective effect against death or neurodevelopmental impairment in extremely preterm infants. The effect was partly mediated by ANS-associated reductions in rates of severe intracranial hemorrhage and/or cystic periventricular leukomalacia. These results support prompt administration of ANS, with the goal of a complete course prior to delivery.

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.

76 FR 75845 - Approval and Promulgation of Implementation Plans; State of Tennessee: Prevention of Significant...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-05

... major stationary thresholds (marginal, moderate, serious, severe, and extreme NAA classifications) and... offset ratios for marginal, moderate, serious, severe, and extreme ozone NAA. EPA finalized regulations...

Virtual Reality to Assess and Treat Lower Extremity Disorders in Post-stroke Patients.

PubMed

Luque-Moreno, C; Oliva-Pascual-Vaca, A; Kiper, P; Rodríguez-Blanco, C; Agostini, M; Turolla, A

2016-01-01

This article is part of the Focus Theme of Methods of Information in Medicine on "Methodologies, Models and Algorithms for Patients Rehabilitation". To identify support of a virtual reality system in the kinematic assessment and physiotherapy approach to gait disorders in individuals with stroke. We adapt Virtual Reality Rehabilitation System (VRRS), software widely used in the functional recovery of the upper limb, for its use on the lower limb of hemiplegic patients. Clinical scales have been used to relate them with the kinematic assessment provided by the system. A description of the use of reinforced feedback provided by the system on the recovery of deficits in several real cases in the field of physiotherapy is performed. Specific examples of functional tasks have been detailed, to be considered in creating intelligent health technologies to improve post-stroke gait. Both participants improved scores on the clinical scales, the kinematic parameters in leg stance on plegic lower extremity and walking speed > Minimally Clinically Important Difference (MCID). The use of the VRRS software attached to a motion tracking capture system showed their practical utility and safety in enriching physiotherapeutic assessment and treatment in post-stroke gait disorders.

Protein Sequence Classification with Improved Extreme Learning Machine Algorithms

PubMed Central

2014-01-01

Precisely classifying a protein sequence from a large biological protein sequences database plays an important role for developing competitive pharmacological products. Comparing the unseen sequence with all the identified protein sequences and returning the category index with the highest similarity scored protein, conventional methods are usually time-consuming. Therefore, it is urgent and necessary to build an efficient protein sequence classification system. In this paper, we study the performance of protein sequence classification using SLFNs. The recent efficient extreme learning machine (ELM) and its invariants are utilized as the training algorithms. The optimal pruned ELM is first employed for protein sequence classification in this paper. To further enhance the performance, the ensemble based SLFNs structure is constructed where multiple SLFNs with the same number of hidden nodes and the same activation function are used as ensembles. For each ensemble, the same training algorithm is adopted. The final category index is derived using the majority voting method. Two approaches, namely, the basic ELM and the OP-ELM, are adopted for the ensemble based SLFNs. The performance is analyzed and compared with several existing methods using datasets obtained from the Protein Information Resource center. The experimental results show the priority of the proposed algorithms. PMID:24795876

[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.

Neuroimaging and Neurodevelopmental Outcome in Extremely Preterm Infants

PubMed Central

Barnes, Patrick D.; Bulas, Dorothy; Slovis, Thomas L.; Finer, Neil N.; Wrage, Lisa A.; Das, Abhik; Tyson, Jon E.; Stevenson, David K.; Carlo, Waldemar A.; Walsh, Michele C.; Laptook, Abbot R.; Yoder, Bradley A.; Van Meurs, Krisa P.; Faix, Roger G.; Rich, Wade; Newman, Nancy S.; Cheng, Helen; Heyne, Roy J.; Vohr, Betty R.; Acarregui, Michael J.; Vaucher, Yvonne E.; Pappas, Athina; Peralta-Carcelen, Myriam; Wilson-Costello, Deanne E.; Evans, Patricia W.; Goldstein, Ricki F.; Myers, Gary J.; Poindexter, Brenda B.; McGowan, Elisabeth C.; Adams-Chapman, Ira; Fuller, Janell; Higgins, Rosemary D.

2015-01-01

BACKGROUND: Extremely preterm infants are at risk for neurodevelopmental impairment (NDI). Early cranial ultrasound (CUS) is usual practice, but near-term brain MRI has been reported to better predict outcomes. We prospectively evaluated MRI white matter abnormality (WMA) and cerebellar lesions, and serial CUS adverse findings as predictors of outcomes at 18 to 22 months’ corrected age. METHODS: Early and late CUS, and brain MRI were read by masked central readers, in a large cohort (n = 480) of infants <28 weeks’ gestation surviving to near term in the Neonatal Research Network. Outcomes included NDI or death after neuroimaging, and significant gross motor impairment or death, with NDI defined as cognitive composite score <70, significant gross motor impairment, and severe hearing or visual impairment. Multivariable models evaluated the relative predictive value of neuroimaging while controlling for other factors. RESULTS: Of 480 infants, 15 died and 20 were lost. Increasing severity of WMA and significant cerebellar lesions on MRI were associated with adverse outcomes. Cerebellar lesions were rarely identified by CUS. In full multivariable models, both late CUS and MRI, but not early CUS, remained independently associated with NDI or death (MRI cerebellar lesions: odds ratio, 3.0 [95% confidence interval: 1.3–6.8]; late CUS: odds ratio, 9.8 [95% confidence interval: 2.8–35]), and significant gross motor impairment or death. In models that did not include late CUS, MRI moderate-severe WMA was independently associated with adverse outcomes. CONCLUSIONS: Both late CUS and near-term MRI abnormalities were associated with outcomes, independent of early CUS and other factors, underscoring the relative prognostic value of near-term neuroimaging. PMID:25554820

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.

Upper Gastrointestinal Hemorrhage: Development of the Severity Score.

PubMed

Chaikitamnuaychok, Rangson; Patumanond, Jayanton

2012-12-01

Emergency endoscopy for every patient with upper gastrointestinal hemorrhage is not possible in many medical centers. Simple guidelines to select patients for emergency endoscopy are lacking. The aim of the present report is to develop a simple scoring system to classify upper gastrointestinal hemorrhage (UGIH) severity based on patient clinical profiles at the emergency departments. Retrospective data of patients with UGIH in a university affiliated hospital were analyzed. Patients were criterion-classified into 3 severity levels: mild, moderate and severe. Clinical and laboratory information were compared among the 3 groups. Significant parameters were selected as indicators of severity. Coefficients of significant multivariable parameters were transformed into item scores, which added up as individual severity scores. The scores were used to classify patients into 3 urgency levels: non-urgent, urgent and emergent groups. Score-classification and criterion-classification were compared. Significant parameters in the model were age ≥ 60 years, pulse rate ≥ 100/min, systolic blood pressure < 100 mmHg, hemoglobin < 10 g/dL, blood urea nitrogen ≥ 35 mg/dL, presence of cirrhosis and hepatic failure. The score ranged from 0 to 27, and classifying patients into 3 urgency groups: non-urgent (score < 4, n = 215, 21.2%), urgent (score 4 - 16, n = 677, 66.9%) and emergent (score > 16, n = 121, 11.9%). The score correctly classified 81.4% of the patients into their original (criterion-classified) severity groups. Under-estimation (7.5%) and over-estimation (11.1%) were clinically acceptable. Our UGIH severity scoring system classified patients into 3 urgency groups: non-urgent, urgent and emergent, with clinically acceptable small number of under- and over-estimations. Its discriminative ability and precision should be validated before adopting into clinical practice.

Changes in neurodevelopmental outcomes at 18 to 22 months' corrected age among infants of less than 25 weeks' gestational age born in 1993-1999.

PubMed

Hintz, Susan R; Kendrick, Douglas E; Vohr, Betty R; Poole, W Kenneth; Higgins, Rosemary D

2005-06-01

Increased survival rates for extremely preterm, extremely low birth weight infants during the postsurfactant era have been reported, but data on changes in neurosensory and developmental impairments are sparse. To compare neuromotor and neurodevelopmental outcomes at 18 to 22 months' corrected age for infants of <25 weeks' estimated gestational age (EGA) who were born in the 1990s. This was a multicenter, retrospective, comparative analysis of infants of <25 weeks' EGA, with birth weights of 501 to 1000 g, born between January 1993 and June 1996 (epoch I) or between July 1996 and December 1999 (epoch II), in the National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental assessments were performed at 18 to 22 months' corrected age. Logistic-regression models were constructed to evaluate the independent risk of cerebral palsy, Mental Development Index of <70, Psychomotor Development Index of <70, and neurodevelopmental impairment. A total of 366 patients in epoch I and 473 patients in epoch II were evaluated. Prenatal steroid use, cesarean section, surfactant treatment, bronchopulmonary dysplasia, and severe retinopathy of prematurity were more likely in epoch II, whereas Apgar scores of <5 at 5 minutes, patent ductus arteriosus, and severe intraventricular hemorrhage were more likely in epoch I. The prevalences of cerebral palsy, Psychomotor Development Index of <70, and neurodevelopmental impairment were similar between epochs. The prevalences of Mental Development Index of <70 were 40% for epoch I and 47% for epoch II. Regression analysis revealed that epoch II was an independent risk factor for Mental Developmental Index of <70 (epoch I versus II: odds ratio: 0.63; 95% confidence interval: 0.45-0.87) but not for other outcomes. Early childhood neurodevelopmental outcomes among infants of <25 weeks' EGA are not improving in the postsurfactant era, despite more aggressive perinatal and neonatal treatment. Later childhood follow-up assessment is needed to delineate trends in severe cognitive impairment in this extremely high-risk group.

Upper extremity palsy following cervical decompression surgery results from a transient spinal cord lesion.

PubMed

Hasegawa, Kazuhiro; Homma, Takao; Chiba, Yoshikazu

2007-03-15

Retrospective analysis. To test the hypothesis that spinal cord lesions cause postoperative upper extremity palsy. Postoperative paresis, so-called C5 palsy, of the upper extremities is a common complication of cervical surgery. Although there are several hypotheses regarding the etiology of C5 palsy, convincing evidence with a sufficient study population, statistical analysis, and clear radiographic images illustrating the nerve root impediment has not been presented. We hypothesized that the palsy is caused by spinal cord damage following the surgical decompression performed for chronic compressive cervical disorders. The study population comprised 857 patients with chronic cervical cord compressive lesions who underwent decompression surgery. Anterior decompression and fusion was performed in 424 cases, laminoplasty in 345 cases, and laminectomy in 88 cases. Neurologic characteristics of patients with postoperative upper extremity palsy were investigated. Relationships between the palsy, and patient sex, age, diagnosis, procedure, area of decompression, and preoperative Japanese Orthopaedic Association score were evaluated with a risk factor analysis. Radiographic examinations were performed for all palsy cases. Postoperative upper extremity palsy occurred in 49 cases (5.7%). The common features of the palsy cases were solely chronic compressive spinal cord disorders and decompression surgery to the cord. There was no difference in the incidence of palsy among the procedures. Cervical segments beyond C5 were often disturbed with frequent multiple segment involvement. There was a tendency for spontaneous improvement of the palsy. Age, decompression area (anterior procedure), and diagnosis (ossification of the posterior longitudinal ligament) are the highest risk factors of the palsy. The results of the present study support our hypothesis that the etiology of the palsy is a transient disturbance of the spinal cord following a decompression procedure. It appears to be caused by reperfusion after decompression of a chronic compressive lesion of the cervical cord. We recommend that physicians inform patients and surgeons of the potential risk of a spinal cord deficit after cervical decompression surgery.

Predictors of patients who will develop prolonged occult hypoperfusion following blunt trauma.

PubMed

Schulman, Andrew M; Claridge, Jeffrey A; Carr, Gordon; Diesen, Diana L; Young, Jeffrey S

2004-10-01

Prolonged occult hypoperfusion or POH (serum lactate >2.4 mmol/L persisting >12 hours from admission) represents a reversible risk factor for adverse outcomes following traumatic injury. We hypothesized that patients at increased risk for POH could be identified at the time of admission. Prospective data from adult trauma admissions between January 1, 1998 and December 31, 2000 were analyzed. Potential risk factors for POH were determined by univariate analysis (p < or =0.10= significant). Significant factors were tested in a logistic regression model (LR) (p < or =0.05= significant). The predictive ability of the LR was tested by receiver operating curve (ROC) analysis (p < or =0.05= significant). Three hundred seventy-eight patients were analyzed, 129 with POH. Injury Severity Score (ISS), emergency department Glasgow Coma Scale score, hypotension, and the individual Abbreviated Injury Scale score (AIS) for Head (H), Abdominal/Pelvic Viscera (A) and Pelvis/Bony Extremity (P) were significantly associated with POH. LR demonstrated that ISS, A-AIS > or =3 and P-AIS > or =3 were independent predictors of POH (p <0.05). ROC analysis of the LR equation was statistically significant (Area=0.69, p <0.001). We identified factors at admission that placed patients at higher risk for developing POH. Select patients may benefit from rapid, aggressive monitoring and resuscitation, possibly preventing POH and its associated morbidity and mortality.

Patterns of injury to restrained children in side impact motor vehicle crashes: the side impact syndrome.

PubMed

Orzechowski, Kelly M; Edgerton, Elizabeth A; Bulas, Dorothy I; McLaughlin, Patrick M; Eichelberger, Martin R

2003-06-01

Injury patterns among children in frontal collisions have been well documented, but little information exists regarding injuries to children in side impact collisions. Restrained children 14-years-old or younger admitted to the hospital for crash injuries were analyzed. Data concerning injuries, medical treatment, and outcome were correlated with crash data. Case reviews achieved consensus regarding injury contact points. Side impacts were compared with frontal impacts. These results were then compared with data from the National Automotive Sampling System. There were no differences between the groups with respect to age, sex, restraint type, or seat position. Compared with frontal crashes, children in side impacts were more likely to have an Injury Severity Score > 15 (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.7-5.8) and were more likely to have Abbreviated Injury Scale score 2+ injuries to the head (OR, 2.5; 95% CI, 1.4-4.4), chest (OR, 4.0; 95% CI, 2.0-8.0), and cervical spine (OR, 3.7; 95% CI, 1.2-11.3). When compared with National Automotive Sampling System data, similar trends were seen regarding Abbreviated Injury Scale score 2+ injuries to the head, chest, and extremities. In this study population, side impacts resulted in more injuries to the head, cervical spine, and chest. Knowledge of this pattern-the side impact syndrome-can help guide diagnosis, treatment, and prevention strategy.

Approximate matching of regular expressions.

PubMed

Myers, E W; Miller, W

1989-01-01

Given a sequence A and regular expression R, the approximate regular expression matching problem is to find a sequence matching R whose optimal alignment with A is the highest scoring of all such sequences. This paper develops an algorithm to solve the problem in time O(MN), where M and N are the lengths of A and R. Thus, the time requirement is asymptotically no worse than for the simpler problem of aligning two fixed sequences. Our method is superior to an earlier algorithm by Wagner and Seiferas in several ways. First, it treats real-valued costs, in addition to integer costs, with no loss of asymptotic efficiency. Second, it requires only O(N) space to deliver just the score of the best alignment. Finally, its structure permits implementation techniques that make it extremely fast in practice. We extend the method to accommodate gap penalties, as required for typical applications in molecular biology, and further refine it to search for sub-strings of A that strongly align with a sequence in R, as required for typical data base searches. We also show how to deliver an optimal alignment between A and R in only O(N + log M) space using O(MN log M) time. Finally, an O(MN(M + N) + N2log N) time algorithm is presented for alignment scoring schemes where the cost of a gap is an arbitrary increasing function of its length.

A Pilot Study of Heart Rate Variability Biofeedback Therapy in the Treatment of Perinatal Depression on a Specialized Perinatal Psychiatry Inpatient Unit

PubMed Central

Beckham, Jenna; Greene, Tammy B.; Meltzer-Brody, Samantha

2012-01-01

Purpose Heart rate variability biofeedback (HRVB) therapy may be useful in treating the prominent anxiety features of perinatal depression. We investigated the use of this non-pharmacologic therapy among women hospitalized with severe perinatal depression. Methods Three questionnaires, the State Trait Anxiety Inventory (STAI), Warwick Edinburgh Mental Well-Being Scale (WEMWBS), and Linear Analog Self Assessment (LASA), were administered to fifteen women in a specialized inpatient perinatal psychiatry unit. Participants were also contacted by telephone after discharge to assess continued use of HRVB techniques. Results The use of HRVB was associated with an improvement in all three scales. The greatest improvement (−13.867, p<0.001 and −11.533, p<0.001) was among STAI scores. A majority (81.9%, n=9) of women surveyed by telephone also reported continued frequent use at least once per week, and over half (54.6%, n=6) described the use of HRVB techniques as very or extremely beneficial. Conclusions The use of HRVB was associated with statistically significant improvement on all instrument scores, the greatest of which was STAI scores, and most women reported frequent continued use of HRVB techniques after discharge. These results suggest that HRVB may be particularly beneficial in the treatment of the prominent anxiety features of perinatal depression, both in inpatient and outpatient settings. PMID:23179141

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.

Minimally invasive surgery using intraoperative electron-beam radiotherapy for the treatment of soft tissue sarcoma of the extremities with tendon involvement.

PubMed

Matsumine, Akihiko; Tsujii, Masaya; Nakamura, Tomoki; Asanuma, Kunihiro; Matsubara, Takao; Kakimoto, Takuya; Yada, Yuki; Takada, Akinori; Ii, Noriko; Nomoto, Yoshihito; Sudo, Akihiro

2016-08-12

When a soft tissue sarcoma (STS) is located at the distal part of an extremity and involves the tendon, a wide excision usually causes severe functional disability. We therefore developed a minimally invasive surgical technique using intraoperative electron-beam radiotherapy (IOERT) to reduce the incidence of post-operative functional disability in patients with peri-/intra-tendinous STS. We assessed the clinical outcomes of the novel minimally invasive surgery. The study population included five patients who received treatment for distal extremity STSs. After elevating the tumor mass, including the tendon and nerve from the tumor bed with a wide margin, a lead board was inserted beneath the tumor mass to shield the normal tissue. IOERT (25-50 Gy) was then applied, and the tumor excised with care taken to maintain the continuity of the tendon. In a desmoid patient, local recurrence was observed outside the irradiated field. No cases of neuropathy or bone necrosis were observed. The mean limb function score was excellent in all patients. None of the high-grade sarcoma patients had local recurrence or distant metastasis. Although the current study is only a pilot study with a small number of patients, it shows that this minimally invasive procedure has the potential to become a standard treatment option for selected patients. H17-250 (registered 2 November 2005) and H25-250 (modified from H17-250, registered 5 December 2013).

A Randomized, Controlled Trial of Mirror Therapy for Upper Extremity Phantom Limb Pain in Male Amputees.

PubMed

Finn, Sacha B; Perry, Briana N; Clasing, Jay E; Walters, Lisa S; Jarzombek, Sandra L; Curran, Sean; Rouhanian, Minoo; Keszler, Mary S; Hussey-Andersen, Lindsay K; Weeks, Sharon R; Pasquina, Paul F; Tsao, Jack W

2017-01-01

Phantom limb pain (PLP) is prevalent in patients post-amputation and is difficult to treat. We assessed the efficacy of mirror therapy in relieving PLP in unilateral, upper extremity male amputees. Fifteen participants from Walter Reed and Brooke Army Medical Centers were randomly assigned to one of two groups: mirror therapy ( n  = 9) or control ( n  = 6, covered mirror or mental visualization therapy). Participants were asked to perform 15 min of their assigned therapy daily for 5 days/week for 4 weeks. The primary outcome was pain as measured using a 100-mm Visual Analog Scale. Subjects in the mirror therapy group had a significant decrease in pain scores, from a mean of 44.1 (SD = 17.0) to 27.5 (SD = 17.2) mm ( p  = 0.002). In addition, there was a significant decrease in daily time experiencing pain, from a mean of 1,022 (SD = 673) to 448 (SD = 565) minutes ( p  = 0.003). By contrast, the control group had neither diminished pain ( p  = 0.65) nor decreased overall time experiencing pain ( p  = 0.49). A pain decrement response seen by the 10th treatment session was predictive of final efficacy. These results confirm that mirror therapy is an effective therapy for PLP in unilateral, upper extremity male amputees, reducing both severity and duration of daily episodes. NCT0030144 ClinicalTrials.gov.

Secondary abdominal compartment syndrome after complicated traumatic lower extremity vascular injuries.

PubMed

Macedo, F I B; Sciarretta, J D; Otero, C A; Ruiz, G; Ebler, D J; Pizano, L R; Namias, N

2016-04-01

Secondary abdominal compartment syndrome (ACS) can occur in trauma patients without abdominal injuries. Surgical management of patients presenting with secondary ACS after isolated traumatic lower extremity vascular injury (LEVI) continues to evolve, and associated outcomes remain unknown. From January 2006 to September 2011, 191 adult trauma patients presented to the Ryder Trauma Center, an urban level I trauma center in Miami, Florida with traumatic LEVIs. Among them 10 (5.2 %) patients were diagnosed with secondary ACS. Variables collected included age, gender, mechanism of injury, and clinical status at presentation. Surgical data included vessel injury, technical aspects of repair, associated complications, and outcomes. Mean age was 37.4 ± 18.0 years (range 16-66 years), and the majority of patients were males (8 patients, 80 %). There were 7 (70 %) penetrating injuries (5 gunshot wounds and 2 stab wounds), and 3 blunt injuries with mean Injury Severity Score (ISS) 21.9 ± 14.3 (range 9-50). Surgical management of LEVIs included ligation (4 patients, 40 %), primary repair (1 patient, 10 %), reverse saphenous vein graft (2 patients, 20 %), and PTFE interposition grafting (3 patients, 30 %). The overall mortality rate in this series was 60 %. The association between secondary ACS and lower extremity vascular injuries carries high morbidity and mortality rates. Further research efforts should focus at identifying parameters to accurately determine resuscitation goals, and therefore, prevent such a devastating condition.

Development and Validation of a Risk Scoring System for Severe Acute Lower Gastrointestinal Bleeding.

PubMed

Aoki, Tomonori; Nagata, Naoyoshi; Shimbo, Takuro; Niikura, Ryota; Sakurai, Toshiyuki; Moriyasu, Shiori; Okubo, Hidetaka; Sekine, Katsunori; Watanabe, Kazuhiro; Yokoi, Chizu; Yanase, Mikio; Akiyama, Junichi; Mizokami, Masashi; Uemura, Naomi

2016-11-01

We aimed to develop and validate a risk scoring system to determine the risk of severe lower gastrointestinal bleeding (LGIB) and predict patient outcomes. We first performed a retrospective analysis of data from 439 patients emergently hospitalized for acute LGIB at the National Center for Global Health and Medicine in Japan, from January 2009 through December 2013. We used data on comorbidities, medication, presenting symptoms, and vital signs, and laboratory test results to develop a scoring system for severe LGIB (defined as continuous and/or recurrent bleeding). We validated the risk score in a prospective study of 161 patients with acute LGIB admitted to the same center from April 2014 through April 2015. We assessed the system's accuracy in predicting patient outcome using area under the receiver operating characteristics curve (AUC) analysis. All patients underwent colonoscopy. In the first study, 29% of the patients developed severe LGIB. We devised a risk scoring system based on nonsteroidal anti-inflammatory drugs use, no diarrhea, no abdominal tenderness, blood pressure of 100 mm Hg or lower, antiplatelet drugs use, albumin level less than 3.0 g/dL, disease scores of 2 or higher, and syncope (NOBLADS), which all were independent correlates of severe LGIB. Severe LGIB developed in 75.7% of patients with scores of 5 or higher compared with 2% of patients without any of the factors correlated with severe LGIB (P < .001). The NOBLADS score determined the severity of LGIB with an AUC value of 0.77. In the validation (second) study, severe LGIB developed in 35% of patients; the NOBLADS score predicted the severity of LGIB with an AUC value of 0.76. Higher NOBLADS scores were associated with a requirement for blood transfusion, longer hospital stay, and intervention (P < .05 for trend). We developed and validated a scoring system for risk of severe LGIB based on 8 factors (NOBLADS score). The system also determined the risk for blood transfusion, longer hospital stay, and intervention. It might be used in decision making regarding intervention and management. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

The effect of polytrauma as a possible confounder in the outcome of monotraumatic vs polytraumatic paraplegic patients: a clinical cohort study.

PubMed

Putz, C; Schuld, C; Gantz, S; Grieser, T; Akbar, M; Moradi, B; Wiedenhöfer, B; Fürstenberg, C H; Gerner, H J; Rupp, R

2011-06-01

Clinical cohort study. To evaluate if the impact of the severity of the trauma as a possible confounding factor influences the neurological and functional recovery in paraplegia during the course of a 6-month follow-up period after injury. Spinal Cord Injury Center, Heidelberg University Hospital, Germany. A retrospective monocentric analysis, from 2002 to 2008, of the Heidelberg European Multicenter Study about spinal cord injury database was performed. We included 31 paraplegic patients (neurological level T1-T12) who were assigned either to a monotrauma (polytraumaschluessel (PTS) 1) or to a polytrauma (PTS≥2) group. The American Spinal Injury Association Impairment Scale, lower extremity motor score, pin prick, light touch and the spinal cord independence measure (SCIM) were obtained at five distinct time points after trauma. Data were analyzed using Mann-Whitney U-test (α<0.05). The changes in lower extremity motor score, pin prick and light touch showed no significant differences in both groups over the whole evaluation period. Polytraumatic paraplegics showed a significantly delayed increase of SCIM between 2 and 6 weeks compared with monotraumatic patients, followed by a quantitative increase in the subitems bladder management, bowel management, use of toilet and prevention of pressure sores between 3 and 6 months (P=0.031). The mean length of primary rehabilitation in the polytrauma group was 5.5 vs 3.6 months in monotrauma. The prognosis of polytraumatic paraplegics in terms of neurological recovery is not inferior to those with monotrauma. Multiple-injured patients need a prolonged hospital stay to reach the functional outcome of monotraumatic patients.

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.

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.

Severe upper extremity injuries in frontal automobile crashes: the effects of depowered airbags.

PubMed

Jernigan, M Virginia; Rath, Amber L; Duma, Stefan M

2005-03-01

The purpose of this study was to determine the effects of depowered frontal airbags on the incidence of severe upper extremity injuries. The National Automotive Sampling System database files from 1993 to 2000 were examined in a study that included 2,413,347 occupants who were exposed to an airbag deployment in the United States. Occupants exposed to a depowered airbag deployment were significantly more likely to sustain a severe upper extremity injury (3.9%) than those occupants exposed to a full-powered airbag deployment (2.5%) (P=.01). Full-powered systems resulted in an injury distribution of 89.2% fractures and 7.9% dislocations compared with depowered systems with 55.3% fractures and 44.3% dislocations. Although depowered airbags were designed to reduce the risk of injuries, they appear to have increased the overall incidence of severe upper extremity injuries through a shift from long bone fractures to joint dislocations.

Soft-Tissue Injuries Associated With High-Energy Extremity Trauma: Principles of Management.

PubMed

Norris; Kellam

1997-01-01

The management of high-energy extremity trauma has evolved over the past several decades, and appropriate treatment of associated soft-tissue injuries has proved to be an important factor in achieving a satisfactory outcome. Early evaluation of the severely injured extremity is crucial. Severe closed injuries require serial observation of the soft tissues and early skeletal stabilization. Open injuries require early aggressive debridement of the soft tissues followed by skeletal stabilization. Temporary wound dressings should remain in place until definitive soft-tissue coverage has been obtained. Definitive soft-tissue closure will be expedited by serial debridements performed every 48 to 72 hours in a sterile environment. Skeletal union is facilitated by early bone grafting and/or modification of the stabilizing device. Aggressive rehabilitation, includ-ing early social reintegration, are crucial for a good functional outcome. Adherence to protocols is especially beneficial in the management of salvageable severely injured extremities.

Ion Channel Gene Expression in Lung Adenocarcinoma: Potential Role in Prognosis and Diagnosis

PubMed Central

Ko, Jae-Hong; Gu, Wanjun; Lim, Inja; Bang, Hyoweon; Ko, Eun A.; Zhou, Tong

2014-01-01

Ion channels are known to regulate cancer processes at all stages. The roles of ion channels in cancer pathology are extremely diverse. We systematically analyzed the expression patterns of ion channel genes in lung adenocarcinoma. First, we compared the expression of ion channel genes between normal and tumor tissues in patients with lung adenocarcinoma. Thirty-seven ion channel genes were identified as being differentially expressed between the two groups. Next, we investigated the prognostic power of ion channel genes in lung adenocarcinoma. We assigned a risk score to each lung adenocarcinoma patient based on the expression of the differentially expressed ion channel genes. We demonstrated that the risk score effectively predicted overall survival and recurrence-free survival in lung adenocarcinoma. We also found that the risk scores for ever-smokers were higher than those for never-smokers. Multivariate analysis indicated that the risk score was a significant prognostic factor for survival, which is independent of patient age, gender, stage, smoking history, Myc level, and EGFR/KRAS/ALK gene mutation status. Finally, we investigated the difference in ion channel gene expression between the two major subtypes of non-small cell lung cancer: adenocarcinoma and squamous-cell carcinoma. Thirty ion channel genes were identified as being differentially expressed between the two groups. We suggest that ion channel gene expression can be used to improve the subtype classification in non-small cell lung cancer at the molecular level. The findings in this study have been validated in several independent lung cancer cohorts. PMID:24466154

Considering interactive effects in the identification of influential regions with extremely rare variants via fixed bin approach

PubMed Central

2014-01-01

In this study, we analyze the Genetic Analysis Workshop 18 (GAW18) data to identify regions of single-nucleotide polymorphisms (SNPs), which significantly influence hypertension status among individuals. We have studied the marginal impact of these regions on disease status in the past, but we extend the method to deal with environmental factors present in data collected over several exam periods. We consider the respective interactions between such traits as smoking status and age with the genetic information and hope to augment those genetic regions deemed influential marginally with those that contribute via an interactive effect. In particular, we focus only on rare variants and apply a procedure to combine signal among rare variants in a number of "fixed bins" along the chromosome. We extend the procedure in Agne et al [1] to incorporate environmental factors by dichotomizing subjects via traits such as smoking status and age, running the marginal procedure among each respective category (i.e., smokers or nonsmokers), and then combining their scores into a score for interaction. To avoid overlap of subjects, we examine each exam period individually. Out of a possible 629 fixed-bin regions in chromosome 3, we observe that 11 show up in multiple exam periods for gene-smoking score. Fifteen regions exhibit significance for multiple exam periods for gene-age score, with 4 regions deemed significant for all 3 exam periods. The procedure pinpoints SNPs in 8 "answer" genes, with 5 of these showing up as significant in multiple testing schemes (Gene-Smoking, Gene-Age for Exams 1, 2, and 3). PMID:25519400

Management of pediatric snake bites: are we doing too much?

PubMed

Correa, Jesus A; Fallon, Sara C; Cruz, Andrea T; Grawe, Glenda H; Vu, Phong V; Rubalcava, Daniel M; Kaziny, Brent; Naik-Mathuria, Bindi J; Brandt, Mary L

2014-06-01

The optimal management of children with snake bite injuries is not well defined. The purpose of this study was to review the use of antivenom, diagnostic tests, and antibiotics in children bitten by venomous snakes in a specific geographic region (Southeast Texas). This is a retrospective single-center review of all patients with snake bite injury from 1/2006 to 6/2012. An envenomated bite was defined as causing edema, discoloration of the skin, necrosis, or systemic effects. The severity of injury was scored using a novel 4-point scale based on initial physical examination alone. One hundred fifty-one children (mean age 8.4±4.3years) were treated for a snake bite. There were no mortalities. Lower extremity injuries were most common (60%). Most bites were from copperheads (43%). Envenomation was evident in 82% (average wound score: 2.61±0.81). The median hospital stay for admitted patients (79%) was 2days (range 1-7). Four patients required surgery for complications of the snake bite. Fifty-two children (34%) received CroFab, with one allergic reaction. 22/135 (16%) had evidence of coagulopathy. Seventy-two children (48%) received IV antibiotics. Despite a high rate of envenomated bites in Southeast Texas, significant morbidity is rare. Children with an envenomation score of 1 or 2 are unlikely to be coagulopathic, suggesting that laboratory investigation should be reserved for patients with higher scores. The indications for the administration of CroFab deserve further prospective study. Copyright © 2014 Elsevier Inc. All rights reserved.

Racial differences in knee osteoarthritis pain: potential contribution of occupational and household tasks.

PubMed

Allen, Kelli D; Chen, Jiu-Chiuan; Callahan, Leigh F; Golightly, Yvonne M; Helmick, Charles G; Renner, Jordan B; Schwartz, Todd A; Jordan, Joanne M

2012-02-01

We examined whether occupational and household tasks contributed to differences in pain between African Americans and whites with radiographic knee osteoarthritis (OA). Participants from the Johnston County Osteoarthritis Project self-reported the frequency (often/always vs never/seldom/sometimes) of performing 9 occupational tasks involving lower extremity joint loading at their longest job (N = 868) and current job (N = 273), as well as 8 household tasks ever performed (N = 811) and currently being performed (N = 767). The associations of the numbers of occupational or household tasks with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale were first examined in simple linear regression models. If significantly associated with greater pain, each of these was included in adjusted linear regression models to examine whether the association of race with pain remained statistically significant. African Americans reported significantly greater WOMAC pain scores than whites. Exposures to more occupational tasks at the longest job and the current job were associated with greater WOMAC pain scores (p < 0.01). The association of race with greater pain scores remained statistically significant when controlling for occupational tasks at the longest job, but was reduced by 26% and no longer significant when controlling for the number of current occupational tasks. Exposures to an increasing number of household tasks were associated with lower pain scores and were not further analyzed. Current performance of physically demanding occupational tasks contributed to racial differences in pain severity among individuals with knee OA. Better workplace policies to accommodate OA-related limitations may help to reduce racial differences in pain.

Autism beyond diagnostic categories: characterization of autistic phenotypes in schizophrenia.

PubMed

Kästner, Anne; Begemann, Martin; Michel, Tanja Maria; Everts, Sarah; Stepniak, Beata; Bach, Christiane; Poustka, Luise; Becker, Joachim; Banaschewski, Tobias; Dose, Matthias; Ehrenreich, Hannelore

2015-05-13

Behavioral phenotypical continua from health to disease suggest common underlying mechanisms with quantitative rather than qualitative differences. Until recently, autism spectrum disorders and schizophrenia were considered distinct nosologic entities. However, emerging evidence contributes to the blurring of symptomatic and genetic boundaries between these conditions. The present study aimed at quantifying behavioral phenotypes shared by autism spectrum disorders and schizophrenia to prepare the ground for biological pathway analyses. Specific items of the Positive and Negative Syndrome Scale were employed and summed up to form a dimensional autism severity score (PAUSS). The score was created in a schizophrenia sample (N = 1156) and validated in adult high-functioning autism spectrum disorder (ASD) patients (N = 165). To this end, the Autism Diagnostic Observation Schedule (ADOS), the Autism (AQ) and Empathy Quotient (EQ) self-rating questionnaires were applied back to back with the newly developed PAUSS. PAUSS differentiated between ASD, schizophrenia and a disease-control sample and substantially correlated with the Autism Diagnostic Observation Schedule. Patients with ADOS scores ≥12 obtained highest, those with scores <7 lowest PAUSS values. AQ and EQ were not found to vary dependent on ADOS diagnosis. ROC curves for ADOS and PAUSS resulted in AuC values of 0.9 and 0.8, whereas AQ and EQ performed at chance level in the prediction of ASD. This work underscores the convergence of schizophrenia negative symptoms and autistic phenotypes. PAUSS evolved as a measure capturing the continuous nature of autistic behaviors. The definition of extreme-groups based on the dimensional PAUSS may permit future investigations of genetic constellations modulating autistic phenotypes.

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.

Evaluation of the DSM-5 Severity Indicator for Anorexia Nervosa.

PubMed

Machado, Paulo P P; Grilo, Carlos M; Crosby, Ross D

2017-05-01

This study tested the new DSM-5 severity criterion for anorexia nervosa (AN) based on proposed body mass index (BMI) cut-points. Participants were a clinical sample of 201 treatment-seeking patients diagnosed with DSM-5 AN in Portugal. Participants were categorised based on DSM-5 severity levels and were compared on demographic and clinical variables assessed with the Eating Disorder Examination-Questionnaire. Based on DSM-5 severity definitions for AN, 73 (36.3%) participants were categorised as mild (≥17.0 BMI), 40 (19.9%) as moderate (16-16.99 BMI), 30 (14.9%) as severe (15-15.99 BMI) and 58 (28.9%) as extreme (<15 BMI). The severity groups did not differ significantly in age or gender. Analyses comparing the severity groups on measures of eating-disorder psychopathology revealed no significant differences on the Eating Disorder Examination-Questionnaire global or subscale scores. The groups also did not differ significantly on the frequency of binge eating or purging episodes within the past 28 days. Our findings, in this clinical sample of patients with AN in Portugal, provide no evidence for the new DSM-5 severity ratings based on BMI level. Further research on the validity of the DSM-5 specifiers is needed and should test additional clinical or functional variables and especially prognostic utility for course and outcome across eating disorders. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

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.

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.

The Hand Burn Severity (HABS) score: A simple tool for stratifying severity of hand burns.

PubMed

Bache, Sarah E; Fitzgerald O'Connor, Edmund; Theodorakopoulou, Evgenia; Frew, Quentin; Philp, Bruce; Dziewulski, Peter

2017-02-01

Hand burns represent a unique challenge to the burns team due to the intricate structure and unrivalled functional importance of the hand. The initial assessment and prognosis relies on consideration of the specific site involved as well as depth of the burn. We created a simple severity score that could be used by referring non-specialists and researchers alike. The Hand Burn Severity (HABS) score stratifies hand burns according to severity with a numerical value of between 0 (no burn) and 18 (most severe) per hand. Three independent assessors scored the photographs of 121 burned hands of 106 adult and paediatric patients, demonstrating excellent inter-rater reliability (r=0.91, p<0.0001 on testing with Lin's correlation coefficient). A significant relationship was shown between the HABS score and a reliable binary outcome of the requirement for surgical excision on Mann-Whitney U testing (U=152; Z=9.8; p=0.0001). A receiver operator characteristic (ROC) curve analysis found a cut off score of 5.5, indicating that those with a HABS score below 6 did not require an operation, whereas those with a score above 6 did. The HABS score was shown to be more sensitive and specific that assessment of burn depth alone. The HABS score is a simple to use tool to stratify severity at initial presentation of hand burns which will be useful when referring, and when reporting outcomes. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Contralaterally Controlled Functional Electrical Stimulation Improves Hand Dexterity in Chronic Hemiparesis: A Randomized Trial.

PubMed

Knutson, Jayme S; Gunzler, Douglas D; Wilson, Richard D; Chae, John

2016-10-01

It is unknown whether one method of neuromuscular electrical stimulation for poststroke upper limb rehabilitation is more effective than another. Our aim was to compare the effects of contralaterally controlled functional electrical stimulation (CCFES) with cyclic neuromuscular electrical stimulation (cNMES). Stroke patients with chronic (>6 months) moderate to severe upper extremity hemiparesis (n=80) were randomized to receive 10 sessions/wk of CCFES- or cNMES-assisted hand opening exercise at home plus 20 sessions of functional task practice in the laboratory for 12 weeks. The task practice for the CCFES group was stimulation assisted. The primary outcome was change in Box and Block Test (BBT) score at 6 months post treatment. Upper extremity Fugl-Meyer and Arm Motor Abilities Test were also measured. At 6 months post treatment, the CCFES group had greater improvement on the BBT, 4.6 (95% confidence interval [CI], 2.2-7.0), than the cNMES group, 1.8 (95% CI, 0.6-3.0), between-group difference of 2.8 (95% CI, 0.1-5.5), P=0.045. No significant between-group difference was found for the upper extremity Fugl-Meyer (P=0.888) or Arm Motor Abilities Test (P=0.096). Participants who had the largest improvements on BBT were <2 years post stroke with moderate (ie, not severe) hand impairment at baseline. Among these, the 6-month post-treatment BBT gains of the CCFES group, 9.6 (95% CI, 5.6-13.6), were greater than those of the cNMES group, 4.1 (95% CI, 1.7-6.5), between-group difference of 5.5 (95% CI, 0.8-10.2), P=0.023. CCFES improved hand dexterity more than cNMES in chronic stroke survivors. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00891319. © 2016 American Heart Association, Inc.

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.

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.

Effects of work-related stress on work ability index among refinery workers

PubMed Central

Habibi, Ehsanollah; Dehghan, Habibollah; Safari, Shahram; Mahaki, Behzad; Hassanzadeh, Akbar

2014-01-01

Introduction: Work-related stress is one of the basic problems in industrial also top 10 work-related health problems and it is increasingly implicated in the development a number of problems such as cardiovascular disease, musculoskeletal diseases, early retirement to employees. On the other hand, early retirement to employees from the workplace has increased on the problems of today's industries. Hereof, improving work ability is one of the most effective ways to enhance the ability and preventing disability and early retirement. The aim of This study is determine the relationship between job stress score and work ability index (WAI) at the refinery workers. Materials and Methods: This is a cross-sectional study in which 171 workers from a refinery in isfahan in 2012 who were working in different occupational groups participated. Based on appropriate assignment sampling, 33 office workers, 69 operational workers, and 69 maintenance workers, respectively, were invited to participate in this study. Two questionnaires including work related-stress and WAI were filled in. Finally, the information was analyzed using the SPSS-20 and statistic tests namely, analysis of covariance Kruskal-Wallis test. Pearson correlation coefficient, ANOVA and t-test. Results: Data analysis revealed that 86% and 14% of participants had moderate and severe stress respectively. Average score of stress and standard deviation was 158.7 ± 17.3 that was in extreme stress range. Average score and standard deviation of WAI questionnaire were 37.18 and 3.86 respectively. That placed in a good range. Pearson correlation coefficient showed that WAI score had significant reversed relationship with a score of stress. Conclusion: According to the results, mean stress score among refinery worker was high and one fator that affect work abiity was high stress, hence training on communication skills and safe working environment in order to decreses stress, enhance the work ability of workers. PMID:24741658

Predictors of Change in Physical Function in Older Adults in Response to Long-Term, Structured Physical Activity: The LIFE Study.

PubMed

Layne, Andrew S; Hsu, Fang-Chi; Blair, Steven N; Chen, Shyh-Huei; Dungan, Jennifer; Fielding, Roger A; Glynn, Nancy W; Hajduk, Alexandra M; King, Abby C; Manini, Todd M; Marsh, Anthony P; Pahor, Marco; Pellegrini, Christine A; Buford, Thomas W

2017-01-01

To evaluate the extent of variability in functional responses in participants in the Lifestyle Interventions and Independence for Elders (LIFE) study and to identify the relative contributions of intervention adherence, physical activity, and demographic and health characteristics to this variability. Secondary analysis. Multicenter institutions. A volunteer sample (N=1635) of sedentary men and women aged 70 to 89 years who were able to walk 400m but had physical limitations, defined as a Short Physical Performance Battery (SPPB) score of ≤9. Moderate-intensity physical activity (n=818) consisting of aerobic, resistance, and flexibility exercises performed both center-based (2times/wk) and home-based (3-4times/wk) sessions or health education program (n=817) consisting of weekly to monthly workshops covering relevant health information. Physical function (gait speed over 400m) and lower extremity function (SPPB score) assessed at baseline and 6, 12, and 24 months. Greater baseline physical function (gait speed, SPPB score) was negatively associated with change in gait speed (regression coefficient β=-.185; P<.001) and change in SPPB score (β=-.365; P<.001), whereas higher number of steps per day measured by accelerometry was positively associated with change in gait speed (β=.035; P<.001) and change in SPPB score (β=.525; P<.001). Other baseline factors associated with positive change in gait speed and/or SPPB score include younger age (P<.001), lower body mass index (P<.001), and higher self-reported physical activity (P=.002). Several demographic and physical activity-related factors were associated with the extent of change in functional outcomes in participants in the LIFE study. These factors should be considered when designing interventions for improving physical function in older adults with limited mobility. Copyright © 2016 American Congress of Rehabilitation Medicine. All rights reserved.

Effects of work-related stress on work ability index among refinery workers.

PubMed

Habibi, Ehsanollah; Dehghan, Habibollah; Safari, Shahram; Mahaki, Behzad; Hassanzadeh, Akbar

2014-01-01

Work-related stress is one of the basic problems in industrial also top 10 work-related health problems and it is increasingly implicated in the development a number of problems such as cardiovascular disease, musculoskeletal diseases, early retirement to employees. On the other hand, early retirement to employees from the workplace has increased on the problems of today's industries. Hereof, improving work ability is one of the most effective ways to enhance the ability and preventing disability and early retirement. The aim of This study is determine the relationship between job stress score and work ability index (WAI) at the refinery workers. This is a cross-sectional study in which 171 workers from a refinery in isfahan in 2012 who were working in different occupational groups participated. Based on appropriate assignment sampling, 33 office workers, 69 operational workers, and 69 maintenance workers, respectively, were invited to participate in this study. Two questionnaires including work related-stress and WAI were filled in. Finally, the information was analyzed using the SPSS-20 and statistic tests namely, analysis of covariance Kruskal-Wallis test. Pearson correlation coefficient, ANOVA and t-test. Data analysis revealed that 86% and 14% of participants had moderate and severe stress respectively. Average score of stress and standard deviation was 158.7 ± 17.3 that was in extreme stress range. Average score and standard deviation of WAI questionnaire were 37.18 and 3.86 respectively. That placed in a good range. Pearson correlation coefficient showed that WAI score had significant reversed relationship with a score of stress. According to the results, mean stress score among refinery worker was high and one fator that affect work abiity was high stress, hence training on communication skills and safe working environment in order to decreses stress, enhance the work ability of workers.

Predicting work-related disability and medical cost outcomes: a comparison of injury severity scoring methods.

PubMed

Sears, Jeanne M; Blanar, Laura; Bowman, Stephen M

2014-01-01

Acute work-related trauma is a leading cause of death and disability among U.S. workers. Occupational health services researchers have described the pressing need to identify valid injury severity measures for purposes such as case-mix adjustment and the construction of appropriate comparison groups in programme evaluation, intervention, quality improvement, and outcome studies. The objective of this study was to compare the performance of several injury severity scores and scoring methods in the context of predicting work-related disability and medical cost outcomes. Washington State Trauma Registry (WTR) records for injuries treated from 1998 to 2008 were linked with workers' compensation claims. Several Abbreviated Injury Scale (AIS)-based injury severity measures (ISS, New ISS, maximum AIS) were estimated directly from ICD-9-CM codes using two software packages: (1) ICDMAP-90, and (2) Stata's user-written ICDPIC programme (ICDPIC). ICDMAP-90 and ICDPIC scores were compared with existing WTR scores using the Akaike Information Criterion, amount of variance explained, and estimated effects on outcomes. Competing risks survival analysis was used to evaluate work disability outcomes. Adjusted total medical costs were modelled using linear regression. The linked sample contained 6052 work-related injury events. There was substantial agreement between WTR scores and those estimated by ICDMAP-90 (kappa=0.73), and between WTR scores and those estimated by ICDPIC (kappa=0.68). Work disability and medical costs increased monotonically with injury severity, and injury severity was a significant predictor of work disability and medical cost outcomes in all models. WTR and ICDMAP-90 scores performed better with regard to predicting outcomes than did ICDPIC scores, but effect estimates were similar. Of the three severity measures, maxAIS was usually weakest, except when predicting total permanent disability. Injury severity was significantly associated with work disability and medical cost outcomes for work-related injuries. Injury severity can be estimated using either ICDMAP-90 or ICDPIC when ICD-9-CM codes are available. We observed little practical difference between severity measures or scoring methods. This study demonstrated that using existing software to estimate injury severity may be useful to enhance occupational injury surveillance and research. Copyright © 2013 Elsevier Ltd. All rights reserved.

Measurement of COPD Severity Using a Survey-Based Score

PubMed Central

Omachi, Theodore A.; Katz, Patricia P.; Yelin, Edward H.; Iribarren, Carlos; Blanc, Paul D.

2010-01-01

Background: A comprehensive survey-based COPD severity score has usefulness for epidemiologic and health outcomes research. We previously developed and validated the survey-based COPD Severity Score without using lung function or other physiologic measurements. In this study, we aimed to further validate the severity score in a different COPD cohort and using a combination of patient-reported and objective physiologic measurements. Methods: Using data from the Function, Living, Outcomes, and Work cohort study of COPD, we evaluated the concurrent and predictive validity of the COPD Severity Score among 1,202 subjects. The survey instrument is a 35-point score based on symptoms, medication and oxygen use, and prior hospitalization or intubation for COPD. Subjects were systemically assessed using structured telephone survey, spirometry, and 6-min walk testing. Results: We found evidence to support concurrent validity of the score. Higher COPD Severity Score values were associated with poorer FEV1 (r = −0.38), FEV1% predicted (r = −0.40), Body mass, Obstruction, Dyspnea, Exercise Index (r = 0.57), and distance walked in 6 min (r = −0.43) (P < .0001 in all cases). Greater COPD severity was also related to poorer generic physical health status (r = −0.49) and disease-specific health-related quality of life (r = 0.57) (P < .0001). The score also demonstrated predictive validity. It was also associated with a greater prospective risk of acute exacerbation of COPD defined as ED visits (hazard ratio [HR], 1.31; 95% CI, 1.24-1.39), hospitalizations (HR, 1.59; 95% CI, 1.44-1.75), and either measure of hospital-based care for COPD (HR, 1.34; 95% CI, 1.26-1.41) (P < .0001 in all cases). Conclusion: The COPD Severity Score is a valid survey-based measure of disease-specific severity, both in terms of concurrent and predictive validity. The score is a psychometrically sound instrument for use in epidemiologic and outcomes research in COPD. PMID:20040611

Root resorption diagnosed with cone beam computed tomography after 6 months and at the end of orthodontic treatment with fixed appliances.

PubMed

Makedonas, Dimitrios; Lund, Henrik; Hansen, Ken

2013-05-01

To investigate the prevalence of orthodontically induced root resorption after treatment and the correlation with resorption found after 6 months of treatment. One hundred fifty-six patients (11-18 years) treated with fixed appliances and extraction of four premolars were examined with cone beam computed tomography before treatment, after 6 months of treatment (n  =  97), and at the end of active treatment. The Malmgren Index was used to describe the degree of root resorption. Severe root resorption (>2 mm, score 3) was found in 25.6% of the patients at the end of treatment. Extreme root resorption was found in one patient. Root resorption was seen more frequently in the maxillary incisor region. There was no correlation between the severity of root resorption after 6 months and the amount observed at the end of treatment. Furthermore, no correlation was seen between treatment duration and the severity of root resorption. Clinically significant resorption was diagnosed in 25.6% of the patients, but no correlations, either with the resorption seen after 6 months or with the length of treatment, were found. Radiographic examination after 3 to 6 months of orthodontic treatment is too early and will not reduce the number of patients who will have teeth with severe root resorption.

Association Between Early Low-Dose Hydrocortisone Therapy in Extremely Preterm Neonates and Neurodevelopmental Outcomes at 2 Years of Age.

PubMed

Baud, Olivier; Trousson, Clémence; Biran, Valérie; Leroy, Emilie; Mohamed, Damir; Alberti, Corinne

2017-04-04

Dexamethasone to prevent bronchopulmonary dysplasia in very preterm neonates was associated with adverse neurodevelopmental events. Early low-dose hydrocortisone treatment has been reported to improve survival without bronchopulmonary dysplasia but its safety with regard to neurodevelopment remains to be assessed. To assess whether early hydrocortisone therapy in extremely preterm infants is associated with neurodevelopmental impairment at 2 years of age. An exploratory secondary analysis of the PREMILOC (Early Low-Dose Hydrocortisone to Improve Survival without Bronchopulmonary Dysplasia in Extremely Preterm Infants) randomized clinical trial conducted between 2008 and 2014 in 21 French neonatal intensive care units. Randomization was stratified by gestational age groups. Neurodevelopmental assessments were completed from 2010 to 2016. After birth, patients were randomly assigned to receive placebo or hydrocortisone (0.5 mg/kg twice per day for 7 days, followed by 0.5 mg/kg per day for 3 days). The prespecified exploratory secondary outcome of neurodevelopmental impairment was based on a standardized neurological examination and the revised Brunet-Lézine scale (global developmental quotient score and subscores; mean norm, 100 [SD, 15]). The minimal clinically important difference on the global developmental quotient was 5 points. Of 1072 neonates screened, 523 were assigned to hydrocortisone (n = 256) or placebo (n = 267) and 406 survived to 2 years of age. A total of 379 patients (93%; 46% female) were evaluated (194 in the hydrocortisone group and 185 in the placebo group) at a median corrected age of 22 months (interquartile range, 21-23 months). The distribution of patients without neurodevelopmental impairment (73% in the hydrocortisone group vs 70% in the placebo group), with mild neurodevelopmental impairment (20% in the hydrocortisone group vs 18% in the placebo group), or with moderate to severe neurodevelopmental impairment (7% in the hydrocortisone group vs 11% in the placebo group) was not statistically significantly different between groups (P = .33). The mean global developmental quotient score was not statistically significantly different between groups (91.7 in the hydrocortisone group vs 91.4 in the placebo group; between-group difference, 0.3 [95% CI, -2.7 to 3.4]; P = .83). The incidence of cerebral palsy or other major neurological impairments was not significantly different between groups. In this exploratory analysis of secondary outcomes of a randomized clinical trial of extremely preterm infants, early low-dose hydrocortisone was not associated with a statistically significant difference in neurodevelopment at 2 years of age. Further randomized studies are needed to provide definitive assessment of the neurodevelopmental safety of hydrocortisone in extremely preterm infants. clinicaltrials.gov Identifier: NCT00623740.

The autism diagnostic observation schedule, module 4: revised algorithm and standardized severity scores.

PubMed

Hus, Vanessa; Lord, Catherine

2014-08-01

The recently published Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2) includes revised diagnostic algorithms and standardized severity scores for modules used to assess younger children. A revised algorithm and severity scores are not yet available for Module 4, used with verbally fluent adults. The current study revises the Module 4 algorithm and calibrates raw overall and domain totals to provide metrics of autism spectrum disorder (ASD) symptom severity. Sensitivity and specificity of the revised Module 4 algorithm exceeded 80 % in the overall sample. Module 4 calibrated severity scores provide quantitative estimates of ASD symptom severity that are relatively independent of participant characteristics. These efforts increase comparability of ADOS scores across modules and should facilitate efforts to examine symptom trajectories from toddler to adulthood.

Increased prevalence of posttraumatic stress disorder in CRPS.

PubMed

Speck, V; Schlereth, T; Birklein, F; Maihöfner, C

2017-03-01

Although specific psychological disorders in complex regional pain syndrome (CRPS) have not been identified, studies suggest that CRPS patients may have increased rates of traumatic life events. Because these events do not always lead to apparent psychological symptoms, we systematically screened CRPS patients for posttraumatic stress disorder (PTSD) to determine if PTSD could be a risk factor for CRPS. Consecutive CRPS patients referred to two university hospital centres (University of Erlangen, UMC Mainz) between December 2011 and April 2013 were prospectively examined using a diagnostic PTSD instrument (Post-traumatic Stress Diagnostic Scale (PDS). We also tested maladaptive coping strategies (brief-COPE inventory) and the PDS severity score as predictors for CRPS. Patients with non-CRPS extremity pain and healthy individuals were used as control groups. We collected data from 152 patients with CRPS, 55 control patients and 55 age- and sex-matched healthy individuals. Fifty-eight CRPS patients (38%), six non-CRPS pain patients (10%) and two healthy individuals (4%) met diagnostic criteria for PTSD. Initial PTSD symptom onset was prior to CRPS in 50 CRPS patients (86%) and during the course of CRPS in eight patients. Results of a logistic regression revealed that the PTSD severity score was associated with CRPS (p < 0.0001). Maladaptive coping strategies (p < 0.0001) were related to PTSD. posttraumatic stress disorder (PTSD) is more frequent in patients with CRPS than it is in the general population. Research has not yet provided support for specific psychological predictors for CRPS. © 2016 European Pain Federation - EFIC®.

Clinical Muscle Testing Compared with Whole-Body Magnetic Resonance Imaging in Facio-scapulo-humeral Muscular Dystrophy.

PubMed

Regula, J U; Jestaedt, L; Jende, F; Bartsch, A; Meinck, H-M; Weber, M-A

2016-12-01

The objective of this study was to evaluate the clinical usefulness of whole-body magnetic resonance imaging (MRI) in facio-scapulo-humeral muscular dystrophy (FSHD). In 20 patients with genetically proven FSHD1, we prospectively assessed muscular involvement and correlated the results of semi-quantitative manual muscle testing and other parameters such as disease duration, creatine kinase (CK) levels and repeat length of the D4Z4 locus with whole-body MRI. Clinical muscle testing revealed the trapezius, pectoralis and infraspinatus as the most severely affected muscles in the shoulder, and the knee flexors and gluteus medius in the hip girdle. MRI revealed the trapezius and serratus anterior muscles in the shoulder, and the hamstrings and adductor muscles in the hip girdle, as the most severely affected muscle groups. Overall, degrees of fatty degeneration on MRI scans correlated significantly with clinical weakness. Moreover, we could detect clear affection of the trunk muscles. Corresponding to earlier reports, asymmetric involvement was frequent in both clinical examination and MRI scoring. Moreover, MRI revealed inhomogeneous muscle degeneration in a considerable proportion of both, muscles and patients. Both clinical and MRI scores significantly correlated to disease duration, but not to fragment size or CK levels. Fatty degeneration in whole-body MRI correlates well to clinical muscle testing of the extremities but gives more information on deeper or trunk muscles. It shows structural changes in muscular disorders and may become an excellent tool for assessment of muscle involvement and follow-up studies.

A comparative review of Haute Autorité de Santé and National Institute for Health and Care Excellence health technology assessments of Ikervis® to treat severe keratitis in adult patients with dry eye disease which has not improved despite treatment with tear substitutes.

PubMed

Eroglu, Yasmina Iffet

2017-01-01

Background: In 2015, Ikervis® became the only EMA-approved cyclosporine A (CsA) eye-drop for the treatment of severe keratitis in adult patients with dry eye disease, which has not improved despite treatment with tear substitutes. Since the 1980s, CsA has been used empirically for ocular conditions in veterinary medicine then in humans. However, its extremely low aqueous solubility led to its administration in vegetable oils, which is characterized by low ocular availability, poor intraocular penetration, poor tolerability and short shelf-life. Concentrations from 0.05% to 2% are compounded on an industrial scale and reimbursed throughout Europe. In France, Ikervis® has been granted an ASMR score of 5 by HAS, whereas in UK NICE endorsed its use. Objective: To review the dry eye disease environment, its challenges and available treatment options, and compare the NICE and HAS assessments to question HAS' decision to maintain full reimbursement of compounded CsA formulations in the absence of evidence, while reimbursing the EMA-approved drug at 15%. extensive search on PubMED. Results: Comparator selection, composite score assessment and use of CE model are key differentiators. Conclusion: In topical formulations, improvements to the vehicle are key innovations that can bring significant benefits. After the USA, a Compounding Act is needed in Europe.

A comparative review of Haute Autorité de Santé and National Institute for Health and Care Excellence health technology assessments of Ikervis® to treat severe keratitis in adult patients with dry eye disease which has not improved despite treatment with tear substitutes

PubMed Central

Eroglu, Yasmina Iffet

2017-01-01

ABSTRACT Background: In 2015, Ikervis® became the only EMA-approved cyclosporine A (CsA) eye-drop for the treatment of severe keratitis in adult patients with dry eye disease, which has not improved despite treatment with tear substitutes. Since the 1980s, CsA has been used empirically for ocular conditions in veterinary medicine then in humans. However, its extremely low aqueous solubility led to its administration in vegetable oils, which is characterized by low ocular availability, poor intraocular penetration, poor tolerability and short shelf-life. Concentrations from 0.05% to 2% are compounded on an industrial scale and reimbursed throughout Europe. In France, Ikervis® has been granted an ASMR score of 5 by HAS, whereas in UK NICE endorsed its use. Objective: To review the dry eye disease environment, its challenges and available treatment options, and compare the NICE and HAS assessments to question HAS’ decision to maintain full reimbursement of compounded CsA formulations in the absence of evidence, while reimbursing the EMA-approved drug at 15%. Method: extensive search on PubMED. Results: Comparator selection, composite score assessment and use of CE model are key differentiators. Conclusion: In topical formulations, improvements to the vehicle are key innovations that can bring significant benefits. After the USA, a Compounding Act is needed in Europe. PMID:28839524

Cognitive predictors and moderators of winter depression treatment outcomes in cognitive-behavioral therapy vs. light therapy.

PubMed

Sitnikov, Lilya; Rohan, Kelly J; Evans, Maggie; Mahon, Jennifer N; Nillni, Yael I

2013-12-01

There is no empirical basis for determining which seasonal affective disorder (SAD) patients are best suited for what type of treatment. Using data from a parent clinical trial comparing light therapy (LT), cognitive-behavioral therapy (CBT), and their combination (CBT + LT) for SAD, we constructed hierarchical linear regression models to explore baseline cognitive vulnerability constructs (i.e., dysfunctional attitudes, negative automatic thoughts, response styles) as prognostic and prescriptive factors of acute and next winter depression outcomes. Cognitive constructs did not predict or moderate acute treatment outcomes. Baseline dysfunctional attitudes and negative automatic thoughts were prescriptive of next winter treatment outcomes. Participants with higher baseline levels of dysfunctional attitudes and negative automatic thoughts had less severe depression the next winter if treated with CBT than if treated with LT. In addition, participants randomized to solo LT who scored at or above the sample mean on these cognitive measures at baseline had more severe depressive symptoms the next winter relative to those who scored below the mean. Baseline dysfunctional attitudes and negative automatic thoughts did not predict treatment outcomes in participants assigned to solo CBT or CBT + LT. Therefore, SAD patients with extremely rigid cognitions did not fare as well in the subsequent winter if treated initially with solo LT. Such patients may be better suited for initial treatment with CBT, which directly targets cognitive vulnerability processes. Copyright © 2013 Elsevier Ltd. All rights reserved.

Dysfunctional error-related processing in incarcerated youth with elevated psychopathic traits

PubMed Central

Maurer, J. Michael; Steele, Vaughn R.; Cope, Lora M.; Vincent, Gina M.; Stephen, Julia M.; Calhoun, Vince D.; Kiehl, Kent A.

2016-01-01

Adult psychopathic offenders show an increased propensity towards violence, impulsivity, and recidivism. A subsample of youth with elevated psychopathic traits represent a particularly severe subgroup characterized by extreme behavioral problems and comparable neurocognitive deficits as their adult counterparts, including perseveration deficits. Here, we investigate response-locked event-related potential (ERP) components (the error-related negativity [ERN/Ne] related to early error-monitoring processing and the error-related positivity [Pe] involved in later error-related processing) in a sample of incarcerated juvenile male offenders (n = 100) who performed a response inhibition Go/NoGo task. Psychopathic traits were assessed using the Hare Psychopathy Checklist: Youth Version (PCL:YV). The ERN/Ne and Pe were analyzed with classic windowed ERP components and principal component analysis (PCA). Using linear regression analyses, PCL:YV scores were unrelated to the ERN/Ne, but were negatively related to Pe mean amplitude. Specifically, the PCL:YV Facet 4 subscale reflecting antisocial traits emerged as a significant predictor of reduced amplitude of a subcomponent underlying the Pe identified with PCA. This is the first evidence to suggest a negative relationship between adolescent psychopathy scores and Pe mean amplitude. PMID:26930170

Cedar pollen aggravates atopic dermatitis in childhood monozygotic twin patients with allergic rhino conjunctivitis.

PubMed

Murakami, Yukako; Matsui, Saki; Kijima, Akiko; Kitaba, Shun; Murota, Hiroyuki; Katayama, Ichiro

2011-09-01

We report a case of 7-year-old monozygotic twin patients with atopic dermatitis. The HLA haplotypes were HLA A2, A11, B27, B61, DR1, and DR4. Both serum IgE levels and cedar pollen radioallergosorbent test (RAST) scores were high in the twins (elder/younger sister: IgE: 5170/3980 IU/ml and Japansese cedar pollen: >100/64.0) in contrast to low mite and food RAST scores (Dermatophagoides Pterygonium; 0.59/0.4 and egg white 9.24/4.6). The patients showed positive immediate (20 min in both sisters) and delayed (24 hours in elder sister, 24, 48, 72 hours in younger sister) reactions to a scratch test with Japanese cedar pollen. Skin lesions on the face were aggravated and extended to the trunk and extremities during the Japanese cedar pollen season and gradually subsided in summer. Oral provocation with egg white or cow milk showed no exacerbations, and topical corticosteroid did not improve the eczema. In contrast, successful protection from severe scratching behaviors was achieved by use of topical anti-allergic eye drops and wearing nightgowns made by the mother.

Executive performance in older Portuguese adults with low education.

PubMed

Pavão Martins, Isabel; Maruta, Carolina; Freitas, Vanda; Mares, Inês

2013-01-01

Evaluation of executive functions is essential in clinical diagnosis, yet there are limited data regarding the performance of participants with low education. We present results on several measures of executive functions obtained in community-dwelling adults with an overall low education and study the effect of this variable in each test. A sample of 479 adults (64% female, mean age 66.4 years) was assessed by a battery comprising 13 measures of executive function (Trail Making Test; Symbol Search; Matrix reasoning; Semantic and phonemic verbal fluencies; Stroop test; and digit spans). Tests' psychometric properties and the effects of age, gender, and education were studied across education levels within each age group. Tests showed good psychometric properties. Education explained more variance than age in the majority of measures, with lower educational levels being significantly associated to worse scores. Tables are presented with mean scores, standard deviation, and the value of extreme percentiles for younger (50-65, N = 232) and older (>65 years, N = 247) × education (0-3, 4, 5-9, and >9 years) subgroups. Education-adjusted norms are necessary for an adequate interpretation of test results. The present data may be useful for clinicians caring for populations with low literacy.

The influence of nontraditional training modalities on physical performance: review of the literature.

PubMed

O'Hara, Reginald B; Serres, Jennifer; Traver, Kyle L; Wright, Bruce; Vojta, Chris; Eveland, Ed

2012-10-01

The primary purpose of this effort was to review several forms of nontraditional (NT) training programs, including heavy lower extremity strength training, CrossFit training, kettlebell training, and agility training, and discuss the effects of these exercise regimens on physical performance. The secondary purpose was to evaluate NT fitness training programs for evidence that they may provide beneficial options to help airmen improve their fitness scores. A search of the literature for 1980-2010 was performed using the Franzello Aeromedical Library, Public Medicine, and Air Force Institute of Technology search engines. There were 50 articles located and the authors selected 29 articles that specifically addressed the primary and secondary purposes of this literature review. This review indicates that an NT training approach is warranted in the general Air Force population. Heavy leg strength training and agility training show promise in enhancing aerobic fitness and improving fitness scores, particularly among members who have difficulty passing a physical fitness test. Most of the nontraditional forms of physical training are not supported in the scientific literature, with the exception of heavy leg strength training and agility training. However, even these NT forms of training require further investigation.

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.

Increasing Onshore Oil Production: An Unexpected Explosion in Trauma Patients

PubMed Central

Urban, Dakota M.; Ward, Jeanette G.; Helmer, Stephen D.; Cook, Alan D.; Haan, James M.

2018-01-01

Introduction Few data currently exist which are focused on type and severity of onshore oil extraction-related injuries. The purpose of this study was to evaluate injury patterns among onshore oil field operations. Methods A retrospective review was conducted of all trauma patients aged 18 and older with an onshore oil field-related injury admitted to an American College of Surgeons-verified level 1 trauma center between January 1, 2003 and June 30, 2012. Data collected included demographics, injury severity and details, hospital outcomes, and disposition. Results A total of 66 patients met inclusion criteria. All patients were male, of which the majority were Caucasian (81.8%, n = 54) with an average age of 36.5 ± 11.8 years, injury severity score of 9.4 ± 8.9, and Glasgow Coma Scale score of 13.8 ± 3.4. Extremity injuries were the most common (43.9%, n = 29), and most were the result of being struck by an object (40.9%, n = 27). Approximately one-third of patients (34.8%, n = 23) were admitted to the intensive care unit. Nine patients (13.6%) required mechanical ventilation while 27 (40.9%) underwent operative treatment. The average hospital length of stay was 5.8 ± 16.6 days, and most patients (78.8%, n = 52) were discharged home. Four patients suffered permanent disabilities, and there were two deaths. Conclusion Increased domestic onshore oil production inevitably will result in higher numbers of oil field-related traumas. By focusing on employees who are at the greatest risk for injuries and by targeting the main causes of injuries, training programs can lead to a decrease in injury incidence. PMID:29796152

Increasing Onshore Oil Production: An Unexpected Explosion in Trauma Patients.

PubMed

Urban, Dakota M; Ward, Jeanette G; Helmer, Stephen D; Cook, Alan D; Haan, James M

2018-05-01

Few data currently exist which are focused on type and severity of onshore oil extraction-related injuries. The purpose of this study was to evaluate injury patterns among onshore oil field operations. A retrospective review was conducted of all trauma patients aged 18 and older with an onshore oil field-related injury admitted to an American College of Surgeons-verified level 1 trauma center between January 1, 2003 and June 30, 2012. Data collected included demographics, injury severity and details, hospital outcomes, and disposition. A total of 66 patients met inclusion criteria. All patients were male, of which the majority were Caucasian (81.8%, n = 54) with an average age of 36.5 ± 11.8 years, injury severity score of 9.4 ± 8.9, and Glasgow Coma Scale score of 13.8 ± 3.4. Extremity injuries were the most common (43.9%, n = 29), and most were the result of being struck by an object (40.9%, n = 27). Approximately one-third of patients (34.8%, n = 23) were admitted to the intensive care unit. Nine patients (13.6%) required mechanical ventilation while 27 (40.9%) underwent operative treatment. The average hospital length of stay was 5.8 ± 16.6 days, and most patients (78.8%, n = 52) were discharged home. Four patients suffered permanent disabilities, and there were two deaths. Increased domestic onshore oil production inevitably will result in higher numbers of oil field-related traumas. By focusing on employees who are at the greatest risk for injuries and by targeting the main causes of injuries, training programs can lead to a decrease in injury incidence.

Correlates of disability related to seizures in persons with epilepsy.

PubMed

Sajobi, Tolulope T; Jette, Nathalie; Fiest, Kirsten M; Patten, Scott B; Engbers, Jordan D T; Lowerison, Mark W; Wiebe, Samuel

2015-09-01

Seizure-related disability is an important contributor to health-related quality of life in persons with epilepsy. Yet, there is little information on patient-centered reports of seizure-related disability, as most studies focus on specific constructs of health-related disability, rather than epilepsy. We investigated how patients rate their own disability and how these ratings correlate with various clinical and sociodemographic characteristics. In a prospective cohort of 250 adults with epilepsy consecutively enrolled in the Neurological Disease and Depression Study (NEEDs), we obtained a broad range of clinical and patient-reported measures, including patients' ratings of seizure-related disability and epilepsy severity using self-completed, single-item, 7-point response global assessment scales. Spearman's correlation, multiple linear regression, and mediation analyses were used to examine the association between seizure-related disability scores and clinical and demographic characteristics of persons with epilepsy. The mean age and duration of epilepsy was 39.8 and 16.7 years, respectively. About 29.5% of the patients reported their seizures as "not at all disabling," whereas 5.8% of the patients reported them as "extremely disabling." Age, seizure freedom at 1 year, anxiety, and epilepsy severity were identified as statistically significant predictors of disability scores. The indirect effects of age and seizure freedom, attributable to mediation through epilepsy severity, accounted for 25.0% and 30.3% of the total effects of these determinants on seizure-related disability, respectively. Measuring seizure-related disability has heuristic value and it has important correlates and mediators that can be targeted for intervention in practice. Addressing modifiable factors associated with disability (e.g., seizure freedom and anxiety) could have a significant impact on decreasing the burden of disability in people with epilepsy. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

Pregnancy-associated spinal osteoporosis treated with bisphosphonates: long-term follow-up of maternal and infants outcome.

PubMed

Vujasinovic-Stupar, Nada; Pejnovic, Nada; Markovic, Ljiljana; Zlatanovic, Maja

2012-03-01

Pregnancy-associated spinal osteoporosis (PPSO) is a rare condition characterized by severe back pain occurring near the end of the first pregnancy or shortly afterward. The aim of this report is to present a 12-year follow-up of a patient with PPSO. Also, the outcomes of patient's two pregnancies and her infants after long-term treatment with bisphosphonates are assessed. A young woman was referred to our tertiary care hospital aged 30 years, due to intense pain in thoracic and lumbar region that started during the last month of her first pregnancy and got worse after delivery. Bone mineral density (BMD) measurement, clinical, and biochemical parameters were performed. Extremely low lumbar spine BMD, L2-L4: 0.627 g/cm(2), T-score -4.8, Z-score -4.3, 52% young adult indicated severe osteoporosis. Cyclical treatment with etidronate and then pamidronate was started, and a substantial increase in the BMD and the reduction in back pain intensity were observed. An increase in BMD of 44.8% over baseline was observed after 12 years of follow-up. Her two pregnancies were uneventful, and no neonatal adverse effects were observed. Control DXA scan in her girl child aged 6.8 years revealed low BMD at the lumbar spine. As PPSO seems to be an underdiagnosed severe disease, caution is recommended if back pain occurs in the last trimester or early post-partum period. Although pre-pregnancy use of bisphosponates does not pose a substantial fetal risk, their use in women of childbearing age might best be done only when strong clinical indications exist.

Including a range of outcome targets offers a broader view of fibromyalgia treatment outcome: results from a retrospective review of multidisciplinary treatment.

PubMed

Marcus, Dawn A; Bernstein, Cheryl D; Haq, Adeel; Breuer, Paula

2014-06-01

Fibromyalgia is associated with substantial functional disability. Current drug and non-drug treatments result in statistically significant but numerically small improvements in typical numeric measures of pain severity and fibromyalgia impact. The aim of the present study was to evaluate additional measures of pain severity and functional outcome that might be affected by fibromyalgia treatment. This retrospective review evaluated outcomes from 274 adults with fibromyalgia who participated in a six-week, multidisciplinary treatment programme. Pain and function were evaluated on the first and final treatment visit. Pain was evaluated using an 11-point numerical scale to determine clinically meaningful pain reduction (decrease ≥ 2 points) and from a pain drawing. Function was evaluated by measuring active range of motion (ROM), walking distance and speed, upper extremity exercise repetitions, and self-reports of daily activities. Numerical rating scores for pain decreased by 10-13% (p < 0.01) and Fibromyalgia Impact Questionnaire (FIQ) scores decreased by 20% (p < 0.001). More substantial improvements were noted when using alternative measures. Clinically meaningful pain relief was achieved by 37% of patients, and the body area affected by pain decreased by 31%. ROM showed significant improvements in straight leg raise and cervical motion, without improvements in lumbar ROM. Daily walking distance increased fourfold and arm exercise repetitions doubled. Despite modest albeit statistically significant improvements in standard measures of pain severity and the FIQ, more substantial pain improvement was noted when utilizing alternative measures of pain and functional improvement. Alternative symptom assessment measures might be important outcome measures to include in drug and non-drug studies to better understand fibromyalgia treatment effectiveness. © 2013 John Wiley & Sons, Ltd.

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.

Relationship between cognitive and non-cognitive symptoms of delirium.

PubMed

Rajlakshmi, Aarya Krishnan; Mattoo, Surendra Kumar; Grover, Sandeep

2013-04-01

To study relationship between the cognitive and the non-cognitive symptoms of delirium. Eighty-four patients referred to psychiatry liaison services and met DSM-IVTR criteria of delirium were assessed using the Delirium Rating Scale Revised-1998 (DRSR-98) and Cognitive Test for Delirium (CTD). The mean DRS-R-98 severity score was 17.19 and DRS-R-98 total score was 23.36. The mean total score on CTD was 11.75. The mean scores on CTD were highest for comprehension (3.47) and lowest for vigilance (1.71). Poor attention was associated with significantly higher motor retardation and higher DRS-R-98 severity scores minus the attention scores. There were no significant differences between those with and without poor attention. Higher attention deficits were associated with higher dysfunction on all other domains of cognition on CTD. There was significant correlation between cognitive functions as assessed on CTD and total DRS-R-98 score, DRS-R-98 severity score and DRS-R-98 severity score without the attention item score. However, few correlations emerged between CTD domains and CTD total scores with cognitive symptom total score of DRS-R-98 (items 9-13) and non-cognitive symptom total score of DRS-R-98 (items 1-8). Our study suggests that in delirium, cognitive deficits are quite prevalent and correlate with overall severity of delirium. Attention deficit is a core symptom of delirium. Copyright © 2012 Elsevier B.V. All rights reserved.

Voice Handicap Index in Persian Speakers with Various Severities of Hearing Loss.

PubMed

Aghadoost, Ozra; Moradi, Negin; Dabirmoghaddam, Payman; Aghadoost, Alireza; Naderifar, Ehsan; Dehbokri, Siavash Mohammadi

2016-01-01

The purpose of this study was to assess and compare the total score and subscale scores of the Voice Handicap Index (VHI) in speakers with and without hearing loss. A further aim was to determine if a correlation exists between severities of hearing loss with total scores and VHI subscale scores. In this cross-sectional, descriptive analytical study, 100 participants, divided in 2 groups of participants with and without hearing loss, were studied. Background information was gathered by interview, and VHI questionnaires were filled in by all participants. For all variables, including mean total score and VHI subscale scores, there was a considerable difference in speakers with and without hearing loss (p < 0.05). The correlation between severity of hearing loss with total score and VHI subscale scores was significant. Speakers with hearing loss were found to have higher mean VHI scores than speakers with normal hearing. This indicates a high voice handicap related to voice in speakers with hearing loss. In addition, increased severity of hearing loss leads to more severe voice handicap. This finding emphasizes the need for a multilateral assessment and treatment of voice disorders in speakers with hearing loss. © 2017 S. Karger AG, Basel.

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

Pleasantness, activation, and sex differences in advertising.

PubMed

Whissell, C; McCall, L

1997-10-01

Advertisements in men's, women's, girls', and boys' magazines (n = 38,195 words) were scored objectively in terms of 15 measures of linguistic style, e.g., use of common words, use of long words, use of specific words and emotional tone (pleasantness and activation, as measured by the Dictionary of Affect). There were several sex- and age-related differences among advertisements from different sources. Advertisements from boys' magazines were extremely active, those from women's and girls' magazines were shorter and unusually pleasant. In two follow-up studies (N = 122 volunteers), objective emotional measures of advertising text proved to be related to ratings of persuasion and of success of appeal for individual advertisements. The most preferred advertisement for women was pleasant and active, that for men unpleasant and active. When men and women created advertisements, women's were shorter and more pleasant.

Staging systems of hepatocellular carcinoma: A review of literature

PubMed Central

Maida, Marcello; Orlando, Emanuele; Cammà, Calogero; Cabibbo, Giuseppe

2014-01-01

Hepatocellular carcinoma (HCC) is a major health problem with a high incidence and mortality all over the world. Natural history of HCC is severe and extremely variable, and prognostic factors influencing outcomes are incompletely defined. Over time, many staging and scoring systems have been proposed for the classification and prognosis of patients with HCC. Currently, the non-ideal predictive performance of existing prognostic systems is secondary to their inherent limitations, as well as to a non-universal reproducibility and transportability of the results in different populations. New serological and histological markers are still under evaluation with promising results, but they require further evaluation and external validation. The aim of this review is to highlight the main tools for assessing the prognosis of HCC and the main concerns, pitfalls and warnings regarding its staging systems currently in use. PMID:24764652

Analysis of Shahid Rajaee hospital administrative data on injuries resulting from car accidents in Shiraz, Iran: 2011-2014 data.

PubMed

Yadollahi, Mahnaz; Ghiassee, Aida; Anvar, Mehrdad; Ghaem, Hale; Farahmand, Mohammad

2017-02-01

The administrative data from trauma centers could serve as potential sources of invaluable information while studying epidemiologic features of car accidents. In this cross-sectional analysis of Shahid Rajaee hospital administrative data, we aimed to evaluate patients injured in car accidents in terms of age, gender, injury severity, injured body regions and hospitalization outcome in the recent four years (2011-2014). The hospital registry was accessed at Shiraz Trauma Research Center (Shiraz, Iran) and the admission's unit data were merged with the information gathered upon discharge. A total number of 27,222 car accident patients aged over 15 years with International Classification of Diseases 10th revision (ICD-10) external causes of injury codes (V40.9-V49.9) were analyzed. Injury severity score and injured body regions were determined based on converting ICD-10 injury codes to Abbreviated Injury Scale (AIS-98) severity codes using a domestically developed electronic algorithm. A binary logistic regression model was applied to the data to examine the contribution of all independent variables to in-hospital mortality. Men accounted for 68.9% of the injuries and the male to female ratio was 2.2:1. The age of the studied population was (34 ± 15) years, with more than 77.2% of the population located in the 15-45 years old age group. Head and neck was the most commonly injured body region (39.0%) followed by extremities (27.2%). Injury severity score (ISS) was calculated for 13,152 (48.3%) patients, of whom, 80.9% had severity scores less than 9. There were 332 patients (1.2%) admitted to the intensive care units and 422 in-hospital fatalities (1.5%) were recorded during the study period. Age above 65 years [OR = 7.4, 95% CI (5.0-10.9)], ISS above 16 [OR = 9.1, 95% CI (5.5-14.9)], sustaining a thoracic injury [OR = 7.4, 95% CI (4.6-11.9)] and head injury [OR = 4.9, 95% CI (3.1-7.6)] were the most important independent predictors of death following car accidents. Hospital administrative databases of this hospital could be used as reliable sources of information in providing epidemiologic reports of car accidents in terms of severity and outcomes. Improving the quality of recordings at hospital databases is an important initial step towards more comprehensive injury surveillance in Fars, Iran. Copyright © 2017. Production and hosting by Elsevier B.V.

76 FR 38360 - Workshop-Monitoring Changes in Extreme Storm Statistics: State of Knowledge; Notice of Open...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-30

... Changes in Extreme Storm Statistics: State of Knowledge; Notice of Open Public Workshop AGENCY: National... .) SUPPLEMENTARY INFORMATION: This workshop will provide an update to the climate science surrounding extreme... storms. Specific topics include: Severe Thunderstorms (and associated hail and winds), tornadoes, extreme...

Brain Arterial Diameters as a Risk Factor for Vascular Events.

PubMed

Gutierrez, Jose; Cheung, Ken; Bagci, Ahmet; Rundek, Tatjana; Alperin, Noam; Sacco, Ralph L; Wright, Clinton B; Elkind, Mitchell S V

2015-08-06

Arterial luminal diameters are routinely used to assess for vascular disease. Although small diameters are typically considered pathological, arterial dilatation has also been associated with disease. We hypothesize that extreme arterial diameters are biomarkers of the risk of vascular events. Participants in the Northern Manhattan Study who had a time-of-flight magnetic resonance angiography were included in this analysis (N=1034). A global arterial Z-score, called the brain arterial remodeling (BAR) score, was obtained by averaging the measured diameters within each individual. Individuals with a BAR score <-2 SDs were considered to have the smallest diameters, individuals with a BAR score >-2 and <2 SDs had average diameters, and individuals with a BAR score >2 SDs had the largest diameters. All vascular events were recorded prospectively after the brain magnetic resonance imaging. Spline curves and incidence rates were used to test our hypothesis. The association of the BAR score with death (P=0.001), vascular death (P=0.02), any vascular event (P=0.05), and myocardial infarction (P=0.10) was U-shaped except for ischemic stroke (P=0.74). Consequently, incidence rates for death, vascular death, myocardial infarction, and any vascular event were higher in individuals with the largest diameters, whereas individuals with the smallest diameters had a higher incidence of death, vascular death, any vascular event, and ischemic stroke compared with individuals with average diameters. The risk of death, vascular death, and any vascular event increased at both extremes of brain arterial diameters. The pathophysiology linking brain arterial remodeling to systemic vascular events needs further research. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

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.

GCRBS score: a new scoring system for predicting outcome in severe falciparum malaria.

PubMed

Mohapatra, Biranchi Narayan; Jangid, Sanjay Kumar; Mohanty, Rina

2014-01-01

Severe falciparum malaria is a critical illness resulting in multi-organ dysfunction and death. Severe malaria is defined by the World Health Organisation as a qualitative variable. The purpose of this study is to devise a scoring system for predicting outcome in severe falciparum malaria. 112 cases of severe falciparum malaria diagnosed as per the WHO criteria, were evaluated to determine the parameters which were significantly associated with mortality. Of all the parameters studied, five variables namely cerebral malaria (GCS < 11), Renal failure (Creatinine > 3 mg/dl), Respiratory distress (Respiratory rate > 24/min), Jaundice (Bilirubin >10 mg/dl) and Shock (Systolic BP < 90 mm of Hg) were all found to be associated with a poor prognosis. The five selected parameters were analysed using the Odds ratio and a new scoring system named as GCRBS score was designed with a possible score from 0-10. With a cut-off score of 5, the GCRBS score predicted mortality with a sensitivity of 85.3% and a specificity of 95.6%. The GCRBS score is easy to calculate and apply. Of the 5 parameters, 3 are clinical which can be determined at bedside and only 2 are biochemical which can be done in any laboratory.The most important advantage of this scoring system is that all the 5 parameters are to be assessed quantitatively for allotting a score, which would eliminate the possibility of observer bias.

Cross-timescale Interference and Rainfall Extreme Events in South Eastern South America

NASA Astrophysics Data System (ADS)

Munoz, Angel G.

The physical mechanisms and predictability associated with extreme daily rainfall in South East South America (SESA) are investigated for the December-February season. Through a k-mean analysis, a robust set of daily circulation regimes is identified and then it is used to link the frequency of rainfall extreme events with large-scale potential predictors at subseasonal-to-seasonal scales. This basic set of daily circulation regimes is related to the continental and oceanic phases of the South Atlantic Convergence Zone (SACZ) and wave train patterns superimposed on the Southern Hemisphere Polar Jet. Some of these recurrent synoptic circulation types are conducive to extreme rainfall events in the region through synoptic control of different meso-scale physical features and, at the same time, are influenced by climate phenomena that could be used as sources of potential predictability. Extremely high rainfall (as measured by the 95th- and 99th-percentiles) is preferentially associated with two of these weather types, which are characterized by moisture advection intrusions from lower latitudes and the Pacific; another three weather types, characterized by above-normal moisture advection toward lower latitudes or the Andes, are preferentially associated with dry days (days with no rain). The analysis permits the identification of several subseasonal-to-seasonal scale potential predictors that modulate the occurrence of circulation regimes conducive to extreme rainfall events in SESA. It is conjectured that a cross-timescale interference between the different climate drivers improves the predictive skill of extreme precipitation in the region. The potential and real predictive skill of the frequency of extreme rainfall is then evaluated, finding evidence indicating that mechanisms of climate variability at one timescale contribute to the predictability at another scale, i.e., taking into account the interference of different potential sources of predictability at different timescales increases the predictive skill. This fact is in agreement with the Cross-timescale Interference Conjecture proposed in the first part of the thesis. At seasonal scale, a combination of those weather types tends to outperform all the other potential predictors explored, i.e., sea surface temperature patterns, phases of the Madden-Julian Oscillation, and combinations of both. Spatially averaged Kendall’s τ improvements of 43% for the potential predictability and 23% for realtime predictions are attained with respect to standard models considering sea-surface temperature fields alone. A new subseasonal-to-seasonal predictive methodology for extreme rainfall events is proposed, based on probability forecasts of seasonal sequences of these weather types. The cross-validated realtime skill of the new probabilistic approach, as measured by the Hit Score and the Heidke Skill Score, is on the order of twice that associated with climatological values. The approach is designed to offer useful subseasonal-to-seasonal climate information to decision-makers interested not only in how many extreme events will happen in the season, but also in how, when and where those events will probably occur. In order to gain further understanding about how the cross-timescale interference occurs, an externally-forced Lorenz model is used to explore the impact of different kind of forcings, at inter-annual and decadal scales, in the establishment of constructive interactions associated with the simulated “extreme events”. Using a wavelet analysis, it is shown that this simple model is capable of reproducing the same kind of cross-timescale structures observed in the wavelet power spectrum of the Nino3.4 index only when it is externally forced by both inter-annual and decadal signals: the annual cycle and a decadal forcing associated with the natural solar variability. The nature of this interaction is non-linear, and it impacts both mean and extreme values in the time series. No predictive power was found when using metrics like standard deviation and auto-correlation. Nonetheless, it was proposed that an early warning signal for occurrence of extreme rainfall in SESA may be possible via a continuous monitoring of relative phases between the cross-timescale leading components.

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.

Upper-extremity phocomelia reexamined: a longitudinal dysplasia.

PubMed

Goldfarb, Charles A; Manske, Paul R; Busa, Riccardo; Mills, Janith; Carter, Peter; Ezaki, Marybeth

2005-12-01

In contrast to longitudinal deficiencies, phocomelia is considered a transverse, intercalated segmental dysplasia. Most patients demonstrate severe, but not otherwise classifiable, upper-extremity deformities, which usually cannot be placed into one of three previously described phocomelia groups. Additionally, these phocomelic extremities do not demonstrate true segmental deficits; the limb is also abnormal proximal and distal to the segmental defect. The purpose of this investigation was to present evidence that upper-extremity abnormalities in patients previously diagnosed as having phocomelia in fact represent a proximal continuum of radial or ulnar longitudinal dysplasia. The charts and radiographs of forty-one patients (sixty extremities) diagnosed as having upper-extremity phocomelia were reviewed retrospectively. On the basis of the findings on the radiographs, the disorders were categorized into three groups: (1) proximal radial longitudinal dysplasia, which was characterized by an absent proximal part of the humerus, a nearly normal distal part of the humerus, a completely absent radius, and a radial-sided hand dysplasia; (2) proximal ulnar longitudinal dysplasia, characterized by a short one-bone upper extremity that bifurcated distally and by severe hand abnormalities compatible with ulnar dysplasia; and (3) severe combined dysplasia, with type A characterized by an absence of the forearm segment (i.e., the radius and ulna) and type B characterized by absence of the arm and forearm (i.e., the hand attached to the thorax). Twenty-nine limbs in sixteen patients could be classified as having proximal radial longitudinal dysplasia. Systemic medical conditions such as thrombocytopenia-absent radius syndrome were common in those patients, but additional musculoskeletal conditions were rare. Twenty limbs in seventeen patients could be classified as having proximal ulnar longitudinal dysplasia. Associated musculoskeletal abnormalities, such as proximal femoral focal deficiency, were common in those patients. Eleven limbs in ten patients were identified as having severe combined dysplasia, which was type A in seven of them and type B in four. Four patients with severe combined dysplasia had congenital cardiac anomalies, and four had associated musculoskeletal abnormalities. Three of the four patients with the type-B disorder had a contralateral ulnar longitudinal dysplasia. We propose that cases previously classified as upper-extremity phocomelia represent a spectrum of severe longitudinal dysplasia, as none of the sixty extremities that we studied demonstrated a true intercalary deficiency. These findings have both developmental and genetic implications.

Spontaneous Coronary Artery Dissection

MedlinePlus

... blood vessels. Fibromuscular dysplasia occurs more often in women than it does in men. Extreme physical exercise. People who recently participated in extreme or intense exercises, such as extreme aerobic activities, may be at higher risk of SCAD. Severe ...

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.

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.

[The optimization of restoration approaches of advanced hand activity using the sensorial glove and the mCIMT method].

PubMed

Mozheiko, E Yu; Prokopenko, S V; Alekseevich, G V

To reason the choice of methods of restoration of advanced hand activity depending on severity of motor disturbance in the top extremity. Eighty-eight patients were randomized into 3 groups: 1) the mCIMT group, 2) the 'touch glove' group, 3) the control group. For assessment of physical activity of the top extremity Fugl-Meyer Assessment Upper Extremity, Nine-Hole Peg Test, Motor Assessment Scale were used. Assessment of non-use phenomenon was carried out with the Motor Activity Log scale. At a stage of severe motor dysfunction, there was a restoration of proximal departments of a hand in all groups, neither method was superior to the other. In case of moderate severity of motor deficiency of the upper extremity the most effective was the method based on the principle of biological feedback - 'a touch glove'. In the group with mild severity of motor dysfunction, the best recovery was achieved in the mCIMT group.

Commonly used severity scores are not good predictors of mortality in sepsis from severe leptospirosis: a series of ten patients.

PubMed

Velissaris, Dimitrios; Karanikolas, Menelaos; Flaris, Nikolaos; Fligou, Fotini; Marangos, Markos; Filos, Kriton S

2012-01-01

Introduction. Severe leptospirosis, also known as Weil's disease, can cause multiorgan failure with high mortality. Scoring systems for disease severity have not been validated for leptospirosis, and there is no documented method to predict mortality. Methods. This is a case series on 10 patients admitted to ICU for multiorgan failure from severe leptospirosis. Data were collected retrospectively, with approval from the Institution Ethics Committee. Results. Ten patients with severe leptospirosis were admitted in the Patras University Hospital ICU in a four-year period. Although, based on SOFA scores, predicted mortality was over 80%, seven of 10 patients survived and were discharged from the hospital in good condition. There was no association between SAPS II or SOFA scores and mortality, but survivors had significantly lower APACHE II scores compared to nonsurvivors. Conclusion. Commonly used severity scores do not seem to be useful in predicting mortality in severe leptospirosis. Early ICU admission and resuscitation based on a goal-directed therapy protocol are recommended and may reduce mortality. However, this study is limited by retrospective data collection and small sample size. Data from large prospective studies are needed to validate our findings.

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.

Association of Neurodevelopmental Outcomes and Neonatal Morbidities of Extremely Premature Infants With Differential Exposure to Antenatal Steroids

PubMed Central

Chawla, Sanjay; Natarajan, Girija; Shankaran, Seetha; Pappas, Athina; Stoll, Barbara J.; Carlo, Waldemar A.; Saha, Shampa; Das, Abhik; Laptook, Abbot R.; Higgins, Rosemary D.

2017-01-01

IMPORTANCE Many premature infants are born without exposure to antenatal steroids (ANS) or with incomplete courses. This study evaluates the dose-dependent effect of ANS on rates of neonatal morbidities and early childhood neurodevelopmental outcomes of extremely premature infants. OBJECTIVE To compare rates of neonatal morbidities and 18- to 22-month neurodevelopmental outcomes of extremely premature infants exposed to no ANS or partial or complete courses of ANS. DESIGN, SETTING, AND PARTICIPANTS In this observational cohort study, participants were extremely premature infants (birth weight range, 401–1000 g; gestational age, 22–27 weeks) who were born at participating centers of the National Institute of Child Health and Human Development Neonatal Research Network between January 2006 and December 2011. Data were analyzed between October 2013 and May 2016. MAIN OUTCOMES AND MEASURES Rates of death or neurodevelopmental impairment at 18 to 22 months’ corrected age. Neurodevelopmental impairment was defined as the presence of any of the following: moderate to severe cerebral palsy, a cognitive score less than 85 on the Bayley Scales of Infant and Toddler Development III, blindness, or deafness. RESULTS There were 848 infants in the no ANS group, 1581 in the partial ANS group, and 3692 in the complete ANS group; the mean (SD) birth weights were 725 (169), 760 (173), and 753 (170) g, respectively, and the mean (SD) gestational ages were 24.5 (1.4), 24.9 (2), and 25.1 (1.1) weeks. Of 6121 eligible infants, 4284 (70.0%) survived to 18- to 22-month follow-up, and data were available for 3892 of 4284 infants (90.8%). Among the no, partial, and complete ANS groups, there were significant differences in the rates of mortality (43.1%, 29.6%, and 25.2%, respectively), severe intracranial hemorrhage among survivors (23.3%, 19.1%, and 11.7%), death or necrotizing enterocolitis (48.1%, 37.1%, and 32.5%), and death or bronchopulmonary dysplasia (74.9%, 68.9%, and 65.5%). Additionally, death or neurodevelopmental impairment occurred in 68.1%, 54.4%, and 48.1% of patients in the no, partial, and complete ANS groups, respectively. Logistic regression analysis revealed that complete (odds ratio, 0.63; 95% CI, 0.53–0.76) and partial (odds ratio, 0.77; 95% CI, 0.63–0.95) ANS courses were associated with lower rates of death or neurodevelopmental impairment compared with the no ANS group. The reduction in the rate of death or neurodevelopmental impairment associated with exposure to a complete ANS course may be mediated through a reduction in rates of severe intracranial hemorrhage and/or cystic periventricular leukomalacia in the neonatal period. CONCLUSIONS AND RELEVANCE Antenatal steroid exposure was associated with a dose-dependent protective effect against death or neurodevelopmental impairment in extremely preterm infants. The effect was partly mediated by ANS-associated reductions in rates of severe intracranial hemorrhage and/or cystic periventricular leukomalacia. These results support prompt administration of ANS, with the goal of a complete course prior to delivery. PMID:27723868

The effect of insoles on foot pain and daily activities.

PubMed

Amer, Ahmed O; Jarl, Gustav M; Hermansson, Liselotte N

2014-12-01

Foot pain decreases individuals' ability to perform daily activities. Insoles are often prescribed to reduce the pain which, in turn, may promote return to normal activities. To evaluate the effects of insoles on foot pain and daily activities, and to investigate the relationship between individuals' satisfaction with insoles and actual use of them. A 4-week pre-post intervention follow-up. Brief Pain Inventory, International Physical Activity Questionnaire and Lower Extremities Functional Status were used as outcome measures. Client Satisfaction with Device was used in the follow-up. A total of 67 participants answered the questionnaires (81% women). Overall, a reduction in Pain Severity (p = 0.002) and Pain Interference (p = 0.008) was shown. Secondary analyses revealed a significant effect only in women. No changes in daily activities (Walking, p = 0.867; Total Physical Activity, p = 0.842; Lower Extremities Functional Status, p = 0.939) could be seen. There was no relation between Client Satisfaction with Device measures and duration of insole use. A difference in sex was shown; women scored higher than men on Pain Severity. Insoles reduce pain and pain interference with daily activities for women with foot pain. Satisfaction with the insoles is not a predictor of actual insole use. The effect of insoles on activity performance needs further study. This study provides evidence for prescribing insoles to people with foot pain. Nonetheless, insoles are not enough to increase their physical activity level in the short term. Satisfaction with insoles and duration of use are not correlated and cannot be inferred from each other. © The International Society for Prosthetics and Orthotics 2013.

Improving Global Forecast System of extreme precipitation events with regional statistical model: Application of quantile-based probabilistic forecasts

NASA Astrophysics Data System (ADS)

Shastri, Hiteshri; Ghosh, Subimal; Karmakar, Subhankar

2017-02-01

Forecasting of extreme precipitation events at a regional scale is of high importance due to their severe impacts on society. The impacts are stronger in urban regions due to high flood potential as well high population density leading to high vulnerability. Although significant scientific improvements took place in the global models for weather forecasting, they are still not adequate at a regional scale (e.g., for an urban region) with high false alarms and low detection. There has been a need to improve the weather forecast skill at a local scale with probabilistic outcome. Here we develop a methodology with quantile regression, where the reliably simulated variables from Global Forecast System are used as predictors and different quantiles of rainfall are generated corresponding to that set of predictors. We apply this method to a flood-prone coastal city of India, Mumbai, which has experienced severe floods in recent years. We find significant improvements in the forecast with high detection and skill scores. We apply the methodology to 10 ensemble members of Global Ensemble Forecast System and find a reduction in ensemble uncertainty of precipitation across realizations with respect to that of original precipitation forecasts. We validate our model for the monsoon season of 2006 and 2007, which are independent of the training/calibration data set used in the study. We find promising results and emphasize to implement such data-driven methods for a better probabilistic forecast at an urban scale primarily for an early flood warning.

Improved survival in UK combat casualties from Iraq and Afghanistan: 2003-2012.

PubMed

Penn-Barwell, Jowan G; Roberts, Stuart A G; Midwinter, Mark J; Bishop, Jon R B

2015-05-01

The United Kingdom was at war in Iraq and Afghanistan for more than a decade. Despite assertions regarding advances in military trauma care during these wars, thus far, no studies have examined survival in UK troops during this sustained period of combat. The aims of this study were to examine temporal changes of injury patterns defined by body region and survival in a population of UK Military casualties between 2003 and 2012 in Iraq and Afghanistan. The UK Military Joint Theatre Trauma Registry was searched for all UK Military casualties (survivors and fatalities) sustained on operations between January 1, 2003, and December 31, 2012. The New Injury Severity Score (NISS) was used to stratify injury severity. There were 2,792 UK Military casualties sustaining 14,252 separate injuries during the study period. There were 608 fatalities (22% of all casualties). Approximately 70% of casualties injured in hostile action resulted from explosive munitions. The extremities were the most commonly injured body region, involved in 43% of all injuries. The NISS associated with a 50% chance of survival rose each year from 32 in 2003 to 60 in 2012. An improvement in survival during the 10-year period is demonstrated. A majority of wounds are a result of explosive munitions, and the extremities are the most commonly affected body region. The authors recommend the development of more sophisticated techniques for the measuring of the performance of combat casualty care systems to include measures of morbidity and functional recovery as well as survival. Epidemiologic study, level III.

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

Relationship between lower urinary tract symptoms and cardiovascular risk scores including Framingham risk score and ACC/AHA risk score.

PubMed

Lee, Bora; Lee, Sang Wook; Kang, Hye Rim; Kim, Dae In; Sun, Hwa Yeon; Kim, Jae Heon

2018-01-01

This study attempted to investigate the association between lower urinary tract symptoms (LUTS) and cardiovascular disease (CVD) risk using International Prostate Symptom Score (IPSS) and CVD risk scores and to overcome the limitations of previous relevant studies. A total of 2994 ostensibly healthy males, who participated in a voluntary health check in a health promotion center from January 2010 to December 2014, were reviewed. CVD risk scores were calculated using Framingham risk score and American College of Cardiology (ACC)/American Heart Association (AHA) score. Correlation and multivariate logistic regression analysis to predict the CVD risk severity were performed. Correlation between total IPSS with CVD risk scores demonstrated significant positive associations, which showed higher correlation with ACC/AHA score than the Framingham score (r = 0.18 vs 0.09, respectively). For ACC/AHA score, the partial correlation after adjustment of body mass index (BMI) showed significant positive correlations between all LUTS parameters and PSA. For the Framingham score, all variables, except IPSS Q2 and IPSS Q6, showed significant positive correlations. After adjustment of BMI, prostate volume and PSA, only the severe LUTS group showed significant relationship with intermediate-high CVD risk severity, as compared with normal LUTS group (OR = 2.97, 95%CI (1.35-6.99)). Using two validated CVD risk calculators, we observed that LUTS is closely associated with future CVD risk. To predict the intermediate-high CVD risk severity, severe LUTS was a sentinel sign, the presence of which warrants the importance of an earlier screening for CVD. © 2017 Wiley Periodicals, Inc.

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.

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.

Application of RFID technology-upper extremity rehabilitation training.

PubMed

Chen, Chih-Chen; Chen, Yu-Luen; Chen, Shih-Ching

2016-01-01

[Purpose] Upper extremity rehabilitation after an injury is very important. This study proposes radio frequency identification (RFID) technology to improve and enhance the effectiveness of the upper extremity rehabilitation. [Subjects and Methods] People use their upper extremities to conduct daily activities. When recovering from injuries, many patients neglect the importance of rehabilitation, which results in degraded function. This study recorded the training process using the traditional rehabilitation hand gliding cart with a RFID reader, RFID tags in the panel, and a servo host computer. [Results] Clinical evidence, time taken to achieve a full score, counts of missing the specified spots, and Brunnstrom stage of aided recovery, the proximal part of the upper extremity show that the RFID-based upper extremity training significantly and reduce negative impacts of the disability in daily life and activities. [Conclusion] This study combined a hand-gliding cart with an RFID reader, and when patients moved the cart, the movement could be observed via the activated RFID tags. The training data was collected and quantified for a better understanding of the recovery status of the patients. Each of the participating patients made progress as expected.

Improvement in GOS and GOSE scores 6 and 12 months after severe traumatic brain injury.

PubMed

Corral, Luisa; Ventura, José Luis; Herrero, José Ignacio; Monfort, Jose Luis; Juncadella, Montserrat; Gabarrós, Andreu; Bartolomé, Carlos; Javierre, Casimiro F; García-Huete, Lucía

2007-11-01

To assess improvements in Glasgow Outcome Scale (GOS) and GOS extended (GOSE) scores between 6 months and 1 year following severe traumatic brain injury (TBI). One studied 214 adult patients with severe TBI with Glasgow Coma Scale (GCS) <9 admitted to Intensive Care Unit (ICU). GOS scores were obtained 6 and 12 months after injury in 195 subjects. Patients were predominantly male (84%) and median age was 35 years. Outcome (GOS and GOSE at 6 months and 1 year) was better in the high GCS score at admission (6-8) group than in the low score group (3-5). The improvement in GOS scores between 6 months and 1 year was greater in the high GCS score at admission group than in the low score group. At 6 months, 75 patients had died and 120 survived. None died between the 6-12-month assessments; at 12 months, 36% had improved GOS score. GOS scores improved between 6-12 months after severe TBI in 36% of survivors and it is concluded that the expectancy of improvement is incomplete at 6 months. This improvement was greater in patients with better GCS scores (6-8) at admission than in those with worse GCS scores (3-5).

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

Staging dementia using Clinical Dementia Rating Scale Sum of Boxes scores: a Texas Alzheimer's research consortium study.

PubMed

O'Bryant, Sid E; Waring, Stephen C; Cullum, C Munro; Hall, James; Lacritz, Laura; Massman, Paul J; Lupo, Philip J; Reisch, Joan S; Doody, Rachelle

2008-08-01

The Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB) score is commonly used, although the utility regarding this score in staging dementia severity is not well established. To investigate the effectiveness of CDR-SOB scores in staging dementia severity compared with the global CDR score. Retrospective study. Texas Alzheimer's Research Consortium minimum data set cohort. A total of 1577 participants (110 controls, 202 patients with mild cognitive impairment, and 1265 patients with probable Alzheimer disease) were available for analysis. Receiver operating characteristic curves were generated from a derivation sample to determine optimal cutoff scores and ranges, which were then applied to the validation sample. Optimal ranges of CDR-SOB scores corresponding to the global CDR scores were 0.5 to 4.0 for a global score of 0.5, 4.5 to 9.0 for a global score of 1.0, 9.5 to 15.5 for a global score of 2.0, and 16.0 to 18.0 for a global score of 3.0. When applied to the validation sample, kappa scores ranged from 0.86 to 0.94 (P < .001 for all), with 93.0% of the participants falling within the new staging categories. The CDR-SOB score compares well with the global CDR score for dementia staging. Owing to the increased range of values, the CDR-SOB score offers several advantages over the global score, including increased utility in tracking changes within and between stages of dementia severity. Interpretive guidelines for CDR-SOB scores are provided.

Staging Dementia Using Clinical Dementia Rating Scale Sum of Boxes Scores

PubMed Central

O'Bryant, Sid E.; Waring, Stephen C.; Cullum, C. Munro; Hall, James; Lacritz, Laura; Massman, Paul J.; Lupo, Philip J.; Reisch, Joan S.; Doody, Rachelle

2012-01-01

Background The Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB) score is commonly used, although the utility regarding this score in staging dementia severity is not well established. Obiective To investigate the effectiveness of CDRSOB scores in staging dementia severity compared with the global CDR score. Design Retrospective study. Setting Texas Alzheimer's Research Consortium minimum data set cohort. Participants A total of 1577 participants (110 controls, 202 patients with mild cognitive impairment, and 1265 patients with probable Alzheimer disease) were available for analysis. Main Outcome Measures Receiver operating characteristic curves were generated from a derivation sample to determine optimal cutoff scores and ranges, which were then applied to the validation sample. Results Optimal ranges of CDR-SOB scores corresponding to the global CDR scores were 0.5 to 4.0 for a global score of 0.5, 4.5 to 9.0 for a global score of 1.O, 9.5 to 15.5 for a global score of 2.0, and 16.0 to 18.0 for a global score of 3.0. When applied to the validation sample, κ scores ranged from 0.86 to 0.94 (P <.001 for all), with 93.0% of the participants falling within the new staging categories. Conclusions The CDR-SOB score compares well with the global CDR score for dementia staging. Owing to the increased range of values, the CDR-SOB score offers several advantages over the global score, including increased utility in tracking changes within and between stages of dementia severity. Interpretive guidelines for CDR-SOB scores are provided. PMID:18695059

Association of Cognitive and Noncognitive Symptoms of Delirium: A Study from Consultation-liaison Psychiatry Set-up.

PubMed

Grover, Sandeep; Mehra, Aseem; Chakrabarti, Subho; Avasthi, Ajit

2016-12-01

This study aims to evaluate the cognitive functions of patients with delirium using Hindi Mental Status Examination (HMSE), to study the correlation of cognitive functions assessed by HMSE with noncognitive symptoms as assessed using Delirium Rating Scale-Revised 1998 (DRS-R-98) and to study the association of cognitive functions assessed using HMSE and DRS-R98. A total of 76 consecutive patients fulfilling the diagnosis of delirium were evaluated on DRS-R-98, HMSE, and Short Informant Questionnaire on Cognitive Decline in the Elderly (retrospective IQCODE). The mean DRS-R-98 score 33.9 (standard deviation [SD] - 7.2) and the mean DRS-R-98 severity score was 25.9 (SD - 7.2). The mean score on HMSE was 19.3 (7.98). There were significant correlations of all the domains of HMSE with DRS-R-98 total score, DRS-R-98 severity score, DRS-R-98 cognitive subscale score, DRS-R-98 noncognitive domain subscale score, and DRS severity score without attention score. When the association of each item of DRS-R-98 and HMSE was evaluated, except for the items of delusions, lability of affect and motor retardation, there were significant negative association between all the items of DRS-R-98 and HMSE, indicating that higher severity of cognitive symptoms as assessed on HMSE is associated with higher severity of all the cognitive symptoms and most of the noncognitive symptoms as assessed by DRS-R-98. The present study suggests that attention deficits in patients with delirium influence the severity of cognitive and noncognitive symptoms of delirium. Further, the present study suggests an increase in the severity of cognitive symptoms in other domains is also associated with an increase in the severity of noncognitive symptoms of delirium.

Joint health scores in a haemophilia A cohort from Pakistan with minimal or no access to factor VIII concentrate: correlation with thrombin generation and underlying mutation.

PubMed

Khanum, F; Bowen, D J; Kerr, B C; Collins, P W

2014-05-01

Haemophilia A is associated with recurrent joint bleeding which leads to synovitis and debilitating arthropathy. Coagulation factor VIII level is an important determinant of bleed number and development of arthropathy . The aim of this study was to compare the haemophilia joint health score (HJHS) and Gilbert score with severity, age, thrombin generation (TG) and underlying mutation in a haemophilia A cohort which had minimal access to haemostatic replacement therapy. Ninety-two haemophilia A individuals were recruited from Pakistan. Age, age at first bleed, target joints, haemophilic arthropathy joints, HJHS and Gilbert score were recorded. A strong correlation was found between HJHS and Gilbert score (r = 0.98), both were significantly higher in severe (n = 59) compared with non-severe (n = 29) individuals before the age of 12 years (P ≤ 0.01) but not thereafter. When individuals were divided according to developmental age (<12 years, 12-16 years and >16 years), both HJHS and Gilbert score were significantly lower in the youngest group (P ≤ 0.001), there was no difference between 12-16 years and >16 years. In severe individuals there was no correlation between in vitro TG and joint score, whereas in non-severe individuals there was a weak negative correlation. In the severe group, no significant difference was observed for either joint score according to the underlying mutation type (inversion, missense, nonsense, frameshift). In this cohort of haemophilia A individuals with minimal access to haemostatic treatment, haemophilic arthropathy correlated with severity and age; among severe individuals, joint health scores did not relate to either the underlying mutation or in vitro TG. © 2013 John Wiley & Sons Ltd.

Exploring Learners’ Mental Health Profile: A study in Universiti Tun Hussein Onn Malaysia

NASA Astrophysics Data System (ADS)

Lee, M. F.; Lai, C. S.

2017-08-01

Mental health issue was a serious matter that was often neglected by people. This article will describe a study of the mental health profile among the learners of Malaysia Technical University (MTU) that focus on Universiti Tun Hussein Onn Malaysia (UTHM). A survey using DASS-21 inventory and self-developed questionnaire was used for this study to investigate learners’ mental health level in three elements and factors contribute towards mental health. A total number of 450 students from seven faculties in UTHM was strata randomly selected as sampel for this study. The relationships between factors of mental health and the elements of mental health was identified. Collected data was analysed using percentage, mean score, standard deviation and multiple linear regression. Findings showed that majority of students possess normal level but the percentage of severe and extremely severe level was increasing. The main factor highly significantly correlate to all the mental health elements was self-evaluation. Hence, it is highly recommended that mental health issue needs great attention and remedial action from higher learning institution, non-governmental organizations, parents, students themselves and other concerned bodies.

Mexico City's Petroleos Mexicanos explosion: disaster management and air medical transport.

PubMed

Urquieta, Emmanuel; Varon, Joseph

2014-01-01

Mexico City is the largest metropolitan area in the Americas and 1 of the largest in the world; its geographic location and uncontrolled population and industrial growth make this metropolis prone to natural and human-made disasters. Mass casualty disaster responses in Mexico City tend to have complications from multiple logistical and operational challenges. This article focuses on the experiences and lessons learned from an explosion that occurred in a government building in Mexico City and the current status of mass casualty disaster risks and response strategies in Mexico City as well as air medical evacuation, which is a critical component and was shown to be extremely useful in the evacuation of 15 critically ill and polytraumatized patients (Injury Severity Score > 15). Several components of the public and privately owned emergency medical services and health care systems among Mexico City pose serious logistical and operational complications, which finally will be addressed by a joint emergency preparedness council to unify criteria in communications, triage, and incident/disaster command post establishment. Copyright © 2014 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

Comparison of multianalyte proficiency test results by sum of ranking differences, principal component analysis, and hierarchical cluster analysis.

PubMed

Škrbić, Biljana; Héberger, Károly; Durišić-Mladenović, Nataša

2013-10-01

Sum of ranking differences (SRD) was applied for comparing multianalyte results obtained by several analytical methods used in one or in different laboratories, i.e., for ranking the overall performances of the methods (or laboratories) in simultaneous determination of the same set of analytes. The data sets for testing of the SRD applicability contained the results reported during one of the proficiency tests (PTs) organized by EU Reference Laboratory for Polycyclic Aromatic Hydrocarbons (EU-RL-PAH). In this way, the SRD was also tested as a discriminant method alternative to existing average performance scores used to compare mutlianalyte PT results. SRD should be used along with the z scores--the most commonly used PT performance statistics. SRD was further developed to handle the same rankings (ties) among laboratories. Two benchmark concentration series were selected as reference: (a) the assigned PAH concentrations (determined precisely beforehand by the EU-RL-PAH) and (b) the averages of all individual PAH concentrations determined by each laboratory. Ranking relative to the assigned values and also to the average (or median) values pointed to the laboratories with the most extreme results, as well as revealed groups of laboratories with similar overall performances. SRD reveals differences between methods or laboratories even if classical test(s) cannot. The ranking was validated using comparison of ranks by random numbers (a randomization test) and using seven folds cross-validation, which highlighted the similarities among the (methods used in) laboratories. Principal component analysis and hierarchical cluster analysis justified the findings based on SRD ranking/grouping. If the PAH-concentrations are row-scaled, (i.e., z scores are analyzed as input for ranking) SRD can still be used for checking the normality of errors. Moreover, cross-validation of SRD on z scores groups the laboratories similarly. The SRD technique is general in nature, i.e., it can be applied to any experimental problem in which multianalyte results obtained either by several analytical procedures, analysts, instruments, or laboratories need to be compared.

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

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.

Developing a cumulative anatomic scoring system for military perineal and pelvic blast injuries.

PubMed

Mossadegh, Somayyeh; Midwinter, M; Parker, P

2013-03-01

Improvised explosive device (IED) yields in Afghanistan have increased resulting in more proximal injuries. The injury severity score (ISS) is an anatomic aggregate score of the three most severely injured anatomical areas but does not accurately predict severity in IED related pelvi-perineal trauma patients. A scoring system based on abbreviated injury score (AIS) was developed to reflect the severity of these injuries in order to better understand risk factors, develop a tool for future audit and improve performance. Using standard AIS descriptors, injury scales were constructed for the pelvis (1, minor to 6, maximal). The perineum was divided into anterior and posterior zones as relevant to injury patterns and blast direction with each soft tissue structure being allocated a score from its own severity scale. A cumulative score, from 1 to 36 for soft tissue, or a maximum of 42 if a pelvic fracture was involved, was created for all structures injured in the anterior and posterior zones. Using this new scoring system, 77% of patients survived with a pelvi-perineal trauma score (PPTS) below 5. There was a significant increase in mortality, number of pelvic fractures and amputations with increase in score when comparing the first group (score 1-5) to the second group (score 6-10). For scores between 6 and 16 survival was 42% and 22% for scores between 17 and 21. In our cohort of 62 survivors, 1 patient with an IED related pelvi-perineal injury had a 'theoretically un-survivable' maximal ISS of 75 and survived, whereas there were no survivors with a PPTS greater than 22 but this group had no-one with an ISS of 75 suggesting ISS is not an accurate reflection of the true severity of pelvi-perineal blast injury. This scoring system is the initial part of a more complex logistic regression model that will contribute towards a unique trauma scoring system to aid surgical teams in predicting fluid requirements and operative timelines. In austere environments, it may also help to prevent futile resuscitations. Better correlation between measurement of severity and outcome would aid performance improvement monitoring. In the longer term it will also allow benchmarking of current survival rates and comparisons in the future.

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.

THE PANC 3 SCORE PREDICTING SEVERITY OF ACUTE PANCREATITIS.

PubMed

Beduschi, Murilo Gamba; Mello, André Luiz Parizi; VON-Mühlen, Bruno; Franzon, Orli

2016-03-01

About 20% of cases of acute pancreatitis progress to a severe form, leading to high mortality rates. Several studies suggested methods to identify patients that will progress more severely. However, most studies present problems when used on daily practice. To assess the efficacy of the PANC 3 score to predict acute pancreatitis severity and its relation to clinical outcome. Acute pancreatitis patients were assessed as to sex, age, body mass index (BMI), etiology of pancreatitis, intensive care need, length of stay, length of stay in intensive care unit and mortality. The PANC 3 score was determined within the first 24 hours after diagnosis and compared to acute pancreatitis grade of the Revised Atlanta classification. Out of 64 patients diagnosed with acute pancreatitis, 58 met the inclusion criteria. The PANC 3 score was positive in five cases (8.6%), pancreatitis progressed to a severe form in 10 cases (17.2%) and five patients (8.6%) died. Patients with a positive score and severe pancreatitis required intensive care more often, and stayed for a longer period in intensive care units. The PANC 3 score showed sensitivity of 50%, specificity of 100%, accuracy of 91.4%, positive predictive value of 100% and negative predictive value of 90.6% in prediction of severe acute pancreatitis. The PANC 3 score is useful to assess acute pancreatitis because it is easy and quick to use, has high specificity, high accuracy and high predictive value in prediction of severe acute pancreatitis.

THE PANC 3 SCORE PREDICTING SEVERITY OF ACUTE PANCREATITIS

PubMed Central

BEDUSCHI, Murilo Gamba; MELLO, André Luiz Parizi; VON-MÜHLEN, Bruno; FRANZON, Orli

2016-01-01

Background : About 20% of cases of acute pancreatitis progress to a severe form, leading to high mortality rates. Several studies suggested methods to identify patients that will progress more severely. However, most studies present problems when used on daily practice. Objective : To assess the efficacy of the PANC 3 score to predict acute pancreatitis severity and its relation to clinical outcome. Methods : Acute pancreatitis patients were assessed as to sex, age, body mass index (BMI), etiology of pancreatitis, intensive care need, length of stay, length of stay in intensive care unit and mortality. The PANC 3 score was determined within the first 24 hours after diagnosis and compared to acute pancreatitis grade of the Revised Atlanta classification. Results : Out of 64 patients diagnosed with acute pancreatitis, 58 met the inclusion criteria. The PANC 3 score was positive in five cases (8.6%), pancreatitis progressed to a severe form in 10 cases (17.2%) and five patients (8.6%) died. Patients with a positive score and severe pancreatitis required intensive care more often, and stayed for a longer period in intensive care units. The PANC 3 score showed sensitivity of 50%, specificity of 100%, accuracy of 91.4%, positive predictive value of 100% and negative predictive value of 90.6% in prediction of severe acute pancreatitis. Conclusion : The PANC 3 score is useful to assess acute pancreatitis because it is easy and quick to use, has high specificity, high accuracy and high predictive value in prediction of severe acute pancreatitis. PMID:27120730

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.

[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.

The impact of DSM-5 on the diagnosis and severity indicator of eating disorders in a treatment-seeking sample.

PubMed

Nakai, Yoshikatsu; Nin, Kazuko; Noma, Shun'ichi; Teramukai, Satoshi; Fujikawa, Kei; Wonderlich, Stephen A

2017-11-01

To examine the impact of the DSM-5 on the diagnoses and severity indicators of eating disorders, we conducted a comparative study on the classification of eating disorders including subtypes of anorexia nervosa (AN) between the DSM-IV and DSM-5 criteria. In addition, we studied the association of the DSM-5 severity criteria and clinical variables. Participants were 304 outpatients, aged 16-45 years, with eating disorders, diagnosed using semi-structured clinical interviews and the eating disorder examination questionnaire (EDE-Q). The severity of AN, bulimia nervosa (BN), and binge-eating disorder (BED) was rated from mild to extreme using the DSM-5 severity criteria. The DSM-5 remarkably reduced the number of diagnoses in the residual category from 37.5% to 9.2% and effectively differentiated the diagnostic groups in eating disorder psychopathology. Unexpectedly, however, the scores of all the EDE-Q subscales significantly decreased as severity ratings increased in the DSM-5 AN. Furthermore, while the AN binge-eating/purging group reported significantly lower severity ratings than the AN restricting group, the former displayed more severe eating disorder psychopathology than the latter. In the BN and BED groups, the level of eating concern increased as severity ratings increased, but the severity groups did not differ on other eating pathology variables. The DSM-5 effectively reduced the reliance on residual categories and differentiated the diagnostic groups in eating disorder psychopathology. However, our findings show limited support for the DSM-5 severity specifiers for eating disorders. It is necessary to test additional clinical or functional variables for severity specifiers across eating disorders. © 2017 Wiley Periodicals, Inc.

Neither got a good bill of musculoskeletal health: a comparative study among medical and dental students.

PubMed

Coskun Benlidayi, Ilke; Al-Bayati, Zainb; Guzel, Rengin; Sarpel, Tunay

2018-06-06

It has been well established that musculoskeletal complaints are common among dentistry students. However, data regarding the comparison of overall musculoskeletal health between dental and medical students is scarce. The objective of the current study was to compare musculoskeletal health between medical and dental students. The population of the current study was comprised of fourth- and fifth-year students from medical and dental faculties of the same university who were at least three months in clinical training. Self-administered multi-item questionnaires regarding the musculoskeletal complaints were distributed to these students. A comparative analysis was carried out on the responses derived from the medical and dental students. A total of 219 students completed the questionnaire, yielding a response rate of 81.1%. Almost four fifth (80.4%) of the students reported musculoskeletal pain, with frequencies of 85.9 and 75.8% in dental and medical students, respectively (p > 0.05). Total, upper extremity and neck VAS scores were significantly higher in dental students than those in medical students (p < 0.01, p < 0.001 and p < 0.05, respectively). The rate of mild-severe pain sufferers in the upper extremity was also higher among dental students (p < 0.001). Musculoskeletal pain is frequent in both medical and dental students. However, the intensity of pain - particularly for the upper extremity and neck - is higher among dental students. The findings of the current study might be attributed to the fact that dental education requires more physical burden during routine clinical training than medical education.

Fall management in Alzheimer-related dementia: a case study.

PubMed

Mirolsky-Scala, Gail; Kraemer, Theresa

2009-01-01

Nursing home residents with dementia are at an increased risk of falls. This case report describes a physical therapist's approach to fall management in a patient with Alzheimer's disease in a long-term care facility. An 85-year-old female with Alzheimer's disease began to experience impaired balance and weakness resulting in gait deviations and falls. The combination of clinical findings, scores on several clinical measures, and fall history classified her as being at high risk for future falls. The physical therapy fall management program included lower extremity and core therapeutic exercise, balance, gait, and assistive device training, and caregiver instruction in the form of a functional maintenance program (FMP) with focus on activities that activated the implicit memory system while emphasizing aspects of communication that are typically preserved in patients with dementia. After 4 weeks of twelve 30 minute sessions, the patient's Tinetti Assessment Tool score increased from 8/28 to 16/28 and Berg Balance Scale score from 7/56 to 19/56. The number of documented incident reports related to falls decreased from 2 to 0 in a 4-week period of time. On the International Classification of Functioning, Disability, and Health, the patient improved in 4 areas of the Impairments of Body Functions domain, in 12 areas of the Activity Limitations and Participation Restriction domain, and in 3 areas of the Environmental Factors domain. Positive functional outcomes were achieved through a modification of typical fall prevention interventions that took into consideration the patient's decreased cognition, communication deficits, and behavior problems.

Extreme Environments Capabilities at Glenn Research Center

NASA Technical Reports Server (NTRS)

Balcerski, Jeffrey; Kremic, Tibor; Arnett, Lori; Vento, Dan; Nakley, Leah

2016-01-01

The NASA Glenn Research Center has several facilities that can provide testing for extreme evironments of interest to the New Frontiers community. This includes the Glenn Extreme Enivironments Rig (GEER) which can duplicate the atmospheric chemistry and conditions for the Venus surface or any other planet with a hot environment. GRC also has several cryogenic facilities which have the capability to run with hydrogen atmospheres, hydrocarbon atmosphere, CO2 based atmospheres or nitrogen atmospheres. The cryogenic facilities have the capability to emulate Titan lakes.

Decreased gray matter volume in the left hippocampus and bilateral calcarine cortex in coal mine flood disaster survivors with recent onset PTSD.

PubMed

Zhang, Jian; Tan, Qingrong; Yin, Hong; Zhang, Xiaoliang; Huan, Yi; Tang, Lihua; Wang, Huaihai; Xu, Junqing; Li, Lingjiang

2011-05-31

Although limbic structure changes have been found in chronic and recent onset post-traumatic stress disorder (PTSD) patients, there are few studies about brain structure changes in recent onset PTSD patients after a single extreme and prolonged trauma. In the current study, 20 coal mine flood disaster survivors underwent magnetic resonance imaging (MRI). Voxel-based morphometry (VBM) and region of interest (ROI) techniques were used to detect the gray matter and white matter volume changes in 10 survivors with recent onset PTSD and 10 survivors without PTSD. The correlation between the Clinician-Administered PTSD Scale (CAPS) and gray matter density in the ROI was also studied. Compared with survivors without PTSD, survivors with PTSD had significantly decreased gray matter volume and density in left anterior hippocampus, left parahippocampal gyrus, and bilateral calcarine cortex. The CAPS score correlated negatively with the gray matter density in bilateral calcarine cortex and left hippocampus in coal mine disaster survivors. Our study suggests that the gray matter volume and density of limbic structure decreased in recent onset PTSD patients who were exposed to extreme trauma. PTSD symptom severity was associated with gray matter density in calcarine cortex and hippocampus. 2010 Elsevier Ireland Ltd. All rights reserved.

Comparisons of the Outcome Prediction Performance of Injury Severity Scoring Tools Using the Abbreviated Injury Scale 90 Update 98 (AIS 98) and 2005 Update 2008 (AIS 2008).

PubMed

Tohira, Hideo; Jacobs, Ian; Mountain, David; Gibson, Nick; Yeo, Allen

2011-01-01

The Abbreviated Injury Scale (AIS) was revised in 2005 and updated in 2008 (AIS 2008). We aimed to compare the outcome prediction performance of AIS-based injury severity scoring tools by using AIS 2008 and AIS 98. We used all major trauma patients hospitalized to the Royal Perth Hospital between 1994 and 2008. We selected five AIS-based injury severity scoring tools, including Injury Severity Score (ISS), New Injury Severity Score (NISS), modified Anatomic Profile (mAP), Trauma and Injury Severity Score (TRISS) and A Severity Characterization of Trauma (ASCOT). We selected survival after injury as a target outcome. We used the area under the Receiver Operating Characteristic curve (AUROC) as a performance measure. First, we compared the five tools using all cases whose records included all variables for the TRISS (complete dataset) using a 10-fold cross-validation. Second, we compared the ISS and NISS for AIS 98 and AIS 2008 using all subjects (whole dataset). We identified 1,269 and 4,174 cases for a complete dataset and a whole dataset, respectively. With the 10-fold cross-validation, there were no clear differences in the AUROCs between the AIS 98- and AIS 2008-based scores. With the second comparison, the AIS 98-based ISS performed significantly worse than the AIS 2008-based ISS (p<0.0001), while there was no significant difference between the AIS 98- and AIS 2008-based NISSs. Researchers should be aware of these findings when they select an injury severity scoring tool for their studies.

Treatment outcome of creatine transporter deficiency: international retrospective cohort study.

PubMed

Bruun, Theodora U J; Sidky, Sarah; Bandeira, Anabela O; Debray, Francoise-Guillaume; Ficicioglu, Can; Goldstein, Jennifer; Joost, Kairit; Koeberl, Dwight D; Luísa, Diogo; Nassogne, Marie-Cecile; O'Sullivan, Siobhan; Õunap, Katrin; Schulze, Andreas; van Maldergem, Lionel; Salomons, Gajja S; Mercimek-Andrews, Saadet

2018-06-01

To evaluate the outcome of current treatment for creatine transporter (CRTR) deficiency, we developed a clinical severity score and initiated an international treatment registry. An online questionnaire was completed by physicians following patients with CRTR deficiency on a treatment, including creatine and/or arginine, and/or glycine. Clinical severity score included 1) global developmental delay/intellectual disability; 2) seizures; 3) behavioural disorder. Phenotype scored 1-3 = mild; 4-6 = moderate; and 7-9 = severe. We applied the clinical severity score pre- and on-treatment. Seventeen patients, 14 males and 3 females, from 16 families were included. Four patients had severe, 6 patients had moderate, and 7 patients had a mild phenotype. The phenotype ranged from mild to severe in patients diagnosed at or before 2 years of age or older than 6 years of age. The phenotype ranged from mild to severe in patients with mildly elevated urine creatine to creatinine ratio. Fourteen patients were on the combined creatine, arginine and glycine therapy. On the combined treatment with creatine, arginine and glycine, none of the males showed either deterioration or improvements in their clinical severity score, whereas two females showed improvements in the clinical severity score. Creatine monotherapy resulted in deterioration of the clinical severity score in one male. There seems to be no correlation between phenotype and degree of elevation in urine creatine to creatinine ratio, genotype, or age at diagnosis. Combined creatine, arginine and glycine therapy might have stopped disease progression in males and improved phenotype in females.

A Comparison of Diarrheal Severity Scores in the MAL-ED Multisite Community-Based Cohort Study

PubMed Central

Lee, Gwenyth O.; Richard, Stephanie A.; Kang, Gagandeep; Houpt, Eric R.; Seidman, Jessica C.; Pendergast, Laura L.; Bhutta, Zulfiqar A.; Ahmed, Tahmeed; Mduma, Estomih R.; Lima, Aldo A.; Bessong, Pascal; Jennifer, Mats Steffi; Hossain, Md. Iqbal; Chandyo, Ram Krishna; Nyathi, Emanuel; Lima, Ila F.; Pascal, John; Soofi, Sajid; Ladaporn, Bodhidatta; Guerrant, Richard L.; Caulfield, Laura E.; Black, Robert E.; Kosek, Margaret N.

2016-01-01

ABSTRACT Objectives: There is a lack of consensus on how to measure diarrheal severity. Within the context of a multisite, prospective cohort study, we evaluated the performance of a modified Vesikari score (MAL-ED), 2 previously published scores (Clark and CODA [a diarrheal severity score (Community DiarrheA) published by Lee et al]), and a modified definition of moderate-to-severe diarrhea (MSD) based on dysentery and health care worker diagnosed dehydration. Methods: Scores were built using maternally reported symptoms or fieldworker-reported clinical signs obtained during the first 7 days of a diarrheal episode. The association between these and the risk of hospitalization were tested using receiver operating characteristic analysis. Severity scores were also related to illness etiology, and the likelihood of the episode subsequently becoming prolonged or persistent. Results: Of 10,159 episodes from 1681 children, 143 (4.0%) resulted in hospitalization. The area under the curve of each score as a predictor of hospitalization was 0.84 (95% confidence interval: 0.81, 0.87) (Clark), 0.85 (0.82, 0.88) (MAL-ED), and 0.87 (0.84, 0.89) (CODA). Severity was also associated with etiology and episode duration. Although families were more likely to seek care for severe diarrhea, approximately half of severe cases never reached the health system. Conclusions: Community-based diarrheal severity scores are predictive of relevant child health outcomes. Because they require no assumptions about health care access or utilization, they are useful in refining estimates of the burden of diarrheal disease, in estimating the effect of disease control interventions, and in triaging children for referral in low- and middle-income countries in which the rates of morbidity and mortality after diarrhea remain high. PMID:27347723

A Retrospective Review of Treatment Results for Patients With Central Centrifugal Cicatrical Alopecia.

PubMed

Eginli, Ariana; Dothard, Emily; Bagayoko, Courtney W; Huang, Karen; Daniel, Alyssa; McMichael, Amy J

2017-04-01

INTRODUCTION: Central centrifugal cicatricial alopecia (CCCA) is a form of scarring alopecia primarily affecting women of African descent on the crown of the scalp. Limited data exists regarding evidence-based treatment for CCCA.

OBJECTIVE: To examine photos of subjects with CCCA before and after treatment in order to evaluate results of treatment and compare results of different treatment regimens.

METHODS: Photographs of 15 subjects with CCCA before and after treatment were evaluated by two blinded investigators who assigned disease severity scores to photographs based on a published scale: Central Scalp Alopecia Photographic Scale in African American Women.

RESUTLS: Median change in severity score (post-treatment severity score - pre-treatment severity score) was 0.5 (P = 0.58) for all 15 subjects receiving a series of 7 to 8 intralesional steroid injections along with topical steroids (Class I/II) +/- minoxidil and +/- anti-dandruff shampoo, indicating worsening of disease after treatment. Subjects receiving minoxidil versus those who did not (0.25 vs 0.5; P = 0.38) and subjects receiving anti-dandruff shampoo versus those who did not (0.0 vs 0.5; P = 0.42) demonstrated no statistically significant difference in pre- and post-treatment severity scores. Of 15 subjects, 5/15 (33.3%) had decreased severity scores, 8/15 (53.3%) had increased severity scores, and 2/15 (13.3%) had no change in severity scores.

CONCLUSIONS: Although no statistically significant difference was found in pre- versus post-treatment disease severity, this may indicate intralesional steroid injections and topical steroids +/- minoxidil and +/- anti-dandruff shampoo halt disease progression.

J Drugs Dermatol. 2017;16(4):317-320.

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'.

Determining venous thromboembolic risk assessment for patients with trauma: the Trauma Embolic Scoring System.

PubMed

Rogers, Frederick B; Shackford, Steven R; Horst, Michael A; Miller, Jo Ann; Wu, Daniel; Bradburn, Eric; Rogers, Amelia; Krasne, Margaret

2012-08-01

This study aimed to determine the relative "weight" of risk factors known to be associated with venous thromboembolism (VTE) for patients with trauma based on injuries and comorbidities. A retrospective review of 16,608 consecutive admissions to a trauma center was performed. Patients were separated into those who developed VTE (n = 141) versus those who did not (16,467). Univariate analysis was performed for each risk factor reported in the trauma literature. Risk factors that were shown to be significant (p < 0.05) by univariate analysis underwent multivariate analysis to develop odds ratios for VTE. The Trauma Embolic Scoring System (TESS) was derived from the multivariate coefficients. The resulting TESS was compared with a data set from the National Trauma Data Bank (2002-2006) to determine its ability to predict VTE. The multivariate analysis demonstrated that age, Injury Severity Score, obesity, ventilator use for more than 3 days, and lower-extremity trauma were significant predictors of VTE in our patient population. The TESS was from 0 to 14, with the best prediction for those patients with a score of more than 6 (sensitivity, 81.6%; specificity, 84%). Overall, the model had excellent discrimination in predicting VTE with a receiver operating characteristic curve of 0.89. The VTE rates for TESS in the National Trauma Data Bank data set were similar for all integers except for 3 and 4, in which the VTE rates were significantly higher (3, 0.2% vs. 0.6%; 4, 0.4% vs. 1.0%). The TESS provides an objective measure of classifying VTE risk for patients with trauma. The TESS could allow informed decision making regarding prophylaxis strategies in patients with trauma.

The pain experience of inpatients in a teaching hospital: revisiting a strategic priority.

PubMed

Jabusch, Kimberly M; Lewthwaite, Barbara J; Mandzuk, Lynda L; Schnell-Hoehn, Karen N; Wheeler, Barbara J

2015-02-01

For hospital executives and clinicians to improve pain management, organizations must examine the current pain experience of in-patients beyond simply measuring patient satisfaction. The aim of this study was to quantify the prevalence of pain among adult in-patients and the degree of interference pain had on daily activities. A descriptive, cross-sectional study was undertaken in a 530 bed tertiary care, teaching hospital in central Canada. A convenience sample (N = 88) of adult medical-surgical patients completed the Short Form-Brief Pain Inventory survey. Pain prevalence was 70.4%. The mean pain severity score was 3.76 (standard deviation, SD = 2.88) and mean pain interference score on daily activities was 4.56 (SD = 3.93). The most frequently identified site of pain was the lower extremities (n = 15, 28%). Women had higher mean scores on pain "right now" compared to men (p < 0.05). The sample majority (n = 81) indicated hospital staff asked about the presence of pain. Seventy-nine percent (n = 57) reported hospital staff "always" did everything they could to help manage pain. Eighty-four percent (n = 61) selected "always" or "usually" to describe their ability to be involved in deciding pain treatments. The mean pain relief score from treatments was 61% (SD = 34.79). Significant positive correlations were found between pain intensity ratings and pain interference on all daily activities (p < 0.001). Pain prevalence remains high with a significant relationship between pain and activities of daily living. The study provides baseline data to direct future initiatives at improving pain management. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Estimation of Symptom Severity Scores for Patients with Schizophrenia Using ERP Source Activations during a Facial Affect Discrimination Task.

PubMed

Kim, Do-Won; Lee, Seung-Hwan; Shim, Miseon; Im, Chang-Hwan

2017-01-01

Precise diagnosis of psychiatric diseases and a comprehensive assessment of a patient's symptom severity are important in order to establish a successful treatment strategy for each patient. Although great efforts have been devoted to searching for diagnostic biomarkers of schizophrenia over the past several decades, no study has yet investigated how accurately these biomarkers are able to estimate an individual patient's symptom severity. In this study, we applied electrophysiological biomarkers obtained from electroencephalography (EEG) analyses to an estimation of symptom severity scores of patients with schizophrenia. EEG signals were recorded from 23 patients while they performed a facial affect discrimination task. Based on the source current density analysis results, we extracted voxels that showed a strong correlation between source activity and symptom scores. We then built a prediction model to estimate the symptom severity scores of each patient using the source activations of the selected voxels. The symptom scores of the Positive and Negative Syndrome Scale (PANSS) were estimated using the linear prediction model. The results of leave-one-out cross validation (LOOCV) showed that the mean errors of the estimated symptom scores were 3.34 ± 2.40 and 3.90 ± 3.01 for the Positive and Negative PANSS scores, respectively. The current pilot study is the first attempt to estimate symptom severity scores in schizophrenia using quantitative EEG features. It is expected that the present method can be extended to other cognitive paradigms or other psychological illnesses.

Development and Validation of a Disease Severity Scoring Model for Pediatric Sepsis.

PubMed

Hu, Li; Zhu, Yimin; Chen, Mengshi; Li, Xun; Lu, Xiulan; Liang, Ying; Tan, Hongzhuan

2016-07-01

Multiple severity scoring systems have been devised and evaluated in adult sepsis, but a simplified scoring model for pediatric sepsis has not yet been developed. This study aimed to develop and validate a new scoring model to stratify the severity of pediatric sepsis, thus assisting the treatment of sepsis in children. Data from 634 consecutive patients who presented with sepsis at Children's hospital of Hunan province in China in 2011-2013 were analyzed, with 476 patients placed in training group and 158 patients in validation group. Stepwise discriminant analysis was used to develop the accurate discriminate model. A simplified scoring model was generated using weightings defined by the discriminate coefficients. The discriminant ability of the model was tested by receiver operating characteristic curves (ROC). The discriminant analysis showed that prothrombin time, D-dimer, total bilirubin, serum total protein, uric acid, PaO2/FiO2 ratio, myoglobin were associated with severity of sepsis. These seven variables were assigned with values of 4, 3, 3, 4, 3, 3, 3 respectively based on the standardized discriminant coefficients. Patients with higher scores had higher risk of severe sepsis. The areas under ROC (AROC) were 0.836 for accurate discriminate model, and 0.825 for simplified scoring model in validation group. The proposed disease severity scoring model for pediatric sepsis showed adequate discriminatory capacity and sufficient accuracy, which has important clinical significance in evaluating the severity of pediatric sepsis and predicting its progress.