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IntroductionImpaired balance-regulation after stroke put patients and therapists at risk for injury during rehabilitation. Body-weight-support systems (BWSSs) minimize this risk and allow patients to safely practice balance activities during therapy. Treadmill based balance perturbation systems with BWSSs are known to improve balance in patients with age or disease related impairments. However, these stationary systems are unable accommodate complex exercises requiring more freedom of movement.ObjectiveTo evaluate the impact of a new balance perturbation module, which is directly integrated to a track-mounted BWSS, has on patient balance after acute stroke.DesignUnblinded quasi-randomized controlled pilot study.SettingRehabilitation centered long-term acute care hospital.ParticipantsStroke rehabilitation inpatients with an admission Berg Balance Scale (BBS) assessment score ≥21/56.InterventionsBWSS and BWSS with perturbation (BWSS-P) training was incorporated into the participants’ regular treatment. While both groups conducted the same balance and gait activities during their treatment sessions, the BWSS-P sessions included lateral and anterior/posterior resistive or assistive balance perturbations.Main outcome measuresBBS and Activities-Specific Balance-Confidence (ABC) assessments were the main outcome measure collected. Institutional BBS data from fiscal-year 2018, prior to installation of the track mounted BWSS, was used as a historical standard-of-care (SOC) baseline.ResultsImproved post-intervention BBS and ABC assessment scores showed all participants benefited from therapy (p≤0.0438). The BBS percent-change of the BWSS-P [mean (SD) n] [66.95% (43.78%) 14] and BWSS control [53.29% (24.13%) 15] were greater than the SOC group [28.31% (17.25%) 30] (p≤0.0178), with no difference between BWSS groups (p=0.6669); ABC percent score-changes were also similar (p≥0.8036).ConclusionsBWSS groups demonstrated similar BBS and ABC score improvements, indicating balance perturbations are not detrimental to post-acute stroke rehabilitation and are safe to use. This data provides strong rationale for conducting a larger follow-up study to further assess if this new perturbation system provides additional benefit to stroke patient balance during rehabilitation.Clinical Trial RegistrationNCT04919161

ObjectiveTo describe characteristics, clinical management, and patient outcomes during and after acute COVID-19 phase in a long-term acute care hospital in the Northeastern United States.MethodsA single-center retrospective analysis of electronic medical records of patients treated for COVID-19-related impairments, from March 19, 2020 through August 14, 2020, was conducted to evaluate patient outcomes in response to the facility’s holistic treatment approach.Results118 admissions were discharged by the data cut-off. Mean patient age was 63 years, 64.1% were male, and 29.9% of patients tested-positive for SARS-CoV-2 infection at admission. The mean (SD) length-of-stay at was 25.5 (13.0) days and there was a positive correlation between patient age and length-of-stay. Of the 51 patients non-ambulatory at admission, 83.3% were ambulatory at discharge. Gait increased 217.4 feet from admission to discharge, a greater increase than the reference cohort of 146.3 feet. 93.8% (15/16) of patients mechanically ventilated at admission were weaned before discharge (mean 11.3 days). 74.7% (56/75) of patients admitted with a restricted diet were discharged on a regular diet.ConclusionThe majority of patients treated at a long-term acute care hospital for severe COVID-19 and related complications improved significantly through coordinated care and rehabilitation.

Research Objectives To determine if inducing safe postural-perturbations with the TRiP-module during standing and ambulation exercises in the ZeroG body-weight support system, more effectively improves patient balance than ZeroG without these perturbations. Design Study was an unblinded randomized control pilot study. Setting Study was conducted at Gaylord Specialty Healthcare, a long-term acute care rehabilitation hospital located in Wallingford, Connecticut, USA. Participants Inpatient stroke rehabilitation patients were considered for the study if their Berg Balance Scale score was ≥ 21/56. Consented participants were randomly assigned to either the ZeroG or ZeroG+TRiP group. Interventions ZeroG interventions consisted of balance activities including ambulation, marching, side-stepping, retro-ambulation, step-taps, and step-ups. ZeroG+TRiP interventions included these same activities, with the addition of a sudden and brief assistive or resistive force in the lateral, anterior, or posterior direction. Participants completed eight-sessions over two-weeks, starting at TRiP level-one and progressing to level-ten based on the participant's progress and therapist's discretion. Main Outcome Measures The main study outcomes were the Activities-Specific Balance Confidence (ABC) and Berg Balance Scale assessments. Results Institutional Berg Balance data from 2018 served as a historical Standard of Care (SOC) baseline. SOC, ZeroG, and ZeroG+TRiP groups displayed improved post-intervention Berg Balance scores (p≤0.0025), however, the post-intervention scores were not different between groups. Calculating the Berg Balance score percent change [mean(SD)n], the ZeroG+TRiP [66.95%(43.78%)14] and ZeroG groups [53.29%(24.13%)15] were significantly greater than the SOC group [28.31%(17.25%)30] (p≤0.0178), with no difference between the ZeroG groups (p=0.6669). The post intervention ABC assessment scores were similarly improved (p≤0.0438), with no difference between ZeroG groups. Conclusions Participants in both ZeroG groups demonstrated similar Berg Balance Scale and ABC score improvements, indicating the TRiP Module is not detrimental to post-acute stroke rehabilitation and can be safely used. This pilot-study then provides the rationale for conducting a larger study to better assess if the TRiP protocol provides an additional benefit to stroke patients during inpatient rehabilitation. Author(s) Disclosures Aretech, LLC provided financial assistance for protected time to complete the administrative work associated with this pilot study. Authors have no other disclosures.

Objectives Prednisone is a widely used anti-inflammatory for a variety of conditions. While oral liquid formulations of prednisone enable weight-based dosing, children frequently find them to be objectionable due to bitter taste. This limitation of prednisone can adversely impact patient acceptance and may result in non-compliance. Efforts to mask flavours often result in poorly controlled, heterogeneous particle distributions and can provide ineffective taste masking. The present work utilized a novel drug delivery technology developed by Orbis Biosciences, Inc., to create an oral taste-masked formulation of prednisone. Methods The study examined the palatability of Orbis’ microsphere prednisone formulation in healthy young adults (n = 24). Four test articles were used in the study including a reference formulation (Roxanne Laboratories), a control and the test formulation (Orbis) prepared in two different ways. Study participants were randomized in a crossover design. Key findings Results indicated that the test prednisone formulation was indistinguishable from the control, and both were preferable to the reference formulation in every category of palatability assessed using a validated 9-point Hedonic Scale. The data also suggested that preparing the microsphere suspension immediately before administration results in the most ideal palatability properties. Conclusions In conclusion, the novel microsphere formulation technology was effective in taste-masking prednisone.

Objective: Magnesium sulfate (MgSO4) administration to patients with preterm delivery has been associated with a decrease in cerebral palsy. At our institution, a protocol was established regarding the administration of magnesium sulfate for patients in preterm labor at less than 32 weeks of gestation. Despite this protocol, not all eligible patients received this therapy. The purpose of this study was to investigate potential barriers to MgSO4 administration. Methods: A retrospective chart review was performed of those patients who received the diagnosis of “Early Onset Delivery” or “preterm labor” from January through December of 2010, to see what therapies were offered and received. Results: 119 patients met initial criteria. Of those, 68 patients had preterm labor less than 32 weeks. 15 of the 68 patients (22%) received MgSO4. Of those patients that did not receive MgSO4, only 6 delivered 4, and those that were eligible and did not. Potential barriers included short time frame from presentation to delivery, treatment not considered by healthcare provider, and unanticipated delivery. No patient declined therapy. Conclusions: At our institution, the rate of MgSO4 administration for neuroprotection to eligible candidates was 75%. The subgroup of patients where MgSO4 was not administered in eligible candidates was unanticipated delivery (4), and premature rupture of membranes (1). A 4 gram load of MgSO4 should be attempted prior to delivery of eligible patients, as this strategy has also been shown to be of benefit.

Objective: The use of intramuscular 17-alpha-hydroxyprogesterone caproate (17-OHPC) has been shown to be beneficial for the prevention of preterm birth (PTB) in women with a prior history. Not all patients with a prior preterm birth receive 17-OHPC. The purpose of this study was to investigate potential barriers to receiving this therapy. Methods: A retrospective chart review of those patients at our institution who received the diagnosis of “previous preterm delivery” in 2010 and 2011 was performed to see whether they were offered and received 17-OHPC. Patients were considered eligible if they had a prior delivery at less than 36 weeks of gestation secondary to idiopathic preterm labor. For those patients that were deemed eligible but did not receive therapy, an explanation was sought. Results: Sixty-six charts were reviewed in detail. Forty-three patients were considered eligible to receive 17-OHPC. The remaining had medical indications for delivery including premature rupture of membranes (PROM) (15), intrauterine growth restriction (IUGR) (1), and hypertension (2). Of the 43 patients deemed eligible, 17 did not receive 17-OHPC. Of these, eight patients were not offered therapy, 2 patients declined therapy, 3 patients presented with therapy after 28 weeks (too late), and 4 received a prophylactic cerclage as their only therapy. There were no significant differences between the two groups. Conclusion: In an effort to increase 17-OHPC use among eligible patients, we must continually identify physician biases and patient barriers that prevent utilization of this intervention. In addition, patients who deliver preterm should be told the importance of presenting early in subsequent pregnancies in order to receive the full benefits of this therapy.

A count of the type and brand of spent alkaline batteries from a collection program operated by Butler County, Ohio was performed to determine the level of brand diversity, to provide estimates of the size of the waste stream, and quantities collected for recycling and for landfilling. The program has a total of 37 school drop off sites at both public and private elementary, middle and high schools. Several additional sites for battery drop include public libraries in the towns of Hamilton, Fairfield, Oxford, two county government administration centers, and two major retail stores in Fairfield and West Chester townships. A total of 32,866 spent alkaline batteries with a calculated mass of approximately 943.37 kg representing 10–15% of the recycling collection were counted by size and brand type. All five types (AAA, AA, C, D, and 9V) of spent alkaline batteries had approximately 68–76% of the samples concentrated among three or four brands. The number of brands varied among types with AAA (123); AA (228); C (44); D (65); 9V (79). The total annual spent alkaline waste stream mass for Butler County is estimated to be 84,665 kg, and a mass of the spent alkaline battery waste stream collected for Butler County is approximately 7.4% (6289.1 kg) to 11.1% (9433.7 kg). Several other battery types (lead, Ni–Cd, lithium, and button batteries) were observed and comprised 60.2 kg. Butler County spends $10,000 to collect the batteries each year and the estimated cost for collecting all batteries in the County would be an additional minimum cost of $144,000 to $186,000 per year translating into a per capita cost of approximately $0.39–0.51 per Butler County resident annually. The results of this investigation are useful for recycling program development, developing environmental policies specific to the United States and can be used for comparative purposes with other battery waste streams globally.

Surveys were conducted using a pre-tested questionnaire in 1991 and 1993 in South Africa to find out how the people perceive the government's social responsibility with special reference to the provision of free health care and other determinants of well-being. Provision of jobs for the unemployed and free education were identified to be the main priorities. Free health care ranked as the fifth priority. The study supports the call for increasing participation of communities in determining and prioritising their needs. It also calls on health care professionals to support the communities by advocating for policies that are directed twoards the perceived needs of the community and to use the present available resources efficiently.