Search

Background Obesity is a known factor for the development of abnormal respiratory physiology. However, several studies have found that obesity does not hinder functional recovery in patients hospitalized for postacute care following a stroke or cardiovascular event. This study was designed to determine the effect of overweight and obesity on patients with acute pulmonary disease, hospitalized in an inpatient rehabilitation facility (IRF). Objective To investigate the impact of body mass index (BMI) on indices of function, specifically, the functional independence measure (FIM) among patients with pulmonary related debility admitted to a rehabilitation hospital. Design Retrospective cohort study. Setting Pulmonary unit in an acute freestanding rehabilitation hospital. Patients All patients admitted to an IRF with a diagnosis of pulmonary related debility over a 6-year period. Methods The data used in the study included the patient height and weight (measured on admission) and FIM (scored on admission and discharge). Main outcome measures The primary study outcome measure was the change in FIM per day by the patients' BMI category. Results For the 381 patients admitted during the observation period, BMI was compared with FIM score changes per day (FIM efficiency). After adjusting for age and sex, the FIM efficiency only slightly differed by BMI, failing to reach statistical significance. However, age did significantly influence the outcome (P = .05). Conclusion This study demonstrates that among a large group of patients with a pulmonary related debility, there was no statistically significant correlation between BMI and FIM efficiency. The overweight patients were similar in progression to those who were underweight, normal weight, and obese. However, this study found that increased age adversely affected the outcome of rehabilitation. Level of evidence III.

Background and Objective: Given the known association between inflammatory conditions and stroke, this study was designed to assess whether the diagnosis of human immunodeficiency virus (HIV) – which is associated with chronic inflammation – would affect the functional trajectory of patients hospitalized for the treatment of stroke. Methods: This is a retrospective study comparing the functional outcomes of 688,066 stroke patients with a diagnosis of HIV to those without a diagnosis of HIV from 2002 to 2017. Results: HIV+ patients were found to have a much lower age at admission, with a difference of over 10 years when compared to HIV− patients. HIV+ patients were also less likely to discharge to home when compared to HIV− patients (P < 0.0001). Gains in functional independence measure (FIM) scores per day were found to be greater among those who were HIV− compared to those who were HIV+ (P = 0.086). Factors associated with a lower FIM efficiency included older age at admission, male gender, and having a hemorrhagic stroke (P < 0.0001). Conclusion: This study found that, among those hospitalized for the treatment of a stroke, the functional gain per day was inferior among those with HIV than among those without HIV at admission.

Objective: The objective of this study is to investigate the association between body mass index (BMI) and the functional progress among patients with a recent hip replacement. Data suggest that a number of medical societies and organizations are restricting patient access to joint replacement surgeries based on the patient's BMI. This restriction seems to be related to the increased risk of complications, primarily wound infections, at the time of surgery. Few studies have been conducted on the relationship between BMI and outcomes during rehabilitation after hip replacement surgery. Design: Retrospective cohort study. Setting: All patients admitted to a rehabilitation hospital, with a recent diagnosis of hip replacement and available hospital admission height and weight data during the years 2014-2017. Main Outcome Measure: Functional independence measure (FIM) gain per day of patients by BMI category. Results: The chart review identified 479 patients had undergone hip replacement surgery. Over half of the patients were overweight or obese. FIM efficiency (FIM change/day) was the highest in the obese class II category (3.65), followed by obese class III (3.60). The differences in FIM efficiency between the normal and obese I groups reached statistical significance in favor of obese I (P = 0.024). Conclusion: This study did not demonstrate that obesity significantly impairs functional outcomes during the rehabilitation process after hip replacement surgery.

Elective orthopedic surgeries are often deferred or declined due to concern about the patient's elevated body mass index (BMI). The study team conducted a literature review of studies focusing on the relationship between BMI and outcomes of elective orthopedic surgical procedures. The literature review found that overweight and obese patients have similar gains in function and pain reduction as do patients with normal weight, with adverse perioperative outcomes more evident in the higher levels of obesity. These data suggest a need to review the current policies concerning surgical eligibility based on BMI. These data suggest that restrictions of surgical procedures based on BMI may be too restrictive and should be revised based on the current literature.

Introduction and Background: Early detection and treatment of deep venous thrombosis (DVT) can decrease the morbidity of postthrombotic syndrome as well as the mortality and morbidity resulting from pulmonary embolism. Despite this risk, it is not the standard of care to screen patients for DVT on admission to an inpatient rehabilitation facility (IRF). There are few studies examining the prevalence of occult DVT on admission to acute IRF and the effect of this screening. Guidelines for the prophylaxis of hospitalized patients have informed patient's care for years. Recently, however, the patient population in the inpatient rehabilitation hospitals has changed, and new prophylactic medications have been introduced. Given these changes, the study reviewed the frequency of lower-extremity DVT among consecutive patients admitted to a university-based freestanding rehabilitation facility. Materials and Methods: This pilot, prospective observational cross-sectional study was designed to better understand the prevalence of occult DVT among patients admitted to a freestanding IRF and to identify associated clinical factors. All consecutive patients admitted to our university-based IRF between October and December 2017, excluding those with a preexisting DVT diagnosis or the inability to undergo lower-extremity ultrasound, were consented. All patients were assessed with a bilateral duplex ultrasound of the lower extremities within 72 h of admission. Results: Of 98 patients screened, 47 (48.0%) were male and 51 (53.1%) were female, with a mean age of 61.4 (±14.2) years. The most common admission diagnoses were ischemic stroke (23.5%), debility/medical complexity (22.4%), and hemorrhagic stroke (11.2%). One patient was positive for a lower-extremity DVT on admission screening duplex ultrasound, yielding an incidence of 1.02%. Conclusions: Our study suggests that DVT screening by duplex ultrasound for all patients admitted to an acute IRF does not seem clinically warranted.

A common problem for healthcare providers is accurately tracking patients&rsquo, adherence to medication and providing real-time feedback on the management of their medication regimen. This is a particular problem for eye drop medications, as the current commercially available monitors focus on measuring adherence to pills, and not to eye drops. This work presents an intelligent bottle sleeve that slides onto a prescription eye drop medication bottle. The intelligent sleeve is capable of detecting eye drop use, measuring fluid level, and sending use information to a healthcare team to facilitate intervention. The electronics embedded into the sleeve measure fluid level, dropper orientation, the state of the dropper top (on/off), and rates of angular motion during an application. The sleeve was tested with ten patients (age &ge, 65) and successfully identified and timestamped 94% of use events. On-board processing enabled event detection and the measurement of fluid levels at a 0.4 mL resolution. These data were communicated to the healthcare team using Bluetooth and Wi-Fi in real-time, enabling rapid feedback to the subject. The healthcare team can therefore monitor a log of medication use behavior to make informed decisions on treatment or support for the patient.

Recent research has shown that the prevalence of stroke incidents and the number of survivors in developing countries surpass those from developed countries. This study aimed to enumerate the prevalence of post-stroke psychiatric and cognitive symptoms among stroke survivors from West and South Asia and Africa through a systematic review and meta-analysis. Data from each country was systematically acquired from five major databases (PsycINFO, Web of Science, Scopus, PubMed/Medline, and Google Scholar (for any missing articles and grey literature)). Meta-analytic techniques were then used to estimate the prevalence of various post-stoke psychiatric and cognitive symptoms. A total of 36 articles were accrued from 11 countries, of which 25 were evaluated as part of the meta-analysis. The pooled prevalence of post-stroke depression as per the Hospital Anxiety and Depression Scale (HADS), Hamilton Depression Rating Scale, Patient Health Questionnaire, Schedules for Clinical Assessment in Neuropsychiatry (SCAN), Geriatric Depression Scale, and the Montgomery–Asberg Depression Rating Scale ranged from 28.00 to 50.24%. Pooled prevalence of post-stroke anxiety based on the HADS and SCAN was 44.19% and 10.96%, respectively. The pooled prevalence of post-stroke cognitive impairment as per the Mini-Mental Status Examination was 16.76%. This present review has suggested that both psychiatric and cognitive symptoms are common among stroke survivors. Concerted efforts are needed to institute robust studies using culturally sensitive measures to contemplate mechanisms that address the unmet needs of this vulnerable population.

Objective: To investigate the effects of body mass index (BMI) on the rehabilitation process in patients with a recent knee replacement. Design: This retrospective cohort study included all patients admitted to a rehabilitation hospital, with a recent diagnosis of knee replacement and available hospital admission data including height and weight, between 2014 and 2017. Setting: Rehabilitation hospital. Participants: Study participants included patients who had undergone knee replacement surgery (N=742), with available BMI data. Interventions: None. Main Outcome Measures: FIM scores, including FIM change per day (FIM efficiency) by BMI category. Results: The chart review identified 742 patients who had undergone knee replacement surgery, with available BMI data. The identified patients ranged in age from 58 to 85 years, with a mean age of 70 years. Of the patients included in the study, 24 were male, 49 were female, 73 were within the normal weight class, 180 in the overweight class, 189 in the obese class I, 143 in the obese class II, and 157 patients were classified as obese class III. The mean FIM efficiency was highest in the obese class II category (3.96). In a multivariate analysis after controlling for age, obese classes II and III had significantly better FIM efficiency. Conclusion: This study did not demonstrate that obesity adversely affects the rate of recovery during hospitalization after knee replacement surgery. Keywords: Body mass index, Rehabilitation, Total knee arthroplasty

Discolored Hand after Carpal Tunnel Injection A 43-year-old woman with carpal tunnel syndrome received a glucocorticoid injection into the left carpal tunnel. Within 5 minutes, the skin overlying t...

Objective this study was designed to better understand the evolution of the ankle brachial Index (ABI) over time, so as to better inform clinical decision-making. Methods patient selection included consecutive patients with at least two documented ABI Indexes obtained at Emory Healthcare between April 2005 and April 2013. Retrospective chart reviews were conducted on consecutive patients to assess ABI Index values, time between ABIs and whether revascularization had occurred between the two ABI measures. Qualifying patients included 76 patients with two ABIs and without a surgical intervention between the two measures. Results the primary study outcome measure was the change in ABI per day. The average change in ABI per year was calculated as -0.012045. Extrapolating from these data, the estimated time in which meaningful deterioration (0.1) was found to be 8.3 years. Conclusion these data demonstrate a change in ABI that is minimal and thus suggest that without intervening medical treatments that would change the ABI, routinely repeating this test is not warranted.

Background Although many studies have demonstrated that obesity is correlated with an increased risk of chronic disease, some have reported a paradox by which those in the higher weight categories actually recover better during hospitalization. This study was designed to determine whether this obesity paradox is also reflected in the recovery of patients with traumatic brain injury (TBI) undergoing care in a rehabilitation hospital. Objective To investigate the association between body mass index (BMI) and the functional progress of patients with TBI, admitted to a rehabilitation hospital. Design Retrospective cohort study. Methods The study included all patients admitted to the brain injury unit of a rehabilitation hospital over a 6-year period. The data used for this study included patient height and weight (measured on admission) and functional independence measurements (scored on admission and discharge). Main outcome measures Functional independence measure (FIM) change per day, BMI category. Results For the 444 patients admitted, the overall FIM efficiency did not differ significantly by BMI (P = .93). After adjusting for age and gender, overweight and obese patients had the lowest FIM efficiency (1.04 for both groups), followed by the underweight and normal weight groups (1.11 and 1.26, respectively). Conclusion This study demonstrated that higher BMI was not significantly correlated with the rate of functional recovery among patients admitted to a rehabilitation hospital for TBI. Level of evidence III.

Objectives: There is a dearth of studies examining the kicks used in Tae Kwon Do (TKD). This study sought to compare the biomechanics of various TKD kicking techniques. Methods: A motion analysis video-camera based system was used to study the biomechanics of three different types of kicks performed by five Black Belt level athletes. The velocity of the kicking foot, the velocity of the pelvis, and the lower body linear momentum were estimated to compare the kicking techniques. Results: Similar patterns of ankle, knee, and hip movement were found for different kicks. The greatest peak foot velocity was observed for the front kick. The peak linear momentum of the lower body was highest for the side kick. Subjects who were able to simultaneously reach peak pelvis velocity and peak lower body linear momentum displayed the best performance. Techniques performed with a step forward after the kicks delivered a more powerful blow than techniques performed by returning to the initial position. Conclusion: This study shows that the fastest kick is the front kick and the most powerful kick is the side kick. The effectiveness of the technique is associated with the coordination of movement of the pelvis and lower body.

Topical formulations of diclofenac, a nonsteroidal anti-inflammatory drug commonly prescribed to treat musculoskeletal complaints such as osteoarthritis, low back pain, and myofascial pain, are available in the form of a solution, gel, and patch. The topical application of diclofenac results in substantially lower systemic exposure to diclofenac compared with oral diclofenac, resulting in a more favorable side effect profile. To the authors' knowledge, this is the first case report of a lower gastrointestinal bleed associated with diclofenac topical patch use in a 77 yr-old-woman with a history of colonic mass and atrial fibrillation on antiplatelet therapy.

Objective To investigate the association between body mass index (BMI) and the functional progress of patients with stroke, admitted to a rehabilitation hospital. Design A retrospective cohort study. Setting A freestanding university rehabilitation hospital stroke unit. Participants All patients (N=819) admitted to the stroke unit of a rehabilitation hospital during the study. Interventions Not applicable. Main Outcome Measures The primary study outcome measure was the FIM efficiency of patients by BMI category. Results For the 819 patients admitted during the observation period, BMI was compared with FIM score changes per day (FIM efficiency). After adjusting for age and sex, the FIM efficiency differed by BMI. The underweight group had the lowest FIM efficiency, followed by the obese and normal-weight subgroups. The overweight group had the highest FIM efficiency ( P =.05) when compared with the obese subgroup. Conclusions Among patients admitted to an acute rehabilitation hospital for stroke rehabilitation, overweight patients had better functional progress than did patients in the other weight categories.

A micro-plenoptic system was developed to image the 3D structure of the human iris in single-exposure photographs. 3D iris patterns were effectively captured. Iris depth varied from 20~80 μm in a 4.9×3.9 mm2 area.

SummaryBackground The mechanisms by which viruses induce asthma exacerbations are not well understood. Objective We characterized fluctuations in nasal aspirate cytokines during naturally occurring respiratory viral infections in children with asthma. Methods Sixteen children underwent home collections of nasal aspirates when they were without cold symptoms and again during self-reported respiratory illnesses. The presence of viral infection was ascertained by multiplex PCR. Cytokines were measured using multiplex immune assay. mRNA expression for selected markers of viral infection was measured using RT-PCR. A cumulative respiratory symptom score was calculated for each day of measurement. Generalized estimated equations were used to evaluate associations between viral infection and marker elevation, and between marker elevation and symptom score. Results The 16 patients completed a total of 37 weeks of assessment (15 ‘well’ weeks; 22 self-assessed ‘sick’ weeks). Viral infections were detected in 3 of the ‘well’ weeks and 17 of the ‘sick’ weeks (10 rhinovirus, three coronavirus, two influenza A, two influenza B, two respiratory syncytial virus, one parainfluenza). Compared to virus-negative well weeks, nasal aspirate IFN-γ, CXCL8/IL-8, CXCL10/IP-10, CCL5/RANTES, CCL11/eotaxin-1, CCL2/MCP-1, CCL4/MIP-1β, CCL7/MCP-3, and CCL20/MIP3α protein levels increased during virus-positive sick weeks. Only a subset of cytokines (IFN-γ, CXCL8, CCL2, CCL4, CCL5, and CCL20) correlated with self-reported respiratory tract symptoms. While many aspirates were dilute and showed no mRNA signal, viral infection significantly increased the number of samples that were positive for IFN-λ1, IFN-λ2/3, TLR3, RIG-I, and IRF7 mRNA. Conclusions and clinical relevance We conclude that in children with asthma, naturally occurring viral infections apparently induce a robust innate immune response including expression of specific chemokines, IFNs, and IFN-responsive genes.

Summary Background The detection of mood and anxiety disorders is of great clinical importance in patients with chronic disease but data on the occurrence of affective dysfunction is lacking among people with epilepsy (PWE) in non-western populations. Further compounding such situation, the validity of some of the common assessment measures has not been examined. Objective The study aims to investigate the application of the Hospital Anxiety and Depression Scale (HADS) by identifying patients with comorbid affective dysfunctions in an Omani population. The semi structured interview, Composite International Diagnostic Interview (CIDI) will be used to establish the psychometric property of HADS in the Omani population. Methods PWE (n = 150) were screened with the semi-structured, (CIDI) and the HADS. A receiver operating characteristics (ROC) curve was calculated to discriminate the power of the HADS for every possible threshold score. Results The semi-structured interview revealed the prevalence rate of 27% for depressive disorder and 45% for anxiety disorder. The best compromise using, the cut-off score of 7 or 8, gave a sensitivity of 99% for depression and 83–91% for anxiety and a specificity of 87.5–100% for depression and 85–94% for anxiety. Conclusions Findings suggest that HADS is a useful screening tool for this particular population. This finding is discussed from the socio-cultural perspective of Omani society.

To test for and characterize heterogeneity in ancestral contributions to individuals among a population of Mexican American (MA) and non-Hispanic white (NHW) stroke/transient ischemic attack (TIA) cases, data from a community-based stroke surveillance study in south Texas were used. Strokes/TIA cases were identified (2004-2006) with a random sample asked to provide blood. Race-ethnicity was self-reported. Thirty-three ancestry informative markers were genotyped and individual genetic admixture estimated using maximum likelihood methods. Three hypotheses were tested for each MA using likelihood ratio tests: (1) H(0) : μi = 0 (100% Native American), (2) H(0) : μi = 1.00 (100% European), (3) H(0) : μi = 0.59 (average European). Among 154 self-identified MAs, estimated European ancestry varied from 0.26 to 0.98, with an average of 0.59 (SE = 0.014). We rejected hypothesis 1 for every MA and rejected hypothesis 2 for all but two MAs. We rejected hypothesis 3 for 40 MAs (20 59%). Among 84 self-identified NHWs, the estimated fraction of European ancestry ranged from 0.83 to 1.0, with an average of 0.97 (SE = 0.014). Self-identified MAs, and to a lesser extent NHWs, from an established bi-ethnic community were heterogeneous with respect to genetic admixture. Researchers should not use simple race-ethnic categories as proxies for homogeneous genetic populations when conducting gene mapping and disease association studies in multi-ethnic populations.

Purpose: To measure the time needed to teach a series of martial arts techniques to proficiency. Methods: Fifteen volunteer subjects without any prior martial arts or self-defense experience were recruited. A panel of martial arts experts selected 21 different techniques including defensive stances, arm blocks, elbow strikes, palm strikes, thumbs to eyes, instep kicks and a carotid neck restraint. The critical elements of each technique were identified by the panel and incorporated into a teaching protocol, and then into a scoring system. Two black belt martial arts instructors directed a total of forty-five 45-minute training sessions. Videotaped proficiency testing was performed weekly. The videotapes were reviewed by the investigators to determine the proficiency levels of each subject for each technique. Results: The techniques were rated by the average number of training sessions needed for an individual to develop proficiency in that technique. The mean number of sessions necessary to train individuals to proficiency ranged from 27 to 38.3. Using this system, the most difficult techniques seemed to be elbow strikes to the rear, striking with thumbs to the eyes and arm blocking. Conclusions: In this study 29 hours of training was necessary to train novice students to be proficient in 21 offensive and defensive martial arts techniques. To our knowledge, this is the first study that attempts to measure the learning curves involved when teaching martial arts techniques.

Introduction/Background Overweight and obesity as a risk factor for pulmonary problems has been well-established. Many studies have suggested that obesity may offer a clinical advantage as it relates to post cardiac intervention morbidity, length of stay, and mortality. There are few studies about the obesity paradox with regard to pulmonary debility. This study was designed to determine whether this obesity paradox is also reflected in the recovery of patients with debility secondary to a pulmonary event who were undergoing care in a rehabilitation hospital. Material and method Retrospective cohort study included all patients admitted to the pulmonary unit of a rehabilitation hospital from January 2000–April 2006. Results For the 381 patients admitted during the observation period, BMI was compared with FIM score changes per day (FIM efficiency). After adjusting for age, and sex, the FIM efficiency only slightly differed by BMI subgroups (P = 0.12). The difference among FIM efficiency was not, however, large enough to be considered significant. Conclusion This study is not inconsistent with the findings of other medical subspecialties suggestive of a non-significant U shaped curve when comparing medical outcomes with BMI. In conclusion, we cannot expect inferior performance from patients with BMI in the obese category.

Strangman GE, O'Neil-Pirozzi TM, Goldstein R, Kelkar K, Katz DI, Burke D, Rauch SL, Savage CR, Glenn MB. Prediction of memory rehabilitation outcomes in traumatic brain injury by using functional magnetic resonance imaging. Objective To evaluate the ability of functional magnetic resonance imaging (fMRI) measures collected from people with traumatic brain injury (TBI) to provide predictive value for rehabilitation outcomes over and above standard predictors. Design Prospective study. Setting Academic medical center. Participants Persons (N=54) with TBI greater than 1 year postinjury. Intervention A novel 12-session group rehabilitation program focusing on internal strategies to improve memory. Main Outcome Measure The Hopkins Verbal Learning Test−Revised (HVLT-R) delayed recall score. Results fMRI measures were collected while participants performed a strategically directed word memorization task. Prediction models were multiple linear regressions with the following primary predictors of outcome: age, education, injury severity, preintervention HVLT-R, and task-related fMRI activation of the left dorsolateral and left ventrolateral prefrontal cortex (VLPFC). Baseline HVLT-R was a significant predictor of outcome ( P= .007), as was injury severity (for severe vs mild, P =.049). We also found a significant quadratic (inverted-U) effect of fMRI in the VLPFC ( P= .007). Conclusions This study supports previous evidence that left prefrontal activity is related to strategic verbal learning, and the magnitude of this activation predicted success in response to cognitive memory rehabilitation strategies. Extreme under- or overactivation of VLPFC was associated with less successful learning after rehabilitation. Further study is necessary to clarify this relationship and to expand and optimize the possible uses of functional imaging to guide rehabilitation therapies.

We present our experience with 30 patients on functional outcomes of patients with anoxic brain injury (ABI, n=15) due to cardiac etiologies from freestanding inpatient rehabilitation hospital. A convenience sample of patient with traumatic brain injury (TBI, n=15) with similar demographic characteristic to ABI was used for comparison on indices of activity of daily living, cognition, mobility as well as other indices of functional prognosis such as hospital length of stay, cost and discharge predisposition. No statistical significant differences were found between the two groups on the presently employed outcome measures. This investigation supports the positive impact of inpatient rehabilitation for individuals with hypoxia of cardiac etiology. Future research comparing outcomes of ABI to TBI with larger, controlled trials is warranted.

Post-transcriptional RNA processing is an important regulatory control mechanism for determining the phenotype of eukaryotic cells. The processing of a transcribed RNA species into alternative splice isoforms yields products that can perform different functions. Each type of cell in a multi-cellular organism is presumed to actively control the relative quantities of alternative splice isoforms. In this study, the alternatively spliced isoforms of five mRNA transcription units were examined by quantitative reverse transcription–PCR amplification. We show that interindividual variation in splice-isoform selection is very highly constrained when measured in a large population of genetically diverse mice (i.e., full siblings; N = 150). Remarkably, splice-isoform ratios are among the most invariant phenotypes measured in this population and are confirmed in a second, genetically distinct population. In addition, the patterns of splice-isoform selection show tissue-specific and age-related changes. We propose that splice-isoform selection is exceptionally robust to genetic and environmental variability and may provide a control point for cellular homeostasis. As a consequence, splice-isoform ratios may be useful as a practical quantitative measure of the physiological status of cells and tissues.

To explore the relationship between serum testosterone levels, age, length of stay, admission, discharge and changes in functional capacity over time among patients with traumatic brain injury treated in a rehabilitation hospital.This study used a nonrandomized chart review of 54 males, consecutively admitted to a brain injury rehabilitation hospital.The charts of 54 males consecutively admitted to a brain injury rehabilitation unit between the periods of December 2004 and May 2005 were included in this study. Individuals were included in this study if they were 18 years of age or older, had suffered a traumatic brain injury, undergone admission and discharge, functional independence measure (FIM) testing and had received a serum testosterone level check within one to seven days from admission.The main outcome measure of this study was the FIM changes over time, as compared with admission testosterone levels. Low serum testosterone levels on admission to the in-patient rehabilitation unit were associated with longer lengths of stay, lower average admission FIM scores, less improvement in FIM scores, and a lower FIM efficiency. Although not statistically significant, individuals presenting to our unit with low testosterone levels, on average, stayed 26 days longer than did those with normal levels. Age and the presence of multi-trauma did not appear to be factors associated with serum testosterone levels. Changes in discharge cognitive FIM scores between the two groups approached statistical significance (p = 0.06).This pilot study suggests that testosterone levels may be important in the recovery of patients with traumatic brain injury, treated at an in-patient rehabilitation hospital.

The rehabilitation of the traumatic brain injury (TBI) patient is especially challenging in non-western populations as the phenotypic indicators as well as the neurobehavioral assessments for the survivors of brain injury are limited.The study screened for the prevalence of anxiety and depressive states among patients with TBI and examined the validity of the Hospital Anxiety and Depression Scale (HADS) to identify TBI patients with comorbid affective dysfunctions, specifically anxiety and depressive disorders, in an Omani population.Sixty-eight survivors of TBI were screened with the semi-structured, Composite International Diagnostic Interview (CIDI) and the HADS. A receiver operating characteristics (ROC) curve was calculated to discriminate the power of the HADS for every possible threshold score.The semi-structured interview revealed the prevalence rate of 57.4% for depressive disorder and 50% for anxiety disorder. The sensitivity (53.8%) and specificity 75.9%, gave the best compromise using the cut-off score of 4, suggesting HADS is not a useful screening tool for this particular population.Phenotypic indicators as detected by CIDI revealed that prevalence of affective dysfunctionality is common among this TBI population. Although the HADS is the most widely used screening instrument in other clinical populations, it does not appear to be a reliable resource in identifying depression and anxiety in people with traumatic brain injury in Oman.

A previous analysis of serum insulin-like growth factor I (IGF-I) levels in a mouse population ( n = 961) derived from a cross of (BALB/cJ × C57BL/6J) F1females and (C3H/HeJ × DBA/2J) F1males documented quantitative trait loci (QTL) on chromosomes 1, 10, and 17. We employed a newly developed, random walk-based method to search for three- and four-way allelic combinations that might influence IGF-I levels through nonadditive (conditional or epistatic) interactions among 185 genotyped biallelic loci and with significance defined by experiment-wide permutation ( P < 0.05). We documented a three-locus combination in which an epistatic interaction between QTL on paternal-derived chromosomes 5 and 18 had an opposite effect on the phenotype based on the allele inherited at a third locus on maternal-derived chromosome 17. The search also revealed three four-locus combinations that influence IGF-I levels through nonadditive genetic interactions. In two cases, the four-allele combinations were associated with animals having high levels of IGF-I, and, in the third case, a four-allele combination was associated with animals having low IGF-I levels. The multiple-locus genome scan algorithm revealed new IGF-I QTL on chromosomes 2, 4, 5, 7, 8, and 12 that had not been detected in the single-locus genome search and showed that levels of this hormone can be regulated by complex, nonadditive interactions among multiple loci. The analysis method can detect multilocus interactions in a genome scan experiment and may provide new ways to explore the genetic architecture of complex physiological phenotypes.

To compare the functional outcomes of patients with anoxic brain injury (ABI) due to cardiac and non-cardiac aetiologies.Retrospective chart review over 4 years.Freestanding rehabilitation hospital.Thirteen patients with cardiac ABI and 13 patients with non-cardiac ABI.Comprehensive, multi-disciplinary inpatient rehabilitation services.Rehabilitation hospital length of stay (LOS) and cost; Functional Independence Measure (FIM) scores and its various sub-sets on admission and discharge; FIM efficiency and change; and discharge disposition.Patients with cardiac ABI were similar in gender and ethnicity when compared to patients with non-cardiac ABI but were older (average age 52 vs 42) with a higher percentage of cardiac patients married (77% vs 39%). No statistically significant differences were found between the two groups on all sub-sets of the FIM on admission and discharge as well as the different FIM efficiencies. However, there was a trend for the cardiac ABI patients to have a greater efficiency in improving mobility during rehabilitation when compared to non-cardiac ABI patients. The rehabilitation hospital LOS was approximately 28 days less for patients with cardiac ABI (41.49 vs 69.84 days), but this difference was not statistically significant (p=0.26). The mean rehabilitation cost for patients with cardiac ABI was approximately $14,000 less than that for those with non-cardiac ABI ($44,181 vs $58,187). This difference was not statistically significant (p=0.15). Cardiac ABI patients were more likely to be discharged directly to home from rehabilitation when compared to non-cardiac ABI patients (p=0.06).This pilot study demonstrates some differences in the recovery patterns of patients with ABI who had a cardiac aetiology and those who had non-cardiac aetiologies. While both groups experienced similar progress during rehabilitation, those with cardiac ABI made gains with a shorter LOS and less rehabilitation costs when compared to non-cardiac ABI patients. These data suggest a trend towards greater cost and length of stay for patients with ABI who had non-cardiac aetiologies.

A combination of approaches - gene mapping, biomarker analysis, and studies of signal transduction - has helped to clarify the mechanisms of age-related change in mouse immune status and the implications of immune aging for late-life disease. Mapping studies have documented multiple quantitative trait loci (QTL) that influence the levels of age-sensitive T-cell subsets. Some of these QTL have effects that are demonstrable in young-adult mice (8 months of age) and others demonstrable only in middle-aged mice (18 months). Biomarker studies show that T-cell subset levels measured at 8 or 18 months are significant predictors of lifespan for mice dying of lymphoma, fibrosarcoma, mammary adenocarcinoma, or all causes combined. Mice whose immune systems resemble that of young animals, i.e. with low levels of CD4(+) and CD8(+) memory T cells and relatively high levels of CD4(+) T cells, tend to outlive their siblings with the opposite subset pattern. Biochemical analyses show that T cells from aged mice show defects in the activation process within a few minutes of encountering a stimulus and that the defects precede the recognition by the T-cell receptor of agonist peptides on the antigen-presenting cell. Defective assembly of cytoskeletal fibers and hyperglycosylation of T-cell surface glycoproteins contribute to the immunodeficiency state, and indeed treatment with a sialylglycoprotein endopeptidase can restore full function to CD4(+) T cells from aged donors in vitro.

The disturbance of motivation and its relationship to depression continues to spark contradictory findings among European and North American populations. Could a cross-cultural study shed some light on the situation? This study aims to detect the prevalence of apathy and to test whether the Apathy Evaluation Scale (AES) can spot the presence or absence of depression in survivors of traumatic brain injury (TBI) in Oman. Eighty subjects who sustained a TBI were given an Arabic version of the AES and were also interviewed with the semistructured Composite International Diagnostic Interview (CIDI). The authors found that the incidence of apathy and depression among Omani people who sustained TBI is similar to that reported elsewhere. The AES has poor discriminatory power in identifying cases of depression. These findings emphasize the importance of developing assessment tools that are culturally sensitive in light of the rising incidence of TBI in developing countries such as Oman.

To compare the functional outcomes of patients with anoxic brain injury (ABI) and patients with traumatic brain injury (TBI) following inpatient rehabilitation.Retrospective chart review.Data on 68 patients with brain injury (34 with ABI and 34 with TBI) were collected.The ABI and TBI groups were demographically similar, except that patients with ABI were more likely to be married. Both groups significantly improved their function and were similar upon discharge. For the ABI group, there were trends toward a shorter length of stay, increased total FIM efficiency and decreased cost of stay when compared with the TBI group. The patients with ABI tended to be discharged to a sub-acute rehabilitation facility more than those in the TBI group.This study is important because it shows that patients with ABI benefit from inpatient rehabilitation and made significant functional gains comparable to the gains of patients with TBI.

Genotype information was collected at 87 loci in a group of 1,108 UM-HET3 mice bred as the progeny of [BALB/cJ × C57BL/6J]F1mothers and [C3H/HeJ × DBA/2J]F1fathers, for which thyroxine (T4), insulin-like growth factor I (IGF-I), and leptin levels had been measured at 4 and 15 mo of age. The data provided significant evidence for quantitative trait loci (QTL) modulating IGF-I levels on chromosomes 1, 3, 8, 10, and 17; for loci affecting T4on chromosomes 4, 15, and 17; and for leptin on chromosome 3. Fecal levels of corticosterone at 17 mo of age were influenced by a QTL on chromosome 1. Nine other gene/hormone associations reached a nominal P < 0.01, providing suggestive but not statistical evidence for additional QTL. QTL with an influence on a given hormone were in nearly all cases additive, with little or no evidence for epistasis. Of the 12 strongest QTL, 5 had effects that were age dependent, having more effect in 15-mo-old than in 4-mo-old mice in all but one case; the other QTL had effects that were apparently age-independent. These results show that the genetic controls over late-life hormone levels are complex and dependent on effects of genes that act both early and late in the life course.

Upper-extremity deep vein thrombosis (UEDVT) was an understudied disease until recently. Previously thought of as benign, UEDVT has been shown in recent studies to pose a significant risk for pulmonary embolus and death. This article reviews the epidemiology, risk factors, clinical features, diagnostic tests, treatment options, complications, and prevention strategies for patients with UEDVT.

Objective The purpose of this study was to evaluate the effects of methylphenidate on heart rate and blood pressure in patients with acquired brain injury. Design The records of 60 consecutive hospitalized patients with acquired brain injury were reviewed for treatment with methylphenidate. Seventeen patients met the inclusion criteria. Systolic blood pressure, diastolic blood pressure, and heart rate recordings were compared before and after the introduction of methylphenidate. Results There was no significant difference in mean systolic blood pressure, diastolic blood pressure, and heart rate when patients received (118 mm Hg, 74 mm Hg, and 88 bpm) and did not receive (118 mm Hg, 73 mm Hg, and 86 bpm) methylphenidate. It was unclear whether there was a true trend toward medication effect on heart rate and blood pressure during the peak dose period. Conclusions This retrospective study points to safe sympathetic effects of methylphenidate, yet future prospective studies are warranted to clarify the effects of methylphenidate on heart rate and blood pressure in the acquired brain injury population.

Objectives: To determine whether patients with carpal tunnel syndrome have an objective swelling of their hands. Design: A prospective, cross-sectional study of consecutive patients. Setting: Two independent electromyographic laboratories. Participants: Sixty-three patients referred for electrodiagnostic work-up. Interventions: NCS/EMG testing and volumetric analysis. Limb volume was measured using the water displacement method using a volumeter. Main Outcome Measures: Differences in volume (DHV) and EMG/NCS data. Results: EMG results indicated that 24 subjects (38%) had findings consistent with CTS. Data concerning subjective swelling was available for only six of these 24 subjects. The data, which are limited by low power, indicate that there was no difference 1) between the volume of the affected hand and the unaffected hand among those with CTS; 2) between the DHV of those with CTS and those without;. 3) Patients with lower extremity complaints had significantly less DHV than those with an upper extremity complaint (p

Background: As conceptions of mental illness are often dictated by prevailing socio-cultural factors and the philosophy of the time, there is little research to substantiate how mental illness is perceived in the Arab world in the light of both traditional and more recent modernization and acculturation processes. Aims: To examine whether social factors exert an influence on a person's attitude towards people with mental illness (PWMI) in the rapidly changing country of Oman. Methods: This study compares the response elicited from medical students, relatives of psychiatric patients and the general Omani public on the causes of mental illness, attitudes toward PWMI and the care and management of people with mental illness. Results: This study found no relationship between attitudes towards PWMI, and demographic variables such as age, educational level, marital status, sex and personal exposure to people with mental illness. Both medical students and the public rejected a genetic factor as the cause of mental illness; instead they favoured the role of spirits as the aetiological factor for mental illness. There were favourable responses on statements regarding value of life, family life, decision-making ability, and the management and care of mental illness. However, both medical students and the public thought that PWMI tend to have peculiar and stereotypical appearances and the majority preferred that facilities for psychiatric care should be located away from the community. Although the relatives of psychiatric patients were concerned about the welfare of mental patients, their responses varied and were often contingent upon their expectations. Conclusions: The data suggest that neither socio-demographic factors nor previous exposure to PWMI was related to attitudes towards PWMI. Although the attitudes of Omanis toward PWMI appear to fluctuate in complex ways, traditional beliefs on mental illness have yet to be eroded by exposure to a biomedical model of mental illness. This study largely supports the view that the extent of stigma varies according to the cultural and sociological backgrounds of each society.

Objective: The purpose of this study was to assess the validity of the Eating Attitude Test (EAT) in identifying the presence and severity of eating pathology in male and female Omani urban adolescents and to establish cut-off scores that matched those of anorexia identified by gold standard interviews without fear of fatness criteria. Methods: Both females (n=126) and males (n=136) were screened using the Arabic version of the EAT- 26 and interviewed using a semi-structured, Composite International Diagnostic Interview (CIDI) in order to investigate the relationship between false positives and false negatives at various EAT-26 cut-off points. A receiver operating characteristics (ROC) curve was calculated to discriminate the power of the EAT-26 for every possible threshold score. Results: The EAT-26 identified 29% of the subjects as probable anorexic cases as against 9.5% identified during the structured interview based on the anorexia gold standard (32% males and 68% females). The sensitivity and specificity of the EAT-26 were respectively 24% and 69.6%. When using the ROC curve, a cut-off score of 10 gave the best compromise between sensitivity (64%) and specificity (38%). Discussion: Although the EAT-26 is the most widely used screening instrument in cross-cultural studies, it does not appear to be reliable in identifying probable cases of anorexia among Omani adolescents. The use of a gold standard interview without fat phobia criteria indicated that the rate of anorexia nervosa may be more prevalent among males than previously estimated. This intriguingly high preponderance of males is discussed in terms of prevailing demographic trends in Oman.

OBJECTIVE To describe the demographics, precipitating factors, substances and methods used for deliberate self-harm in Oman. METHODS Data were extracted from the Accident and Emergency (A & E) records of patients treated at the A & E units in Muscat from 1993 to 1998. Data were obtained form the history, and clinical findings resulting form deliberate self-harm. RESULTS During the 5-year study period, 123 persons presented to various hospitals in the Muscat area with injuries that resulted form deliberate self-harm. Most of these cases were women, students and unemployed. There was a high incidence of family, marital and psychiatric or social problems. The methods of self-harm were most often analgesics (such as paracetamol) and non-pharmaceutical chemicals. CONCLUSIONS The rate of self-injurious behaviour is low in Oman, compared with other countries, including other Islamic countries. The data illustrate a rising rate and a tendency to ingest toxic doses of analgesics or non-pharmaceutical chemicals.

A micro-plenoptic system was designed to capture the three-dimensional (3D) topography of the anterior iris surface by simple single-shot imaging. Within a depth-of-field of 2.4 mm, depth resolution of 10 µm can be achieved with accuracy (systematic errors) and precision (random errors) below 20%. We demonstrated the application of our micro-plenoptic imaging system on two healthy irides, an iris with naevi, and an iris with melanoma. The ridges and folds, with height differences of 10~80 µm, on the healthy irides can be effectively captured. The front surface on the iris naevi was flat, and the iris melanoma was 50 ± 10 µm higher than the surrounding iris. The micro-plenoptic imaging system has great potential to be utilized for iris disease diagnosis and continuing, simple monitoring.

Asthma patients often have trouble gaining control of their disease because there is no optimal and reliable method to monitor their progress. While spirometry in the clinic provides adequate information for diagnosis and initial prescription, symptom journals and peak flow meters used at home are not particularly helpful in preventing asthma attacks. The 30-day hospital readmission rate following an asthma attack is 12%. Home spirometers are available, however they can be prohibitively expensive. An affordable, accurate method of monitoring lung function daily at home in concordance with a digital system of communication between physician and patient, may allow earlier changes in management and enable patients to more easily control their asthma. We present the design of a sensor and compatible smart-phone application to monitor lung function by analysis of tracheal breath sound recordings. Human subject testing is pending IRB approval.

Rationale: The mechanism by which viruses cause exacerbations of chronic airway disease and the capacity of patients with cystic fibrosis (CF) to respond to viral infection are not precisely known. Objectives: To determine the antiviral response to infection in patients with CF. Methods: Sputum was collected from patients with CF with respiratory exacerbation. Viruses were detected in multiplex polymerase chain reaction (PCR)–based assays. Gene expression of 84 antiviral response genes was measured, using a focused quantitative PCR gene array. Measurements and Main Results: We examined 36 samples from 23 patients with respiratory exacerbation. Fourteen samples tested virus-positive and 22 virus-negative. When we compared exacerbations associated with rhinovirus (RV, n = 9) and influenza (n = 5) with virus-negative specimens, we found distinct patterns of antiviral gene expression. RV was associated with greater than twofold induction of five genes, including those encoding the monocyte-attracting chemokines CXCL10, CXCL11, and CXCL9. Influenza was associated with overexpression of 20 genes, including those encoding the cytokines tumor necrosis factor and IL-12; the kinases MEK, TBK-1, and STAT-1; the apoptosis proteins caspase-8 and caspase-10; the influenza double-stranded RNA receptor RIG-I and its downstream effector MAVS; and pyrin, an IFN-stimulated protein involved in influenza resistance. Conclusions: We conclude that virus-induced exacerbations of CF are associated with immune responses tailored to specific infections. Influenza induced a more potent response consisting of inflammation, whereas RV infection had a pronounced effect on chemokine expression. As far as we are aware, this study is the first to compare specific responses to different viruses in live patients with chronic airway disease.

The incidence of depression and its association with subject characteristics in outpatients with traumatic brain injury (TBI) were investigated. Logistic regression was estimated with depressed/not-depressed as the dependent variable in 41 outpatients with TBI who filled out the Beck Depression Inventory-II (BDI-II). Twenty-four of 41 subjects (59%) scored in the depressed categories based on BDI-II scores >13. Fourteen (34%) scored in the moderate or severe depression categories (BDI>19). Logistic regression demonstrated a positive relationship amongst depression and age, female gender, mild TBI, and use of antidepressant and stimulant drugs; and a negative relationship between depression and violent aetiology of injury. ANOVA demonstrated that individuals with mild TBI were significantly older than those with moderate or severe TBI, which might account for the association between depression and age. The implications of these results are discussed.

Objectives To test the ability of patients with brain injury to use a patient locator and minder (PLAM) system to assist in their adherence to therapy schedules. Participants Five patients with acquired brain injury who were inpatients on an acute rehabilitation floor of a rehabilitation hospital. Measures The number of human prompts necessary to direct a patient to, and ensure arrival at, a scheduled therapy destination and the proportion of therapy sessions requiring no prompting was measured both before and after the introduction of the PLAM system. Results With the PLAM system, the average number of human prompts dropped by more than 50%, and the number of sessions requiring no prompting increased from 7% to 44%. Conclusion The PLAM system described in this article seems feasible and useful for patients with acquired brain injury in assisting them with arrival at their therapy destinations without the assistance of staff.

Previous reports in the literature concerning cerebrovascular accident have illustrated cases of post-stroke tremor. Treatments of these studies have varied. Trials of levo-dopa have been reported in two such cases. This case study reports on a case of a patient with a left thalamic, left superior cerebellar artery infarction with a lacunar infarction in the basal ganglia. The patient developed a violent tremor/movement disorder which was unresponsive to haloperidol. With this failure, and with the evidence of a basal ganglion lesion, levo-dopa/carbi-dopa was introduced as an intervention. The amplitude of the tremor was dramatically reduced, with protective devices removed, and with complete cessation of the tremor at rest. The medication was withdrawn and reintroduced with a reduction and subsequent resolution of the symptoms. A discussion of the previous studies of movement disorder with cerebrovascular accident is included.

A capillary electrophoresis method was developed and characterized for analyzing the spectrum of collagen subspecies in collagen preparations. The Bio-Rad CE-SDS protein kit was used for the dynamic sieving separation of collagen subspecies in this CE method (DSCE). The optimized method utilized a 36 cm (or 24 cm) x 50 microm uncoated capillary, electrophoretic injection at 10 kV for 10 s, a run voltage of 15 kV, a capillary temperature of 20 degrees C, and UV detection at 220 nm. A preliminary validation of the method was performed. The assay had good repeatability (RSDs for peaks were 15%), and responses were linear for assay solutions with collagen concentrations from 0.125 to 1.25 mg/ml. The DSCE electropherogram of bovine skin collagen provided a profile of subspecies similar in number and relative abundance to that generated by scanning of Coomassie-stained SDS-PAGE gels.

Kerrigan DC, Riley PO, Rogan S, Burke DT. Compensatory advantages of toe walking. Arch Phys Med Rehabil 2000;81:38-44. Objectives: The study's hypothesis is that toe walking requires less peak muscle strength distally about the ankle and knee compared with normal heel-toe walking and thus may have compensatory advantages for patients with upper motor neuron injury and distal muscle weakness. Design: Motion analysis and force platform data were collected in able-bodied subjects during toe walking and normal walking. Sagittal plane joint torques reflecting muscle force requirements and joint powers reflecting nonisometric muscle contraction were compared between the two conditions using paired t tests, applying a Bonferroni correction for multiple comparisons. Setting: A gait laboratory. Subjects: Seventeen able-bodied adults, 9 of whom were ballet dancers. Main Outcome Measures: Peak hip, knee, and ankle joint torque and power variables during walking. Results: Peak ankle plantarflexor torque and ankle power generation during terminal stance and preswing were reduced ( p p Conclusion: Toe walking may require less ankle plantarflexor, ankle dorsiflexor, and knee extensor strength than normal heel-toe walking and thus may have compensatory advantages for patients with upper motor neuron injury and distal lower extremity weakness. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation