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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.

Objective Outpatient clinics lack infrastructure to easily measure and understand patient wait times. Our objective was to design a low-cost, portable passive real time locating system within an outpatient clinic setting to measure patient wait times and patient-provider interactions. Materials and Methods Direct observation was used to determine workflow in an outpatient glaucoma clinic at the University of Michigan. We used off-the shelf, antenna-integrated ultra-high frequency (UHF) RFID readers (ThingMagic, Astra-Ex, Woburn, MA) and UHF re-useable passive RFID tags (Zebra Impinj Monza 4QT, Seattle, WA). We designed a custom RFID management application in the Java programming language that was equipped with ‘live’ device administration to collect time and location data from patients and providers. These hardware choices enabled low cost system installation. Hidden Markov Modeling (HMM) was used to smooth patient and provider location data. Location data were validated against direct observations and EHR evaluation. Results The HMM smoothed RFID system data accurately predicted patient location 80.6% of the time and provider location 79.1% of the time, compared to direct observation locations, an improvement over the raw RFID location data (65.0% and 77.9% accurate, respectively). Patient process time was on average 42.8 min (SD = 27.5) and wait time was 47.9 min (SD = 33.1). The installation and recurring capital costs of the system are approximately 10% of available commercially-supplied patient/provider tracking systems. Discussion Passive RFID time study systems can enable real-time localization of people in clinic, facilitating continuous capture of patient wait times and patient-provider interactions. The system must be tailored to the clinic to accurately reflect patient and provider movement. Conclusions Capturing wait time data continuously and passively can empower continuous clinical quality improvement initiatives to enhance the patient experience.

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.

CRISPR/Cas9 genome-editing has emerged as a powerful tool to create mutant alleles in model organisms. However, the precision with which these mutations are created has introduced a new set of complications for genotyping and colony management. Traditional gene-targeting approaches in many experimental organisms incorporated exogenous DNA and/or allele specific sequence that allow for genotyping strategies based on binary readout of PCR product amplification and size selection. In contrast, alleles created by non-homologous end-joining (NHEJ) repair of double-stranded DNA breaks generated by Cas9 are much less amenable to such strategies. Here we describe a novel genotyping strategy that is cost effective, sequence specific and allows for accurate and efficient multiplexing of small insertion-deletions and single-nucleotide variants characteristic of CRISPR/Cas9 edited alleles. We show that ligation detection reaction (LDR) can be used to generate products that are sequence specific and uniquely detected by product size and/or fluorescent tags. The method works independently of the model organism and will be useful for colony management as mutant alleles differing by a few nucleotides become more prevalent in experimental animal colonies.

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.

Finding the causative genetic variations that underlie complex adult traits is a significant experimental challenge. The unbiased search strategy of genome-wide association (GWAS) has been used extensively in recent human population studies. These efforts, however, typically find only a minor fraction of the genetic loci that are predicted to affect variation. As an experimental model for the analysis of adult polygenic traits, we measured a mouse population for multiple phenotypes and conducted a genome-wide search for effector loci. Complex adult phenotypes, related to body size and bone structure, were measured as component phenotypes, and each subphenotype was associated with a genomic spectrum of candidate effector loci. The strategy successfully detected several loci for the phenotypes, at genome-wide significance, using a single, modest-sized population (N = 505). The effector loci each explain 2%–10% of the measured trait variation and, taken together, the loci can account for over 25% of a trait's total population variation. A replicate population (N = 378) was used to confirm initially observed loci for one trait (femur length), and, when the two groups were merged, the combined population demonstrated increased power to detect loci. In contrast to human population studies, our mouse genome-wide searches find loci that individually explain a larger fraction of the observed variation. Also, the additive effects of our detected mouse loci more closely match the predicted genetic component of variation. The genetic loci discovered are logical candidates for components of the genetic networks having evolutionary conservation with human biology.

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.

An integrated microfluidic device with on-chip photodiode is fabricated for single strand DNA (ssDNA) separation and detection. The microfluidic component is fabricated by parylene thin-wall technology. In order to achieve oxygen free environment for acrylamide gel polymerization in microfluidic channel, alumina inner coating is introduced to decrease parylene thin film permeability. On-chip high sensitivity photodiode successfully detected ssDNA fluorescence at the end of separation. Results show alumina is a good oxygen barrier which secures excellent cross-linking of the sieving matrix. Single base pair resolution for ssDNA separation in this device has been achieved.

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.

We describe the theoretical design of a microchip for the amplification, detection and counting of individual nucleic acid molecules in an ensemble of non-specific molecules. The device permits access to individual molecules through the transformation of a three-dimensional amplification reaction volume into a two-dimensional area or a one-dimensional line. The nucleic acid molecules in the amplification solution can be spatially separated along a one-dimensional line or across a two-dimensional area. The arrangement of the molecules is governed by the geometry of the microreactor in a manner analogous to the concept of 'limiting dilution' in a volume of fluid. When PCR amplification is allowed to proceed, the target sequences on individual molecules are amplified and diffuse outward. At the end of the amplification process, the zones of concentrated DNA surrounding the individual molecules can be detected as spatially resolved signals through the use of DNA binding dyes or fluorescence resonance energy transfer (FRET) probes. These amplification peaks would serve to establish a count of the number of target molecules in a sample with a much higher accuracy than that of traditional quantification using real-time PCR. The theoretical accuracy of this technique is only limited by the Poisson statistics of sampling.