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The development of inexpensive and well-activated water-splitting catalysts is required to reduce the use of conventional fossil fuels. In this study, a trimetallic Fe-Co-Ni catalyst was fabricated using a simple ion electrodeposition method. The metal deposition was performed using cyclic voltammetry, which was more efficient than constant-voltage deposition and significantly increased the stability of the catalyst. The synthesized material presented the morphology of a nanoflower in which the nanosheets were agglomerated. The Fe-Co-Ni catalyst exhibited excellent oxygen evolution reaction (OER) properties because the charge-transfer rate was improved owing to the synergistic effect of the metals. The OER was performed in a 1 M KOH solution using a three-electrode system, and the overpotential was 302 mV at 100 mA/cm

OBJECTIVE Post-stroke insomnia is common and negatively impacts stroke recovery. The objective of this study was to determine the effectiveness of bright light therapy as a treatment for early, patients with mild-to-moderate stroke who had post-stroke insomnia. METHODS This study was randomized, double-blind, and placebo-controlled (clinicaltrials.gov ID: NCT04721574). A 2-week trial was conducted in patients with mild-to-moderate stroke who had post-stroke insomnia. Only patients who had experienced a first episode of stroke were enrolled in this study. Sleep parameters were measured using the Actiwatch Spectrum Pro for 7 days before and after light therapy. The instrument specifically collected data concerning sleep, mood state, fatigue and subjective quality of life. Participants with post-stroke insomnia received bright light therapy (10,000-lux) or placebo therapy for 30 minutes in the early morning. A total of 112 eligible participants entered the study, but only 56 patients were randomized to treatment (27 to bright light therapy and 29 to placebo therapy). RESULTS Results from analysis of variance showed that the mean change of sleep latency (F(1, 55) =4.793, P = 0.033) and sleep efficiency (F(1, 55) = 5.625, p = 0.022) were significantly superior in bright light therapy over placebo. Bright light therapy resulted in significant improvements in daytime sleepiness, fatigue, mood, and quality of life in study participants (p < 0.05). CONCLUSION Bright light therapy is a non-pharmacological treatment for early post-stroke insomnia in patients who suffered a mild to moderate stroke. Additionally, bright light therapy is effective to treat daytime sleepiness, fatigue, poor mood, and quality of life in patients with post-stroke insomnia.

Elections and pandemics highlight how much one’s safety depends on fellow community members, a realization that is especially threatening when this collective perceives political realities inconsistent with one’s own. Two longitudinal studies examined how people restored safety to social bonds when everyday experience suggested that fellow community members inhabited inconsistent realities. We operationalized consensus political realities through the negativity of daily nationwide social media posts mentioning President Trump (Studies 1 and 2), and the risks of depending on fellow community members through the pending transition to a divided Congress during the 2018 election season (Study 1), and escalating daily U.S. COVID-19 infections (Study 2). On days that revealed people could not count on fellow community members to perceive the same reality of President Trump’s stewardship they perceived, being at greater risk from the judgment and behavior of the collective community motivated people to find greater happiness in their family relationships.

The oxygen evolution reaction (OER) at anode requires high overpotential and is still challenging. The metallic core-oxyhydroxide layer structure is an efficient method to lower an overpotential. We synthesized Fe rich FeCo core-Co rich FeCo oxyhydroxide layer with a different particle size of 173 nm, 225 nm, and 387 nm (FeCo 173, 225, 387) through a difference in the reduction rate of Fe/Co precursors using facile modified polyol synthesis. To investigate the effect of conductivity, CoFe2O4 nanoparticles of 80–130 nm were synthesized. Among samples, FeCo 173 showed remarkable catalytic performance of 316 mV at a current density of 10 mA/cm2 in 0.1 M KOH compared to RuO2 (408 mV), FeCo 225 (323 mV), FeCo 387 (334 mV), CoFe2O4 (382 mV). Moreover, FeCo 173 showed good stability for 60,000 s while RuO2 showed a gradual increase in overpotential to maintain 10 mA/cm2 after 15,000 s in chronopotentiometry. The excellent performance was attributed to Fe-rich metallic core, a small amount of Fe doping into CoOOH, and the synergic effect between the active site of Co rich FeCoOOH and conductive Fe rich metallic core. Following this result, it shows that the use of such FeCo electrodes has advantages in the production of hydrogen via electrochemical water oxidation.

A model of the social-safety system is proposed to explain how people sustain a sense of safety in the relational world when they are not able to foresee the behavior of others. In this model, people can escape the acute anxiety posed by agents in their personal relational world behaving unexpectedly (e.g., spouse, child) by defensively imposing well-intentioned motivations on the agents controlling their sociopolitical relational world (e.g., President, Congress). Conversely, people can escape the acute anxiety posed by sociopolitical agents behaving unexpectedly by defensively imposing well-intentioned motivations on the agents controlling their personal relational world. Two daily diary studies, a longitudinal study of the 2018 midterm election, and a 3-year longitudinal study of newlyweds supported the hypotheses. On a daily basis, people who were less certain they could trust their romantic partner defended against acutely unforeseeable behavior in one relational world by affirming faith in the well-intentioned motivations of agents in the alternate world. Moreover, when people were more in the personal daily habit of finding safety in the alternate relational world in the face of the unexpected, those who were initially uncertain they could trust their romantic partner later evidenced greater comfort depending on their personal relationship partners. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

This review discusses important scientific progress, problems, and prospects of lignin-based materials in the field of rechargeable batteries. Lignin, a component of the secondary cell wall, is considered a promising source of biomass. Compared to cellulose, which is the most extensively studied biomass material, lignin has a competitive price and a variety of functional groups leading to broad utilization such as adhesive, emulsifier, pesticides, polymer composite, carbon precursor, etc. The lignin-based materials can also be applied to various components in rechargeable batteries such as the binder, separator, electrolyte, anode, and cathode. This review describes how lignin-based materials are adopted in these five components with specific examples and explains why lignin is attractive in each case. The electrochemical behaviors including charge–discharge profiles, cyclability, and rate performance are discussed between lignin-based materials and materials without lignin. Finally, current limitations and future prospects are categorized to provide design guidelines for advanced lignin-based materials.

There has been no comparison of the determinants of admission route between acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We examined whether factors associated with direct versus transferred-in admission to regional cardiocerebrovascular centers (RCVCs) differed between AIS and AMI.Using a nationwide RCVC registry, we identified consecutive patients presenting with AMI and AIS between July 2016 and December 2018. We explored factors associated with direct admission to RCVCs in patients with AIS and AMI and examined whether those associations differed between AIS and AMI, including interaction terms between each factor and disease type in multivariable models. To explore the influence of emergency medical service (EMS) paramedics on hospital selection, stratified analyses according to use of EMS were also performed.Among the 17,897 and 8,927 AIS and AMI patients, 66.6% and 48.2% were directly admitted to RCVCs, respectively. Multivariable analysis showed that previous coronary heart disease, prehospital awareness, higher education level, and EMS use increased the odds of direct admission to RCVCs, but the odds ratio (OR) was different between AIS and AMI (for the first 3 factors, AMIAIS; for EMS use, AMIAIS). EMS use was the single most important factor for both AIS and AMI (OR, 4.72 vs. 3.90). Hypertension and hyperlipidemia increased, while living alone decreased the odds of direct admission only in AMI; additionally, age (65-74 years), previous stroke, and presentation during non-working hours increased the odds only in AIS. EMS use weakened the associations between direct admission and most factors in both AIS and AMI.Various patient factors were differentially associated with direct admission to RCVCs between AIS and AMI. Public education for symptom awareness and use of EMS is essential in optimizing the transportation and hospitalization of patients with AMI and AIS.

Does exposure to income inequality in adolescence relate to well-being in adulthood? In Studies 1 and 2 ( N = 888), individuals who grew up in U.S. counties with higher income inequality expected g...

Objective: The principal objectives of this study were to investigate relationships between objective sleep parameters, that is, sleep onset latency, wake after sleep onset, number of awakenings, sleep efficiency, and sleep duration, and quality of life after mild to moderate stroke.Methods: The subjects were 112 first-time mild to moderate stroke patients admitted to a rehabilitation unit. Physical functions, depression, anxiety, quality of life, subjective insomnia, quality of sleep, and fatigue were assessed at about 20 days after stroke. Objective sleep parameters were also assessed using a wrist-worn Actiwatch.Results: Patients with insomnia had greater sleep onset latencies (p = .001), wake after sleep onset (p = .005), awoke more frequently (p = .013), and slept less efficiency (p < .001) than patients without insomnia, but total sleep durations were similar. In all participants, lower overall domain of quality of life was significantly associated with sleep onset latency (p = .009), and total insomnia severity index (p < .001), total Epworth Sleepiness Scale (p < .001), the National Institute's Health Stroke Scale (p = .004), the Modified Barthel Index (p = .034), and Screening Tests for Aphasia and Neurologic-Communication Disorders (p = .044) scores.Conclusion: Objective sleep parameters (sleep onset latency and sleep efficiency) were found to be associated with quality of life during the early stage of rehabilitation in mild to moderate stroke patients.

How do people think about happiness? Is it something best enjoyed as an investment over time, or is it something fleeting that should be savored? When people view happiness as an investment, they may endorse delaying happiness (DH)-the belief that working hard and sacrificing opportunities for happiness now will contribute to greater future happiness. When people view happiness as fleeting, they may endorse living in the moment (LM)-the belief that one should seize proximal opportunities to experience happiness now, rather than later. Using a mix of cross-sectional, meta-analytic (Studies 1, 2a, 2b, 2c), experimental (Study 3), and daily diary methods (Study 4), people who endorsed DH or LM beliefs anticipated more positive affect upon goal attainment and experienced greater well-being, but only DH was related to more negative affect when pursuing nonfocal goals and less delay discounting of future rewards. Implications for self-regulation and emotion are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The purpose of the present study was to examine the severity of suicidal ideation of the older adults according to the amount of involvement in grandchild care. Data for this research were drawn from a cross-sectional study conducted on community-dwelling adults aged 65 years or older. The 922 participants were divided into three groups according to their involvement in grandchild care: 18.5% had provided daily care, 12.4% had provided occasional care, and 69.1% had never cared for their grandchildren. ANCOVA analysis showed that the scores for depression was significantly lower in the group which took care of their grandchildren occasionally compared to the other two groups. The scores for suicidal ideation was significantly higher in the group which had never taken care of their grandchildren compared to the other two groups. Current study suggests that grandparenting may have a positive effect on suicidal ideation of the older adults.

In this paper, we show that individuals’ self-regulatory focus and imagery processing affect the persuasiveness of metaphorical advertisements. Study 1 show that metaphorical advertisements enhance...

Although people may think that money improves one’s relationships, research suggests otherwise. Focusing on money is associated with spending less time maintaining relationships and less desire to rely on others for help. But why does focusing on money relate to worse social outcomes? We propose that when people base their self-esteem on financial success—that is, have financially contingent self-worth—they are likely to feel pressured to pursue success in this domain, which may come at the expense of spending time with close others. Consistent with this idea, results of four cross-sectional studies ( N = 2,439) and a daily diary study ( N = 246) revealed that basing one’s self-worth on financial success is associated with greater feelings of loneliness and social disconnection, and this may be related to experiencing less autonomy and spending less time with family and friends.

This paper reports a mechanism for corticospinal tract injury in a patient with hemiplegia following traumatic brain injury (TBI) based on diffusion tensor tractography (DTT) finding. A 73-year-old male with TBI resulting from a fall, without medical history, was diagnosed as having left convexity epidural hematoma (EDH). He underwent craniotomy and suffered motor weakness on the right side of the body. Two weeks after onset, he was transferred to a rehabilitation department with an alerted level of consciousness. Four weeks after onset, his motor functions were grade 1 by the Medical Research Council’s (MRC) standards in the right-side limbs and grade 4 in the left-side limbs. The result of DTT using the different regions of interest (ROIs) showed that most of the right corticospinal tract (CST) did not reach the cerebral cortex around where the EDH was located, and when the ROI was placed on upper pons, a disconnection of the CST was shown and a connection of the CST in ROI with the middle pons appeared. However, the right CST was connected to the cerebral cortex below the pons regardless of ROI. This study is the first report to use DTT to detect that the discontinuation of the left CST in the cerebral cortex and injury lesions below the lower pons and between the upper and lower pons are responsible for motor weakness in a patient.

We report diffusion tensor tractography (DTT) of the corticospinal tract (CST) in a patient with paresis of all four limbs following subarachnoid hemorrhage (SAH) with intraventricular hemorrhage (IVH) after the rupture of an anterior communicating artery (ACoA) aneurysm rupture. The 73-year-old female was admitted to our emergency room in a semi-comatose mental state. After coil embolization—an acute SAH treatment—she was transferred to our rehabilitation department with motor weakness development, two weeks after SAH. Upon admission, she was alert but she complained of motor weakness (upper limbs: MRC 3/5, and lower limbs: MRC 1/5). Four weeks after onset, DTT showed that the bilateral CSTs failed to reach the cerebral cortex. The left CST demonstrated a wide spread of fibers within the corona radiata as well as significantly lower tract volume (TV) and higher fractional anisotropy (FA) as well as mean diffusivity (MD) compared to the controls. On the other hand, the right CST shifted to the posterior region at the corona radiata, and MD values of the right CST were significantly higher when compared to the controls. Changes in both CSTs were attributed to vasogenic edema and compression caused by untreated hydrocephalus. We demonstrate in this case, two different pathophysiological entitles, contributing to this patient’s motor weakness after SAH.

BACKGROUND Dysphagia is a commonly developed complication after stroke and may lead to pneumonia. Several screening tests for dysphagia have been introduced, but no consensus has been reached regarding the test that best detects dysphagia or swallowing difficulties. Maximum phonation time (MPT) can measure laryngeal and pharyngeal function indirectly by providing a means of assessing vocal cord integrity. Because vocal cords play a role in sound production and also protect the airways, we considered MPT might be used to screen for penetration and aspiration into airways in stroke patients. AIM The purpose of this study was to investigate the ability of MPT to differentiate between stroke patients with or without penetration/aspiration and the relationships between MPT and videofluoroscopic swallowing study (VFSS) findings and those of other swallowing screening tests. DESIGN Prospective observational study. SETTING Korean tertiary hospital. POPULATION One hundred six Patients with acute stroke patients with suspected dysphagia referred for VFSS from January 2016 to December 2017. METHODS MPT differences among a normal group, a penetration group, and an aspiration group were analyzed, and correlations between MPT and age, Penetration Aspiration Scale (PAS), American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale (ASHA-NOMS), Functional Dysphagia Scale (FDS) scores were investigated. RESULTS MPTs were found to be significantly different in normal, penetration, and aspiration groups in stroke patients (P

The purpose of the present double-blind randomized placebo-controlled clinical study was to investigate the effects of Passionflower on polysomnographic sleep parameters in subjects with insomnia disorder. A total number 110 adult participants (mean age = 40.47 ± 11.68, Female = 53.6%) met the inclusion criteria of insomnia disorder according to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). After randomization, patients received either the Passionflower extract or the placebo for 2 weeks. Patients underwent an overnight polysomnography and completed sleep diaries, Insomnia Severity Index, and Pittsburgh Sleep Quality Index. Within group comparisons were analyzed with paired t-tests or Wilcoxon's signed rank tests, and between-group comparisons were analyzed with independent t-tests or Mann-Whitney U Tests, as appropriate. Total sleep time (TST) was significantly increased in the Passionflower group compared with placebo (Passionflower vs placebo, 23.05 ± 54.26 vs -0.16 ± 53.12; P = 0.049). Sleep efficiency and wake after sleep onset (WASO) significantly improved after 2 weeks in the Passionflower group but there was no difference compared with the placebo group. The current study demonstrated the positive effects of Passionflower on objective sleep parameters including TST on polysomnography in adults with insomnia disorder. Further study is needed to investigate the clinical efficacy of Passionflower on insomnia.

Objective To evaluate the effect of high-intensity interval training (HIIT) on psychological symptoms, activity states, and cardiovascular functions in patients with myocardial infarction (MI) of low and moderate risk stratification. Methods This prospective study randomly allocated 44 patients with MI to 18 sessions of HIIT or conventional moderate-intensity continuous training (MICT). Outcome measures were assessed at baseline and after 18 sessions. Results Post-exercise cardiovascular and functional states, maximal oxygen uptake (VO2max), metabolic equivalents (METs), 6-Minute Walking Test (6MWT), and Korean Activity Scale/Index (KASI) scores were significantly improved in the HIIT group compared to those in the MICT group after 18 exercise sessions. In particular, VO2max was significantly (p

Although stroke elicits progressive cognitive decline and is a leading cause of dementia, molecular interplay between stroke and Alzheimer's disease (AD) pathology has not been fully elucidated. Furthermore, studies on the effects of post-stroke rehabilitation on AD pathology are limited. We evaluated the acute effect of stroke on tau modification, and the molecular effects of task-specific training (TST) on tau modification using a model of photochemically-induced thrombosis (PIT)-induced cortical infarction. Following PIT in the dominant side of sensorimotor cortex, the rehabilitation group received 4-weeks of TST rehabilitation once daily by single pellet reaching training, whereas the sedentary control group did not received any type of training. Cortical expression levels of proteins related to tau modification were evaluated on post-stroke day 1 (PSD1) and 28; functional tests were also evaluated performed every week. The expression levels of acetyl-tau, phosphorylated-tau (p-tau), cyclooxygenase-2 and Akt-mTORC1-p70S6K pathway in infarcted cortices on PSD1 were significantly greater, whereas the expression levels of p-AMPK were significantly lower than in the paired contralateral sides. TST rehabilitation for 4 weeks greatly improved functional motor performance but not memory, which concurred with the down-regulations of ipsilateral p-AMPK, cyclooxygenase-2, Akt-mTORC1-p70S6K pathway, and p-tau in rehabilitation group. PIT-induced cortical infarction was found to induce cortical tau modification through the Akt-mTORC1-p70S6K activation, and to suppress the expression of AMPK-related proteins. TST rehabilitation greatly improved motor function, but not memory, and suppressed p-tau expression and neuroinflammation. Nevertheless, the role of TST-mediated regulation of tau hyperphosphorylation required further clarification.

Objective To evaluate effects of caregiver's education program on their satisfaction, as well as patient functional recovery, performed in addition to daily conventional rehabilitation treatment. Methods Three hundred eleven subjects diagnosed with first-onset stroke and transferred to the Department of Physical Medicine and Rehabilitation of Inha University Hospital were surveyed. In 2015, caregivers attended an education program for acute and subacute stroke patients. Patients who received an additional rehabilitation therapy were assigned to the experimental group (n=81), whereas the control group (n=100) consisted of transfer cases in 2014 with only conventional treatment. The experimental group was classified by severity using the Korean version of the National Institutes of Health Stroke Scale (K-NIHSS), which was administered to all 181 subjects, in addition to, the Korean version of the Mini Mental Status Examination (K-MMSE), a Modified Barthel Index (K-MBI), and the Berg Balance Scale (K-BBS). Caregiver satisfaction and burden before and after education programs were assessed using the Canadian Occupational Performance Measure (COPM), as well as family burden and caregiver burnout scales. Results No significant intergroup difference was observed between initial K-NIHSS, K-MMSE, K-BBS, K-MBI scores, and times from admission to transfer. Those with moderate or severe strokes under the experimental condition showed a more significant improvement than the control group as determined by the K-NIHSS and K-BBS, as well as tendential K-MMSE and K-MBI score increases. Satisfaction was significantly greater for family members and formal caregivers of patients with strokes of moderate severity in the experimental group. Conclusion The caregiver's education program for stroke subjects had a positive outcome on patients' functional improvement and caregiver satisfaction. The authors believe that the additional rehabilitation therapy with the education program aids patients to achieve functional improvements for an optimal return to social life.

This study investigated the time taken for upper extremity spasticity to develop and its regional difference after first-ever stroke onset in a nationwide multicenter study in South Korea. The retrospective observational study included 861 individuals with post-stroke spasticity in the upper limbs. Spasticity in the upper extremity joints was defined as a modified Ashworth Scale score ≥1. The median time to develop upper limb spasticity after stroke onset was 34 days. 12% of post-stroke spasticity cases developed between 2 months and 3 months and 13% developed after 3 months from onset. At the time of diagnosis of spasticity, most patients showed only a slight increase in muscle tone, which was observed most frequently in the elbow, followed by the wrist, and fingers. Younger stroke survivors were more spastic, and the severity of spasticity increased with time. Approximately half of the patients with post-stroke spasticity developed spasticity during the first month. However, post-stroke spasticity can develop more than 3 months after stroke onset. Therefore, it is important to assess spasticity, even in the chronic state.

In this paper, a new auto-scoring algorithm that automatically evaluates the Berg balance scale (BBS) tasks is proposed. The BBS can be used as an indicator for patients to analyze their rehabilitation status by themselves. In the proposed method, the patient must use a wearable inertial measurement unit (IMU) sensor, and the result of the patient’s BBS task execution would be scored automatically by the evaluation algorithm. The proposed evaluation algorithm involves only few computations and has high scoring accuracy. Nonlinear kernel principal component analysis and a small number of linear features were combined to reduce the features from each sensor, and the algorithm model was implemented using a support vector machine (SVM), a machine learning technique with low computational complexity. The effectiveness of the algorithm was evaluated through clinical evaluation of 53 subjects with up to eight IMU sensors. The average accuracy of the proposed algorithm using eight sensors was 93.2%, and that using five sensors was 91.5%. There was a 12.6% and 10.9% increase in accuracy, respectively, compared to a previous study. The training and testing times of the proposed SVM model were over 38 times faster than the multi-layer perceptron model used in a previous study.

The thalamus, located between the cerebrum and midbrain, is a nuclear complex connected to the cerebral cortex that influences motor skills, cognition, and mood. The thalamus is composed of 50-60 nuclei and can be divided into four areas according to vascular supply. In addition, it can be divided into five areas according to function. Many studies have reported on a thalamic infarction causing motor or sensory changes, but few have reported on behavioral and executive aspects of the ophthalmoplegia of the thalamus. This study reports a rare case of a paramedian thalamus infarction affecting the dorsomedial area of the thalamus, manifesting as oculomotor nerve palsy, an abnormal behavioral change, and executive dysfunction. This special case is presented with a review of the anatomical basis and function of the thalamus.

Many studies have examined the relationship between cognition, and the cingulum and uncinate fasciculus (UF). In this study, diffusion tensor tractography (DTT) was used to investigate the correlation between fractional-anisotropy (FA) values and the number of fibers in the cingulum and UF in patients with and without cognitive impairment. The correlation between cognitive function, and the cingulum and UF was also investigated. Thirty patients (14 males, age = 70.68 &plusmn, 7.99 years) were divided into a control group (n = 14) and mild-cognitive-impairment (MCI) group (n = 16). The Seoul Neuropsychological Screening Battery (SNSB) and DTT were performed to assess cognition and bilateral tracts of the cingulum and UF. The relationship between SNSB values and the cingulum and UF was analyzed. The number of fibers in the right cingulum and right UF were significantly different between the two groups. The MCI group showed thinner tracts in both the cingulum and UF compared to the control group. A significant relationship was found between the number of fibers in the right UF and delayed memory recall. In conclusion, memory loss in MCI was associated with a decreased number of fibers in the right UF, while language and visuospatial function were related to the number of fibers in the right cingulum.

Objectives:The aim of this study was to determine whether children with Tourette disorder (TD) have functional impairment and executive dysfunction in comparison to children with attention-deficit hyperactivity disorder (ADHD) and non-affected controls. Methods:From January 2006 to December 2013, 45 children and adolescents with TD and 50 children and adolescents with ADHD diagnosed at the Soonchunhyang University Bucheon Hospital and 50 non-affected controls were enrolled in this study. Functional impairment of the subjects was assessed using the Child and Adolescents Functioning Impairment Scale (CAFIS), parent and teacher versions. In addition, neuropsychological tests including Stroop color-word Test, Finger windows Test (FWT), and Digit span were administered. Outcomes were compared across the TD, ADHD, and non-affected controls. Results:No difference in CAFIS-parent and CAFIS-teacher results was observed between children with TD and non-affected controls, whereas, children with ADHD showed more impairments relative to non-affected controls in the CAFIS-parent. According to the Stroop color-word Test, FWT, and Digit span, executive function in children with TD did not differ from non-affected controls. Children with ADHD had poorer performance in measures of the Stroop color-word Test compared to children with TD. Conclusion:Children and adolescents with TD but not ADHD were not significantly different from non-affected controls on most measures of functional impairment and executive function. These findings suggest that an education program and intervention for children with TD would be important to reducing the stigma of TD.

The purpose of this report was to provide information for patients receiving inpatient rehabilitation after stroke and to identify the possible factors influencing functional outcome after inpatient rehabilitation. Stroke patients (n = 5,212) who were discharged from the Departments of Rehabilitation Medicine (RM) of university hospitals and rehabilitation hospitals from 2007 through 2011 were participants. Prevalence, age, transfer time after onset, length of stay (LOS), functional status at admission and discharge were analyzed. In all stroke subjects, cerebral infarctions (67%) were more common than hemorrhages. Cerebral infarctions in the middle cerebral artery territory were most common, while the basal ganglia and cerebral cortex were the most common areas for hemorrhagic stroke. The LOS decreased from 45 to 28 days. Transfer time after onset decreased from 44 to 30 days. Shorter transfer time after onset was correlated with better discharge functional status and shorter LOS. Initial functional status was correlated with discharge functional status. In ischemic stroke subtypes, cerebellar and brainstem strokes predicted better outcomes, while strokes with more than one territory predicted poorer outcomes with more disabilities. In hemorrhagic stroke subtypes, initial and discharge functional status was the lowest for cortical hemorrhages and highest for brainstem hemorrhages. This report shows that LOS and transfer time after onset has been decreased over time and initial functional status and shorter transfer after onset are predictors of better functional outcome at discharge.

Objective The aim of the study was to explore the impact of insomnia and sleep disturbance on the functional outcomes of mild and moderated stroke. Design A multicenter-observational and correlation study was performed. Two hundred eighty patients with mild-moderate severity stroke admitted to three acute hospitals rehabilitation departments. Diagnostic Statistical Manual of Mental Disorders, Fourth Edition, criteria were used to define patients with insomnia and any sleep disturbance. Patient's initial and final functions were evaluated using the Korean version of the Berg Balance Scale, the Korean version of Modified Barthel Index, the Korean version of Mini-Mental State Examination, the Korean version of the Frontal Assessment Battery, and the Korean version of National Institute of Health Stroke Scale. Sleep disturbance and function were assessed with respect to stroke severity as defined by the Korean version of National Institute of Health Stroke Scale. Results The prevalence of Diagnostic Statistical Manual of Mental Disorders, Fourth Edition insomnia and any sleep disturbance were 26.9% and 56.7%, respectively. After adjusting for age, sex, depression, anxiety, length of stay, and hypnotic usage, the improvement of Korean version of the Berg Balance Scale was significantly lower in the any sleep disturbance group. In the moderate stroke group, the Korean version of the Berg Balance Scale improvement was significantly lower in the any sleep disturbance group, whereas in the mild stroke group, the Korean version of the Berg Balance Scale improvement was not significant. Conclusions Sleep disturbance after stroke was found to have negative effects on functional recovery, especially balance improvement in moderate stroke group.

Despite advancing rehabilitation programs, stroke is the most prevalent disease to cause disablement. With the increase of the elderly population, the number of stroke patients increases as well. Although stroke patients at an early stage depend on a stroke unit in the acute hospital, their functional recovery and long-term health status are more affected by subacute rehabilitation hospital. Moreover, a stroke patient’s initial evaluation is crucial for prognosis and establishment of rehabilitation training strategies. The earlier stroke patients start their rehabilitation treatment, the better results they can attain; the recovery from stroke occurs within 3 months after the onset of stroke. Similarly, while neurological and functional recovery occurs in the acute and subacute stages, sometimes, it occurs 6 months after the onset of stroke or in the chronic stage. There are two main mechanisms of neurological recovery. The first is activity-dependent neuroplasticity in the injured cortical representation area, and second is vicariation, which is an operating mechanism as a substitute for the injured brain function in the remnant cortical area, outside of the damaged brain area. This stroke recovery is affected by many factors that influence reorganization of the damaged brain and early rehabilitation; furthermore, intensive rehabilitation and organized enriched environments also significantly affect recovery. In addition, there are substantial researches about new rehabilitation treatment, likely rTMS, tDCT, robotic therapies, mirror therapy, virtual reality, and drug augmentation; therefore, the results of these studies are expected to highlight promising rehabilitation treatments for stroke in the future.

Objective The principal objective of this study was to investigate the relationship between insomnia and health-related quality of life (HRQoL) during the early stage of stroke rehabilitation. Methods The subjects were 214 first-time stroke patients admitted to a rehabilitation unit at one of three Korean hospitals. Within 7 days after stroke, functions were evaluated using; the Berg Balance Scale, the Modified Barthel Index, the Mini Mental State Examination, the Frontal Assessment Battery, Screening Tests for Aphasia and Neurologic-Communication Disorders, and the National Institute of Health Stroke Scale. Insomnia, depression, anxiety, and HRQoL were investigated at one month after stroke. Insomnia was defined as presence of at least one of the four following; difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, and non-restorative sleep. HRQoL was assessed using the Short Form Health survey SF-8. Depression and anxiety were measured using the Hospital Anxiety Depression Scale. Multivariate linear regression analysis was conducted to examine the association between insomnia and HRQoL. Results The prevalence of insomnia at one month after stroke was 59.5%. Patients with insomnia were more likely to be older and female and to have depression and anxiety. Patients with insomnia had poorer physical and mental HRQoL. By multivariate analyses, physical HRQoL was significantly associated with type of stroke, hypnotic usage, balancing function, and insomnia. Mental HRQoL was significantly associated with balancing function, depression, and insomnia. Conclusion Insomnia was found to be negatively associated with physical and mental HRQoL in stroke patients during the early stage of rehabilitation.

Alien Hand Syndrome is defined as unwilled, uncontrollable, but seemingly purposeful movements of an upper limb. Two major criteria for the diagnosis are complaint of a foreign limb and complex, autonomous, involuntary motor activity that is not part of an identifiable movement disorder. After a cerebrovascular accident in the corpus callosum, the parietal, or frontal regions, various abnormal involuntary motor behaviors may follow. Although different subtypes of Alien Hand Syndrome have been distinguished, this classification clearly does not cover the wide clinical variety of abnormal motor behaviors of the upper extremity. And there are few known studies about the neurophysiology of this syndrome using transcranial magnetic stimulation (TMS). We recently experienced 2 rare cases of Alien Hand Syndrome which occurred after anterior cerebral artery (ACA) infarction. A 72 year-old male with right hemiplegia following a left ACA infarct had difficulty with voluntarily releasing an object from his grasp. A 47 year-old female with left hemiplegia following a right ACA infarct had a problem termed 'intermanual conflict' in which the two hands appear to be directed at opposing purposes. Both of them had neurophysiologic studies done, and showed reduced amplitude by single pulse MEP and a lack of intracortical inhibition (ICI) by paired pulse TMS. No abnormalities were found in SSEP.

Magnetorheological (MR) fluids, magnetic particles such as carbonyl iron (CI) and magnetite dispersed in a nonmagnetic liquid, change tunably and reversibly from a liquid-like to a solid-like state under applied magnetic field strengths, thus possessing huge engineering applications [1]. Among the many magnetic particles available, CI microspheres have been widely used as magnetizable particles for MR fluids due to their high magnetic permeability, soft magnetic property and common availability [2]. However, their high density causes serious sedimentation drawback and abrasion within equipment of application. A range of strategies including the introduction of additives or coating technologies to the particles have been reported to prevent the CI particles from caking or decreasing the particle density, thereby reducing the sedimentation rate. Three major methods have been applied to improve the sedimentation stability of MR fluids. These include adding surfactants, adding nanoparticles or using nanomagnetizable particles or coating magnetizable particles with polymer [3-5]. In this study, we used octahedral shaped Fe 3 O 4 nanoparticles as an additive for the CI based MR fluids to solve the sedimentation problem. MR properties of two MR fluid systems with and without the octahedral shaped Fe 3 O 4 nanoparticles were examined using a rotational rheometer with magnetic field supply device.

Bisphosphonates have been commonly used for the treatment of osteoporosis. However, there have been recent case reports of atypical fractures citing their long-term use, which inhibits the turnover of bone components. A 64-year-old woman visited the outpatient clinic with pain in her right thigh and ambulation difficulty. We found fractures at both pedicles of L4 vertebra. subtrochanteric region of right femur, and left femoral shaft upon a radiologic examination. She had taken intravenous ibandronic sodium for osteoporosis over 3 years. We changed the bishophonates to a parathyroid hormone because it was suspected that the multiple fractures were caused by the medication. Further, rehabilitation, including progressive weight bearing, was started. After 3 months of the conservative treatment, she was able to walk independently. In conclusion, it is necessary to evaluate the possibility of atypical fractures in osteoporotic patients when they complain of lower extremity pain and to consider alternative treatments instead of bisphosphonates.