Cause Of Impairment Research Articles

BRAIN COMPUTER INTERFACE: THE IMPACT ON NEUROPLASTICITY AND MOTOR LEARNING-A NARRATIVE REVIEW.

Background: Neurological disorders, especially stroke, have now become the major causes of death all around the world. They are also the leading cause of impairments and disabilities among those who survive which leads to dependency in ADL’s and an impairment in overall quality of life. Even though traditional rehabilitation techniques and advances in technology (VR/AR/GAMING/ASSISTIVE DEVICES/EXOSKELETONS) play a major role in the recovery process, not all individuals show a 100% positive outcome. Research suggests that the combination of BCI with traditional rehab techniques or advanced technologies help in increasing neuroplasticity by translating the brain signals into commands that can control external devices thereby leading to improved functions and activities. Objective: The objective of this review is to summarize the available evidence and to highlight the mechanism through which the BCI’s promote neuroplasticity and enhance motor functions. Methods: Articles were searched and reviewed from PubMed, research gate, google scholar using the terms BCI, neuroplasticity, motor functions, neurorehabilitation etc. only the studies which were fully accessible; showed positive outcomes; focusing on motor recovery and neuro rehab were included and the studies which focused on other uses of BCI such as gaming, commercial applications and those that focused on measuring non motor functions and cognitive impairments were excluded. Results and Conclusion: After reviewing the articles it was concluded that BCI in combination with conventional rehab techniques and advanced technologies promote neuroplasticity thereby improving functions through repeated activation of neurons and improving coordination and motor function by enhancing the brain connectivity. Implications: The invention of BCI and its combination with other rehab processes aids in the improvement of motor recovery and an overall improvement in ADL’s and quality of life of patients suffering from various neurological disorders.

Dysfunctional activation of the default mode network in response inhibition in schizophrenia

The aim of this study was to characterize dysfunctional cerebral activation in patients with schizophrenia while they performed a response inhibition task. To achieve this, performance on the task and functional magnetic resonance imaging (fMRI) were compared between healthy control subjects (HC) and patients with schizophrenia (SZ). We focused on the default mode network (DMN), as there is strong evidence in the literature that lack of DMN suppression in schizophrenia is associated with cognitive impairment including poor response inhibition. fMRI was used to measure blood-oxygen-level-dependent activation in 84 subjects (44 SZ and 40 HC) while they performed a Go NoGo task. The subjects were also evaluated for psychiatric symptoms and immediate visual memory.SZ performed more poorly than HC on the task; they had a higher number of commission errors. On the fMRI, the patients consistently evidenced higher activation than the controls in several areas of the default mode network (DMN) including the precuneus, rostral anterior cingulate, parahippocampus and insula. The higher brain activation in the patients with schizophrenia indicates a failure to deactivate the DMN while they perform the response inhibition task. These findings point to the importance of DMN dysfunction as an underlying cause of impairment in response inhibition in schizophrenia. DMN disruptions play an essential role in the cognitive impairment present in schizophrenia.

Effectiveness of video assisted teaching program of pranayama on selected physiological parameters among patients with COPD

BACKGROUND: According to research on the global burden of illness, chronic obstructive pulmonary disease (COPD) is expected to rank third globally in terms of cause of mortality in the first 20 years of the 20th century and fifth in terms of major cause of impairment. A thorough yoga program can enhance general well-being and respiratory function, which will improve a person’s capacity to complete daily chores. MATERIALS AND METHODS: One group pretest and posttest design in a quasi-experimental study was applied. Collected 50 samples by usingnon-probability sampling method to collect data with the help of tool prepared by researcher. The present study was conducted from April 2022 to June 2023. Analyzed by using Statistical Package for the Social Sciences (SPSS) software. RESULTS: The comparison of pretest and posttest physiological parameters of COPD patients. At the 5% significant level, The Student’s paired “t” test is employed, and the mean, standard deviation, and mean difference values are compared. For n = 50-1, or 4 degrees of freedom, the value was 2.00. At the 5% level of significance — a statistically acceptable level of significance — the computed oxygen saturation “t” value, or 29.69, the heart rate (7.16), respiratory rate (16.50), diastolic blood pressure (3.77), and walking distance (15.23), are all significantly greater than the value for general physiological parameters. Thus, the H1 is accepted for oxygen saturation, respiratory rate, and distance in walking. CONCLUSION: Moreover, the study findings highlight the need for ongoing education and outreach efforts to continue improving the health status of COPD patients. This paragraph say that the pranayama is effective in patient with COPD as it help in manageing the illnes and also to improve the lifestyle and also help to im prove the health status of the patient having any other illnesses. In addition, the Compassion of Pranayama and Yoga Pranayama shown effectiveness in daily lifestyle.

Acute Onset of Impaired Consciousness.

Mortality in patients with acute onset of impaired consciousness is high: as many as 10% do not survive. The spectrum of differential diagnoses is wide, and more than one underlying condition is found in one-third of all cases. In this article, we describe a structured approach to patients with acute onset of impaired consciousness in the emergency department. This review is based on pertinent articles retrieved by a selective search of PubMed and on the AWMF guidelines on the most common causes of impairment of consciousness. Impairments of consciousness are classified as quantitative (reduced wakefulness) or qualitative (abnormal content of consciousness). Of all such cases, 45-50% have a primary neurological cause, and approximately 20% are of metabolic or infectious origin. Some cases are due to intoxications, cardiovas - cular disorders, or psychiatric disorders. Important warning signs ("red flags") in acute onset of impaired consciousness are a hyperacute onset, pupillomotor disturbances, focal neurologic deficits, meningismus, headache, tachycardia and tachypnea (with or without fever), muscle contractions, and skin abnormalities. Patients with severely impaired consciousness should be initially treated in the shock room according to the ABCDE scheme. Acute onset of impaired consciousness is a medical emergency. Red flags must be rapidly recognized and treatment initiated immediately. Patients with severely impaired consciousness of new onset and uncertain cause, status epilepticus, lack of protective reflexes, or a new, acute neuro - logic deficit should be admitted via the resuscitation room.

Knee contact forces of individuals with osteoarthritis and those with lower limb amputation: A systematic review.

Osteoarthritis (OA) is a major cause of impairment. Research has shown that individuals with unilateral lower limb amputation (ULLA) are 17 times more likely to develop OA on their sound side limb. Therefore, this review aimed to describe similarities and differences in the biomechanical loading variables of individuals with OA and those with ULLA. Researchers systematically searched PubMed-Medline, EBSCOhost and Web of Science for articles published between January 1990 and February 2022. Included studies investigated the biomechanical profiles (peak external knee adduction moment (KAM); peak external knee flexion moment (KFM); ground reaction force; external knee adduction moment loading rate; external knee adduction moment impulse) of both population groups. A total of 31 articles were included in this review. Only KAM and KFM presented similar profiles in both groups, whilst all other variables were dissimilar. The use of advanced prostheses reduced the loading on the sound side of individuals with ULLA. As both KAM and KFM are surrogate measures for knee contact forces, interventions need to target these variables to help manage and prevent the development of OA. Interventions, particularly for addressing these variables in individuals with ULLA, should be further investigated in future research.

The Tower of London task in children and adolescents with neuropsychiatric disorders

ABSTRACT The Tower of London, Drexel Version, Second Edition (TOL-DX) is purported to measure multiple aspects of executive functions, although it also possesses inherent non-executive demands. Such complexity makes it useful in detecting impairment but difficult in interpreting the neurocognitive cause of impairment, particularly in children. This study investigated the developmental, neurocognitive, and symptom correlates of the TOL-DX in children and adolescents with neuropsychiatric disorders. Two-hundred and thirty-three children and adolescents (7–21 years old) completed the TOL-DX during a neuropsychological evaluation as part of clinical care within a children’s psychiatric hospital. Pearson correlation, regression models, and receiver operating characteristic curve (ROC) analyses examined the association among variables. Visuospatial and executive functions (EF) were most consistently related to total moves, execution time, and violations. TOL-DX variables were associated with attention in younger participants and EF in older participants. No TOL-DX scores were related to parent-reported symptoms. The TOL-DX possesses inherent visuospatial and attention/executive demands in children and adolescents which are difficult to differentiate, differ by age group, and not associated to clinical symptoms. Taken together, the TOL-DX is complex to interpret, but psychometrically sound and sensitive to neurocognitive impairment in children and adolescents with transdiagnostic neuropsychiatric disorders.

A new perspective on water quality: Exploring spatial and temporal patterns of impaired waters

Managing surface water quality is a global challenge, and understanding spatial and temporal patterns of water quality is a key component to effective management. However, analysis of spatiotemporal patterns of impaired waters over broad areas is sparse due to disparate water quality data and variable water quality standards. Thus, here we leverage the Alabama 303(d) List of impaired waters to present a new perspective for investigating spatiotemporal water quality patterns. Every two years, each state in the United States is required to assess its surface water quality and compile a list of impaired waterbodies, meaning waters that do not meet water quality standards for their designated usage – referred to as the 303(d) List. The purpose of the 303(d) List is to identify impaired waters so that corrective action can be taken to reduce pollutant loads and, ultimately, improve water quality. Using GIS, a space time cube was created to analyze and visualize spatiotemporal patterns of the impaired rivers added to the Alabama 303(d) Lists from 1996 to 2022. For this analysis, the percentage of river length impaired out of the total river length, and number of times each impairment cause was listed, were summarized within Alabama sub-basins (Hydrologic Unit Code 8) (n = 51). Trend and hot spot analyses were conducted on the river impairment and causes. There was an up trend in river impairment for eight sub-basins across the state and a downtrend in one sub-basin. Over half of the sub-basins with an up trend in impairment also had an up trend in the number of times pathogens was listed as a cause of impairment. Additionally, coastal sub-basins were found to be a hot spot for river impairment. Interestingly, there was a down trend in the number of times nutrients, ammonia, and siltation were listed as a cause of impairment at the state and sub-basin scales of analysis. Altogether, these findings show the use of spatiotemporal pattern analysis of impaired waters and can indicate where, both spatially and by pollutant, management should prioritize water quality improvement efforts.

Examining the Evidence Regarding Smoking and Patient Outcomes for Isolated Meniscus Pathology: A Comprehensive Systematic Review and Meta-Analysis.

Smoking is a well-known cause of impairment in wound healing and postoperative outcomes; however, its effects on treating meniscus issues remain unclear. This study assesses the relationship between smoking and meniscus treatment outcomes. PubMed, Scopus, Cochrane, and CINAHL were searched from inception to 24 December 2023. Inclusion criteria encompassed studies examining smoking's impact on patient outcomes regarding meniscus pathology. A secondary PubMed search targeted randomized controlled trials (RCTs) in the top ten orthopedic journals focusing on meniscus pathology and smoking as a demographic variable. Meta-analysis of six studies (n = 528) assessed meniscus failure rate based on smoking status. Eighteen observational studies (n = 8353 patients; 53.25% male; mean age: 51.35 ± 11.53 years; follow-up: 184.11 ± 117.34 months) were analyzed, covering meniscus repair, meniscectomy, allograft transplant, conservative care, and arthroscopy. Results showed four studies (36.36%) linked smoking with worse meniscus repair outcomes, while seven studies (63.64%) did not find significant associations. Meta-analysis from six studies showed no significant impact of smoking on repair failure (p = 0.118). Regarding meniscectomy, one study (33.33%) identified a significant association with smoking, but two did not. Only one (3.8%) of the RCTs in leading orthopedic journals included smoking as a factor. The evidence on smoking's effect on meniscus treatment is mixed, necessitating further investigation.

Clinical practice guidelines for diagnostic and treatment of the chronic heart failure.

Chronic heart failure continues to be one of the main causes of impairment in the functioning and quality of life of people who suffer from it, as well as one of the main causes of mortality in our country and around the world. Mexico has a high prevalence of risk factors for developing heart failure, such as high blood pressure, diabetes, and obesity, which makes it essential to have an evidence-based document that provides recommendations to health professionals involved in the diagnosis and treatment of these patients. This document establishes the clinical practice guide (CPG) prepared at the initiative of the Mexican Society of Cardiology (SMC) in collaboration with the Iberic American Agency for the Development and Evaluation of Health Technologies, with the purpose of establishing recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. This document complies with international quality standards, such as those described by the US Institute of Medicine (IOM), the National Institute of Clinical Excellence (NICE), the Intercollegiate Network for Scottish Guideline Development (SIGN) and the Guidelines International Network (G-I-N). The Guideline Development Group was integrated in a multi-collaborative and interdisciplinary manner with the support of methodologists with experience in systematic literature reviews and the development of CPG. A modified Delphi panel methodology was developed and conducted to achieve an adequate level of consensus in each of the recommendations contained in this CPG. We hope that this document contributes to better clinical decision making and becomes a reference point for clinicians who manage patients with chronic heart failure in all their clinical stages and in this way, we improve the quality of clinical care, improve their quality of life and reducing its complications.

Emotion behind the Wheel: Unravelling the Impact of Emotional (dys)Regulation on Young Driving Behaviour—A Systematic Review

Young people engage in a variety of behaviours that can have an impact on their health and safety, including driving and road accidents, which represent a major health issue today. Emotions, and in particular emotional regulation (ER), interact significantly with key elements of driving behaviour, such as risk perception, decision-making, and attention. We carried out a systematic review considering the presence of an association between emotional (dys)regulation and driving behaviour of young adults (18–25 years). A total of 1849 records were selected for screening and, finally, eight full-text articles were included. Two main findings were found: on the one hand, driving anger, unlike other emotional patterns, emerged as a well-defined cause of impairment among young drivers. On the other hand, drivers’ risky behaviour seems to be influenced by a heterogeneous set of factors, such as using specific ER strategies or personality traits (e.g., impulsivity). Expressing one’s emotions adaptively, improving the ability to accept and be aware of negative emotions, and controlling impulsive behaviour could reduce driving risks in young drivers.

Accessible tourism: tourists with physical disability - segmentation based on perceived travel barriers

Purpose This study aims to explore the heterogeneity of the tourist market for people with a physical disability (PwPD) based on travel barriers, to serve them better, from a tourism marketing perspective. Design/methodology/approach A market segmentation analysis was conducted on a sample of 480 PwPD in Sichuan Province, China, based on their perceived travel barriers. Data were obtained through three on-site and four online surveys. A four-step factor-item mixed segmentation, including factor analysis, cluster analysis, discriminant analysis and chi-square tests, was applied to examine the differences among PwPD tourist market segments in terms of various demographic characteristics, disability conditions (e.g. duration of disabilities and causes of impairment) and travel features (e.g. travel frequency and tourist destinations). Findings This study revealed that the PwPD tourist market is heterogeneous due to individual perceived travel barriers. Three market segments were identified, namely, the Explorer Moderates group, the Explorer Minimals group and the Explorer Intensives group. Additionally, the three market segments were found to have significant differences in terms of travel barriers, demographic characteristics, travel features and disability conditions. Practical implications This research provides suggestions for authorities and private entities to optimize the layout of accessible facilities in public areas for the benefit of all. It also offers crucial implications for tourism marketers to determine the key facets of marketing, for travel organizers to evolve the organization of travel groups for PwPD, and for practitioners to provide personalized tourism services. Originality/value To the best of the authors’ knowledge, this study is the first to apply perceived travel barriers as a market segmentation criterion in understanding PwPD as a heterogeneous travel market. The findings of this study initially expand the scope of application of the travel barrier model and deepen understanding of the Chinese PwPD tourist market from a marketing perspective. The study results elucidated the heterogeneity and characteristics of this market through a four-step factor-item mixed segmentation approach, offering new insights into the behaviors and experiences of travelers with disabilities.

Constraint-induced movement therapy through telerehabilitation for upper extremity function in stroke

BackgroundStroke is considered to be a leading cause of impairment. After experiencing strokes, patients are frequently left with impaired motor function, making it difficult to carry out daily tasks. The most extensively researched method for treating stroke patients in recent decades is CIMT (constraint-induced movement therapy), which was developed to treat upper limb deficits following stroke. CIMT entails limiting the use of the unaffected limb, altering behavior to increase the use of the affected limb, and finally, mass-training of the affected limb. ObjectiveThe current study aimed to determine the effectiveness of CIMT through TR for upper extremity function in stroke patients. Materials and methodsThirty post-stroke participants were selected on the basis of inclusion and exclusion criteria, and allocated into group A and group B. Group A was treated with CIMT in the physiotherapy department and group B was treated with CIMT through TR. Outcome measures were the Fugl-Meyer Assessment scale for upper extremities (FMA-UE), the Wolf Motor Function Test (WMFT), and the Motor Activity Log (MAL). ResultsBoth groups showed significant improvements in FMA-UE, WMFT and MAL-A0U, MAL-Q0M scores. However, there were no significant differences between groups A and B in FMA-UE, WMFT, MAL-AOU, and MAL-QOM scores in the inter-group analysis. ConclusionCIMT via TR was equally effective than CIMT in physiotherapy department for upper extremity function in stroke. Further studies should be conducted to identify the long-term effectiveness of this approach.

Epigenetic perspective on atherosclerotic cardiovascular diseases: The holistic principle of systems biology and epigenetic reasoning

Atherosclerosis and coronary artery disease are the main causes of impairment and cardiac death, placing a significant burden on our health-care system. This review focuses on elucidating the involvement of various epigenetic mechanisms in the genesis and progression of cardiovascular diseases (CVDs), particularly chronic CVDs. The deregulation of epigenetic mechanisms plays a crucial role in the progression of CVDs, prompting exploration into novel preventive approaches. Advancements in molecular procedures, network-based approaches, and data analysis have identified new targets in CVDs, permitting the utilization of individualized epigenetic factors for personalized diagnosis and treatment. While promising for improving diagnostic and prognostic assessments, the clinical implementation of epigenetic biomarkers lags behind. Multicenter clinical documentation in a large sample population is crucial to confidently ascertain the clinical utility of specific epigenetic biomarkers. Of particular interest is the interplay between epigenetics and the conflict between the gene-based reductionist theory and the holistic principle of systems biology (SB). The holistic principle analyzes the structural organization and regulation of biological networks, influencing the genesis and progression of complex cardiac diseases like CVDs. This review emphasizes the complexity of CVDs, elucidates the interrelationship between disease networks and epigenetic mechanisms, and highlights the importance of the holistic principle of SB, coupled with artificial intelligence, in clarifying this interrelationship. The constant and uninterrupted epigenetic impact holds immense potential for advancing our understanding of disease progression and treatment across cells and tissues. Despite these advancements, the full integration of the epigenetic impact into medical practice remains incomplete, with limited utilization in clinical applications. Nevertheless, it is likely that in the near future, the epigenetic regulation of gene expression, with its lifelong and extended effects on health, will become an integral part of everyday clinical practice.

A systematic review on physiological role of yoga and pranayama in management of orthostatic hypotension and vasovagal syncope

OH and VVS are increasingly recognized as important causes of impairment of quality of life and potentially of poor prognosis. Existing management therapies have modest effect. Recently few studies have emerged and have demonstrated the efficacy of yoga and pranayama in disorders having autonomic imbalance, suggesting its possible efficacy in OH and VVS.This review aims to determine the effectiveness of yogic practices in patients with orthostatic hypotension (OH) and recurrent vasovagal syncope (VVS). A Medline search was done in Google chrome to review relevant articles in English literature considering the eligibility criteria that the article should focus on yoga and pranayama and its physiological effects on OH and VVS. The main outcome expected was attenuation of OH and frequency of attacks of syncope and presyncope.: Out of the total 86 articles searched, 7 articles (3 RCTs, 3 observational/interventional, 1 review) full filled the eligibility criteria and depicted that yogic practices can have positive impact in attenuation of orthostatic hypotension and reduce the frequency of attacks of syncope and presyncope, among patients with recurrent VVS. However, we recommend higher-quality RCTs in future to confirm our results.

Prevalence and Cause of Loss of Visual Acuity and Visual Field in Highly Myopic Eyes: The Beijing Eye Study

To explore prevalence and causes of loss of visual acuity and visual field in highly myopic eyes. Population-based study. The participants (n=4439) of the Beijing Eye Study underwent an ophthalmological and systemic examination including frequency doubling technology perimetry (FDT). High myopia was defined by a refractive error of ≤-6Dpt or axial length >26.0 mm. Prevalence of vision impairment causes. The study included 212 highly myopic eyes (154 participants;mean age:56.2±9.6 years;refractive error:-9.87±3.70 Dpt;range:-20.87 to -6.00Dpt; axial length:27.2±1.3mm;range:26.01-30.88mm). Moderate/severe vision impairment (MSVI) (best corrected visual acuity (BCVA) from <6/18 to 3/60) and blindness (BCVA <3/60 or <10° visual field around central fixation) was present in 40/212 (18.9%;95%CI:13.6,24.2) eyes, and in 10/212 (4.7%;95%CI:1.8, 7.6) eyes, respectively. BCVA decreased with more myopic refractive error (beta:-0.55;B:-0.08;95%CI:-0.09,-0.06;P<0.001). Primary (i.e., most influential) causes for MSVI and blindness were myopic macular degeneration (MMD) (29/50;58%), age-related macular degeneration (1/50;2%), and branch macular retinal vein occlusion (1/50;2%). Secondary causes were MMD (4/50;8%) and optic nerve atrophy (14/50 (28%), differentiated into a non-glaucomatous type (NGOA) (9/50;18%) and glaucomatous type (GOA) (5/50;10%). Prevalence of MMD as vision impairment cause (mean:40/212 (18.9%;95%CI:13.6,24.2) increased from 1/61 (1.6%;95%CI:0.00,4.9) in the group of -6.00 to ≥-7.00Dpt, to 16/25 (64.0%;95%CI:43.8,84.2) in the group of <-15.0Dpt. Higher MMD prevalence correlated with higher myopic refractive error (OR:0.70;95%CI:0.61;0.81;P<0.001) and higher prevalence of concomitant optic neuropathy (OR:86.2;95%CI:16.1,463;P<0.001). Optic neuropathy prevalence as cause of vision impairment (mean:19/212;9.0%;95%CI:5.0,13.0) increased from 0/61 (0%) in the refractive error group of -6.00Dpt to ≥-7.00Dpt, to 9/25 (36.0%;95%CI:16.0,56.0) in the group of <-15.0Dpt. Higher optic neuropathy prevalence correlated with more myopic refractive error (P<0.001) and older age (P=0.02). GOA prevalence (mean:6/212;2.8%;95%CI:1.0,5.0) and NGOA prevalence (mean:13/212 (6.1%;95%CI:3.0,9.0) increased from 0/61 (0%) in the group of -6.00 to ≥-7.00Dpt, to 4/25 (16.0%;95%CI:1.0,31.0) and 5/25 (20%;95%CI:3.0,37.0), respectively, in the group of <-15.0Dpt. In this population-based recruited, highly myopic cohort, prevalence of optic neuropathy (9.0%) as vision impairment cause was lower than MMD prevalence (18.9%), and it was an important reason for vision impairment in the group of <-15Dpt. MMD was vision impairment cause in 16/25 (64.0%) eyes with <-15.0Dpt refractive error.

Lower limb rehabilitation using modified constraint-induced movement therapy and motor relearning program on balance and gait in sub-acute hemiplegic stroke: a comparative study

Background: A stroke is described by the World Health Organization as “a clinical syndrome with rapidly developing symptoms that consist of a focal (or global, in a situation of coma) disruption of cerebral function that lasts more than 24 hours or leads to mortality without a known cause other than a vascular origin”. Stroke is the most prevalent cause of impairment and mortality on a global scale. Modified constraint-induced movement therapy (mCIMT) is an approach to therapy for motor disabilities that involves constraining the movements of the nonparetic limb, diligent practice and behaviour modification to extend the time the paretic limb is utilized for daily tasks. The motor relearning program (MRP) method involves many aspects of motor learning theory and is helpful in providing instructions for retraining practical skills (including walking, standing and sitting in balance and transferring abilities). So, the objective of this study is to assess the impact of the MRP and mCIMT on balance and gait in sub-acute hemiplegic stroke patients. Methods: In this study, each group will consist of 17 people in total. The randomization procedure will be conducted using a computer-generated random number system. For sample distribution, we will use the sequentially numbered opaque sealed envelope technique. Outcome measures will be as follows: Berg balance scale, Dynamic gait index, Trunk impairment scale, Functional reach test, 10 Meter walk test and Fall efficacy test. Each patient will be evaluated prior to and during treatment at baseline and six weeks later. Conclusions: There is sufficient evidence to derive the conclusion that the functional mobility and balance of stroke victims can be improved with physiotherapy. Therefore, this study will try to seek the comparison of mCIMT and MRP in sub-acute stroke subjects and compare the two regimes to determine which one will be superior. Registration: CTRI (CTRI/2023/05/052674; 16/05/2023).

The Florida experience: time for a revitalized and restructured Clean Lakes Program

Canfield, DE Jr., Bachmann RW, Hoyer MV. 2023. The Florida experience: time for a revitalized and restructured Clean Lakes Program. Lake Reserv Manage. 39:191–212. Anthropogenic nonpoint source nutrient enrichment of lakes is a worldwide problem, but inputs from the watershed to Florida lakes may not be as severe as speculated. Long-term trends for total phosphorus (TP), total nitrogen (TN), chlorophyll (Chl), and Secchi disk transparency (SDT), enrichment surrogates, in 381 lakes monitored for 20–43 yr and having extensive management to none demonstrated improvements in trophic conditions following point source removals. Afterward, TP (R2 = 0.85), TN (R2 = 0.49), and Chl (R2 = 0.50) continued to decline significantly (P < 0.05) and SDT (R2 = 0.63) increased. For 99 state-designated “impaired” lakes, TP (R2 = 0.73), TN (R2 = 0.45), and Chl (R2 = 0.44) also declined and SDT (R2 = 0.69) increased. To consider natural background conditions, lakes were assigned to their ambient TP and TN zones. Geometric TP (93%) and TN (82%) zone averages for each lake after removal of point sources remained within each zone’s 95% confidence interval. Individual lake trend analyses documented that ∼80% showed no (most) or an improving trend for the trophic state variables. After correcting for “statistically meaningful” results or to remove false significances, <5% of the lakes had trophic state variable changes associated with eutrophication. If lakes are to be rehabilitated and/or protected to maintain designated uses, exclusive focus on watershed management of nonpoint source nutrients and associated regulatory actions should not be relied on to correct “impairments” in a timely manner. Management priorities should focus on actual causes of impairment and the most effective and efficient approaches for improvement.

A Multiple Case Study of Career Construction and Career Development Processes of People with Adventitious Blindness

A Multiple Case Study of Career Construction and Career Development Processes of People with Adventitious Blindness

COMPARATIVE STUDY ON THE EFFECTIVENESS OF MUSCLE ENERGY TECHNIQUE AND ACTIVE RELEASE TECHNIQUE ON THE GLENOHUMERAL INTERNAL ROTATION DEFICIT (GIRD) IN YOUNG THROWING ATHLETES

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Glenohumeral internal rotation deficit (GIRD) is one of the most common causes of impairments in overhead throwing athletes due to high intense and repeated throwing activities. The purpose of this study is to compare the effects of Muscle energy technique and Active release technique in overhead throwing athletes with Glenohumeral internal rotation deficits. &lt;strong&gt;Materials and Methods:&lt;/strong&gt; A total of 42 athletes with age group 18-25 were selected for the study and a simple random lottery method was used to divide the sample into three groups; Group A (n=14) received muscle energy technique and conventional therapy, Group B (n=14) received active release technique and conventional therapy, Group C (n=14) received only conventional therapy. Measurements of shoulder internal rotation ROM (by Goniometer) and SPADI (shoulder pain and disability index) were assessed pre- and post-treatment after 4 weeks. &lt;strong&gt;Results:&lt;/strong&gt; The results showed that Group A shows a significant difference in shoulder internal rotation ROM with a p-value &amp;lt;0.05 than Group B and C, but there was no significant difference was found between all the groups in the SPADI score with p-value &amp;gt;0.600. &lt;strong&gt;Conclusion:&lt;/strong&gt; The study concluded that the muscle energy technique is more effective than the active release technique in improving shoulder internal rotation ROM, but both techniques have equally effective in improving shoulder function among athletes with GIRD.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/soc/0009/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Frequency of Non-Specific Low Back Pain Among School Going Adolescents in Peshawar

Nonspecific low back pain is a state which is characterized by discomfort and inflexibility in the lumbo-sacral area without any underlying pathology. NSLBP is taken as non-specific when any mechanical and structural impairment cause is excluded. Initial symptom starts when a person is in the phase of adolescence and further continuous. Objective: To evaluate the frequency of non-specific low back pain in school going adolescents. Methods: Cross sectional study design was used. Total 202 samples were taken through consecutive sampling technique. Study duration was six months. The study setting was different private schools of Hayatabad Peshawar. Students of age 10- to 19-year-old were included in the study. The results were analyzed by using SPSS version 23. Results were shown in the form of tables and graphs. Results: According to the results 108 (53.5%) students reported to have NSLBP. Total 202 subjects were added in study, in which 150 were males and 52 were females. Total 106 participants were between the ages of 10 to 15 years. The remaining 96 students were between the ages of 15 to 19 years. According to Wong-bakers faces pain rating scale 84 participants reported to have non-specific low back pain while 64 participants reported pain for 12 to 24 hours. Students from frontier student’s academy reported to have repeated NSLBP. Conclusion: Nonspecific low back pain is a familiar condition that occurs in school going children and adolescents. Due to heavy back packs, poor posture and prolong setting