Chance Of Recovery Research Articles

Slow demographic change and neurological rehabilitation-Part 1: state of affairs

In the next two decades the aging baby boomers in Germany will gradually be leaving the work force. They are being followed by the much less numerous, "baby bust" generation who now need to finance and staff healthcare for the growing number of old people in society. In order to care for more needy persons with a smaller working population, the healthcare system must be restructured; however, despite these worrisome prospects, the awareness of the problem is still low in many areas. Here we focus on the area in the healthcare system that is growing particularly rapidly and additionally has the greatest need of personnel per patient: the care of the critically ill and functionally impaired patients. The lack of coordination of hospitals, rehabilitation centers and nursing institution is historical in origin. It promotes the tendency to discharge functionally impaired patients to nursing facilities without giving them a chance for recovery of functional autonomy. As the demographic change progresses, this tendency threatens to increase. In afirst of two parts, we attempt to describe the present situation.

ISIC_WSM: Generating Weak Segmentation Maps for the ISIC archive

Recognizing skin cancer in time could greatly increase patients’ chances of recovery. For this reason, in recent years, numerous decision support systems have been proposed to help dermatologists in this diagnosis. These systems are generally based on Convolutional Neural Networks and are used for both segmentation and classification of lesions. Although their main goal is to correctly recognize the lesions’ type, the preliminary segmentation step has been shown to increase the performance of the classifier. In fact, this is not surprising because physicians also use information on the shape of the lesion to make a diagnosis. Thanks to the ISIC archive, a huge number of skin lesion images, along with the corresponding metadata (type, position, dimension, etc.), are publicly available to train a deep neural network, but, unfortunately, only a small fraction of them are labeled for segmentation. To overcome this limitation, in this paper, a weak supervised approach is proposed to extract the segmentation label maps from the entire ISIC archive. Moreover, to demonstrate the quality of the proposed approach, the generated supervisions were first compared with those available in ISIC and, then, used to train a segmentation network, whose performance was evaluated against that obtained using only the small set of ISIC label maps. To foster reproducibility and to promote future research in lesion segmentation and classification, the generated ISIC Weak Segmentation Map (ISIC_WSM) dataset has been released. As far as we know, this is the first dataset that contains segmentation supervisions for clinical images of skin lesions.

496: REVERSIBLE MALIGNANT CEREBRAL EDEMA FOLLOWING CRANIOPLASTY

Introduction: Cranioplasty is a low-risk procedure and is performed for improving hydrocephalus and cerebral protection after decompressive craniectomy. Until recently, a complication that received little attention despite the devastating consequences is malignant cerebral swelling occurring after cranioplasty. There is limited knowledge regarding the pathophysiology or prevention of this condition. We present a novel case wherein a patient developed malignant cerebral swelling and fully recovered from the event. Description: 44-year-old female initially hospitalized in January 2021 for a right MCA occlusion; she received Alteplase and thrombectomy was performed. Hospital course was complicated by post procedure CT head showing midline shift and mass effect for which she was taken for right sided hemicraniectomy and right temporal lobectomy. She underwent tracheostomy, PEG and was discharged. She presented back in August 2021 for an elective right sided cranioplasty. The operative course was uneventful, a hemovac was placed with a subgaleal drain and a postoperative CT head showed cranioplasty in good position. That evening, the patient became increasingly lethargic, and was intubated. She was given hyperosmotic therapy and a repeat CT head showed newly evolving right PCA infarct, cerebellar infarcts with edema, worsening subdural hematoma and left MCA infarcts. While obtaining the repeat CT head, the patient developed seizures with progression to status epilepticus and was started on a midazolam infusion. CEEG showed epileptiform potentials in the right posterior quadrant and left hemisphere, without seizures. Two days later, on a repeat CT head there were no new findings. Patient began to improve clinically, and MRI brain on day 3 didn’t show new infarct or lesion other than encephalomalacia. She was transferred out of the ICU on day 6, a stability CT head three weeks later was stable, and she was discharged to acute rehab. Discussion: Transient malignant swelling followed cranioplasty is a high risk complication and possibly related to severe TBI, SSFS and vacuum suction drainage. Our patient is the first reported survivor from this. Further research and investigation of other cases should be identified to assess for commonalities and interventions to provide the best chance of recovery.

Predictors of time to recovery from uncomplicated severe acute malnutrition among 6–59 months children treated in out patient treatment in health posts of Nagele Arsi district: a retrospective cohort study

BackgroundAccess to outpatient therapeutic feeding programs (OTP) for all children who have uncomplicated severe acute malnutrition (SAM) remains a global public health priority. Identifying predictors that determine time-to-recovery from severe acute malnutrition optimize therapeutic success. However, reliable evidence on the determinants of time to recovery at health posts was not available in Nagele Arsi district of South Ethiopia.ObjectiveThis study was aimed to identify determinants of time-to-recovery from uncomplicated SAM among children aged (6–59) months treated at an OTP in health posts of Nagele Arsi district, Southern Ethiopia.MethodsInstitutional based retrospective cohort study was conducted among 357 children treated in Negele Arsi district from July1, 2018 to June 30, 2020. The children were selected using simple random sampling from 20 health posts. SAM treatment outcomes were compared against international SPHERE standards. The average time-to-recovery was estimated using Kaplan-Meier survival curve and the independent predictors of time to recovery were determined using multivariable Cox-proportional hazard model. The strength of the association was done using adjusted hazard ratio (AHR) with 95% confidence intervals. Statistical significance was declared at p value < 0.05. The results were presented by text, tables and figures.ResultA total of 284 (79.6%) children recovered during follow up. The mean weight gain for recovered children was 4.7 + 2.4 g/kg/day. The median time-to-recovery was 44 days 95% CI (42.7–45.3). Children who received Amoxicillin, AHR =2.574, 95% CI (1.879–3.525); de-wormed, AHR = 1.519, 95% CI (1.137–2.031); received Vitamin A, AHR = 2.518, 95% CI, (1.921–3.301) and new admissions, AHR = 1.823, 95%CI, (1.224–2.715) were more likely to recover. However, those who admitted with non-edema, AHR = 0.256, 95% CI, (0.189–0.346); had cough at admission, AHR = 0.513, 95 CI, (0.366–0.719) and had diarrhea at admission AHR = 0.5, 95% CI, 0.5 (0.350–0.712) were less likely to recover.Conclusion and recommendationThe recovery rate was within the acceptable ranges of International Sphere Standards. Those children who had cough and diarrhea should be given due attention from health extension workers and program planners. Appropriate provision of routine medication and timely intervention of co-morbidity are needed to increase chance of early recovery.

Broadening the Differential of Autoimmune Encephalitis: Diagnostic and Therapeutic Considerations in Down Syndrome Disintegrative Disorder

Objective To assess clinical features of Down Syndrome Disintegrative Disorder (DSDD) in trisomy 21 (T21) patients with a presumed diagnosis of autoimmune encephalitis (AE) and analyze immunotherapy regimens and timing. Background DSDD is characterized by acute to subacute developmental regression in social and functional skills with emergence of autistic behaviors in T21. In contrast to AE, brain imaging, cerebrospinal fluid (CSF) testing and AE antibody panels are often unremarkable in DSDD. However, anti-thyroid antibody seropositivity in the majority of DSDD patients as well as reported positive immunotherapy responses raise the question of an autoimmune etiology. Design/Methods Retrospective analysis of T21 patients with progressive social, cognitive, and/or functional decline referred to the University of Florida neuroimmunology clinic for establishment of care for suspected autoimmune encephalitis. Results Two female T21 patients were included with onset of autism, cognitive decline, insomnia, and psychosis at 12 (P1) and 16 (P2) years of age. Catatonia was present in one patient (P1). Diagnostic work-up was pertinent for anti-thyroid antibody-seropositivity in both cases (anti-microsomal and anti-thyroid peroxidase) and positive oligoclonal bands in one patient (P2). Otherwise, MRI, EEG, CSF and comprehensive serum/CSF AE antibody panels were negative. Both patients were treated with intravenous corticosteroids, intravenous immunoglobulins, and additional immunosuppressive agents (azathioprine [P2]; plasmapheresis, rituximab, cyclophosphamide [P1]). Earlier initiation of immunotherapy (9 months after symptom onset) was associated with partial sustained improvement (P2) while later initiation of immunotherapy (12 months after symptom onset) was associated with partial but non-sustained improvement (P1). Conclusions Both reported cases align with diagnostic features of DSDD and had partial response to immunotherapy. Sustained improvement was associated with earlier immunotherapy initiation. DSDD should be a diagnostic consideration in T21 patients with presumed AE diagnosis in setting of functional decline and developmental regression. Early initiation of immunotherapy should be considered for better chance of sustained recovery.

Emerging nanophotonic biosensor technologies for virus detection

Abstract Highly infectious viral diseases are a serious threat to mankind as they can spread rapidly among the community, possibly even leading to the loss of many lives. Early diagnosis of a viral disease not only increases the chance of quick recovery, but also helps prevent the spread of infections. There is thus an urgent need for accurate, ultrasensitive, rapid, and affordable diagnostic techniques to test large volumes of the population to track and thereby control the spread of viral diseases, as evidenced during the COVID-19 and other viral pandemics. This review paper critically and comprehensively reviews various emerging nanophotonic biosensor mechanisms and biosensor technologies for virus detection, with a particular focus on detection of the SARS-CoV-2 (COVID-19) virus. The photonic biosensing mechanisms and technologies that we have focused on include: (a) plasmonic field enhancement via localized surface plasmon resonances, (b) surface enhanced Raman scattering, (c) nano-Fourier transform infrared (nano-FTIR) near-field spectroscopy, (d) fiber Bragg gratings, and (e) microresonators (whispering gallery modes), with a particular emphasis on the emerging impact of nanomaterials and two-dimensional materials in these photonic sensing technologies. This review also discusses several quantitative issues related to optical sensing with these biosensing and transduction techniques, notably quantitative factors that affect the limit of detection (LoD), sensitivity, specificity, and response times of the above optical biosensing diagnostic technologies for virus detection. We also review and analyze future prospects of cost-effective, lab-on-a-chip virus sensing solutions that promise ultrahigh sensitivities, rapid detection speeds, and mass manufacturability.

Failliet in de Republiek

Between 1643 and 1713, many cities in the economic core areas of the Dutch Republic introduced local ordinances concerning desolate boedels, insolvent estates. This article compares the contents of a substantial number of such ordinances and explains these legal innovations as part of broader patterns of institutional change. The introduction of majority compositions in this period substantially improved the chances for economic recovery of insolvent debtors. It also formed a violation of the creditors’ property rights. This article shows how this was compensated for by a much improved and stricter supervision of insolvency procedures and curators by local authorities. It is argued that these legal and institutional developments should be seen as part of an important shift in public mentalities: local authorities all over the early modern Dutch Republic sought to maintain public order and protect the common good by regulating ever more aspects of society.

REGIONAL NERVE BLOCK FOR SUBCLAVIAN ACCESS TAVI

Transcatheter aortic valve implantation (TAVI) program has started in the UK in 2007 performing 66 cases a year, the number of cases of TAVI done every year has been exponentially increasing since then to reach 6076 cases in the year 2020. (Ludman) The UK TAVI registry has shown a nationwide shift in practice from general anaesthesia to conscious sedation for trans-femoral access TAVI, analysis has shown a fall of In-hospital mortality from 4.7 in 2012 to 1.8% in 2016 (Ludman). This shift, however, has not occurred in the same way for other arterial access like trans-subclavian or trans-axillary, which is still widely practiced in the UK under general anaesthesia. The vast majority of cases in the UK are done through the femoral access, however, finding an alternative approach is sometimes needed due to contraindication to the standard femoral approach, mostly vasculopathy, which usually indicates higher risk patient and higher likelihood of associated co-morbidities. Performing the alternative access TAVI under general anaesthesia adds more risk to the patient and in some cases could be life threatening, some of these patients could be deemed unfit for the procedure. Finding an alternative anaesthetic technique will allow these patients to have their procedures done with lower risk and have the optimum chance for quicker recovery. The technique of combining Superficial cervical plexus block, interscalene block with Pectoral block type II was first described in 2018 by Alexander et al and reproduced by Block et al in the United States in the same year to allow for performing subclavian access TAVI without general anaesthesia. The same technique was partially adopted with some modification by Vivian et al in Canada and Toscano et al in Italy in 2020 and 2021 respectively. In this manuscript we share our experience doing a series of subclavian access TAVI under regional nerve block and conscious sedation at the Freeman hospital in Newcastle upon Tyne, to our knowledge, and from literature search, this is the first time this is performed successfully in the UK as we didn't see any published reports on this technique within the country.

Degenerative cervical myelopathy and alterations in functional cerebral connectivity.

Degenerative cervical myelopathy and alterations in functional cerebral connectivity.

Long-Term Outcomes of Patients with Stroke Predicted by Clinicians to have no Chance of Meaningful Recovery: A Japanese Cohort Study.

Little is known about the natural history of comatose patients with brain injury, as in many countries most of these patients die in the context of withdrawal of life-sustaining therapies (WLSTs). The accuracy of predicting recovery that is used to guide goals-of-care decisions is uncertain. We examined long-term outcomes of patients with ischemic or hemorrhagic stroke predicted by experienced clinicians to have no chance of meaningful recovery in Japan, where WLST in patients with isolated neurological disease is uncommon. We retrospectively reviewed the medical records of all patients admitted with acute ischemic stroke, intracerebral hemorrhage, or nontraumatic subarachnoid hemorrhage between January 2018 and December 2020 to a neurocritical care unit at Toda Medical Group Asaka Medical Center in Saitama, Japan. We screened for patients who were predicted by the attending physician on postinjury day 1-4 to have no chance of meaningful recovery. Primary outcome measures were disposition at hospital discharge and the ability to follow commands and functional outcomes measured by the Glasgow Outcome Scale-Extended (GOS-E), which was assessed 6months after injury. From 860 screened patients, we identified 40 patients (14 with acute ischemic stroke, 19 with intracerebral hemorrhage, and 7 with subarachnoid hemorrhage) who were predicted to have no chance of meaningful recovery. Median age was 77years (interquartile range 64-85), 53% (n = 21) were women, and 80% (n = 32) had no functional deficits prior to hospitalization. Six months after injury, 17 patients were dead, 14 lived in a long-term care hospital, 3 lived at home, 2 lived in a rehabilitation center, and 2 lived in a nursing home. Three patients reliably followed commands, two were in a vegetative state (GOS-E 2), four fully depended on others and required constant assistance (GOS-E 3), one could be left alone independently for 8h per day but remained dependent (GOS-E 4), and one was independent and able to return to work-like activities (GOS-E 5). In the absence of WLST, almost half of the patients predicted shortly after the injury to have no chance of meaningful recovery were dead 6months after the injury. A small minority of patients had good functional recovery, highlighting the need for more accurate neurological prognostication.

Central Neurocytoma: Determining Rate of Shunting and Results after Subtotal and Total Excision

Objective: To assess the shunting rate and the results of control measures in patients having central neurocytoma who underwent total and subtotal resection. Study design: A cross-sectional study Place and Duration This study was conducted in People's University of Medical and Health Sciences for Women Nawabshah from Septmeber 2016 to Septmber 2020 . Methodology: In this study, overall 15 patients were included. Every patient had a follow-up of 2 years. The age of participants was between 13 to 49 years. The data of every patient was recorded which included the demographics (age, gender), early mortality and morbidity, presentation of clinical factors, and radiological findings. The radiological findings include features, tumor location, hydrocephalus, recurrence, and residual. A transcortical approach was used for the treatment of individuals for both, total or subtotal excision. EVD (External Ventricular Drain) was installed which was later replaced by a shunt. For confirmation of diagnosis and guidance of the follow-up, the MIV index and histopathology were used. For residual tumor and recurrence, radiosurgery of Gamma knife or adjuvant radiotherapy was used. Results: There were 3 patients who died due to sepsis and thalamic infarction after the total and subtotal excision. There were 9 patients who had a total excision and 6 patients who had a subtotal excision. Among the 9 patients with a total excision, 3 of them showed small recurrence at 1 year and 18 months follow-up along with a high MIB index. A total of 2 of them needed a shunt. In the remaining participants,the shunt was not placed. Among the 6 patients who had a subtotal excision, 2 of these patients had an early shunt insertion. Five patients were controlled by radiotherapy while one was controlled by radiosurgery. One patient, who was controlled by radiotherapy, failed radiotherapy in his second treatment at 18 months of follow-up. Practical implication : total excision has better results for central neurocytoma and should be considered procedure of choice Conclusion: Central neurocytoma may have a better chance of recovery than other intraventricular tumors if treated with total excision, with a lower incidence of shunt insertion throughout its course. Keywords: neurocytoma, shunt insertion, excision, radiotherapy, total excision

The association between multimorbidity and mobility disability-free life expectancy in adults aged 85 years and over: A modelling study in the Newcastle 85+ cohort.

Mobility disability is predictive of further functional decline and can itself compromise older people's capacity (and preference) to live independently. The world's population is also ageing, and multimorbidity is the norm in those aged ≥85. What is unclear in this age group, is the influence of multimorbidity on (a) transitions in mobility disability and (b) mobility disability-free life expectancy (mobDFLE). Using multistate modelling in an inception cohort of 714 85-year-olds followed over a 10-year period (aged 85 in 2006 to 95 in 2016), we investigated the association between increasing numbers of long-term conditions and (1) mobility disability incidence, (2) recovery from mobility disability and (3) death, and then explored how this shaped the remaining life expectancy free from mobility disability at age 85. Models were adjusted for age, sex, disease group count, BMI and education. We defined mobility disability based on participants' self-reported ability to get around the house, go up and down stairs/steps, and walk at least 400 yards; participants were defined as having mobility disability if, for one or more these activities, they had any difficulty with them or could not perform them. Data were drawn from the Newcastle 85+ Study: a longitudinal population-based cohort study that recruited community-dwelling and institutionalised individuals from Newcastle upon Tyne and North Tyneside general practices. We observed that each additional disease was associated with a 16% increased risk of incident mobility disability (hazard ratio (HR) 1.16, 95% confidence interval (CI): 1.07 to 1.25, p < 0.001), a 26% decrease in the chance of recovery from this state (HR 0.74, 95% CI: 0.63 to 0.86, p < 0.001), and a 12% increased risk of death with mobility disability (HR: 1.12, 95% CI: 1.07- to .17, p < 0.001). This translated to reductions in mobDFLE with increasing numbers of long-term conditions. However, residual and unmeasured confounding cannot be excluded from these analyses, and there may have been unobserved transitions to/from mobility disability between interviews and prior to death. We suggest 2 implications from this work. (1) Our findings support calls for a greater focus on the prevention of multimorbidity as populations age. (2) As more time spent with mobility disability could potentially lead to greater care needs, maintaining independence with increasing age should also be a key focus for health/social care and reablement services.

Clinical features and outcomes of opsoclonus myoclonus ataxia syndrome.

Opsoclonus myoclonus ataxia syndrome (OMAS) is a rare neuroinflammatory disorder. We aimed to retrospectively evaluate clinical and laboratory data and outcomes of 23 children diagnosed with OMAS in two children's hospitals between 2010 and 2021. There were 14 boys and 9 girls aged 4-113 months, median 24 months. Ten (43.5%) children had paraneoplastic causes: neuroblastoma/ganglioneuroblastoma (n=9), acute lymphoblastic leukemia (n=1). Three children had a postinfectious cause (upper respiratory tract infection in 2, EBV infection in 1) and two had a history of vaccination (varicella in 1, hepatitis A and meningococcal in 1). No underlying factor was identified in 8 (34.8%) children. Speech disorders were more frequent in patients with neural tumors than in those without (p=0.017). Intravenous immunoglobulin and steroids were effective as initial treatment in most children. Rituximab resulted in at least mild improvement in all 6 children with persistent or recurrent symptoms. Nine (39%) children experienced at least one relapse. Neurological sequelae were detected in 13 (57%) children. There was no significant correlation between clinical characteristics and outcome, except for higher risk of relapse in case of incomplete recovery after first attack (p=0.001). Acute lymphoblastic leukemia, vaccines against hepatitis A and meningococci can be included among antecedent factors in OMAS. Among clinical symptoms, speech problems might point to the likelihood of an underlying neoplasm in OMAS. Intravenous immunoglobulin and steroids may be chosen for initial treatment while rituximab can increase the chance of recovery in case of persistent or recurrent symptoms. The presence of relapse was associated with poor outcome.

Reduced injury risk links sociality to survival in a group-living primate

Sociality has been linked to a longer lifespan in many mammals, including humans. Yet, how sociality results in survival benefits remains unclear. Using 10 years of data and over 1,000 recorded injuries in rhesus macaques (Macaca mulatta), we tested two injury-related mechanisms by which social status and affiliative partners might influence survival. Injuries increased individual risk of death by 3-fold in this dataset. We found that sociality can affect individuals' survival by reducing their risk of injury but had no effect on the probability of injured individuals dying. Both males and females of high social status (measured as female matrilineal rank and male group tenure) and females with more affiliative partners (estimated using the number of female relatives) experienced fewer injuries and thus were less likely to die. Collectively, our results offer rare insights into one mechanism that can mediate the well-known benefits of sociality on an individual's fitness.

Knowledge Description of S1 Nursing Study Program Students Semester II STIKes Santa Elisabeth Medan about BSE in the Santa Agnes Girls Dormitory 2022

To detect breast cancer early, the effort that women can do by means of Breast Self-Examination or BSE. BSE is an increase in a woman's interest in the state of her own breasts. Women's knowledge still minimal about accurate information on breast cancer and early detection efforts. Understanding of breast cancer and early detection efforts still need to be improved so that the chances of recovery and the number of life ambitions increase. So that the morbidity and mortality of breast cancer sufferers reduced and the quality of life of breast cancer patients is increased. To describe the knowledge of S1 Nursing Study Program Students Semester II STIKes Santa Elisabeth Medan about BSE the Santa Agnes Girls Dormitory in 2022. This type of research is descriptive with a total sampling technique with data collection techniques carried out using a questionnaire distributed via google form. The results of 80 respondents who had sufficient knowledge were 63 respondents (79%) and 17 respondents (21%). Students are expected to increase their knowledge about BSE by digging more information about BSE, through the internet or other mass media. Thus, students more confident in implementing and carrying out breast self-examination measures within themselves, so that breast cancer detected as early as possible and the number of breast cancer sufferers decrease.

Irremediability in psychiatric euthanasia: examining the objective standard.

Irremediability is a key requirement for euthanasia and assisted suicide for psychiatric disorders (psychiatric EAS). Countries like the Netherlands and Belgium ask clinicians to assess irremediability in light of the patient's diagnosis and prognosis and 'according to current medical understanding'. Clarifying the relevance of a default objective standard for irremediability when applied to psychiatric EAS is crucial for solid policymaking. Yet so far, a thorough examination of this standard is lacking. Using treatment-resistant depression (TRD) as a test case, through a scoping review in PubMed, we analyzed the state-of-the-art evidence for whether clinicians can accurately predict individual long-term outcome and single out irremediable cases, by examining the following questions: (1) What is the definition of TRD; (2) What are group-level long-term outcomes of TRD; and (3) Can clinicians make accurate individual outcome predictions in TRD? A uniform definition of TRD is lacking, with over 150 existing definitions, mostly focused on psychopharmacological research. Available yet limited studies about long-term outcomes indicate that a majority of patients with long-term TRD show significant improvement over time. Finally, evidence about individual predictions in TRD using precision medicine is growing, but methodological shortcomings and varying predictive accuracies pose important challenges for its implementation in clinical practice. Our findings support the claim that, as per available evidence, clinicians cannot accurately predict long-term chances of recovery in a particular patient with TRD. This means that the objective standard for irremediability cannot be met, with implications for policy and practice of psychiatric EAS.

Are zombies for real? Evidence from zombie dynamics

This paper analyses zombie firms in a dynamic setup where firm survival not only depends on its current returns, but the firm's exit decision is forward-looking. Building on a model of firm entry and exit and using firm-level data from Finland, we show that the expected future value and growth of a firm are key determinants in whether it is likely to recover from losses accumulated during a spell of weak performance. We find that including firm growth in zombie identification substantially reduces zombie incidence in the data as one third of low interest coverage ratio firms in a common zombie definition are growing companies. Moreover, over a half of exits from zombie status are recoveries to become healthy firms. A policy that may promote the survival of zombie firms is public subsidies. Our analysis does indeed support the notion that subsidized firms are less likely to die, but also their chances of recovery are higher.

The Outcomes of Robotic Rehabilitation Assisted Devices Following Spinal Cord Injury and the Prevention of Secondary Associated Complications

Spinal cord injuries (SCIs) have major consequences on the patient’s health and life. Voluntary muscle paralysis caused by spinal cord damage affects the patient’s independence. Following SCI, an irreversible motor and sensory deficit occurs (spasticity, muscle paralysis, atrophy, pain, gait disorders, pain). This pathology has implications on the whole organism: on the osteoarticular, muscular, cardiovascular, respiratory, gastrointestinal, genito-urinary, skin, metabolic disorders, and neuro-psychic systems. The rehabilitation process for a subject having SCIs can be considered complex, since the pathophysiological mechanism and biochemical modifications occurring at the level of spinal cord are not yet fully elucidated. This review aims at evaluating the impact of robotic-assisted rehabilitation in subjects who have suffered SCI, both in terms of regaining mobility as a major dysfunction in patients with SCI, but also in terms of improving overall fitness and cardiovascular function, respiratory function, as well as the gastrointestinal system, bone density and finally the psychosocial issues, based on multiple clinical trials, and pilot studies. The researched literature in the topic revealed that in order to increase the chances of neuro-motor recovery and to obtain satisfactory results, the combination of robotic therapy, a complex recovery treatment and specific medication is one of the best decisions. Furthermore, the use of these exoskeletons facilitates better/greater autonomy for patients, as well as optimal social integration.

Words of wisdom from older immigrant Latino/as with cancer

Among older Latino/as immigrants diagnosed with Cancer in Central Florida, little is known about the transmission of cancer knowledge to family and friends. This qualitative study explored the open-ended survey responses of 32 older Latino/as participants who reported a cancer diagnosis. We used thematic analysis to understand shared kinship knowledge through advice-giving to family members and friends. Identified advice topics included possessing faith, following up with a doctor, and seeking treatment while remaining positive. Participants’ advice mostly centered on relying on God when coping with a cancer diagnosis. Faith in God provided strength to manage challenges associated with the cancer diagnosis and led to an improved chance of recovery. Older Latino/as with cancer provide information about their cancer diagnosis in an empowering, advising manner to family members and friends. After accepting their cancer diagnosis, they endeavored to demystify the disease by providing words of advice and wisdom to their family and friends.

Does polypharmacy shape dependency transitions in the very old? Findings from the Newcastle 85+ Study.

helping older people to maintain their independence, and identifying risk factors that compromise this, is of high importance. Polypharmacy is common in the very old (aged ≥ 85) but whether it can shape transitions in dependency in this fastest growing subpopulation is unclear. using Newcastle 85+ Study data and multi-state modelling, we investigated the association between each additional medication prescribed and the progression of and recovery from dependency states, over 10 years (age 85-95). Participants were defined as either free from care (independent), requiring care less often than daily (low dependency), or requiring care at regular intervals each day or 24 hourly (medium/high dependency). each additional medication prescribed was associated with a 10% decreased chance of recovery from low dependence to independence (hazard ratio (HR): 0.90, 95% confidence interval (CI): 0.82-0.99). when a relatively able person visits the GP or clinical pharmacist, careful consideration should be given to whether the potential benefits from adding a new medication outweigh the risk to reduced recovery of independence.