Function Classification System Research Articles

Symmetric analysis in a wheelchair basketball player during an incremental intermittent test: a case study

BACKGROUND: Wheelchair basketball (WB) is a sport aimed at people with permanent disabilities in the lower limbs, with a functional classification system that allows the inclusion of various levels of injury from 1 to 4.5. Thus, it is natural that there is an increase in the search for greater sports performance which is related to physiological and kinematic analyses. AIM: The present study aimed to compare the symmetry of temporal kinematic variables in the different zones of effort intensity during an incremental intermittent field test. METHOD: The sample consisted of 1 male player aged (27 years), with spinal cord injury, with more than 5 years of gaming experience. The player performed the incremental field Yo-Yo Test - IR1 and the linear kinematics of the propulsive cycle was estimated. RESULTS: The results indicated that wheelchair propulsion is a symmetrical movement, although some asymmetries seem to be perceived qualitatively, but without a statistically significant difference. CONCLUSION: It was found that despite the injury to the right shoulder, there is symmetry in terms of wheelchair propulsion.

Objective Geographic Information System-Based Context Classification Approach Using Nationally Available Data

For decades the functional classification system (FCS) has guided roadway planning and design in the U.S.A. However, the FCS has a narrow focus, is auto centric, and because of its reliance on a binary classification scheme it lacks the resolution needed to develop context-sensitive designs. National Cooperative Highway Research Program (NCHRP) Report 855, An Expanded Functional Classification for Highways and Streets, introduced an expanded context classification system that supports more integrative and context-adapted roadway designs. This system was subsequently adopted in the seventh edition of the Policy of Geometric Design for Highways and Streets ( Green Book). Transitioning from the FCS to context classification entails a major shift in design practices. The context sets expectations for each setting and informs project development. Despite its advances, NCHRP Report 855 lacks guidance on quantitative measures for performing roadway classification. This paper resolves this issue by presenting an objective geographic information system (GIS)-based process transportation agencies can adopt to define contexts and weave context classification into the entire project development process. The proposed classification is based on measures that can be computed using readily available data, such as the TIGER/Line roadway data, U.S. Census urban-area data, U.S. Census population and employment data at the tract level, building polygon data, and GIS-derived intersection and street data. The application process outlined here provides the basic steps for implementing context classification at the state, regional, or project level.

Context Classification: A New Approach for Improving Highway Design

The Functional Classification System (FCS) in the US has been the driving force in developing and designing roadway projects. FCS was originally developed as a basis for communication between designers and planners but since then, it has expanded and is used throughout the entire project development process and more importantly serves as a surrogate for design inputs (e.g., design speed). However, the FCS has a narrow focus, and it is auto centric. The limited contextual definitions (urban and rural) do not provide the dynamic range of design elements and guidance needed to balance other competing project needs and it lacks the resolution needed to develop context-sensitive designs. NCHRP Report 855 introduced an expanded context classification system that supports more integrative and context-adapted roadway designs. This system was adopted in the 7th Edition of the Policy of Geometric Design for Highways and Streets (Green Book). Transitioning from functional classification to context classification entails a major shift in design practices. Context sets expectations for each setting and informs the entire project development process. This paper presents an update of the Green Book's context classifications and introduces the concept of Transportation Expectations, which are fundamental concepts that define how users expect to move in each context. Examples of applications are presented that explore these concepts and discuss how they could facilitate multimodal roadway designs — the focal point of upcoming Green Book 8th Edition.

Investigating tools for evaluating service and improvement opportunities on bicycle routes in Ohio, United States

Over the past two decades, transportation engineers and urban planners have become increasingly interested in using performance measures to capture roadway infrastructure effects on bicyclists' comfort levels. In this study, a tool is developed for evaluating Ohio's local roads and identifying opportunities for improvement. This begins by assessing the available data sources required to develop a customized model for Ohio, United States. Stakeholder interviews and data assessment outcomes indicate that most local jurisdictions do not have access to all relevant data for a complete bicycle level of traffic stress (LTS) analysis. Therefore, we extend the original bicycle LTS framework by formulating effective methods to deal with missing data. The designed methods are based on Ohio's functional classification system, and existing data on speed limits, traffic volumes, and bicycle facility widths. Our approach enables agencies to conduct bicycle LTS analysis when critical data elements are missing (such as posted speed limits, traffic volumes, and bicycle facility widths). For example, compared to the assignments with completed Mid-Ohio region data, the proposed approach reaches a 90% match in bicycle LTS score assignments in urban areas when road traffic volumes are missing. Local communities in Ohio and beyond can adopt the proposed approach to achieve interim and temporary results when collecting accurate data is not feasible due to time and cost considerations.

A Data-Driven Functional Classification of Urban Roadways Based on Geometric Design, Traffic Characteristics, and Land Use Features

The functional classification system (FCS) of roads means categorizing roads based on their service characteristics. The two primary considerations in classifying highway and street networks are accessibility and mobility, where by increasing the role of one, the other’s role is reduced. In this paper, besides the conventional variables such as geometric design characteristics, parking lots, land use features, and accessibility; the Sydney Coordinated Adaptive Traffic System (SCATS) data following the real-time traffic flow and average speed of vehicles collected by Location-Based Services (LBS) are considered as new variables for estimating the FCS. Linear regression is used to model the importance of the variables. The chi-square test compared the observational and predicted speeds in the five categories of roads in Tehran, the capital of Iran. Results show that on-street parking has the highest impact and the land use variable has the lowest impact on speed that changes the FCS. Moreover, the presented classification was one to two categories compared with the conventional FCS presented in manuals in the case of Tehran’s transportation network as a developing city.

Classification of Congestive Heart Failure from ECG Segments with a Multi-Scale Residual Network

Congestive heart failure (CHF) poses a serious threat to human health. Once the diagnosis of CHF is established, clinical experts need to assess the severity of CHF in a timely manner. It is proved that electrocardiogram (ECG) signals are useful for assessing the severity of CHF. However, since the ECG perturbations are subtle, it is difficult for doctors to detect the differences of ECGs. In order to help doctors to make an accurate diagnosis, we proposed a novel multi-scale residual network (ResNet) to automatically classify CHF into four classifications according to the New York Heart Association (NYHA) functional classification system. Furthermore, in order to make the reported results more realistic, we used an inter-patient paradigm to divide the dataset, and segmented the ECG signals into two different intervals. The experimental results show that the proposed multi-scale ResNet-34 has achieved an average positive predictive value, sensitivity and accuracy of 93.49%, 93.44% and 93.60% respectively for two seconds of ECG segments. We have also obtained an average positive predictive value, sensitivity and accuracy of 94.16%, 93.79% and 94.29% respectively for five seconds of ECG segments. The proposed method can be used as an auxiliary tool to help doctors to classify CHF.

Use of Free-Living Step Count Monitoring for Heart Failure Functional Classification: Validation Study.

BackgroundThe New York Heart Association (NYHA) functional classification system has poor inter-rater reproducibility. A previously published pilot study showed a statistically significant difference between the daily step counts of heart failure (with reduced ejection fraction) patients classified as NYHA functional class II and III as measured by wrist-worn activity monitors. However, the study’s small sample size severely limits scientific confidence in the generalizability of this finding to a larger heart failure (HF) population.ObjectiveThis study aimed to validate the pilot study on a larger sample of patients with HF with reduced ejection fraction (HFrEF) and attempt to characterize the step count distribution to gain insight into a more objective method of assessing NYHA functional class.MethodsWe repeated the analysis performed during the pilot study on an independently recorded dataset comprising a total of 50 patients with HFrEF (35 NYHA II and 15 NYHA III) patients. Participants were monitored for step count with a Fitbit Flex for a period of 2 weeks in a free-living environment.ResultsComparing group medians, patients exhibiting NYHA class III symptoms had significantly lower recorded 2-week mean daily total step count (3541 vs 5729 [steps], P=.04), lower 2-week maximum daily total step count (10,792 vs 5904 [steps], P=.03), lower 2-week recorded mean daily mean step count (4.0 vs 2.5 [steps/minute], P=.04,), and lower 2-week mean and 2-week maximum daily per minute step count maximums (88.1 vs 96.1 and 111.0 vs 123.0 [steps/minute]; P=.02 and .004, respectively).ConclusionsPatients with NYHA II and III symptoms differed significantly by various aggregate measures of free-living step count including the (1) mean and (2) maximum daily total step count as well as by the (3) mean of daily mean step count and by the (4) mean and (5) maximum of the daily per minute step count maximum. These findings affirm that the degree of exercise intolerance of NYHA II and III patients as a group is quantifiable in a replicable manner. This is a novel and promising finding that suggests the existence of a possible, completely objective measure of assessing HF functional class, something which would be a great boon in the continuing quest to improve patient outcomes for this burdensome and costly disease.

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Black Garlic Improves Heart Function in Patients With Coronary Heart Disease by Improving Circulating Antioxidant Levels.

Background: Black garlic (BG) has many health-promoting properties.Objectives: We aimed to explore the clinical effects of BG on chronic heart failure (CHF) in patients with coronary heart disease (CHD).Design: The main components of BG were measured by gas chromatography–mass spectrometry (GC–MS) and its antioxidant properties were determined by the clearance rate of free radicals. One hundred twenty CHF patients caused by CHD were randomly and evenly assigned into BG group and placebo group (CG). The duration of treatment was 6 months. Cardiac function was measured according to the New York Heart Association (NYHA) functional classification system. The following parameters were measured, including walking distance, BNP precursor N-terminal (Nt-proBNP), left-ventricular ejection fraction (LVEF) value, and the scores of quality of life (QOL). The circulating antioxidant levels were compared between two groups.Results: There are 27 main compounds in BG with strong antioxidant properties. BG treatment improved cardiac function when compared with controls (P < 0.05). The QOL scores and LVEF values were higher in the BG group than in the CG group while the concentration of Nt-proBNP was lower in the BG group than in the CG group (P < 0.05). Circulating antioxidant levels were higher in the BG group than in the CG group. Antioxidant levels had positive relation with QOL and LVEF values, and negative relation with Nt-proBNP values.Conclusion: BG improves the QOL, Nt-proBNP, and LVEF in CHF patient with CHD by increasing antioxidant levels.

The Role of Trunk Stabilization in Functional-Classification Levels in Wheelchair Basketball.

To compare classification levels and trunk stabilization of wheelchair basketball players and to identify their norm values of trunk balance. 113 wheelchair basketball players in the super and first Turkish leagues. A modified Wheelchair Skills Test (WST) (version 4.1) was used to evaluate trunk stabilization. Two skills were chosen that correspond to the stationary wheelie activity in WST, the 30-s stationary wheelie and stationary wheelie in 180°. There are no statistical differences between WST rates and point means. The skills and success and safety rates of the players with 1.5 points (51.9%, 44.4%) were lower than those of the players with 1.0 point (70%, 66.7%). In players with 2.5 and 2.0 points, the most successful and safest percentage values were 78.6%, 78.6% and 82.1%, 75%. Although it is expected that trunk stabilization would be better in players with high points, in our study we encountered conflicting results between the points and sitting balance or trunk stabilization. Our study supports the studies in the literature suggesting modifications in the functional-classification system.

Corpus callosum abnormalities: neuroradiological and clinical correlations.

To study neuroradiological features in pediatric patients with corpus callosum abnormalities, using new functional subtyping for the corpus callosum, and to correlate the features with the clinical presentation. We performed a retrospective review of 125 patients with radiologically identified abnormalities of the corpus callosum seen between 1999 and 2012. The study reviewed clinical features, genetic etiology, and chromosomal microarray (CMA) results. We used a new functional classification for callosal abnormalities based on embryological and anatomical correlations with four classes: complete agenesis, anterior agenesis (rostrum, genu, body), posterior agenesis (isthmus, splenium), and complete hypoplasia (thinning). We also studied the presence of extracallosal abnormalities. The new functional callosal subtyping did not reveal significant differences between the various subtypes in association with neurological outcome; however, the presence of cardiac disease was found more frequently in the group with complete agenesis. Thirty-seven per cent (46/125) had identifiable causes: of these, 48% (22/46) had a monogenic disorder, 30% (14/46) had a pathogenic chromosomal copy-number variant detected by CMA or karyotype, and 22% (10/46) had a recognizable clinical syndrome for which no confirmatory genetic test was available (namely Aicardi syndrome/septo-optic dysplasia and Goldenhar syndrome). The diagnostic yield for a significant CMA change was 19%. The presence of Probst bundles was found to be associated with a better neurodevelopmental outcome. The functional classification system alone 'without clinical data' cannot predict the functional outcome. The presence of extracallosal brain abnormalities and an underlying genetic diagnosis predicted a worse neurodevelopmental outcome. This study highlights the importance of CMA testing and cardiac evaluation as part of a routine screen.

Developing Guidelines of a Comprehensive Body Function Classification and Assessment System from the Inclusive Design Perspective

Developing Guidelines of a Comprehensive Body Function Classification and Assessment System from the Inclusive Design Perspective

Designing the Modern Multimodal Urban Arterial

AASHTO's functional classification system specifies that arterials should be designed to provide high mobility and low access; however, this narrow view does not fully represent the vitality of many urban streets, which need to maintain high access and high mobility across a variety of modes. Webster Avenue (US-1) in the Bronx, New York City, was an arterial that was focused on providing vehicular mobility but did not support the mobility and accessibility goals of public transit users and pedestrians. This paper describes results of the multimodal redesign of Webster Avenue by the New York City Department of Transportation (DOT) and the Metropolitan Transit Authority's New York City Transit (NYCT) as part of implementing bus rapid transit (BRT) in the corridor. The new arterial street design improves the organization of traffic: buses, which make frequent stops, now travel exclusively in the right travel lane, while general traffic is able to use the left travel lane. Key project results include a 19% to 23% improvement in bus speeds for the new BRT–select bus service route (compared with the former limited-stop route), 11% to 16% improvement in local bus speeds, maintenance of traffic speeds and volumes, and significant pedestrian safety improvements along the corridor. These results were achieved through extensive outreach and coordination with community stakeholders, careful use of different priority treatments on different parts of the corridor, and the strong working partnership between the New York City DOT and NYCT.

Functional classification and mutation analysis of a synpolydactyly kindred.

The aim of the present study was to analyze a congenital syndactyly/polydactyly kindred and propose a new functional classification method of clinical significance. The modes of inheritance and mutational mechanisms were also determined using genetic analyses. Hand and foot anatomy and functions were measured using photographic images, X-ray imaging and grip ability tests. Genetic analysis comprised the genotyping of polymorphic microsatellite markers at known polydactyly-associated loci and the sequencing of the candidate gene. A functional classification system was devised to divide the clinical features into three types, which included mild, moderate or severe deformity. The family was concluded to have syndactyly type II with autosomal dominant inheritance. The microsatellites, D2S2310 and D2S2314, at the 2q31–32 chromosome, which have previously been associated with synpolydactyly type I, were found to be associated with the disorder in the current family. A 27-bp insertion mutation was identified in the affected individuals in the HOXD13 gene at this locus. The insertion added a further nine alanine residues to the polyalanine stretch within the encoded protein. In conclusion, the functional classification method described in the present study may be used to guide surgical approaches to treatment. A family was identified in whom expansion of the polyalanine tract in the HOXD13 gene causes autosomal dominant hereditary synpolydactyly.

Pfeiffer Syndrome

Among the craniosynostosis syndromes, Pfeiffer syndrome is notable because of high mortality and the need for multiple surgical interventions. However, it is variable in severity. We propose a new classification of Pfeiffer Syndrome to define pathology and function. A retrospective review was conducted of 42 patients with Pfeiffer syndrome treated from 1975 to 2010, the largest series reported to date. The classification was based on a functional assessment of patients in terms of respiratory, ocular, otological, and neurological status. This classification was tested by scoring and stratifying patients as follows: type A (mild problems), B (moderate problems), or C (severe problems). Patients were scored both at the time of presentation and after all surgical interventions to assess change in functional outcome. The functional classification system was compared to another previously reported. Type A patients did not have any change in postoperative functional outcomes (mean preoperative score 1.6, mean postoperative score 1.6); type B patients showed functional improvement (mean preoperative score 4.1, mean postoperative score 3.4) but type C patients (mean preoperative score 7.7, mean postoperative score 4.8) demonstrated the greatest improvement in functional scores after surgical intervention. Suture pathology did not indicate the clinical severity of phenotype, a variance from a previously published classification. The proposed classification is useful to assess severity of phenotype: respiratory, ocular, otologic, and neurologic problems are key indicators of the need for treatment. The classification can provide a helpful guide in multidisciplinary treatment planning, in reporting outcomes, and in the sharing of data among craniofacial anomalies centers.

MicroRNA 210 as a Biomarker for Congestive Heart Failure

MicroRNAs (miRNAs) are endogenous small RNAs that are 18-23 nucleotides long. Recently, plasma miRNAs were reported to be sensitive and specific biomarkers of various pathological conditions. In the present study, we focused on miR-210, which is known to be induced by hypoxia and might therefore be an excellent biomarker for congestive heart failure. Plasma miR-210 levels and expression levels in mononuclear cells and skeletal muscles were elevated in Dahl salt-sensitive rats with heart failure. We also assessed miR-210 expression in patients with heart failure. The miR-210 expression levels in the mononuclear cells of patients with NYHA III and IV heart failure according to the New York Heart Association (NYHA) functional classification system were significantly higher than those with NYHA II heart failure and controls. Although no significant correlation was observed between plasma brain natriuretic peptide (BNP) and plasma miR-210 levels in patients with NYHA II heart failure, patients with an improved BNP profile at the subsequent hospital visit were classified in a subgroup of patients with low plasma miR-210 levels. Plasma miR-210 levels may reflect a mismatch between the pump function of the heart and oxygen demand in the peripheral tissues, and be a new biomarker for chronic heart failure in addition to plasma BNP concentrations.

Series y subseries en un sistema de clasificación funcional

La generalización de los sistemas de clasificación funcional que se han impuesto en la archivística actual nos demanda el replanteamiento de algunos de los tradicionales conceptos de nuestra disciplina y, en ocasiones, la incorporación de otros relativamente nuevos. La experiencia de los archiveros de la Administración Autonómica de Canarias en la construcción de un cuadro de clasificación funcional para todo el fondo de la Institución nos permite reflexionar sobre la operatividad de los conceptos de “serie genérica” y “subserie”, definidos a partir de una interpretación relativamente flexible del principio de procedencia.

A Head and Neck Lymph Node Classification Using an Anatomical Grid System While Maintaining Clinical Relevance

The current classification of head and neck lymph nodes lacks a standardized system that integrates basic anatomy and clinical relevance. Currently, anatomy texts, atlases, and journals used to educate future health care professionals use a classification system that differs from the commonly used clinical nomenclature. As a result, student trainees entering the professional world are confused by lymph node terminology. The purpose of this study was to suggest a lymph node classification system that accurately reflected anatomy and clinical applications. A literature search was conducted on anatomic and clinical texts, atlases, journals, and Web sites. Two recurring classification themes were found from anatomic texts and atlases: superficial and deep chains, and local anatomic structures. Since 1988 the clinical specialties have used a Roman numeral "level" system. The differences between anatomic and clinical classification systems have led to academic frustration. After analysis, a functional classification system was developed that integrated anatomic and clinical terminology from the current classification systems. This suggested system revised the clinically accepted level system approved in 1988 and replaced the terminology with an anatomically derived naming system. This system satisfies the need for a classification that unifies anatomic and clinical applications.

Reconstruction of proximal humerus tumors with massive osteoarticular allograft transplantation

To analyze the functional efficacies and complications for the reconstruction of defects in proximal humerus tumors with massive osteoarticular allograft transplantation and evaluate the feasibility of this method. A retrospective review was performed for proximal humerus tumors surgically treated and followed up from November 2001 to November 2008. There were 6 males and 1 female with an average age of 38.4 years old (range: 21 - 65). The tumor characteristics were as follows: giant cell tumor (n = 5), osteosarcoma (n = 1) and malignant fibrous tissue tumor (n = 1). According to the Enneking classification system, there were IA (n = 5), IIA (n = 1) and IIB (n = 1). All patients were reconstructed with massive osteoarticular allograft transplantation and immobilized with interlocking nail. The average length of massive allograft was 15.2 cm (range: 11 - 19). All patients were followed up for an average of 5.5 years (range: 2 - 8). In a long-term follow-up, atrophy and adsorption of allograft were found in all cases without clinical symptoms. This phenomenon started to appear after 1.5 years. And bone graft disappeared completely in around 6 years postoperatively. The atrophy of bone graft usually originated from greater tubercles and extended gradually to metaphysic. According to the Musculoskeletal Tumor Society (MSTS) functional classification system, the average score of osteoarticular allografts was 17.6 (range: 15 - 19). According to the MSTS radiological evaluation system, the long-term perfect/fair rate was 0. Massive osteoarticular allograft transplantation is one of feasible options for the reconstruction of structural bone defects due to bone tumor resection.

Long Term Cardiac Follow up after Autologous Stem Cell Transplant (ASCT) in Patients (pts) with Cardiac Diseases

Introduction: ASCT offers a chance of prolonged remission and even cure in different oncohematological diseases. Pre transplant impairment of cardiac function is usually referred as a cause of increased morbility and mortality in these patients. In Blood 2006, Vol 108, abst. # 2982 our group reported the findings in patients with previous cardiopathy undergoing ASCT, detecting no differences in the short-term outcome of this population compared with non cardiac affected pts.Objective: Analyze the long term outcome in ASCT pts. who underwent the procedure with a previous cardiac disease.Patient and Methods: Between 1991–2008, 364 pts. received an ASCT at our BMT unit. During the pretransplant evaluation 14/364 pts. (3.8%) were diagnosed with an impairment of the cardiac condition: Dilated left ventricle > 55 mm. and/or abnormal systolic function with ejection fraction < 55%:11/14pts; ischemic cardiopathy including wall motion abnormalities 3/14pts, and moderate to severe valvulopathy 1/14 pts. 3/14 pts died early because of relapse and were not included in this study. Pts population at follow up: mean age 50,1 years (r 28–68), female 45%. Diagnoses: Non Hodgkin lymphoma 6/11, multiple myeloma 2/11, amyloidosis 1/11, acute myeloblastic leukemia 1/11, and Hodgkin disease 1/11. Conditioning chemotherapy regimens included BEAM (5/11), Melphalan (3/11), BuCy (1/11) and CVB (2/11). In the pre ASCT evaluation 7/11 pts showed cardiopathy probably related to previous ASCT chemotherapy toxicity, 2/11 ischemic disease, 1/11 cardiac amyloidosis and 1/11 valvulopathy with the following echocardiographic findings: 5/11 showed dilated left ventricle; 9/11 impaired left ventricle systolic function and segmentary wall motion abnormalities in 2/11. Patient evaluation procedure included: clinical evaluation according to the New York Heart Association (NYHA) functional classification system (FCS), electrocardiography and bidimensional echocardiography. Post ASCT pts were referred to the cardiologist and enalapril treatment was recommended.Results: The post ASCT median time of follow-up was 30 months (r 7–41 months). At the moment of the study evaluation 5/11 patients have relapsed of their haematological disease. 6/11 changed the FCS compared to the pre ASCT evaluation; 3/11 showed improvement and 3/11 worsened the FCS. 5/11 did not show any difference. Echocardiography analysis reported 4 patients with a better condition (reduction of left ventricle enlargement in 1 and increased contractility in 3 cases including one pt with cardiac amyloidosis) and 3 pts worsened their echocardiographic findings showing a severe dysfunction of the ejection fraction in 2 pts. and a more dilated left ventricle in one case. Only one patient presented a major cardiac event in the form of an acute myocardial infarction. He also required a permanent pacemaker. 4/11 pts were not under enalapril treatment as it was recommended. No pt died due to cardiac events.Conclusions: We did not observed cardiac associated mortality in the group of pts with mild or moderate cardiac dysfunction in a follow up of 30 months post-ASCT. Pre ASCT cardiac dysfunction as described above does not preclude the procedure. ASCT seems not to worsen the natural course of the cardiac disease. Further clinical studies are needed to support our findings.