Functional Level Research Articles

POST-OPERATIVE REHABILITATION OF A RIGHT SIDED TOTAL KNEE ARTHROPLASTY PATIENT- A CASE REPORT

Background and purpose:Osteoarthritis(OA) is a progressive degenerative condition resulting from the cartilage wear and tear that leads to knee joint deformities and functional limitations. Total knee arthroplasty (TKA) has become the gold standard treatment for surgically managing knee osteoarthritis, but physical rehabilitation after surgery is critical for returning function to pre-surgery levels. The purpose of this case report is to describe the effectiveness of physical therapy intervention and report outcomes following a right TKA. Case Description:The present case report describes the 12-week outpatient physical therapy rehabilitation of an 86-year-old woman who underwent right-sided TKA. She suffered from knee pain and limited ambulating speed since three years. During outpatient rehabilitation patient received treatment for improving functional mobility, ROM, strength, and gait training. Outcomes:During course of 12 weeks of physical therapy rehabilitation improvement was seen in pain from 2/10 to 0/10 on NPRS, flexion ROM from 110degrees to 130 and strength from 3-/5 to 4/5 on MMT. Additional outcome measures that showed improvement includes Time Up and Go Test (TUG) for mobility from 16.5 to 14.97 seconds and gait speed 0.6 m/s to 0.78 m/s. She was able to accomplish both short-term and long-term goals. Discussion:This study supports that early mobilization and therapeutic exercises in post knee arthroplasty can improve functional outcomes and help patient to return to the prior level of function. Although, it is recommended that further research is needed to be done on a larger population to establish its effectiveness.

Cognitive Function and Variability in Antipsychotic Drug–Naive Patients With First-Episode Psychosis

Cognitive impairment contributes significantly to clinical outcome and level of function in individuals with psychotic disorders. These impairments are present already at psychosis onset at a group level; however, the question of heterogeneity in cognitive function among patients has not been systematically investigated. To provide an updated quantification of cognitive impairment at psychosis onset before patients receive potentially confounding antipsychotic treatment, and to investigate variability in cognitive function compared with healthy controls. In this systematic review and meta-analysis, PubMed articles were searched up to September 15, 2022. Original studies reporting data on cognitive function in antipsychotic drug-naive patients with first-episode psychosis (FEP) were included. Data were independently extracted by 2 researchers. Cognitive tasks were clustered according to 6 domains of the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery and the domain of executive function. Random-effects model meta-analyses of mean differences and coefficient of variation ratios (CVRs) were performed, as well as meta-regressions, assessment of study quality, and publication bias. The main outcome measure was Hedges g for mean differences in cognition and CVR for within-group variability. Fifty studies were included in the analysis with a total of 2625 individuals with FEP (mean [SD] age, 25.2 [3.6] years, 60% male; 40% female) and 2917 healthy controls (mean [SD] age, 26.0 [4.6]; 55% male; 45% female). In all cognitive domains, the FEP group displayed significant impairment compared with controls (speed of processing: Hedges g = -1.16; 95% CI, -1.35 to -0.98; verbal learning: Hedges g = -1.08; 95% CI, -1.28 to -0.88; visual learning: Hedges g = -1.05; 95% CI, -1.27 to -0.82; working memory: Hedges g = -1.04; 95% CI, -1.35 to -0.73; attention: Hedges g = -1.03; 95% CI, -1.24 to -0.82; reasoning/problem solving: Hedges g = -0.90; 95% CI, -1.12 to -0.68; executive function: Hedges g = -0.88; 95% CI, -1.07 to -0.69). Individuals with FEP also exhibited a larger variability across all domains (CVR range, 1.34-1.92). Results of this systematic review and meta-analysis identified cognitive impairment in FEP before the initiation of antipsychotic treatment, with large effect sizes. The high variability within the FEP group suggests the need to identify those individuals with more severe cognitive problems who risk worse outcomes and could benefit the most from cognitive remediation.

Facile Fabrication of Hollow Nanoporous Carbon Architectures by Controlling MOF Crystalline Inhomogeneity for Ultra‐Stable Na‐Ion Storage

AbstractHollow nanoporous carbon architectures (HNCs) present significant utilitarian value for a wide variety of applications. Facile and efficient preparation of HNCs has long been pursued but still remains challenging. Herein, we for the first time demonstrate that single‐component metal–organic frameworks (MOFs) crystals, rather than the widely reported hybrid ones which necessitate tedious operations for preparation, could enable the facile and versatile syntheses of functional HNCs. By controlling the growth kinetics, the MOFs crystals (STU‐1) are readily engineered into different shapes with designated styles of crystalline inhomogeneity. A subsequent one‐step pyrolysis of these MOFs with intraparticle difference can induce a simultaneous self‐hollowing and carbonization process, thereby producing various functional HNCs including yolk‐shell polyhedrons, hollow microspheres, mesoporous architectures, and superstructures. Superior to the existing methods, this synthetic strategy relies only on the complex nature of single‐component MOFs crystals without involving tedious operations like coating, etching, or ligand exchange, making it convenient, efficient, and easy to scale up. An ultra‐stable Na‐ion battery anode is demonstrated by the HNCs with extraordinary cyclability (93 % capacity retention over 8000 cycles), highlighting a high level of functionality of the HNCs.

A Comparison of Outcomes in Acute Perilunate Injuries: Systematic Review and Meta-Analysis of Treatment Approaches.

Perilunate dislocations (PLD) and fracture-dislocations (PLFD) comprise a spectrum of high-energy wrist injuries. The purpose of this review was to review operative strategies for perilunate injuries based on approach and compare outcomes. A systematic review of literature on PLD and fracture-dislocations was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed and EMBASE databases were queried for literature. Inclusion criteria included English studies reporting clinical or functional outcomes of acute PLD and PLFD. Twenty-nine full-text articles (604 PLD and PLFD injuries) were included. The most common method of PLD and PLFD fixation is through an open approach with combined volar and dorsal exposure. There were no differences between approaches with regard to total arc range of motion, grip strength, Mayo Wrist Score, or mean scapholunate angle. Similarly, there was no difference between approaches and postoperative radiographic arthritis or complications. Most patients were able to return to their prior level of function and work. The incidence of postoperative complications ranged from 0% to 22.5%. Current evidence shows no difference in postoperative total wrist arc range of motion, grip strength (as compared to contralateral), or Mayo Wrist Score with regard to surgical approach. The most common method of PLD and PLFD fixation in the literature is through an open approach with combined volar and dorsal exposure. There is a large difference in reported rates of radiographic arthritis, although this finding does not appear to correlate with postoperative pain or disability. I, Systematic Review.

Facile Fabrication of Hollow Nanoporous Carbon Architectures by Controlling MOF Crystalline Inhomogeneity for Ultra-Stable Na-Ion Storage.

Hollow nanoporous carbon architectures (HNCs) present significant utilitarian value for a wide variety of applications. Facile and efficient preparation of HNCs has long been pursued but still remains challenging. Herein, we for the first time demonstrate that single-component metal-organic frameworks (MOFs) crystals, rather than the widely reported hybrid ones which necessitate tedious operations for preparation, could enable the facile and versatile syntheses of functional HNCs. By controlling the growth kinetics, the MOFs crystals (STU-1) are readily engineered into different shapes with designated styles of crystalline inhomogeneity. A subsequent one-step pyrolysis of these MOFs with intraparticle difference can induce a simultaneous self-hollowing and carbonization process, thereby producing various functional HNCs including yolk-shell polyhedrons, hollow microspheres, mesoporous architectures, and superstructures. Superior to the existing methods, this synthetic strategy relies only on the complex nature of single-component MOFs crystals without involving tedious operations like coating, etching, or ligand exchange, making it convenient, efficient, and easy to scale up. An ultra-stable Na-ion battery anode is demonstrated by the HNCs with extraordinary cyclability (93 % capacity retention over 8000 cycles), highlighting a high level of functionality of the HNCs.

Transcranial direct current stimulation for chronic headaches, a randomized, controlled trial.

Chronic headaches are a frequent cause of pain and disability. The purpose of this randomized trial was to examine whether transcranial direct current stimulation (tDCS) applied to the primary motor cortex, reduces pain and increases daily function in individuals suffering from primary chronic headache. A prospective, randomized, controlled trial, where participants and assessors were blinded, investigated the effect of active tDCS vs. sham tDCS in chronic headache sufferers. Forty subjects between 18 and 70 years of age, with a diagnosis of primary chronic headache were randomized to either active tDCS or sham tDCS treatment groups. All patients received eight treatments over four consecutive weeks. Anodal stimulation (2 mA) directed at the primary motor cortex (M1), was applied for 30 min in the active tDCS group. Participants in the sham tDCS group received 30 s of M1 stimulation at the start and end of the 30-minute procedure; for the remaining 29 min, they did not receive any stimulation. Outcome measures based on data collected at baseline, after eight treatments and three months later included changes in daily function, pain levels, and medication. Significant improvements in both daily function and pain levels were observed in participants treated with active tDCS, compared to sham tDCS. Effects lasted up to 12 weeks post-treatment. Medication use remained unchanged in both groups throughout the trial with no serious adverse effects reported. These results suggest that tDCS has the potential to improve daily function and reduce pain in patients suffering from chronic headaches. Larger randomized, controlled trials are needed to confirm these findings. The study was approved by the local ethics committee (2018/2514) and by the Norwegian Centre for Research Data (54483).

Measuring the impact of information and communication technology investment on the profitability of Indian manufacturing MSME

PurposeThis study aims to investigate the impact of information and communication technology (ICT) investment on the micro, small and medium enterprises (MSME) profitability in the Indian context.Design/methodology/approachThis study used a framework based on the ICT investment and firm size, measuring the impact on profit before depreciation, interest, tax and amortisation of MSME by taking a random sampling of 300 Indian MSME manufacturing firm’s secondary data from the Prowess database. This framework was analysed using the design of experiment (DoE) technique.FindingsThe study showed that ICT investment has a significant positive relationship with profitability. This study examines the different ICT investment levels to predict investment strategies and fine-tune profit targets. The critical finding is that ICT investment maximises profit at one million rupees. This discovery aids MSME leaders’ sustainable business decision-making.Research limitations/implicationsThis study has an explicit limit to the Indian context, where the firm requirements of countries are different, and these findings need to be validated with many operating variables and applied to more firms with more data. Even so, as a theoretical implication, this study took a novel approach to ICT adoption (through ICT investment) in the Indian MSME sector with guiding levels of ICT investment for each type of firm (i.e. micro, small and medium). This study opens new avenues for investigating researchers and stakeholders by exploring other factors responsible for ICT adoption.Practical implicationsThis study uniquely provides practitioners with the functional level of ICT investment for MSMEs in the Indian context. These finding guides top management to make strategic ICT adoption decisions with information symmetry. At the same time, these findings suggest financial institutions astern their credit programme to provide credit for ICT investment in MSMEs.Social implicationsThis study highlights the value of ICT as a practical resource for business owners that significantly makes MSMEs more informed and profitable, thus creating more jobs and incrementing the country’s gross domestic product (GDP).Originality/valueThis study offers unique empirical findings on how decision makers in MSMEs maximise profits through optimal ICT investment levels depending upon the firm size in an emerging economy like India. There is evidence in the study to conclude that ICT is a need of MSME and has implications for firm performance.

Osteoporotic Vertebral Compression Fractures: Medical, Social Aspects, Clinical Picture, Treatment and Medical Rehabilitation. A Review

INTRODUCTION. Osteoporosis is one of the most common metabolic skeletal diseases in the world, which is characterized by a decrease in bone tissue strength and an increased risk of fractures with minimal trauma, including pathological vertebral compression fractures (VCFs). VCFs are accompanied by a decrease in the quality of life of patients with osteoporosis due to a pronounced pain syndrome, sleep problems, decreased motor and social activity, a high risk of falls and fractures, the development of pathological spinal deformities, decreased lung capacity and increased number of comorbid diseases. In this regard, timely treatment and medical rehabilitation in patients with osteoporosis and VCFs are of particular importance to restore functionality, reduce the risk of developing new fractures, disability and death.
 MAIN CONTENT OF THE REVIEW. The literature review is the analysis of 7 domestic and 49 foreign literary sources, which was used to describe the prevalence, medical and social significance and clinical picture of osteoporotic VCFs. It provides data on modern methods of drug and non-drug treatment of patients with VCFs. The effectiveness and limitations of the use of physical therapy methods in the rehabilitation of patients with pathological spinal fractures are described in detail.
 CONCLUSION. It is concluded that VCFs pose a significant healthcare burden due to their high prevalence and negative impact on the quality of life of older patients with osteoporosis. Osteoporotic VCFs lead to the development of severe back pain, limited mobility, spinal deformities, loss of height and permanent disability. An effective strategy for the treatment and rehabilitation of patients with osteoporotic VCFs should include the use analgesics, orthotics, correction of nutritional deficiency, elimination of vitamin D and calcium deficiency, modern methods of physical therapy, fall prevention and timely prescription of effective drugs for pathogenetic therapy of osteoporosis to reduce the risk of pathological fractures in the future and ensure a high level of functioning and of the quality of life.

Defining inappropriate thyroid biopsy?-Proposed definition based on clinical evidence and stakeholder engagement.

Identify factors that can be used to assess the appropriateness of a thyroid biopsy and propose a pathway to define inappropriate thyroid biopsies in practice. We identified factors utilized in clinical guidelines and existing literature to determine the clinical indications for a thyroid biopsy. Subsequently, we assembled a multidisciplinary panel of experts, including patients, clinicians, researchers, and quality experts, to integrate these factors and develop a pathway for assessing the appropriateness of thyroid biopsies. Through literature review and stakeholder engagement, we identified multiple factors to determine if a thyroid biopsy is necessary: ultrasound risk assessment, presence of compressive symptoms and/or clinical suspicion of high-risk thyroid cancer, life expectancy, comorbidity burden, surgical risk, personal risk factors for thyroid cancer, thyroid function levels, local resources and medical expertise and patient values and preferences. We proposed a multiple-tier classification for the appropriateness of thyroid biopsy that begins with ultrasound findings (e.g., size, thyroid cancer risk) and encompasses the evaluation of additional patient-specific factors. Assessment of the appropriateness of a thyroid biopsy is possible. Although, thyroid nodule ultrasound risk assessment is a pivotal factor for this assessment, additional factors should be considered (e.g., life expectancy, personal risk factors for thyroid cancer, patient preferences). Yet, additional efforts are needed to operationalize the objective implementation of these factors in clinical practice.

The impact of hamstring lengthening on stance knee flexion at skeletal maturity in ambulatory cerebral palsy.

This study reports the long-term outcomes of hamstring lengthening to treat flexed knee gait in children with ambulatory cerebral palsy (CP) after skeletal maturity. This retrospective longitudinal observational study used instrumented gait analysis (GA) <8 and >15 years old in children with bilateral CP. The primary variable was knee flexion in stance phase. Eighty children (160 limbs) were included; 49% were male, 51% female. Mean age at first GA was 6.0 (SD: 1.2) years and 19.6 (SD: 4.5) years at final GA. Mean follow-up was 13.7 (SD: 4.7) years. Children were classified as Gross Motor Function Classification System I-8, II-46 and III-26. Average Gross Motor Function Measure Dimension D was 72% (SD: 20%). Hamstring lengthenings occurred once in 82, twice in 54 and three times in 10 limbs. From initial to final GA, average knee flexion in stance was unchanged, 27.8° (SD: 14.8°) to final 27.0° (SD: 11.2°; P = 0.54). Knee flexion at foot contact was 39.6° (SD: 13.0°), improving to final GA of 30.7° (SD: 10.6°; P < 0.001). Initial gait deviation index was 65.8 (SD: 31.9), improving to final 78.9 (SD: 28.2; P < 0.001). Older age, males and concomitant plantar flexor lengthening predicted change toward more flexed knee gait. Hamstring lengthening did not lead to back-kneeing gait at maturity while maintaining childhood stance phase knee flexion. A subgroup still developed significant flexed knee gait posture and may have benefited from more aggressive treatment options. This outcome may also be impacted by diverse functional levels, etiologies and treatments of flexed knee gait.

Effectiveness of using H. Kitaoka (AOFAS) scale, FFI (Italian version), Roles and Maudsley score, VAS in patients with flatfoot

Assessment of the functional capacity of the foot requires adequate tools depending on a specific nosology. Objective: to investigate the possibility of using evaluation scale of H. Kitaoka (American Orthopaedic Foot and Ankle Society (AOFAS)), Foot Function Index (FFI) (Italian version), Roles and Maudsley score, visual analog scale (VAS) in patients with flatfoot. Materials and methods. Clinical and X-ray examinations of 63 patients (78 feet) who had flatfoot were performed. Their average age was 42.5 ± 2.0 (9–72) years. X-ray and clinical indicators were used: horizontal and vertical talo-metatarsal angles (TMA), angle of valgus deviation of the calcaneus, body mass index. The assessment of the functional state of the foot was carried out according to the H. Kitaoka (AOFAS) scale, FFI (Italian version), Roles and Maudsley score, VAS. The strength of the relationship between indicators was studied ­using Pearson’s pairwise correlations; a correlation regression analysis was performed on models where the indicators of rating scales were the dependent variables. Results. There was an inverse correlation between the foot function score (AOFAS) and the age and TMA, a direct correlation between the FFI and the age and body mass index, a direct dependence of functional insufficiency (Roles and Maudsley score) and pain level (VAS) on age. A sufficient degree of correlation (0.5–0.75) was found between the applied scales. Conclusions. Sufficient criterial and construct validity of the AOFAS scale, FFI (Italian version), Roles and Maudsley score, VAS was found when used in patients with flatfoot. The use of selected scales is an adequate tool for assessing functional capacity in patients with flatfoot.

A Detection of Cosmological 21 cm Emission from CHIME in Cross-correlation with eBOSS Measurements of the Lyα Forest

We report the detection of 21 cm emission at an average redshift z¯=2.3 in the cross-correlation of data from the Canadian Hydrogen Intensity Mapping Experiment (CHIME) with measurements of the Lyα forest from eBOSS. Data collected by CHIME over 88 days in the 400–500 MHz frequency band (1.8 < z < 2.5) are formed into maps of the sky and high-pass delay filtered to suppress the foreground power, corresponding to removing cosmological scales with k ∥ ≲ 0.13 Mpc−1 at the average redshift. Line-of-sight spectra to the eBOSS background quasar locations are extracted from the CHIME maps and combined with the Lyα forest flux transmission spectra to estimate the 21 cm–Lyα cross-correlation function. Fitting a simulation-derived template function to this measurement results in a 9σ detection significance. The coherent accumulation of the signal through cross-correlation is sufficient to enable a detection despite excess variance from foreground residuals ∼6–10 times brighter than the expected thermal noise level in the correlation function. These results are the highest-redshift measurement of 21 cm emission to date, and they set the stage for future 21 cm intensity mapping analyses at z > 1.8.

Deep Potential Molecular Dynamics Study of Propane Oxidative Dehydrogenation.

Oxidative dehydrogenation (ODH) of light alkanes is a key process in the oxidative conversion of alkanes to alkenes, oxygenated hydrocarbons, and COx (x = 1,2). Understanding the underlying mechanisms extensively is crucial to keep the ODH under control for target products, e.g., alkenes rather than COx, with minimal energy consumption, e.g., during the alkene production or maximal energy release, e.g., during combustion. In this work, deep potential (DP), a neural network atomic potential developed in recent years, was employed to conduct large-scale accurate reactive dynamic simulations. The model was trained on a sufficient data set obtained at the density functional theory level. The intricate reaction network was elucidated and organized in the form of a hierarchical network to demonstrate the key features of the ODH mechanisms, including the activation of propane and oxygen, the influence of propyl reaction pathways on the propene selectivity, and the role of rapid H2O2 decomposition for sustainable and efficient ODH reactions. The results indicate the more complex reaction mechanism of propane ODH than that of ethane ODH and are expected to provide insights in the ODH catalyst optimization. In addition, this work represents the first application of deep potential in the ODH mechanistic study and demonstrates the ample advantages of DP in the study of mechanism and dynamics of complex systems.

Comprehensive insights into the differences of fungal communities at taxonomic and functional levels in stony coral Acropora intermedia under a natural bleaching event

Previous studies have reported the correlations between bacterial communities and coral bleaching, but the knowledge of fungal roles in coral bleaching is still limited. In this study, the taxonomic and functional diversities of fungi in unbleached, partly bleached and bleached stony coral Acropora intermedia were investigated through the ITS-rRNA gene next-generation sequencing. An unexpected diversity of successfully classified fungi (a total of 167 fungal genera) was revealed in this study, and the partly bleached coral samples gained the highest fungal diversity, followed by bleached and unbleached coral samples. Among these fungi, 122 genera (nearly 73.2%) were rarely found in corals in previous studies, such as Calostoma and Morchella, which gave us a more comprehensive understanding of coral-associated fungi. Positively correlated fungal genera (Calostoma, Corticium, Derxomyces, Fusicolla, Penicillium and Vishniacozyma) and negative correlated fungal genera (Blastobotrys, Exophiala and Dacryopinax) with the coral bleaching were both detected. It was found that a series of fungal genera, dominant by Apiotrichum, a source of opportunistic infections, was significantly enriched; while another fungal group majoring in Fusicolla, a probiotic fungus, was distinctly depressed in the bleached coral. It was also noteworthy that the abundance of pathogenic fungi, including Fusarium, Didymella and Trichosporon showed a rising trend; while the saprotrophic fungi, including Tricladium, Botryotrichum and Scleropezicula demostrated a declining trend as the bleaching deteriorating. The rising of pathogenic fungi and the declining of saprotrophic fungi revealed the basic rules of fungal community transitions in the coral bleaching, but the mechanism of coral-associated fungal interactions still lacks further investigation. Overall, this is an investigation focused on the differences of fungal communities at taxonomic and functional levels in stony coral A. intermedia under different bleaching statuses, which provides a better comprehension of the correlations between fungal communities and the coral bleaching.

Many distressed couples seek community‐based relationship education but don't benefit from it

AbstractObjectiveThe objective of this research was to characterize pretreatment relationship functioning among low‐income couples seeking community‐based relationship education (RE) and determine whether treatment outcomes differ based on this dimension.BackgroundRE programs were developed with the goal of preventing future deterioration among currently satisfied couples, but there is evidence to suggest that distressed couples are seeking community‐based RE to improve their relationship.MethodData were drawn from the Parents and Children Together study, a randomized controlled trial of RE with a sample of 1,595 low‐income couples. Relationship functioning was assessed pre‐randomization and at 12‐months post‐randomization. Latent class analysis was used to identify groups of couples with similar pretreatment functioning, and treatment effects were assessed within each group.ResultsFour classes of pretreatment relationship functioning emerged: Happy, Stable (44%), Moderately Distressed (39%), Highly Distressed Women (10%), and Highly Distressed Men (7%). Significant 12‐month treatment effects were found only for women in the Happy, Stable group.ConclusionA large number of distressed couples enroll in RE programs but do not benefit from the intervention.ImplicationsTo ensure that all couples receive an intervention that is effective for them, changes to the current delivery of community‐based RE programs is needed. Couples should be screened for their level of relationship functioning and assigned to an intervention that is appropriate for their needs. To accomplish this, RE curricula may need to be adapted to address the needs of distressed couples, or RE providers may need to partner with agencies delivering more intensive treatment (such as couple therapy).

Advancing Digital Twin-Based Collision Avoidance: A Comprehensive Analysis of Communication Networks for Safety-Critical Applications in Industry 4.0.

This study presents a theoretical framework for defining the performance level of wireless safety functions within industrial environments. While acknowledging the simplifications inherent in our approach-primarily based on packet loss rates as a measure of system performance-the study underscores the dynamic challenges posed by real-world warehouses. Through an in situ measurement study of a forklift truck safety system, we validate the proposed method and emphasize the need for a more nuanced examination of wireless communication in complex settings. The study advocates for an expanded theoretical framework that considers fluctuations in warehouse dynamics, accounting for their impact on packet loss rates and, consequently, the precision of performance-level assessments. Furthermore, the research highlights the complexity introduced by wireless system characteristics not addressed in the simplified model, urging future investigations to incorporate these factors for a comprehensive understanding of wireless safety systems. The absence of specific criteria for wireless systems within existing standards emphasizes the necessity for a specialized framework in addressing safety aspects unique to wireless applications.

Long-term burden of informal caregiver 7-years after severe childhood traumatic brain injury in the traumatisme grave de l’Enfant (TGE) study

ABSTRACT Objective To investigate reported burden by the Primary Family Caregiver (PFC) 7-years after severe pediatric traumatic brain injury in the TGE (Traumatisme Grave de l’Enfant) longitudinal study. Methods Subjective burden was estimated with the Zarit Burden Inventory (ZBI) in 36 PFC (parents), who rated their own health status (Medical Outcome Study Short Form-12), family functioning and their child’s level of care and needs (Pediatric/Adult Care And Needs Scale [PCANS/CANS]). Data collection included: child and PFC sociodemographic characteristics, injury-related factors, ‘objective’ (e.g. overall level of disability: Glasgow Outcome Scale – Extended, GOS-E/GOS-E-Peds) and ‘subjective’ outcomes (e.g. participation, behavior, executive functions, quality of life and fatigue). Results 25% of PFC reported mild-moderate burden, and 19% moderate-severe burden. Higher burden correlated with worse outcomes in all ‘subjective’ PFC-rated outcomes, and with self-reported participation. The ZBI correlated strongly with CANS/PCANS and GOS-E/GOS-E-Peds. Overall level of disability and PFC-reported executive functioning explained 62% of the ZBI variance. For equal levels of disability, burden was higher when PFC reported a ‘negative’ picture of their child. Conclusion Significant PFC-reported burden 7-years post-injury was associated with overall disability and ‘subjective’ PFC-rated outcomes. Factors influencing parental burden in the long term should be identified and psychological support implemented over time.

Ezetimibe treatment reduces oxidized low-density lipoprotein in biliary cirrhotic rats.

In liver cirrhosis, chronic inflammation is associated with an increase in oxidative stress, and subsequently an increase in the concentration of oxidized low-density lipoprotein (ox-LDL). Ezetimibe is a lipid-lowering agent with anti-inflammation and anti-oxidative stress activities. This study aimed to investigate the effect of ezetimibe treatment on ox-LDL in cirrhotic rats. Biliary cirrhosis was induced in Sprague-Dawley rats with common bile duct ligation (BDL). Sham-operated rats served as surgical controls. Ezetimibe (10 mg/kg/d) or vehicle was administered in the sham-operated or BDL rats for 4 weeks, after which hemodynamic parameters, biochemistry data, and oxidative stress were evaluated. Plasma and intrahepatic ox-LDL levels were also examined, and hepatic proteins were analyzed to explore the mechanism of ezetimibe treatment. The BDL rats had typical features of cirrhosis including jaundice, impaired liver function, hyperlipidemia, and elevated ox-LDL levels compared to the sham-operated rats. Ezetimibe treatment did not affect hemodynamics, liver biochemistry, or plasma lipid levels. However, it significantly reduced oxidative stress, plasma levels of ox-LDL, and tumor necrosis factor α. In addition, ezetimibe upregulated the hepatic protein expression of an ox-LDL scavenger (lectin-like ox-LDL rececptor-1), which resulted in reductions in intrahepatic ox-LDL and fat accumulation in the BDL rats. Nevertheless, ezetimibe treatment did not ameliorate hepatic inflammation or liver fibrosis. Ezetimibe reduced plasma and intrahepatic ox-LDL levels in the cirrhotic rats. Furthermore, it ameliorated intrahepatic fat accumulation and oxidative stress. However, ezetimibe did not alleviate hepatic fibrosis or inflammation in the biliary cirrhotic rats.

Impacts of education level on Montreal Cognitive Assessment and saccades in community residents from Western China

ObjectivesThis cross-sectional study sought to evaluate the effectiveness of the Montreal Cognitive Assessment (MoCA) and saccade in discerning the cognitive function levels among community populations characterized by diverse educational backgrounds. MethodsData from 665 Western China individuals encompassed MoCA scores and saccade performance. The study examined how education level and age influenced these assessments and highlighted the contrasting abilities of these measures in detecting cognitive abnormalities. ResultsThe saccade model revealed a consistent cognitive impairment prevalence (15.5%) compared to previous clinical data (9.7% to 23.3%), while MoCA exhibited variable rates (25.1% to 52.8%). Notably, saccades and MoCA significantly diverged in detecting cognitive dysfunction.Additionally, education level had a greater impact on MoCA (effect size: 0.272) compared to saccades (0.024) affecting all MoCA sub-items, with age exerting a smaller influence on MoCA (0.037) compared to saccades (0.056). ConclusionSaccades are less susceptible to the influence of education level when compared to MoCA, making saccade a potentially more suitable cognitive screening tool for rural community populations. SignificanceThis study represents a pioneering approach by employing saccade detection within community populations to distinguish cognitive function status.

A disparity in prosthetic access for Ecuadorians with lower-limb amputation.

Individuals with disabilities in low- and middle-income countries face barriers to rehabilitation services, including prosthetic care. Many countries, such as Ecuador, have adapted policies toward achieving universal health care coverage. For optimal functional outcomes, understanding the physical potential of prosthetic users is critical for appropriate prosthetic services. To determine the association between the functional level of Ecuadorians with lower-limb amputations and the functional level of their prosthetic componentry. Retrospective study. A data set containing functional level (K-Level) of Ecuadorians with lower-limb amputations and the K-Level of their prosthesis was analyzed. A diverse cohort of 164 participants with unilateral lower-limb amputation was recruited. Most participants were male (76.8%) with transfemoral amputations (56.1%) due to traumatic causes (51.2%). There was a small, positive, and statistically significant correlation between participants' functional levels and prosthetic componentry. Participants's functional levels were typically superior (median = 3) to their prostheses' functional abilities (median = 1), and 37.2% of participants did not have a prosthesis at the time of assessment. These data indicated that participants whose physical ability exceeded basic ambulation lacked access to prostheses to match their functional abilities. The detailed disparity between physical potential and prosthetic access derived from the study's analysis supports investment into high functioning prosthetic componentry and further investigation into where gaps in care exist.