The long-term effects of an implantable drop foot stimulator on gait in hemiparetic patients

Drop foot is a frequent abnormality in gait after central nervous system lesions. Different treatment strategies are available to functionally restore dorsal extension during swing phase in gait. Orthoses as well as surface and implantable devices for electrical stimulation of the peroneal nerve may be used in patients who do not regain good dorsal extension. While several studies investigated the effects of implanted systems on walking speed and gait endurance, only a few studies have focussed on the system’s impact on kinematics and long-term outcomes. Therefore, our aim was to further investigate the effects of the implanted system ActiGait on gait kinematics and spatiotemporal parameters for the first time with a 1-year follow-up period. 10 patients were implanted with an ActiGait stimulator, with 8 patients completing baseline and follow-up assessments. Assessments included a 10-m walking test, video-based gait analysis and a Visual Analogue Scale (VAS) for health status. At baseline, gait analysis was performed without any assistive device as well as with surface electrical stimulation. At follow-up patients walked with the ActiGait system switched off and on. The maximum dorsal extension of the ankle at initial contact increased significantly between baseline without stimulation and follow-up with ActiGait (p = 0.018). While the spatio-temporal parameters did not seem to change much with the use of ActiGait in convenient walking speed, patients did walk faster when using surface stimulation or ActiGait compared to no stimulation at the 10-m walking test at their fastest possible walking speed. Patients rated their health better at the 1-year follow-up. In summary, a global improvement in gait kinematics compared to no stimulation was observed and the long-term safety of the device could be confirmed

Factors affecting medical students in formulating their specialty preferences in Jordan

<p>Abstract</p> <p>Background</p> <p>In recent years there has been a growing appreciation of the issues of career preference in medicine as it may affect student learning and academic performance. However, no such studies have been undertaken in medical schools in Jordan. Therefore, we carried out this study to investigate the career preferences of medical students at Jordan University of Science and Technology and determine factors that might influence their career decisions.</p> <p>Methods</p> <p>A cross-sectional questionnaire-based survey was carried out among second, fourth and sixth year medical students at the Jordan University of Science and Technology, Irbid, Jordan during the academic year 2006/2007. A total of 440 students answered the questionnaire which covered demographic characteristics, specialty preferences, and the factors that influenced these career preferences. Possible influences were selected on the basis of a literature review and discussions with groups of medical students and physicians. Students were asked to consider 14 specialty options and select the most preferred career preference.</p> <p>Results</p> <p>The most preferred specialty expressed by male students was surgery, followed by internal medicine and orthopaedics, while the specialty most preferred by female students was obstetrics and gynaecology, followed by pediatrics and surgery. Students showed little interest in orthopedics, ophthalmology, and dermatology. While 3.1% of females expressed interest in anesthesiology, no male students did. Other specialties were less attractive to most students.</p> <p>Intellectual content of the specialty and the individual's competencies were the most influential on their preference of specialty. Other influential factors were the "reputation of the specialty", "anticipated income", and "focus on urgent care".</p> <p>Conclusion</p> <p>Surgery, internal medicine, pediatrics, and obstetrics and gynaecology were the most preferred specialty preferences of medical students at Jordan University of Science and Technology.</p

The Teacher, the Physician and the Person: How Faculty's Teaching Performance Influences Their Role Modelling

OBJECTIVE: Previous studies identified different typologies of role models (as teacher/supervisor, physician and person) and explored which of faculty's characteristics could distinguish good role models. The aim of this study was to explore how and to which extent clinical faculty's teaching performance influences residents' evaluations of faculty's different role modelling statuses, especially across different specialties. METHODS: In a prospective multicenter multispecialty study of faculty's teaching performance, we used web-based questionnaires to gather empirical data from residents. The main outcome measures were the different typologies of role modelling. The predictors were faculty's overall teaching performance and faculty's teaching performance on specific domains of teaching. The data were analyzed using multilevel regression equations. RESULTS: In total 219 (69% response rate) residents filled out 2111 questionnaires about 423 (96% response rate) faculty. Faculty's overall teaching performance influenced all role model typologies (OR: from 8.0 to 166.2). For the specific domains of teaching, overall, all three role model typologies were strongly associated with "professional attitude towards residents" (OR: 3.28 for teacher/supervisor, 2.72 for physician and 7.20 for the person role). Further, the teacher/supervisor role was strongly associated with "feedback" and "learning climate" (OR: 3.23 and 2.70). However, the associations of the specific domains of teaching with faculty's role modelling varied widely across specialties. CONCLUSION: This study suggests that faculty can substantially enhance their role modelling by improving their teaching performance. The amount of influence that the specific domains of teaching have on role modelling differs across specialties

Convergence process in farms income in Poland after 2006

Przedmiotem pracy była identyfikacja i ocena procesów konwergencji dochodów gospodarstw rolnych w Polsce po 2006 roku. W tym celu dokonano oszacowania wartości wskaźnika σ-konwergencji dochodów z działalności rolniczej w przeliczeniu na 1 gospodarstwo FADN z poszczególnych makroregionów Polski w latach 2006-2011 z wyszczególnieniem typów rolniczych. Przeprowadzone analizy nie pozwalają na ocenę procesów konwergencji w gospodarstwach wyspecjalizowanych w uprawach polowych, uprawach ogrodniczych, chowie zwierząt żywionych w systemie wypasowym oraz chowie zwierząt ziarnożernych. Z kolei w gospodarstwach wyspecjalizowanych w uprawach trwałych, chowie krów mlecznych oraz gospodarstwach o produkcji wielokierunkowej zidentyfikowano występowanie międzyregionalnej dywergencji dochodów z działalności rolniczej.The authors identify and assess the processes of convergence of farm income in Poland after 2006. For this purpose, the values of σ-convergence of agricultural income per 1 household FADN of individual macro-region in Poland in 2006-2011 were estimated detailing the types of production. The conducted analyses do not allow the assessment of the convergence process in the case of farms specialized in field crops, horticultural production, livestock fed on grazing system and granivorous livestock. On the other hand, in the case of farms specialized in permanent crops, dairy farms, multidirectional farms interregional divergence of agricultural income can be identified

Economic and legal condition and profitability of investments for agricultural biogas plants in Poland

W artykule przeanalizowano opłacalność biogazowni rolniczych, które mogą być uruchamiane w polskich gospodarstwach prowadzących produkcję zwierzęcą. Ze względu na wysokie nakłady inwestycyjne, kluczową – z perspektywy rolników – jest kwestia mechanizmu wsparcia finansowego. Analizę efektywności inwestycji przeprowadzono przy założeniu trzech wariantów mocy jednostki kogeneracyjnej zainstalowanej w biogazowni. Dodatkowo rozpatrzono dwa scenariusze wsparcia finansowego odnoszące się do starego „systemu zielonych certyfikatów” oraz nowego mechanizmu wynikającego z „Ustawy o odnawialnych źródłach energii”. Nowy mechanizm, który powinien obowiązywać od 2016 r., zakłada wsparcie odnawialnych źródeł energii poprzez ceny gwarantowane (najmniejsze instalacje) oraz system akcji i gwarancje odkupu energii (większe instalacje).In the paper profitability of biogas production in livestock farms in Poland has been analyzed with a focus on micro biogas plants. Due to the high value of investments a crucial issue from the farmers point of view us a mechanism of financial support. The efficiency of investments has been measured assuming three variants of power of CHP installations. In addition two scenarios of financial support have been taken into consideration: the “old” mechanism of green certificates and a forthcoming mechanism based on the new “Law on Renewable Energy Resources” which is currently subject to the legislative procedure. The new system introduces feed-in tarrifs for small plants and auctions and guarantees of purchase for larger biogas plants. The results of the analyses indicate a strong dependence of the financial effects of microbiogas plants on subsidies. It can be concluded that under the current state of market development and financial support offered to microscale biogas production investments in biogas plants are in general not profitable

Regional differences of vasodilatation and vasomotion response to local heating in human cutaneous microcirculation

Abstract. Background: The aim of this study was to evaluate the vasodilatation and vasomotion response to local heating in the cutaneous microcirculation of the ankle, dorsum of foot and forearm. Recently, it has been suggested that this response differs between the forearm and the leg. Probands and methods: Twenty-nine young healthy adults were recruited. They underwent measurement by laser Doppler flowmetry (LDF) in three sites of the body (ankle, dorsum of foot, forearm). Percentage change of the median flow of the skin before and after provocation and normalised perfusion flow to maximal dilation (cutaneous vascular conductance - CVC % Max) during short provocation test were monitored. Spectral analysis of laser Doppler flowmetry signals was performed using the fast Fourier transform algorithm. Results: Significant differences were found in CVC % Max between ankle/dorsum (45.18 ± 6.38% Max vs. 51.24 ± 6.87% Max, respectively; p &lt; 0.05) and between ankle/forearm (45.18 ± 6.38% Max vs. 54.49 ± 5.37% Max, respectively; p &lt; 0.05). Percentage change of flux after provocation has revealed significant differences between ankle/dorsum (394.1 ± 204.5% vs. 577.4 ± 273.5%, respectively; p &lt; 0.05) and ankle/forearm (394.1 ± 204.5% vs. 637.1 ± 324.7%, respectively; p &lt; 0.05). Total spectral activity of vasomotion has differed between ankle/dorsum and ankle/forearm: 69.59 [49.58 - 96.04] vs. 93.01 [73.15 - 121.8] (p &lt; 0.05) and 69.59 [49.58 - 96.04] vs. 107.5 [80.55 - 155.8] (p &lt; 0.05), respectively. Conclusions: Cutaneous microcirculation exhibits regional differences. Significant variability of function between ankle and dorsum of foot suggests that leg microcirculation is not uniform. </jats:p