Feasibility of Telerehabilitation-Monitored Functional Electrical Stimulation on Walking and Quality of Life in People With Multiple Sclerosis: A Case Series.

BACKGROUND: Foot drop in people with multiple sclerosis (MS) commonly leads to decreased mobility and quality of life (QOL). Functional electrical stimulation (FES) of the peroneal nerve can improve the gait of people with foot drop, yet various barriers restrict widespread use. The purpose of this case series was to examine the feasibility of a telerehabilitation-monitored FES device and report changes in functional mobility and QOL in people with moderate MS-related disability. METHODS: FES use was progressed over 8 weeks via 3 telerehabilitation sessions. Feasibility of telerehabilitation was assessed by percentage of telerehabilitation visits completed and participant-reported satisfaction. At baseline and study completion, functional mobility with and without FES were assessed by the Timed 25-Foot Walk (T25FW), Timed Up and Go (TUG), and 2-Minute Walk Test (2MWT), Multiple Sclerosis Impact Scale (MSIS-29), and the 12-item Multiple Sclerosis Walking Scale (MSWS-12). Fatigue was assessed via the Modified Fatigue Impact Scale (MFIS) before and after the intervention. RESULTS: Eleven participants (mean age = 50.4 years [SD 10.8]; 2 males) completed the study. All (33/33) telerehabilitation visits were completed and participants attained high levels of satisfaction with no adverse events. At 8 weeks, compared to baseline, there were clinically meaningful improvements on the T25FW, 2MWT, and TUG for 45%, 55%, and 82% of participants, respectively. Clinically meaningful improvements on the MSIS-29 and MSWS-12 were also recorded for 64% and 36% of participants, respectively. CONCLUSIONS: Telerehabilitation was safe and feasible for FES intervention, and improvements in functional mobility and QOL were observed. Telerehabilitation to monitor FES may improve access and reduce patient burden; therefore, studying its efficacy is warranted

Continuous Regular Functions

Following Chaudhuri, Sankaranarayanan, and Vardi, we say that a function $f:[0,1] \to [0,1]$ is $r$-regular if there is a B\"{u}chi automaton that accepts precisely the set of base $r \in \mathbb{N}$ representations of elements of the graph of $f$. We show that a continuous $r$-regular function $f$ is locally affine away from a nowhere dense, Lebesgue null, subset of $[0,1]$. As a corollary we establish that every differentiable $r$-regular function is affine. It follows that checking whether an $r$-regular function is differentiable is in $\operatorname{PSPACE}$. Our proofs rely crucially on connections between automata theory and metric geometry developed by Charlier, Leroy, and Rigo

Evaluation of a Direct Fed Microbial an an Enzymatically Hydrolyzed Yeast Product Fed Alone or in Combination to Beef Steers Administered Ractopamine Hydrochloride 28 Days Prior to Harvest During Summer Months in the Northern Plains

Study Description: Single-sourced, newly weaned steers (n=256; initial BW=542 ± 3.7lb; n=64 steers/treatment; 8 steers/pen) were blocked by location in a 2×2 factorial arrangement of DFM (Certillus CP B1801 Dry; Bacillus subtilis, Lactobacillus plantarum; 28 g/steer·d-1) and YCW (Celmanax; 18 g/steer·d-1). Temperature-humidity index (THI) was calculated as: THI=0.81×ambient temperature+[relative humidity×(ambient temperature-14.40)]+46.40. On d-1 and 2 and d-21 and 22 on RH, respiration rate (RR) and panting scores (PS) were determined before and after AM and PM feedings (0700h, 1100h, 1400h, 1700h). RR (n=3 steers/pen) was calculated from: 600/seconds required for 10 flank movements. PS utilized this scoring system: 0 (not distressed) to 4.5 (severely distressed)

Evaluation of a Direct Fed Microbial and/or an Enzymatically Hydrolyzed Yeast Product in Diets Containing Monensin Sodium on Feedlot Phase Growth Performance, Efficiency of Dietary Net Energy Utilization, and Carcass Characteristics in Newly Weaned Beef Steers Fed in Confinement for 258 Days

Study Description: Single-sourced, newly weaned steers (n = 256; initial body weight (BW) = 542 ± 3.7 lb) were allotted to 32 pens (n = 8 pens/treatment with 8 steers/pen). Steers were blocked by location in a 2x2 factorial treatment arrangement of DFM (Certillus CP B1801 Dry; Bacillus subtilis, Lactobacillus plantarum; 28 g/steer·d-1) and YCW (Celmanax; 18 g/steer·d-1). Steers were vaccinated and poured at processing and individually weighed on d 1, 14, 42 (end of receiving phase; implanted), 77, 105 (end of growing phase), 133, 161 (implanted), 182, 230 (start ractopamine HCl) and 258. Growth performance and carcass measurements were recorded

Ruminal bacterial communities differ in early-lactation dairy cows with differing risk of ruminal acidosis

IntroductionEarly-lactation Holstein cows (n= 261) from 32 herds in three regions (Australia, California, and Canada) were previously categorized using a discriminant analysis model as being at a high (26.1% of cows), medium (26.8% of cows), or low risk (47.1% of cows) of ruminal acidosis. We aimed to investigate if (1) risk of acidosis would be associated with ruminal bacterial taxa and dietary nutrient components, (2) there would be individual or combinations of bacterial taxa associated with acidosis-risk groups, and (3) the abundance of bacterial taxa would be associated with the intake of dietary nutrient components.MethodsDiets ranged from pasture supplemented with concentrates to total mixed rations. Bacteria 16S ribosomal DNA sequences from rumen samples collected < 3 hours after feeding via stomach tube were analyzed to determine bacterial presence. The relative abundance of each bacterial phylum and family was center log transformed and the transformed family data were subjected to two redundancy analysis biplots, one for acidosis risk group and one for region, to identify the 20 best-fit bacterial families from each respective redundancy analysis. A total of 29 unique families were identified when the lists of 20 families were combined from each redundancy analysis, and these 29 families were termed "influential" families." The association of acidosis-risk groups with the abundance of individual influential families was assessed by mixed models. Backward stepwise elimination mixed models were used to determine the bacterial taxa associated with each acidosis-risk group and the dietary nutrients associated with the abundance of the bacterial taxa.Results and discussionHigh-risk acidosis cows were associated with increased abundances of Anaerocella_f and Veillonellaceae and decreased abundances of several bacterial families with different characteristics. Five phyla: Firmicutes [odds ratio (OR) = 7.47 ± 7.43], Spirochaetes (OR = 1.28 ± 0.14), Lentisphaerae (OR = 0.70 ± 0.07), Planctomycetes (OR = 0.70 ± 0.09), and Tenericutes (OR = 0.44 ± 0.15), and nine families were associated with a higher risk of acidosis. Of the nine phyla identified to be of interest based on abundance and strength of association with acidosis-risk groups, all had one or more dietary nutrient that predicted their abundance. Sugar was the most frequently associated nutrient with the nine phyla, and was present in 78% (seven out of nine phyla) of the models; crude protein was present in 56% of models and crude fat was present in 44% of the models. Sugar and crude protein were most associated with the influential families and all but three families had one or more nutrient predictive of their abundance. Ruminal bacterial taxa are associated with ruminal acidosis; dietary sugar and crude protein are vital predictors of these and, thus, of ruminal acidosis risk

Advanced HIV disease in the Botswana combination prevention project: prevalence, risk factors, and outcomes.

OBJECTIVE(S): To determine the proportion of individuals linking to HIV-care with advanced HIV-disease (CD4 cell counts ≤200 cells/μl) in the Botswana Combination Prevention Project, describe the characteristics of these individuals, and examine treatment outcomes. DESIGN: A subanalysis of a cluster-randomized HIV-prevention trial. HIV status was assessed in 16-64-year-olds through home and mobile testing. All HIV-positive persons not on antiretroviral therapy were referred to local Ministry of Health and Wellness clinics for treatment. METHODS: Analysis was restricted to the 15 intervention clusters. The proportion of individuals with advanced HIV disease was determined; associations between advanced HIV disease and sex and age explored; and rates of viral suppression determined at 1-year. Mortality and retention in care were compared between CD4 strata (CD4 cell counts ≤200 vs. >200 cells/μl). RESULTS: Overall, 17.2% [430/2499; 95% confidence interval (CI) 15.7-18.8%] of study participants had advanced HIV disease (CD4 cell counts ≤200 cells/μl) at time of clinic linkage. Men were significantly more likely to present with CD4 cell counts 200 cells/μl or less than women [23.7 vs. 13.4%, adjusted odds ratio 1.9, 95% CI 1.5-2.3]. The risk of advanced HIV disease increased with increasing age (adjusted odds ratio 2.2, 95% CI 1.4-3.2 >35 vs. <25 years). Patients with CD4 cell counts 200 cells/μl or less had significantly higher rates of attrition from care during follow-up (hazards ratio 1.47, 95% CI 1.1-2.1). CONCLUSION: Advanced HIV disease due to late presentation to or disengagement from antiretroviral therapy care remains common in the Treat All era in Botswana, calling for innovative testing, linkage, and treatment strategies to engage and retain harder-to-reach populations in care

Against dispositionalism: belief in cognitive science

Dispositionalism about belief has had a recent resurgence. In this paper we critically evaluate a popular dispositionalist program pursued by Eric Schwitzgebel. Then we present an alternative: a psychofunctional, representational theory of belief. This theory of belief has two main pillars: that beliefs are relations to structured mental representations, and that the relations are determined by the generalizations under which beliefs are acquired, stored, and changed. We end by describing some of the generalizations regarding belief acquisition, storage, and change

Population uptake of HIV testing, treatment, viral suppression, and male circumcision following a community-based intervention in Botswana (Ya Tsie/BCPP): a cluster-randomised trial

BACKGROUND: In settings with high HIV prevalence and treatment coverage, such as Botswana, it is unknown whether uptake of HIV prevention and treatment interventions can be increased further. We sought to determine whether a community-based intervention to identify and rapidly treat people living with HIV, and support male circumcision could increase population levels of HIV diagnosis, treatment, viral suppression, and male circumcision in Botswana. METHODS: The Ya Tsie Botswana Combination Prevention Project study was a pair-matched cluster-randomised trial done in 30 communities across Botswana done from Oct 30, 2013, to June 30, 2018. 15 communities were randomly assigned to receive HIV prevention and treatment interventions, including enhanced HIV testing, earlier antiretroviral therapy (ART), and strengthened male circumcision services, and 15 received standard of care. The first primary endpoint of HIV incidence has already been reported. In this Article, we report findings for the second primary endpoint of population uptake of HIV prevention services, as measured by proportion of people known to be HIV-positive or tested HIV-negative in the preceding 12 months; proportion of people living with HIV diagnosed and on ART; proportion of people living with HIV on ART with viral suppression; and proportion of HIV-negative men circumcised. A longitudinal cohort of residents aged 16-64 years from a random, approximately 20% sample of households across the 15 communities was enrolled to assess baseline uptake of study outcomes; we also administered an end-of-study survey to all residents not previously enrolled in the longitudinal cohort to provide study end coverage estimates. Differences in intervention uptake over time by randomisation group were tested via paired Student's t test. The study has been completed and is registered with ClinicalTrials.gov (NCT01965470). FINDINGS: In the six communities participating in the end-of-study survey, 2625 residents (n=1304 from standard-of-care communities, n=1321 from intervention communities) were enrolled into the 20% longitudinal cohort at baseline from Oct 30, 2013, to Nov 24, 2015. In the same communities, 10 791 (86%) of 12 489 eligible enumerated residents not previously enrolled in the longitudinal cohort participated in the end-of-study survey from March 30, 2017, to Feb 25, 2018 (5896 in intervention and 4895 in standard-of-care communities). At study end, in intervention communities, 1228 people living with HIV (91% of 1353) were on ART; 1166 people living with HIV (88% of 1321 with available viral load) were virally suppressed, and 673 HIV-negative men (40% of 1673) were circumcised in intervention communities. After accounting for baseline differences, at study end the proportion of people living with HIV who were diagnosed was significantly higher in intervention communities (absolute increase of 9% to 93%) compared with standard-of-care communities (absolute increase of 2% to 88%; prevalence ratio [PR] 1·08 [95% CI 1·02-1·14], p=0·032). Population levels of ART, viral suppression, and male circumcision increased from baseline in both groups, with greater increases in intervention communities (ART PR 1·12 [95% CI 1·07-1·17], p=0·018; viral suppression 1·13 [1·09-1·17], p=0·017; male circumcision 1·26 [1·17-1·35], p=0·029). INTERPRETATION: It is possible to achieve very high population levels of HIV testing and treatment in a high-prevalence setting. Maintaining these coverage levels over the next decade could substantially reduce HIV transmission and potentially eliminate the epidemic in these areas. FUNDING: US President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention