Use of Neuromuscular Electrical Stimulation in the Treatment of Neonatal Brachial Plexus Palsy: A Literature Review

Background: The purpose of this study was to conduct a review of current literature on the effectiveness of neuromuscular electrical stimulation (NMES) for restoring motion and function in neonatal brachial plexus palsy (NBPP). Method: A database search was conducted for NMES articles published between 1947 and 2015. Pre and posttreatment data were extracted for muscle power, active range of motion (AROM), and morphometric measurements. Results: An initial search yielded 2,721 articles. A further title/abstract review produced 27 articles; of these, four met the inclusion criteria. Treatment protocols varied. There were no changes in average Medical Research Council (MRC) scores following treatment for elbow flexion, shoulder abduction, or wrist extension. Shoulder flexion increased from MRC 1 to 4. AROM improved following treatment. Conclusions: Evidence for improved muscle strength after NMES is mixed. Improvement in AROM is more consistent. Due to variations in treatment modalities, patient profiles, and adjunct treatment, a clinical trial to isolate the effects of NMES in NBPP is required. Since improved motion and function has been reported, NMES in NBPP therapy remains reasonable

Home Exercise DVD Promotes Exercise Accuracy by Caregivers of Children and Adolescents With Brachial Plexus Palsy

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147221/1/pmr2924.pd

Healthâ Related Quality of Life Components in Children With Neonatal Brachial Plexus Palsy: A Qualitative Study

BackgroundCurrently, no published, validated patientâ reported outcome (PRO) measures of healthâ related quality of life (HRQOL) exist for use with neonatal brachial plexus palsy (NBPP). NBPP is a debilitating condition that occurs during the perinatal period, resulting in paralysis/paresis and loss of sensation in the affected arm. Commonly used NBPP measures are not comprehensive and do not fully account for clinically meaningful changes in function or progression of the disorder.ObjectiveTo evaluate important components of HRQOL for children with NBPP and identify where new PRO measures are needed.DesignEleven focus groups comprising children with NBPP (4), family members (6), and professional providers (1) to assess HRQOL.SettingBrachial plexus clinic.ParticipantsChildren with NBPP, their parents, and professional providers.Inclusion CriteriaChildren 7â 17 years old with NBPP; parents/caregivers at least 18 years of age; professionals with â ¥2 years’ experience providing NBPP clinical care; ability to read and speak English fluently.MethodsFocus group sessions were recorded, transcribed verbatim, and deidentified. Qualitative frequency analysis identified different aspects of HRQOL relevant to NBPP. This analysis expands on the groundedâ theory approach to qualitative analysis, including development of a domain framework, open and axial coding, selective coding, and descriptive analysis. The resulting HRQOL domain framework (and frequency analysis) was then compared to the domain framework for existing PRO measures (PROMIS and Neuroâ QoL) to identify components of HRQOL where new PRO measures are needed for NBPP.Main Outcome MeasuresNot applicable.ResultsAlthough many physical, social, and emotional health domains were captured by existing PRO measures, some significant NBPPâ specific topics emerged from qualitative analysisâ functionality, sensory, physical appearance, arm/hand compensation and preference, explaining functionality/appearance to others, and selfâ esteem and body image concerns.ConclusionsDevelopment of sensitive and specific measures capturing arm/hand function and body image would improve the clinical care of patients with NBPP.Level of EvidenceNot applicable.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146831/1/pmr2383.pd

Prevalence of Posterior Shoulder Subluxation in Children With Neonatal Brachial Plexus Palsy After Early Full Passive Range of Motion Exercises

BackgroundChildren with neonatal brachial plexus palsy (NBPP) are often prescribed shoulder range of motion (ROM) exercises; however, the extent and timing of exercise implementation remains controversial in the context of shoulder joint integrity. The association of ROM exercises to delayed posterior shoulder subluxation (PSS) is unknown.ObjectiveTo determine prevalence of PSS in children with NBPP who began full passive ROM exercises before 6 months of age, and characteristics associated with development or absence of PSS in children.DesignCrossâ sectional study.SettingTertiary care NBPP referral center.ParticipantsFortyâ six children with NBPP, aged 24â 57 months, who began full ROM exercises before 6 months of age.MethodsOne radiologist conducted bilateral shoulder ultrasound (US) on each child to evaluate for PSS. One occupational therapist evaluated each child clinically for PSS using defined parameters without knowledge of US results.Main Outcome MeasuresBy US, 20% of children had PSS; 46% had PSS by clinical examination. Shoulder active ROM limitations and history of shoulder surgery were associated with presence of PSS. Extent of NBPP was not associated with PSS.ResultsNine of 46 children (20%) met US criteria for PSS; α angle was 58° ± 21° (mean ± standard deviation [SD]). Twentyâ one children (46%) met clinical criteria. Mean age at examination was 35 ± 10 months. Shoulder active ROM (P â ¤ .004) was associated with PSS, whereas passive ROM was not (P â ¥ .08). History of secondary shoulder surgery and primary nerve graft repair were associated with PSS (P = .04). Extent of NBPP by Narakas classification was not associated with PSS (P = .48).ConclusionsEarly use of fullâ arc passive ROM home exercise program is not associated with increased prevalence of PSS in children with NBPP compared to prevalence of PSS in published literature. We suggest careful clinical examination, based on defined criteria, provides a reasonable screening examination for evaluating PSS that can be confirmed by noninvasive US.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147125/1/pmr21235.pd

Use of Neuromuscular Electrical Stimulation in the Treatment of Neonatal Brachial Plexus Palsy: A Literature Review

Background: The purpose of this study was to conduct a review of current literature on the effectiveness of neuromuscular electrical stimulation (NMES) for restoring motion and function in neonatal brachial plexus palsy (NBPP). Method: A database search was conducted for NMES articles published between 1947 and 2015. Pre and post-treatment data were extracted for muscle power, active range of motion (AROM), and morphometric measurements. Results: An initial search yielded 2,721 articles. A further title/abstract review produced 27 articles; of these, four met the inclusion criteria. Treatment protocols varied. There were no changes in average Medical Research Council (MRC) scores following treatment for elbow flexion, shoulder abduction, or wrist extension. Shoulder flexion increased from MRC 1 to 4. AROM improved following treatment. Conclusions: Evidence for improved muscle strength after NMES is mixed. Improvement in AROM is more consistent. Due to variations in treatment modalities, patient profiles, and adjunct treatment, a clinical trial to isolate the effects of NMES in NBPP is required. Since improved motion and function has been reported, NMES in NBPP therapy remains reasonable

Impaired natural killer cell phenotype and function in idiopathic and heritable pulmonary arterial hypertension

BACKGROUND: Beyond their role as innate immune effectors, natural killer (NK) cells are emerging as important regulators of angiogenesis and vascular remodeling. Pulmonary arterial hypertension (PAH) is characterized by severe pulmonary vascular remodeling and has long been associated with immune dysfunction. Despite this association, a role for NK cells in disease pathology has not yet been described. METHODS AND RESULTS: Analysis of whole blood lymphocytes and isolated NK cells from PAH patients revealed an expansion of the functionally defective CD56(-)/CD16(+) NK subset that was not observed in patients with chronic thromboembolic pulmonary hypertension. NK cells from PAH patients also displayed decreased levels of the activating receptor NKp46 and the killer immunoglobulin-like receptors 2DL1/S1 and 3DL1, reduced secretion of the cytokine macrophage inflammatory protein-1β, and a significant impairment in cytolytic function associated with decreased killer immunoglobulin-like receptor 3DL1 expression. Genotyping patients (n=222) and controls (n=191) for killer immunoglobulin-like receptor gene polymorphisms did not explain these observations. Rather, we show that NK cells from PAH patients exhibit increased responsiveness to transforming growth factor-β, which specifically downregulates disease-associated killer immunoglobulin-like receptors. NK cell number and cytotoxicity were similarly decreased in the monocrotaline rat and chronic hypoxia mouse models of PAH, accompanied by reduced production of interferon-γ in NK cells from hypoxic mice. NK cells from PAH patients also produced elevated quantities of matrix metalloproteinase 9, consistent with a capacity to influence vascular remodeling. CONCLUSIONS: Our work is the first to identify an impairment of NK cells in PAH and suggests a novel and substantive role for innate immunity in the pathobiology of this disease

Examining the moderating effect of individual-level cultural values on users’ acceptance of E-learning in developing countries: a structural equation modeling of an extended technology acceptance model

In this study, we examine the effects of individual-level culture on the adoption and acceptance of e-learning tools by students in Lebanon using a theoretical framework based on the Technology Acceptance Model (TAM). To overcome possible limitations of using TAM in developing countries, we extend TAM to include subjective norms (SN) and quality of work life constructs as additional constructs and a number of cultural variables as moderators. The four cultural dimensions of masculinity/femininity (MF), individualism/collectivism, power distance and uncertainty avoidance were measured at the individual level to enable them to be integrated into the extended TAM as moderators and a research model was developed based on previous literature. To test the hypothesised model, data were collected from 569 undergraduate and postgraduate students using e-learning tools in Lebanon via questionnaire. The collected data were analysed using the structural equation modelling technique in conjunction with multi-group analysis. As hypothesised, the results of the study revealed perceived usefulness (PU), perceived ease of use (PEOU), SN and quality of work life to be significant determinants of students’ behavioural intention (BI) towards e-learning. The empirical results also demonstrated that the relationship between SN and BI was particularly sensitive to differences in individual-cultural values, with significant moderating effects observed for all four of the cultural dimensions studied. Some moderating effects of culture were also found for both PU and PEOU, however, contrary to expectations the effect of quality of work life was not found to be moderated by MF as some previous authors have predicted. The implications of these results to both theory and practice are explored in the paper

Health benefi ts, costs, and cost-eff ectiveness of earlier eligibility for adult antiretroviral therapy and expanded treatment coverage: a combined analysis of 12 mathematical models

Background New WHO guidelines recommend initiation of antiretroviral therapy for HIV-positive adults with CD4 counts of 500 cells per μL or less, a higher threshold than was previously recommended. Country decision makers have to decide whether to further expand eligibility for antiretroviral therapy accordingly. We aimed to assess the potential health benefi ts, costs, and cost-eff ectiveness of various eligibility criteria for adult antiretroviral therapy and expanded treatment coverage. Methods We used several independent mathematical models in four settings—South Africa (generalised epidemic, moderate antiretroviral therapy coverage), Zambia (generalised epidemic, high antiretroviral therapy coverage), India (concentrated epidemic, moderate antiretroviral therapy coverage), and Vietnam (concentrated epidemic, low antiretroviral therapy coverage)—to assess the potential health benefi ts, costs, and cost-eff ectiveness of various eligibility criteria for adult antiretroviral therapy under scenarios of existing and expanded treatment coverage, with results projected over 20 years. Analyses assessed the extension of eligibility to include individuals with CD4 counts of 500 cells per μL or less, or all HIV-positive adults, compared with the previous (2010) recommendation of initiation with CD4 counts of 350 cells per μL or less. We assessed costs from a health-system perspective, and calculated the incremental cost (in US$) per disability-adjusted life-year (DALY) averted to compare competing strategies. Strategies were regarded very cost eff ective if the cost per DALY averted was less than the country’s 2012 per-head gross domestic product (GDP; South Africa:$8040; Zambia: $1425; India:$1489; Vietnam: $1407) and cost eff ective if the cost per DALY averted was less than three times the per-head GDP. Findings In South Africa, the cost per DALY averted of extending eligibility for antiretroviral therapy to adult patients with CD4 counts of 500 cells per μL or less ranged from$237 to $1691 per DALY averted compared with 2010 guidelines. In Zambia, expansion of eligibility to adults with a CD4 count threshold of 500 cells per μL ranged from improving health outcomes while reducing costs (ie, dominating the previous guidelines) to$749 per DALY averted. In both countries results were similar for expansion of eligibility to all HIV-positive adults, and when substantially expanded treatment coverage was assumed. Expansion of treatment coverage in the general population was also cost eff ective. In India, the cost for extending eligibility to all HIV-positive adults ranged from $131 to$241 per DALY averted, and in Vietnam extending eligibility to patients with CD4 counts of 500 cells per μL or less cost $290 per DALY averted. In concentrated epidemics, expanded access for key populations was also cost eff ective. Interpretation Our estimates suggest that earlier eligibility for antiretroviral therapy is very cost eff ective in lowincome and middle-income settings, although these estimates should be revisited when more data become available. Scaling up antiretroviral therapy through earlier eligibility and expanded coverage should be considered alongside other high-priority health interventions competing for health budgets

Science Impacts of the SPHEREx All-Sky Optical to Near-Infrared Spectral Survey: Report of a Community Workshop Examining Extragalactic, Galactic, Stellar and Planetary Science

SPHEREx is a proposed SMEX mission selected for Phase A. SPHEREx will carry out the first all-sky spectral survey and provide for every 6.2" pixel a spectra between 0.75 and 4.18 $\mu$m [with R$\sim$41.4] and 4.18 and 5.00 $\mu$m [with R$\sim$135]. The SPHEREx team has proposed three specific science investigations to be carried out with this unique data set: cosmic inflation, interstellar and circumstellar ices, and the extra-galactic background light. It is readily apparent, however, that many other questions in astrophysics and planetary sciences could be addressed with the SPHEREx data. The SPHEREx team convened a community workshop in February 2016, with the intent of enlisting the aid of a larger group of scientists in defining these questions. This paper summarizes the rich and varied menu of investigations that was laid out. It includes studies of the composition of main belt and Trojan/Greek asteroids; mapping the zodiacal light with unprecedented spatial and spectral resolution; identifying and studying very low-metallicity stars; improving stellar parameters in order to better characterize transiting exoplanets; studying aliphatic and aromatic carbon-bearing molecules in the interstellar medium; mapping star formation rates in nearby galaxies; determining the redshift of clusters of galaxies; identifying high redshift quasars over the full sky; and providing a NIR spectrum for most eROSITA X-ray sources. All of these investigations, and others not listed here, can be carried out with the nominal all-sky spectra to be produced by SPHEREx. In addition, the workshop defined enhanced data products and user tools which would facilitate some of these scientific studies. Finally, the workshop noted the high degrees of synergy between SPHEREx and a number of other current or forthcoming programs, including JWST, WFIRST, Euclid, GAIA, K2/Kepler, TESS, eROSITA and LSST.Comment: Report of the First SPHEREx Community Workshop, http://spherex.caltech.edu/Workshop.html , 84 pages, 28 figure

Measurements of fiducial and differential cross sections for Higgs boson production in the diphoton decay channel at s√=8 TeV with ATLAS

Measurements of fiducial and differential cross sections are presented for Higgs boson production in proton-proton collisions at a centre-of-mass energy of s√=8 TeV. The analysis is performed in the H → γγ decay channel using 20.3 fb−1 of data recorded by the ATLAS experiment at the CERN Large Hadron Collider. The signal is extracted using a fit to the diphoton invariant mass spectrum assuming that the width of the resonance is much smaller than the experimental resolution. The signal yields are corrected for the effects of detector inefficiency and resolution. The pp → H → γγ fiducial cross section is measured to be 43.2 ±9.4(stat.) − 2.9 + 3.2 (syst.) ±1.2(lumi)fb for a Higgs boson of mass 125.4GeV decaying to two isolated photons that have transverse momentum greater than 35% and 25% of the diphoton invariant mass and each with absolute pseudorapidity less than 2.37. Four additional fiducial cross sections and two cross-section limits are presented in phase space regions that test the theoretical modelling of different Higgs boson production mechanisms, or are sensitive to physics beyond the Standard Model. Differential cross sections are also presented, as a function of variables related to the diphoton kinematics and the jet activity produced in the Higgs boson events. The observed spectra are statistically limited but broadly in line with the theoretical expectations