Functional electrical stimulation cycling exercise after spinal cord injury: a systematic review of health and fitness-related outcomes.

ObjectivesThe objective of this review was to summarize and appraise evidence on functional electrical stimulation (FES) cycling exercise after spinal cord injury (SCI), in order to inform the development of evidence-based clinical practice guidelines.MethodsPubMed, the Cochrane Central Register of Controlled Trials, EMBASE, SPORTDiscus, and CINAHL were searched up to April 2021 to identify FES cycling exercise intervention studies including adults with SCI. In order to capture the widest array of evidence available, any outcome measure employed in such studies was considered eligible. Two independent reviewers conducted study eligibility screening, data extraction, and quality appraisal using Cochranes' Risk of Bias or Downs and Black tools. Each study was designated as a Level 1, 2, 3 or 4 study, dependent on study design and quality appraisal scores. The certainty of the evidence for each outcome was assessed using GRADE ratings ('High', 'Moderate', 'Low', or 'Very low').ResultsNinety-two studies met the eligibility criteria, comprising 999 adults with SCI representing all age, sex, time since injury, lesion level and lesion completeness strata. For muscle health (e.g., muscle mass, fiber type composition), significant improvements were found in 3 out of 4 Level 1-2 studies, and 27 out of 32 Level 3-4 studies (GRADE rating: 'High'). Although lacking Level 1-2 studies, significant improvements were also found in nearly all of 35 Level 3-4 studies on power output and aerobic fitness (e.g., peak power and oxygen uptake during an FES cycling test) (GRADE ratings: 'Low').ConclusionCurrent evidence indicates that FES cycling exercise improves lower-body muscle health of adults with SCI, and may increase power output and aerobic fitness. The evidence summarized and appraised in this review can inform the development of the first international, evidence-based clinical practice guidelines for the use of FES cycling exercise in clinical and community settings of adults with SCI. Registration review protocol: CRD42018108940 (PROSPERO)

Identifying Knowledge Gaps with Administrative Health Data: A Cohort Study of Traumatic and Non-Traumatic Spinal Cord Injury in Alberta

Introduction The Spinal Cord Injury (SCI) population consists of two main sub-groups: traumatic (TSCI) and non-traumatic (NTSCI). TSCI has been studied; however less attention has been given to NTSCI. It is important to understand both SCI sub-groups for identification of knowledge gaps and subsequent health service planning. Objectives and Approach The goal is to study the SCI population (both TSCI and NTSCI) in Alberta, Canada, leveraging recent administrative health data. It is difficult to identify NTSCI patients for their heterogeneous conditions, and relatively low prevalence. Consequently, we followed a validated algorithm using particular ICD-10-CA codes, to identify (and index) adult SCI patients from Ambulatory and Inpatient records between April 1, 2006 and March 31, 2016. Indexed patients were linked to various databases (inpatient, ambulatory, physician claims, provincial insurance registry), and analyzed in multiple perspectives such as demographics patterns, deaths, resource and cost utilization, geographic distribution, and care equity between groups. Results Through 10 years of data we have identified 5217 SCI patients (3309 TSCI; 1908 NTSCI). 68.7% TSCI and 58.6% NTSCI are male. NTSCI patients are approximately 10 years older (46.3 TSCI; 54.5 NTSCI), and have a 3-point higher Charlson score. 1-year mortality in NTSCI is approximately 2.4 times the TSCI group. Hospitalizations, ER visits, critical care time have also been examined. Patients with NTSCI had a higher median index LOS (14 days IQR (4-51)) compared to the traumatic group who had much higher variability (11 days IQR (11-65.5)). Noted 13.7% NTSCI patients and 19.5% TSCI do not have hospitalizations after index (a diverse characteristic of SCI). Resource Intensity Weights, physician billing, rural-urban area utilization have also been compared between the sub-groups. Conclusion/Implications With the use of administrative databases and a validated algorithm, we described a diverse patient cohort with two main sub-groups (TSCI/NTSCI). Both groups were analyzed upon multiple topics and showed variations. Our results have provided updated knowledge of a comprehensive SCI population in Alberta, Canada, and may lead to improvements on care-giving model

Quantum plasticity and dislocation-induced supersolidity

We suggest that below a certain temperature T_k, the free energy for the creation of kinks-antikinks pairs in the dislocation network of solid He4 becomes negative. The underlying physical mechanism is the related liberation of vacancies which initiate Feynman's permutation cycles in the bulk. Consequently, dislocations should wander and sweep an increasingly larger volume at low temperatures. This phenomenon should lead both to a stiffening of the solid below T_k and to the appearance of a non zero superfluid fraction at a second temperature T_c < T_k.Comment: Longer revised version with more detailed discussion, submitted to EPJ

Influence of phyllosilicate mineral assemblages, fabrics, and fluids on the behavior of the Punchbowl fault, southern California

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95206/1/jgrb13457.pd

Empowerment, Communication, and Navigating Care: The Experience of Persons With Spinal Cord Injury From Acute Hospitalization to Inpatient Rehabilitation

BackgroundSpinal cord injury (SCI) results in long-term functional impairments that significantly impact participation and role in the community. Newly injured persons are often reintroduced to the community with significant deficits in knowledge, including how to access and navigate community resources and supports. This warrants a better understanding of the patient experience of in-hospital care and discharge planning to ensure individuals with SCI are best supported during transitions in care and while living in the community.ObjectiveTo explore the lived experience of persons with acute SCI and their perceptions of care, focusing on the initial hospital experiences to inpatient rehabilitation.MethodsA phenomenological research study was conducted using semi-structured interviews. Eligible participants had differing etiologies of SCI (including non-traumatic and traumatic SCI), were over the age of 18 at the time of initial care, and experienced acute hospital and inpatient rehabilitation at an Alberta-based institution within the last 10 years. One-on-one interviews took place between March and June 2021 over telephone or virtual platforms (Zoom). Interview transcripts, and field notes developed the text, which underwent hermeneutic analysis to develop central themes.ResultsThe present study included 10 participants living with an SCI in Alberta, Canada. Most participants (80%) were male. Participants' age ranged from 24 to 69 years. The median years since initial SCI was 3 years. Interviews lasted 45–75 min. Seven participants identified as having a traumatic SCI injury and three identified as having a non-traumatic SCI. The interplay between empowerment and disempowerment emerged as the core theme, permeating participants' meanings and perceptions. Three main themes emerged from the interviews regarding the perceptions of the SCI patient experience. Each theme represents a perception central to their inpatient experience: desire to enhance functional independence to empower confidence and self-management; need for effective communication with healthcare providers to support recovery; and navigating appropriate care supports to enhance preparedness for discharge and returning home.ConclusionThis study demonstrates the significant need to enhance education of person/family-centered SCI care, foster positive communication between care recipients and care providers, and facilitate better in-hospital access to appropriate navigation and wayfinding supports

Approaches to big data analysis of interface pressure measurements from continuous pressure imaging technology

Introduction Over 4.5 TB of data will be collected in a randomized clinical trial assessing continuous pressure imaging technology in reducing pressure injuries. To permit efficient analysis we examined different approaches to generating a reduced representation of the data that still produced similar analytical results to the full data set. Objectives and Approach Our primary objective was to develop an approach for reducing the pressure data to a manageable size, without loss of information. Frame by frame analysis of excluded participant imaging data allows us to identify changes in patient position. We explored different sampling frequencies (q5, 30, 60, 120, \& 240 seconds) for analysis, coalesced frames with periods of stillness, and used correlation coefficients as a measure of similarity between adjacent frames to identify patient position changes. Heat maps and plots were used to evaluate the performance characteristics and usefulness of different sampling frequencies and correlation coefficients to compress the data. Results A sampling frequency q60 seconds provided reasonable representation of changes in interface pressure over time. This translates to using only 1.7\% of the collected data in our analyses. When the threshold of correlation coefficient was set at 0.99 for coalescing the information based on position changes, then there was a maximum of 80 position changes detected. Therefore, approximately 160 frames q24 hours is sufficient to represent pressure states of participants at high risk of developing pressure injuries. In total we would require 480 frames (160*3) from 72 hours of collected data for our analyses without loss of position changes and pressure information. This represents approximately 0.185\% of the data collected. Conclusion/Implications Decreasing the sampling frequency significantly reduced our data size without compromising resolution, while the use of correlation coefficients was effective at coalescing the continuous pressure imaging data. These methods of data reduction may be applicable to pre-processing large datasets obtained from other device monitoring technologies

Lumped parameter modeling as a predictive tool for a battery status monitor

The Advanced Technology Development Program is currently evaluating the performance of the second generation of lithium-ion cells (i.e., Gen 2 cells). Both the Gen 2 Baseline and Variant C cells are tested in accordance with the cell-specific test plan, and are removed at roughly equal power fade increments and sent for destructive diagnostic analysis. The diagnostic laboratories did not need all test cells for analysis, and returned five spare cells to the Idaho National Engineering and Environmental Laboratory (INEEL). INEEL used these cells for special pulse testing at various duty cycles, amplitudes, and durations to investigate the usefulness of the lumped parameter model (LPM) as a predictive tool in a battery status monitor (BSM). The LPM is a simplified linear model that accurately predicts the voltage response during certain pulse conditions. A database of parameter trends should enable dynamic predictions of state-of-charge and state-of-health conditions during in-vehicle pulsing. This information could be used by the BSM to provide accurate information to the vehicle control system

Physical and antibiotic stresses require activation of the RsbU phosphatase to induce the general stress response in Listeria monocytogenes

Among pathogenic strains of Listeria monocytogenes, the σB transcription factor has a pivotal role in the outcome of food-borne infections. This factor is activated by diverse stresses to provide general protection against multiple challenges, including those encountered during gastrointestinal passage. It also acts with the PrfA regulator to control virulence genes needed for entry into intestinal lumen cells. Environmental and nutritional signals modulate σB activity via a network that operates by the partner switching mechanism, in which protein interactions are controlled by serine phosphorylation. This network is well characterized in the related bacterium Bacillus subtilis. A key difference in Listeria is the presence of only one input phosphatase, RsbU, instead of the two found in B. subtilis. Here, we aim to determine whether this sole phosphatase is required to convey physical, antibiotic and nutritional stress signals, or if additional pathways might exist. To that end, we constructed L. monocytogenes 10403S strains bearing single-copy, σB-dependent opuCA–lacZ reporter fusions to determine the effects of an rsbU deletion under physiological conditions. All stresses tested, including acid, antibiotic, cold, ethanol, heat, osmotic and nutritional challenge, required RsbU to activate σB. This was of particular significance for cold stress activation, which occurs via a phosphatase-independent mechanism in B. subtilis. We also assayed the effects of the D80N substitution in the upstream RsbT regulator that activates RsbU. The mutant had a phenotype consistent with low and uninducible phosphatase activity, but nonetheless responded to nutritional stress. We infer that RsbU activity but not its induction is required for nutritional signalling, which would enter the network downstream from RsbU

Quantum liquid-crystal order in resonant atomic gases

I review recent studies that predict quantum liquid-crystalline orders in resonant atomic gases. As examples of such putative systems I will discuss an s-wave resonant imbalanced Fermi gas and a p-wave resonant Bose gas. In the former, the liquid-crystalline smectic, nematic and rich variety of other descendant states emerge from strongly quantum- and thermally- fluctuating Fulde-Ferrell and Larkin-Ovchinnikov states, driven by a competition between resonant pairing and Fermi-surface mismatch. In the latter, at intermediate detuning the p-wave resonant interaction generically drives Bose-condensation at a finite momentum, set by a competition between atomic kinetic energy and atom-molecule hybridization. Because of the underlying rotationally-invariant environment of the atomic gas trapped isotropically, the putative striped superfluid is a realization of a quantum superfluid smectic, that can melt into a variety of interesting phases, such as a quantum nematic. I will discuss the corresponding rich phase diagrams and transitions, as well the low-energy properties of the phases and fractional topological defects generic to striped superfluids and their fluctuation-driven descendants.Comment: Invited Review, 25 pages, 17 figure