Outpatient Neurological and Orthopedic Physical Therapy Management for an Individual Diagnosed with a Cervical Central Spinal Cord Lesion: A Case Report

Background: Geriatric patients commonly present to rehabilitation having multiple co-morbidities. One example occurred in an outpatient clinic where the patient presented with a central cord lesion and knee range of motion deficits. Central cord injuries commonly lead to motor impairment, with the upper extremities being affected more than the lower extremities. The rehabilitation for addressing these two conditions often do not have much overlap. However, for patients with unrelated co-morbidities, therapists need to rely on multiple strategies to optimize patient care. Purpose: The purpose of this case report is to illustrate the outpatient plan of care, including both neurological and orthopedic strategies, for an individual with a cervical central cord lesion and bilateral reduced knee range of motion. Case Description: The patient was a 61-year old male who sustained a cervical central spinal cord lesion at the C1-C4 level. He had a history of bilateral total knee arthroplasties over 10 years ago, with notable knee range of motion and functional limitations. He achieved 40 degrees of knee flexion on the left and 85 degrees of knee flexion on his right at initial evaluation. Intervention: Neurological interventions of task specific repetitive practice along with orthopedic interventions of joint mobilizations and exercise were administered with the patient. Outcomes: Outcomes used included: 10 Meter Walk Test, 5x Sit to Stand, Lower Extremity Functional Scale, and goniometry. Discussion: The patient improved in all outcome measures and reported improvement in home and community function. This is one case outlining a patient with both neurological and orthopedic impairments, thus further research into patients with multiple co-morbidities is warranted to improve clinicians’ evidence-based approach and provide optimal patient care

Fat Fisher Zeroes

We show that it is possible to determine the locus of Fisher zeroes in the thermodynamic limit for the Ising model on planar (``fat'') phi4 random graphs and their dual quadrangulations by matching up the real part of the high and low temperature branches of the expression for the free energy. The form of this expression for the free energy also means that series expansion results for the zeroes may be obtained with rather less effort than might appear necessary at first sight by simply reverting the series expansion of a function g(z) which appears in the solution and taking a logarithm. Unlike regular 2D lattices where numerous unphysical critical points exist with non-standard exponents, the Ising model on planar phi4 graphs displays only the physical transition at c = exp (- 2 beta) = 1/4 and a mirror transition at c=-1/4 both with KPZ/DDK exponents (alpha = -1, beta = 1/2, gamma = 2). The relation between the phi4 locus and that of the dual quadrangulations is akin to that between the (regular) triangular and honeycomb lattices since there is no self-duality.Comment: 12 pages + 6 eps figure

Sensitivity Analyses of Optimized Attitude Estimators Using Sensor Fusion Solutions for Low-Cost MEMS Configurations

Since the 1990’s, there has been increased focus on creating navigation systems for small unmanned systems, particularly small unmanned aerial systems (SUAS). Due to size, weight, and cost restrictions, compared to larger more costly manned systems, navigation systems for SUAS have evolved to be quite different from the proven systems of the past. Today, there are many solutions for the problem of navigation for SUAS. The problem has now become choosing the most fitting navigation solution for a given application/mission. This is particularly true for evaluating solutions that are fundamentally different. This research analyses the performance and sensitivity of four sensor fusion solutions for attitude estimation under multiple simulated flight conditions. There are three different hardware configurations between the four estimators. For this reason, each estimator is tuned to be experimentally optimal, as to provide a fair comparison between different estimators. With each estimator tuned to its highest performance, the estimators are compared based on their sensitivity to tuning error, sensor bias, and estimator initialization error. Finally the estimators\u27 accuracy performances are directly compared. This thesis also provides methods to tune different configuration estimators to their individual best performances. These methods show that choosing tuning parameters based on sensor noise covariance, as is typically done in research, does not produce optimal performance for all estimator formulations. After comparing multiple sensitivity and performance properties of the estimators, observations are provided regarding the efficacy of the analyses, including the applicability of the metrics used to determine performance. Some metrics where shown to be misleading for particular estimators or analyses. Ultimately, guidance is given for choosing performance metrics capable of comparing different solutions

Artistic influence, stylistic irony, and musical reference in Dmitri Shostakovich’s Cello Concerto No. 1

This paper examines Dmitri Shostakovich’s Cello Concerto No. 1, opus 107, as an exemplary work of the composer. In order to attempt a holistic understanding of the piece, I approached it in several ways. First, I examined the influence of several composers, including Saint-Saëns, Prokofiev, and especially Mahler. Mahler’s influence is most significant in the juxtaposition of incongruous elements, often to ironic effect. My second major topic of interest is in harmonic processes particular to Shostakovich. His use of harmony is unique in the way it successfully avoids traditional tonal processes while remaining accessible and engaging to the listener. My third area of discussion involves Shostakovich’s frequent use of musical reference, both to his own music and outside sources. References of this nature often have personal significance for Shostakovich, a fact that the Cello Concerto demonstrates. For a fourth approach, I discuss Shostakovich’s formal clarity in this piece, which is another trait that makes his music accessible. This clarity is aided by a cyclic reappearance of the piece’s opening motive in later movements. I also discuss some aspects of orchestration that make the form and content of the piece effective. My research of the concerto indicates that the piece displays a characteristically personal style for Shostakovich, observable in the topics discussed here

Operating room first case start times: a metric to assess systems-based practice milestones?

BACKGROUND: Resident competence in peri-operative care is a reflection on education and cost-efficiency. Inspecting pre-existing operating room metrics for performance outliers may be a potential solution for assessing competence. Statistical correlation of problematic benchmarks may reveal future opportunities for educational intervention. METHODS: Case-log database review yielded 3071 surgical cases involving residents over the course of 5 years. Surgery anticipated and actual start times were evaluated for delays and residents were assessed using the days of resident training performed at the time of each corresponding case. Other variables recorded included day of week, attending anesthesiologist name, attending surgeon name, patient age, sex, American Society of Anesthesiologists physical status classification (ASA PS), and in-patient versus day surgery status. Mixed-effect, multi-variable, linear regression determined independent determinants of delay time. RESULTS: The analysis identified day of the week (F = 25.65, P \u3c 0.0001), days of training (F = 8.39, P = 0.0038), attending surgeon (F = 2.67, P \u3c 0.0001), and anesthesiology resident (F = 1.67, P = 0.0012) as independent predictors of delay time for first-start cases, with an overall regression model F = 3.09, r2 = 0.186, and P \u3c 0.0001. CONCLUSIONS: The day of the week and attending surgeon demonstrated significant impact of case delay compared to resident days trained. If a learning curve for first-case start punctuality exists for anesthesiology residents, it is subtle and irrelevant to operating room efficiency. The regression model accounted for only 19% of the variability in the outcome of delay time, indicating a multitude of additional unidentified factors contributing to operating room efficiency

The Common Sense of Contract Formation

What parties know and think they know about contract law affects their obligations under the law and their intuitive obligations toward one another. Drawing on a series of new experimental questionnaire studies, this Article makes two contributions.First, it lays out what information and beliefs ordinary individuals have about how to form contracts with one another. We find that the colloquial understanding of contract law is almost entirely focused on formalization rather than actual assent, though the modern doctrine of contract formation takes the opposite stance. The second Part of the Article tries to get at whether this misunderstanding matters. Is it the case that, and when do, beliefs and misunderstandings about the nature of legal rules affect parties’ interactions with each other and with the legal system? We find that, indeed, information that a contract has been legally formed has behavioral effects, enhancing parties’ commitments to a deal even when there are no associated formal sanctions. However, we also document a series of situations in which misunderstandings have limited practical repercussions, because even parties who believe that legal obligation is about formalities take seriously the moral obligations associated with informal promises and exchanges. We conclude with brief speculations about the implications of these results for consumer contracts

Breach Is For Suckers

This Article presents results from three experiments offering evidence that parties see breach of contract as a form of exploitation that makes disappointed promisees into Suckers. In psychology, being a sucker turns on a three-part definition: betrayal, inequity, and intention. We used web-based questionnaires to test the effect of each of the three factors separately. Our results support the hypothesis that when breach of contract cues an exploitation schema, people become angry, offended, and inclined to retaliate even when retaliation is costly. This theory offers a useful advance because it explains why victims of breach demand more than similarly situated tort victims and why breaches to engorge gain are perceived to be more immoral than breaches to avoid loss. In general, the sucker theory provides an explanatory framework for recent experimental work showing that individuals view breach as a moral harm. We describe the implications of this theory for doctrinal problems like liquidated damages, willful breach, and promissory estoppel. We then suggest an agenda for further research

The Psychology of Contract Precautions

This research tests the intuition that parties to a contract approach each other differently before the contract is formed than they do once it is finalized. We argue that one of the most important determinants of self-protective behavior is whether the promisee considers herself to be in negotiations or already in an ongoing contract relationship. That shift affects precaution taking even when it has no practical bearing on the costs and benefits of self-protection: the moment of contracting is a reference point that frames the costs and benefits of taking precautions. We present the results of three questionnaire studies in which respondents indicate that they would be more likely to protect their own interests—by requesting a liquidated damages clause, by purchasing a warranty, or by shopping around to ensure the best deal—when the contract is not yet finalized than they would when they understand the agreement to be finalized. We discuss competing explanations for this phenomenon, including both prospect theory and cognitive dissonance. Finally, we explore some doctrinal implications for work on disclosure, modification, and promissory estoppel