Optimal Management for People with Severe Spasticity

Spasticity is characterized by velocity-dependent increase in tonic stretch reflexes and tendon jerks. Many people affected by spasticity receive late treatment, or no treatment, which greatly reduces the potential to regain full motor control and restore function. There is much to consider before determining treatment for people with spasticity. Treatment of pediatric patients increases the complexity, because of the substantial difference between adult and pediatric spasticity. Proper patient evaluation, utilization of scales and measures, and obtaining patient and caregiver history is vital in determining optimal spasticity treatment. Further, taking into consideration the limitations and desires of individuals serve as a guide to best management. We have grouped contributing factors into the IDAHO Criteria to elucidate a multidisciplinary approach, which considers a person’s complete field of experience. This model is applied to goal setting, and recognizes the importance of a spasticity management team, comprising the treatment subject, his/her family, the environment, and a supportive, well-informed medical staff. The criteria take into account the complexity associated with diagnosing and treating spasticity, with the ultimate goal of improved function

Prevalence of cardiac arrhythmias among patients undergoing chronic hemodialysis

Aim. To evaluate the prevalence of arrhythmias in patients undergoing chronic hemodialysis, to characterize the arrhythmia types in relation to the dialysis procedure and to determine their relationship with clinical findings and echocardiographic characteristics.Material and methods. The study involved 152 patients with kidney failure undergoing chronic hemodialysis. All patients underwent an assessment of dialysis parameters, collection of clinical data, and 48-hour Holter monitoring. In addition, 93 patients underwent an echocardiography with an assessment of left ventricular (LV) mass index, LV ejection fraction, left atrial (LA) volume index, E/e’, cardiac output and preload, which was defined as increased LV filling pressure (E/e’ >12) and LA enlargement (LA volume index >30 ml/m2).Results. Among the 152 examined patients, premature supraventricular and ventricular contractions (PVCs) were observed in almost all patients, while 41% had paroxysmal supraventricular tachycardia. Clinically significant arrhythmias included persistent atrial fibrillation (AF) in 8,6% of patients, paroxysmal AF in 3,9%, nonsustained ventricular tachycardia in 19,7%, bradycardia in 4,6%, second-degree atrioventricular block in 1,3% and third-degree atrioventricular block among 2,6%. PVCs were more common on dialysis days, while tachyarrhythmias were more common during dialysis and in the immediate post- dialysis period. Older age (odds ratio (OR) 10 years older, 1,53; 95% confidence interval (CI): 1,15-2,03; P=0,003), lower cardiac output (OR 1 L/min more, 0,66; 95% CI: 0,44-1,00; P=0,05) were independently associated with clinically relevant arrhythmias.Conclusion. In patients on chronic hemodialysis, older age, increased preload and lower cardiac output are independently associated with clinically relevant arrhythmias. In addition, a positive association between increased LV mass index and AF episodes has been demonstrated. Lower cardiac output had positive correlation with AF and ventricular arrhythmias

Rapid synthesis and enhancement in down conversion emission properties of BaAl2O4:Eu2+,RE3+ (RE3+=Y, Pr) nanophosphors

[EN] BaAl2O4:Eu2+,RE3+ (RE3+=Y, Pr) down conversion nanophosphors were prepared at 600 °C by a rapid gel combustion technique in presence of air using boron as flux and urea as a fuel. A comparative study of the prepared materials was carried out with and without the addition of boric acid. The boric acid was playing the important role of flux and reducer simultaneously. The peaks available in the XPS spectra of BaAl2O4:Eu2+ at 1126.5 and 1154.8 eV was ascribed to Eu2+(3d5/2) and Eu2+(3d3/2) respectively which confirmed the presence of Eu2+ ion in the prepared lattice. Morphology of phosphors was characterized by tunneling electron microscopy. XRD patterns revealed a dominant phase characteristics of hexagonal BaAl2O4 compound and the presence of dopants having unrecognizable effects on basic crystal structure of BaAl2O4. The addition of boric acid showed a remarkable change in luminescence properties and crystal size of nanophosphors. The emission spectra of phosphors had a broad band with maximum at 490–495 nm due to electron transition from 4f65d1 → 4f7 of Eu2+ ion. The codoping of the rare earth (RE3+=Y, Pr) ions help in the enhancement of their luminescent properties. The prepared phosphors had brilliant optoelectronic properties that can be properly used for solid state display device applications.The authors gratefully recognize the financial support from the University Grant Commission (UGC), New Delhi [MRP-40-73/2011(SR)] and the European Commission through Nano CIS project (FP7-PEOPLE-2010-IRSES ref. 269279).Singh, D.; Tanwar, V.; Simantilke, AP.; Marí, B.; Kadyan, PS.; Singh, I. (2016). Rapid synthesis and enhancement in down conversion emission properties of BaAl2O4:Eu2+,RE3+ (RE3+=Y, Pr) nanophosphors. Journal of Materials Science: Materials in Electronics. 27(3):2260-2266. https://doi.org/10.1007/s10854-015-4020-1S22602266273J.S. Kim, P.E. Jeon, J.C. Choi, H.L. Park, S.I. Mho, G.C. Kim, Appl Phys Lett 84, 2931 (2004)D. Jia, D.N. Hunter, J Appl Phys 100, 1131251 (2006)H. Aizawa, T. Katsumata, J. Takahashi, K. Matsunaga, S. Komuro, T. Morikawa, E. Toba, Rev Sci Instrum 74, 1344 (2003)C.N. Xu, X.G. Zheng, M. Akiyama, K. Nonaka, T. Watanabe, Appl Phys Lett 76, 179 (2000)C. Feldmann, T. Justel, C.R. Ronda, P.J. Schmidt, Adv Funct Mater 13, 511 (2004)P.J. Saines, M.M. Elcombe, B.J. Kennedy, J Solid State Chem 179, 613 (2006)R. Sakai, T. Katsumata, S. Komuro, T. Morikawa, J Lumin 85, 149 (1999)T. Aitasalo, P. Deren, J Solid State Chem 171, 114 (2003)S. Nakamura, T. Mukai, M. Senoh, J Appl Phys 76, 8189 (1994)S.H.M. Poort, G. Blasse, J Lumin 72, 247 (1997)P. Mingying, H. Guangyan, J Lumin 127, 735 (2007)X. Linjiu, H. Mingrui, T. Yanwen, C. Yongjie, K. Tomoaki, Z. Liqing, W. Ning, Jap J Applied Physics 46, 5871 (2007)T. Aitasalo, J. Hölsä, H. Jungner, M. Lastusaari, J. Niittykoski, J Phys Chem B 110, 4589 (2006)R. Stefani, L.C.V. Rodrigues, C.A.A. Carvalho, M.C.F.C. Felinto, H.F. Brito, M. Lastusaari, J. Hölsä, Opt Mater 31, 1815 (2009)M. Peng, G. Hong, J Lumin 127, 735 (2007)V. Singh, V. Natarajan, J.J. Zhu, Opt Mater 29, 1447 (2007)X.Y. Chen, C. Ma, X.X. Li, C.W. Shi, X.L. Li, D.R. Lu, J Phys Chem C 113, 2685 (2009)A.J. Zarur, J.Y. Ying, Nature 403, 65 (2000)J. Chen, F. Gu, C. Li, Cry Growth Des 8, 3175 (2008)J. Zhang, M. Yang, H. Jin, X. Wang, X. Zhao, X. Liu, L. Peng, Mater Res Bull 47, 247 (2012)P. Maślankiewicz, J. Szade, A. Winiarski, Ph Daniel, Cryst Res Technol 40, 410 (2005)Y.J. Chen, G.M. Qiu, Y.B. Sun et al., J Rare Earths 20, 50 (2002)F.C. Palilla, A.K. Levine, M.R. Tomkus, J Electrochem Soc 115, 642 (1968)J. Niittykoski, T. Aitasalo, J. Holsa, H. Jungner, M. Lastusaari, M. Parkkinen, M. Tukia, J Alloys Compd 374, 108 (2004)A. Nag, T.R.N. Kutty, J Alloys Compd 354, 221 (2003)D. Haranath, P. Sharma, H. Chander, J Phys D Appl Phys 38, 371 (2005

Predictors of the experience of a Cytosponge test: analysis of patient survey data from the BEST3 trial

Availability of data and materials: The trial protocol, statistical analysis plan, and statistical report are available via the University of Cambridge data repository (https://www.data.cam.ac.uk/repository). Datasets will be available from R Fitzgerald ([email protected]) on request.Copyright © The Author(s) 2023. Background: The Cytosponge is a cell-collection device, which, coupled with a test for trefoil factor 3 (TFF3), can be used to diagnose Barrett’s oesophagus, a precursor condition to oesophageal adenocarcinoma. BEST3, a large pragmatic, randomised, controlled trial, investigated whether offering the Cytosponge-TFF3 test would increase detection of Barrett’s. Overall, participants reported mostly positive experiences. This study reports the factors associated with the least positive experience. Methods: Patient experience was assessed using the Inventory to Assess Patient Satisfaction (IAPS), a 22-item questionnaire, completed 7–14 days after the Cytosponge test. Study cohort: All BEST3 participants who answered ≥ 15 items of the IAPS (N = 1458). Statistical analysis: A mean IAPS score between 1 and 5 (5 indicates most negative experience) was calculated for each individual. ‘Least positive’ experience was defined according to the 90th percentile. 167 (11.4%) individuals with a mean IAPS score of ≥ 2.32 were included in the ‘least positive’ category and compared with the rest of the cohort. Eleven patient characteristics and one procedure-specific factor were assessed as potential predictors of the least positive experience. Multivariable logistic regression analysis using backwards selection was conducted to identify factors independently associated with the least positive experience and with failed swallow at first attempt, one of the strongest predictors of least positive experience. Results: The majority of responders had a positive experience, with an overall median IAPS score of 1.7 (IQR 1.5–2.1). High (OR = 3.01, 95% CI 2.03–4.46, p < 0.001) or very high (OR = 4.56, 95% CI 2.71–7.66, p < 0.001) anxiety (relative to low/normal anxiety) and a failed swallow at the first attempt (OR = 3.37, 95% CI 2.14–5.30, p < 0.001) were highly significant predictors of the least positive patient experience in multivariable analyses. Additionally, sex (p = 0.036), height (p = 0.032), alcohol intake (p = 0.011) and education level (p = 0.036) were identified as statistically significant predictors. Conclusion: We have identified factors which predict patient experience. Identifying anxiety ahead of the procedure and discussing particular concerns with patients or giving them tips to help with swallowing the capsule might help improve their experience. Trial registration ISRCTN68382401.The BEST3 trial was funded by Cancer Research UK (C14478/A21047), National Institute for Health Research covering service support costs, the UK National Health Service funding excess treatment costs and Medtronic providing funding for Cytosponge devices and TFF3 antibodies. RCF is funded by a Programme Grant from the Medical Research Council (RG84369) and is CI for the BEST3 trial and the Innovate UK funded DELTA study. JO was supported by PDS’s Cancer Research UK programme Grant (C8162/A16892) and is currently supported by the Barts Charity (EMSG1K1R). RM was supported by PDS’ Cancer Research UK Cancer Prevention Clinical Trials Unit funding (Grant No.: C8162/A25356). SGS is supported by a Yorkshire Cancer Research Fellowship. JW is funded by a Cancer Research UK career development fellowship (C7492/A17219). BG was funded as part of the DELTA study by Innovate UK (Grant No. 41162). FW is supported by the Cancer Research UK CanTest Grant [C8640/A23385]. RL is supported by the Intramural Research Program of the US National Institutes of Health/National Cancer Institute

Analiza niezawodności i zysku dla systemu jednoelementowego z konserwacją zapobiegawczą poddanego maksymalnemu czasowi pracy

This paper deals with the profit analysis of a reliability model for a single-unit system in which unit fails completely either directly from normal mode or via partial failure. The partially failed operating unit is shutdown after a maximum operation time for preventive maintenance. There is a single server who attends the system immediately whenever needed to conduct preventive maintenance at partial failure stage and repair at completely failure stage of the unit. The unit works as new after preventive maintenance and repair. The switch devices are considered as perfect. All random variables are assumed as independent and uncorrelated. The distribution of failure times, maximum operation time, preventive maintenance time and repair time are taken as general. Various reliability characteristics of interest are evaluated by using semi-Markov process and regenerative point technique. The tabular represantation of mean time to system failure (MTSF), availability and profit with respect to maximum rate of operation time has also been shown for a particular case.W niniejszej pracy przedstawiono analizę zysku modelu niezawodności dla systemu jednoelementowego, w którym element ulega całkowitemu uszkodzeniu bezpośrednio z trybu normalnego lub pośrednio na skutek częściowego uszkodzenia. Częściowo uszkodzona działająca jednostka jest wyłączana po upłynięciu maksymalnego czasu pracy w celu przeprowadzenia konserwacji zapobiegawczej. Pojedynczy serwer wspomaga bezzwłocznie system w momencie wystąpienia potrzeby przeprowadzenia konserwacji zapobiegawczej na etapie częściowego uszkodzenia oraz naprawy na etapie uszkodzenia całkowitego. Element działa jak nowy, po konserwacji zapobiegawczej i naprawie. Stan przełączników sieciowych uznaje się za doskonały. Wszystkie zmienne losowe traktowano jako niezależne i nieskorelowane. Rozkład czasów uszkodzeń, maksymalnego czasu pracy, czasu konserwacji zapobiegawczej i czasu naprawy przyjęto jako ogólne. Wybrane parametry niezawodnościowe oceniano za pomocą procesu semimarkowskiego i techniki odnowy RPT. Dla poszczególnych przykładów przedstawiono także tabelaryczne zestawienie średniego czasu do uszkodzenia systemu (MTSF), gotowości i zysku w odniesieniu do maksymalnego czasu pracy

ALOPECIA AREATA AND AUTOIMMUNITY: A CLINICAL STUDY

Alopecia areata (AA) frequently occur in association with other autoimmune diseases such as thyroid disorders, anemias and other skin disorders with autoimmune etiology. Despite numerous studies related to individual disease associations in alopecia areata, there is paucity of literature regarding comprehensive studies on concomitant cutaneous and systemic diseases. The present study has been designed to determine if there is a significant association between alopecia areata and other autoimmune diseases. This study covers 71 patients with the diagnosis of alopecia areata as the case group and 71 patients with no evidence of alopecia areata as the control group. Among the cutaneous diseases associated with AA, atopic dermatitis (AD) showed maximum frequency with an O/E ratio of 2.5, which indicates that it is two to three times more common in patients with alopecia areata. In our study, thyroid disorders showed the highest frequency with on O/E ratio of 3.2 and a P value of 0.01, which is statistically highly significant. Among the thyroid disorders, hypothyroidism was the most frequent association (14.1%) in our study. Since systemic involvement is not infrequent in patients with alopecia areata, it is imperative to screen these patients for associated disorders, particularly atopy, thyroid diseases, anemias and other autoimmune disorders, especially if alopecia areata is chronic, recurrent and extensive

Analiza probabilistyczna dwóch modeli niezawodności systemu jednoelementowego wykorzystujących pojęcia pogwarancyjnej obsługi profilaktycznej oraz degradacji

This paper presents two reliability models of a single-unit system with the concept of preventive maintenance (PM) beyond warranty and degradation. In both the models, repair of any failure during warranty is cost-free to the users, provided failures are not due to the negligence of users. There is a single repairman who always remains with the system. Beyond warranty, the unit goes under PM and works as new after PM (in both models). In model-1, the unit works as new after its repair beyond warranty whereas; in model-2, the unit becomes degraded. After failure, the degraded unit is replaced by a new one. The failure time of the system follows negative exponential distribution while PM, replacement and repair time distributions are taken as arbitrary with different probability density functions. Supplementary variable technique is adopted to derive the expressions for some economic measures such as reliability, mean time to system failure (MTSF), availability and profit function. Using Abel’s lemma, the behaviour of the system in steady-state has been examined. To highlight the behaviour of reliability and profit function, numerical results are considered for particular values of various parameters and repair cost. Profit comparison of both the models is also made to see the usefulness of the concept of degradation.W artykule przedstawiono dwa modele niezawodności systemu jednoelementowego wykorzystujące pojęcia pogwarancyjnej obsługi profilaktycznej oraz degradacji. Oba modele zakładają, że w okresie gwarancyjnym użytkownik nie ponosi żadnych kosztów związanych z naprawą uszkodzeń, chyba że uszkodzenie powstało wskutek zaniedbania ze strony użytkownika. Obsługi są wykonywane przez jedną ekipę remontową, która zawsze pozostaje na stanowisku. Po upływie okresu gwarancyjnego, urządzenie podlega obsłudze profilaktycznej i po jej przeprowadzeniu działa jak nowe (w obu modelach). Model 1 zakłada, że element po naprawie pogwarancyjnej działa jak nowy, natomiast w Modelu 2, element ulega degradacji. Zdegradowany element, który uległ uszkodzeniu, zostaje wymieniony na nowy. Rozkład czasu uszkodzenia jest rozkładem wykładniczym ujemnym, a rozkłady czasu obsługi profilaktycznej, wymiany i naprawy są traktowane jako arbitralne, o różnych funkcjach gęstości prawdopodobieństwa. Zastosowana technika dodatkowej zmiennej pozwoliła na wyprowadzenie wyrażeń dla niektórych miar ekonomicznych, takich jak niezawodność, średni czas do uszkodzenia systemu (MTSF), gotowość i funkcja zysków. Zachowanie systemu w stanie ustalonym badano z wykorzystaniem lematu Abela. Aby przedstawić zachowanie funkcji niezawodności i zysków, analizowano wyniki numeryczne dla poszczególnych wartości różnych parametrów oraz kosztów naprawy. Porównanie zyskowności badanych modeli umożliwiło weryfikację przydatności pojęcia degradacji