Self-Care Trajectories and Reference Percentiles for Children with Cerebral Palsy.

Aims: To create longitudinal trajectories and reference percentiles for performance in self-care of children with cerebral palsy (CP). Methods: Participants were 708 children with CP, 18 months through 11 years of age and their parents residing in 10 regions across Canada and the United States. Gross Motor Function Classification System (GMFCS) levels were determined by consensus between parents and therapists. Parents\u27 completed the Performance in Self-Care domain of the Child Engagement in Daily Life Measure two to five times at 6-month intervals. Nonlinear mixed-effects models were used to create longitudinal trajectories. Quantile regression was used to construct cross-sectional reference percentiles. Results: The trajectories for children in levels I, II, and III are characterized by an average maximum score between 79.6 (level I) and 62.8 (level III) and an average attainment of 90% of the maximum score between 7 and 9 years of age. The trajectories for children in level IV and V show minimal change over time. Extreme variation in performance among children of the same age and GMFCS level complicate interpretation of percentile change of individual children. Conclusion: The findings are useful for monitoring self-care of children with CP and evaluating change for children in GMFCS levels I-III

A Collaborative Approach to Decision Making Through Developmental Monitoring to Provide Individualized Services for Children With Cerebral Palsy.

In this Perspective, we suggest a process to improve physical and occupational therapists’ and families’ collaboration to provide appropriate, efficient, and effective evidence-based services to improve motor function, self-care performance, and participation in family and recreation activities for children with cerebral palsy (CP). This process is informed by 2 multisite prospective cohort studies (Move & PLAY and On Track). The heterogeneity of children with CP is described, limiting the utility of evidence from randomized controlled trials and systematic reviews to inform service planning for children with CP. An evidence-based alternative using prospective cohort studies that produce knowledge of determinants of outcomes important to children and families and methods for developmental monitoring using longitudinal developmental and reference percentile curves to inform individualized care is suggested. Guiding questions are provided to explore how knowledge of determinants and developmental monitoring can inform family-centered, collaborative, strengths-based, and focused service programs to support early development and function. Although this perspective paper is focused on children with CP, the research approach described for collection of useful information and the clinical method of data use may be helpful for people with other heterogeneous chronic health conditions in which physical and occupational therapists face similar challenges

Extending the first-order post-Newtonian scheme in multiple systems to the second-order contributions to light propagation

In this paper, we extend the first-order post-Newtonian scheme in multiple systems presented by Damour-Soffel-Xu to the second-order contribution to light propagation without changing the virtueof the scheme on the linear partial differential equations of the potential and vector potential. The spatial components of the metric are extended to second order level both in a global coordinates ($q_{ij}/ c^4$) and a local coordinates ($Q_{ab}/ c^4$). The equations of $q_{ij}$ (or $Q_{ab}$) are obtained from the field equations.The relationship between $q_{ij}$ and $Q_{ab}$ are presented in this paper also. In special case of the solar system (isotropic condition is applied ($q_{ij} = \delta_{ij} q$)), we obtain the solution of $q$. Finally, a further extension of the second-order contributions in the parametrized post-Newtonian formalism is discussed.Comment: Latex2e; 6 pages PS fil

Super-ASTROD: Probing primordial gravitational waves and mapping the outer solar system

Super-ASTROD (Super Astrodynamical Space Test of Relativity using Optical Devices or ASTROD III) is a mission concept with 3-5 spacecraft in 5 AU orbits together with an Earth-Sun L1/L2 spacecraft ranging optically with one another to probe primordial gravitational-waves with frequencies 0.1 microHz - 1 mHz, to test fundamental laws of spacetime and to map the outer solar system. In this paper we address to its scientific goals, orbit and payload selection, and sensitivity to gravitational waves.Comment: 7 pages, 1 figure, presented to 7th International LISA Symposium, 16-20 June 2008, Barcelona; submitted to Classical and Quantum Gravity; presentation improve

Developmental Trajectories for the Early Clinical Assessment of Balance by Gross Motor Function Classification System Level for Children With Cerebral Palsy.

Background: Children with cerebral palsy (CP) characteristically present with impairments in balance. Currently, the pattern and timing of the development of balance ability have not been described for children with CP of varying Gross Motor Function Classification System (GMFCS) levels. Objective: The purpose of this study was to document longitudinal developmental trajectories in a measure of balance, the Early Clinical Assessment of Balance (ECAB) scores, along with age-specific reference percentiles and the amount of change typical over a 1-year period for children within different GMFCS levels. Design: The design was a longitudinal cohort study. Methods: Participants included 708 children with CP, aged 18 months through their 12th birthday, and their families. Children participated in 2 to 5 assessments using the GMFCS and ECAB. Results: Longitudinal trajectories describing the average change in the ECAB score with respect to age were created by fitting separate nonlinear mixed-effect models for children in each GMFCS level. Reference percentiles were constructed using quantile regression of ECAB data from the first visit (baseline) and 12-month and 24-month visits. Using these reference points, the amount of change in percentiles was calculated for all children by subtracting the baseline percentile score from the 12-month percentile score. Children whose percentile changes are within the 80% limits can usually be described as developing as expected for their age and GMFCS levels. Limitations: Limitations of this study included use of a convenience sample, a ceiling effect of the ECAB for some children in GMFCS levels I and II, and the use of both a 12-month and 24-month study protocol that impacted the number of children available for each assessment session. Conclusions: When used appropriately to monitor development and change over time for children with CP, the ECAB longitudinal trajectories, reference percentiles, and the associated change scores presented here should assist therapists and families in collaborative interaction to proactively plan services and interventions relative to balance ability

Longitudinal trajectories and reference centiles for the impact of health conditions on daily activities of children with cerebral palsy.

AIM: First, to describe the impact of health conditions on daily activities over time in children with cerebral palsy (CP) and to create age-specific reference centiles. Second, to determine the amount of change typical over a 1-year period, across Gross Motor Function Classification System (GMFCS) levels. METHOD: A prospective, cohort design, with five assessments over 2 years, involved 708 children with a confirmed diagnosis of CP participating in the On Track Study (396 males, 312 females; mean age 6y [SD 2y 7mo]; range 18mo-12y at first assessment; 32.1% in GMFCS level I, 22.7% in GMFCS level II, 11.2% in GMFCS level III, 18.2% in GMFCS level IV, 15.7% in GMFCS level V). The impact of health conditions on daily activities was assessed using the Child Health Conditions Questionnaire. Data were analyzed using mixed-effects models and quantile regression. RESULTS: Linear longitudinal trajectories describe the relatively stable impact of health conditions over time for each functional level for children aged 2 years to 12 years, with the lowest scores (least impact) in GMFCS level I and the highest scores (highest impact) in GMFCS level V. Centiles were created for children in each GMFCS level. A system to interpret the magnitude of change over time in centiles was developed. INTERPRETATION: Longitudinal trajectories of co-occurring health conditions assist with understanding children\u27s prognoses. Centiles assist in understanding a child\u27s experience relative to children in similar GMFCS levels. Guidelines are provided to determine if children are progressing \u27as expected\u27, \u27better than expected\u27 or \u27more poorly than expected\u27 in regard to the impact of health conditions on daily activities. WHAT THIS PAPER ADDS: For children with cerebral palsy, the mean impact of health conditions on daily activities is relatively stable. Significant intraindividual and interindividual variability for the impact of health conditions exists, which complicates prognosis. Centiles enable interpretation of the impact of health conditions relative to Gross Motor Function Classification System level

Orbit optimization for ASTROD-GW and its time delay interferometry with two arms using CGC ephemeris

ASTROD-GW (ASTROD [Astrodynamical Space Test of Relativity using Optical Devices] optimized for Gravitation Wave detection) is an optimization of ASTROD to focus on the goal of detection of gravitation waves. The detection sensitivity is shifted 52 times toward larger wavelength compared to that of LISA. The mission orbits of the 3 spacecraft forming a nearly equilateral triangular array are chosen to be near the Sun-Earth Lagrange points L3, L4 and L5. The 3 spacecraft range interferometrically with one another with arm length about 260 million kilometers. In order to attain the requisite sensitivity for ASTROD-GW, laser frequency noise must be suppressed below the secondary noises such as the optical path noise, acceleration noise etc. For suppressing laser frequency noise, we need to use time delay interferometry (TDI) to match the two different optical paths (times of travel). Since planets and other solar-system bodies perturb the orbits of ASTROD-GW spacecraft and affect the (TDI), we simulate the time delay numerically using CGC 2.7 ephemeris framework. To conform to the ASTROD-GW planning, we work out a set of 20-year optimized mission orbits of ASTROD-GW spacecraft starting at June 21, 2028, and calculate the residual optical path differences in the first and second generation TDI for one-detector case. In our optimized mission orbits for 20 years, changes of arm length are less than 0.0003 AU; the relative Doppler velocities are less than 3m/s. All the second generation TDI for one-detector case satisfies the ASTROD-GW requirement.Comment: 17 pages, 7 figures, 1 tabl

Simulation of the White Dwarf -- White Dwarf galactic background in the LISA data

LISA (Laser Interferometer Space Antenna) is a proposed space mission, which will use coherent laser beams exchanged between three remote spacecraft to detect and study low-frequency cosmic gravitational radiation. In the low-part of its frequency band, the LISA strain sensitivity will be dominated by the incoherent superposition of hundreds of millions of gravitational wave signals radiated by inspiraling white-dwarf binaries present in our own galaxy. In order to estimate the magnitude of the LISA response to this background, we have simulated a synthesized population that recently appeared in the literature. We find the amplitude of the galactic white-dwarf binary background in the LISA data to be modulated in time, reaching a minimum equal to about twice that of the LISA noise for a period of about two months around the time when the Sun-LISA direction is roughly oriented towards the Autumn equinox. Since the galactic white-dwarfs background will be observed by LISA not as a stationary but rather as a cyclostationary random process with a period of one year, we summarize the theory of cyclostationary random processes and present the corresponding generalized spectral method needed to characterize such process. We find that, by measuring the generalized spectral components of the white-dwarf background, LISA will be able to infer properties of the distribution of the white-dwarfs binary systems present in our Galaxy.Comment: 14 pages and 6 figures. Submitted to Classical and Quantum Gravity (Proceedings of GWDAW9

Multicenter observational study on factors and outcomes associated with various methicillin-resistant Staphylococcus aureus types in children with cystic fibrosis

Rationale: Methicillin-resistant Staphylococcus aureus (MRSA) prevalence continues to increase in patients with cystic fibrosis (CF) in the United States, reaching 26.5% in 2012. Approximately 30% of strains are SCCmec (staphylococcal cassette chromosome mec) IV type, frequently USA300, which in the general population have different genotypic and phenotypic features than SCCmec II type. Objectives: We hypothesized that risk factors for acquisition and outcomes in patients with CF differed for "health care-associated" (SCCmec II) versus "community-associated" (SCCmec IV)MRSAstrains. Methods: To determine the role of SCCmec type and Panton-Valentine leukocidin (PVL), MRSA isolates from patients not more than 18 years old at seven CF centers were typed and the association of potential risk factors and subsequent clinical course was assessed, using data provided by the CF Patient Registry. Measurements and Main Results: Participants with chronic MRSA (295) had typeable isolates and clinical data; 205 (69.5%) had SCCmec II PVL(-), 39 (13.2%) had SCCmec IV PVL(-), and 51 (17.3%) had SCCmec IVPVL(1) strains.SCCmec IV, comparedwith SCCmec II, increased during the study period, 1996-2010 (P = 0.03). SCCmec II was associated with Pseudomonas aeruginosa-positive cultures and three or more clinic visits in the 6 months preceding the first positive MRSA culture (adjusted odds ratio, 2.05; 95% confidence interval, 1.13-3.74; P = 0.019). Lung function and anthropometrics remained unchanged in the 6 months after initial MRSA detection compared with the 6 months prior. Although CF care increased for participants in both groups in the 6 months after MRSA detection, inhaled antibiotics were prescribed more frequently in those with SCCmec II strains and increased hospitalizations occurred in those with SCCmec IV PVL(-) strains compared with those with PVL(1) strains (adjusted difference, 34.10%; 95% confidence interval, 7.58-60.61; P = 0.012). Participants in both groups had an increase in CF care in the 2 years after MRSA detection compared with the 2 years prior. Conclusions: Increased exposure to CF clinics and P. aeruginosa may constitute risk factors for acquisition of SCCmec II MRSA strains. Clinical interventions increased 6 months and 2 years after initial MRSA detection regardless of SCCmec type

Progress in Interferometry for LISA at JPL

Recent advances at JPL in experimentation and design for LISA interferometry include the demonstration of Time Delay Interferometry using electronically separated end stations, a new arm-locking design with improved gain and stability, and progress in flight readiness of digital and analog electronics for phase measurements.Comment: 11 pages, 9 figures, LISA 8 Symposium, Stanford University, 201