Decision for reconstructive interventions of the upper limb in individuals with tetraplegia: the effect of treatment characteristics

Objective: To determine the effect of treatment characteristics on the\ud decision for reconstructive interventions for the upper extremities (UE) in\ud subjects with tetraplegia. - \ud Setting: Seven specialized spinal cord injury centres in the Netherlands. - \ud Method: Treatment characteristics for UE reconstructive interventions were\ud determined. Conjoint analysis (CA) was used to determine the contribution\ud and the relative importance of the treatment characteristics on the decision\ud for therapy. Therefore, a number of different treatment scenarios using these\ud characteristics were established. Different pairs of scenarios were presented\ud to subjects who were asked to choose the preferred scenario of each set. - \ud Results: forty nine subjects with tetraplegia with a stable C5, C6 or C7\ud lesion were selected. All treatment characteristics significantly influenced\ud the choice for treatment. Relative importance of treatment characteristics\ud were: intervention type (surgery or surgery with FES implant) 13%, number\ud of operations 15%, in patient rehabilitation period 22%, ambulant\ud rehabilitation period 9%, complication rate 15%, improvement of elbow\ud function 10%, improvement of hand function 15%. In deciding for therapy\ud 40% of the subjects focused on one characteristic. - \ud Conclusion: CA is applicable in Spinal Cord Injury medicine to study the\ud effect of health outcomes and non-health outcomes on the decision for\ud treatment. Non-health outcomes which relate to the intensity of treatment\ud are equally important or even more important than functional outcome in the\ud decision for reconstructive UE surgery in subjects with tetraplegia

Verapamil-Sensitive Transport of Quinacrine and Methylene Blue via the Plasmodium falciparum Chloroquine Resistance Transporter Reduces the Parasite's Susceptibility to these Tricyclic Drugs.

BACKGROUND: It is becoming increasingly apparent that certain mutations in the Plasmodium falciparum chloroquine resistance transporter (PfCRT) alter the parasite's susceptibility to diverse compounds. Here we investigated the interaction of PfCRT with 3 tricyclic compounds that have been used to treat malaria (quinacrine [QC] and methylene blue [MB]) or to study P. falciparum (acridine orange [AO]). METHODS: We measured the antiplasmodial activities of QC, MB, and AO against chloroquine-resistant and chloroquine-sensitive P. falciparum and determined whether QC and AO affect the accumulation and activity of chloroquine in these parasites. We also assessed the ability of mutant (PfCRT(Dd2)) and wild-type (PfCRT(D10)) variants of the protein to transport QC, MB, and AO when expressed at the surface of Xenopus laevis oocytes. RESULTS: Chloroquine resistance-conferring isoforms of PfCRT reduced the susceptibility of the parasite to QC, MB, and AO. In chloroquine-resistant (but not chloroquine-sensitive) parasites, AO and QC increased the parasite's accumulation of, and susceptibility to, chloroquine. All 3 compounds were shown to bind to PfCRT(Dd2), and the transport of QC and MB via this protein was saturable and inhibited by the chloroquine resistance-reverser verapamil. CONCLUSIONS: Our findings reveal that the PfCRT(Dd2)-mediated transport of tricyclic antimalarials reduces the parasite's susceptibility to these drugs

A natural orbital functional for the many-electron problem

The exchange-correlation energy in Kohn-Sham density functional theory is expressed as a functional of the electronic density and the Kohn-Sham orbitals. An alternative to Kohn-Sham theory is to express the energy as a functional of the reduced first-order density matrix or equivalently the natural orbitals. In the former approach the unknown part of the functional contains both a kinetic and a potential contribution whereas in the latter approach it contains only a potential energy and consequently has simpler scaling properties. We present an approximate, simple and parameter-free functional of the natural orbitals, based solely on scaling arguments and the near satisfaction of a sum rule. Our tests on atoms show that it yields on average more accurate energies and charge densities than the Hartree Fock method, the local density approximation and the generalized gradient approximations

Improved tensor-product expansions for the two-particle density matrix

We present a new density-matrix functional within the recently introduced framework for tensor-product expansions of the two-particle density matrix. It performs well both for the homogeneous electron gas as well as atoms. For the homogeneous electron gas, it performs significantly better than all previous density-matrix functionals, becoming very accurate for high densities and outperforming Hartree-Fock at metallic valence electron densities. For isolated atoms and ions, it is on a par with previous density-matrix functionals and generalized gradient approximations to density-functional theory. We also present analytic results for the correlation energy in the low density limit of the free electron gas for a broad class of such functionals.Comment: 4 pages, 2 figure

Safety of Dry Needling of the Pronator Teres Muscle in Cadavers: A Potential Treatment for Pronator Syndrome

Background: Entrapment of the median nerve at the pronator teres muscle can contribute to symptoms in the forearm and wrist. The pronator teres is also involved in patterns of spasticity observed in people who had suffered a stroke. Research on treatment efficacy with dry needling is scarce. Objective: To determine if a solid filiform needle safely penetrates the pronator teres muscle during the clinical application of dry needling. Design: A cadaveric descriptive study. Methods: Needle insertion of the pronator teres was conducted in ten cryopreserved forearms with a 30*0.32 mm filiform needle. With the forearm supinated, the needle was inserted 3 cm distal to the mid-point between the biceps tendon insertion and the medial epicondyle. The needle was advanced in a cranial and medial direction to a depth clinically judged to be in the pronator teres muscle. Safety was assessed by measuring the distance from the needle to the surrounding neurovascular bundles. Results: Accurate needle penetration of the pronator teres was observed in 100% of the specimens (mean needle penetration: 16.7 ± 4.3 mm, 95%CI 13.6 to 19.7 mm). No neurovascular bundles were pierced in any of the specimen's forearms. The distances from the tip of the needle to the surrounding neurovascular bundles were 16.4 ± 3.9 mm (95%CI 13.6 to 19.2 mm) to the ulnar nerve (A), 9.0 ± 2.2 mm (95%CI 7.3 to 19.5 mm) to the median nerve (B), and 12.8 ± 4.0 mm (95%CI 10.0 to 15.7 mm) to brachial artery (C). Conclusion: The results from this cadaveric study support the assumption that needling of the pronator teres using described anatomical landmarks can be accurately and safely conducted by an experienced clinician

The value of competitive employment:In-depth accounts of people with intellectual disabilities

BackgroundIncreasing the societal participation of people with intellectual disabilities via competitive employment requires a full understanding of what this means to them. This paper aims to provide an in‐depth examination of the lived experiences of people with intellectual disabilities in competitive employment.MethodInterviews were conducted with six participants with mild intellectual disability or borderline functioning and good verbal communication skills. Interviews were analysed according to the guidelines of interpretative phenomenological analysis (IPA). Member checks were conducted.ResultsAnalysis yielded three main themes: (a) Building on my life experiences, (b) My place at work and (c) Being a valuable member of society, like everyone else.ConclusionsCompetitive employment could make a substantial contribution to the sense of belonging to society and quality of life of people with intellectual disabilities. Nevertheless, they must cope with stigma‐related obstacles and feelings of being dependent on others in the work environment

Phase transition from straight into twisted vortex-lines in dipolar Bose-Einstein condensates

The non-local non-linearity introduced by the dipole-dipole interaction plays a crucial role in the physics of dipolar Bose-Einstein condensates. In particular, it may distort significantly the stability of straight vortex lines due to the rotonization of the Kelvin-wave spectrum. In this paper we analyze this instability showing that it leads to a second-order-like phase transition from a straight vortex-line into novel helical or snake-like configurations, depending on the dipole orientation.Comment: 11 pages, 6 figures, Accepted for publication in New J. Phy

Observation of vortex formation in an oscillating trapped Bose-Einstein condensate

We report on the observation of vortex formation in a Bose-Einstein condensate of Rb-87 atoms. Vortices are generated by superimposing an oscillating excitation to the trapping potential introduced by an external magnetic field. For small amplitudes of the external excitation field we observe a bending of the cloud axis. Increasing the amplitude we observe formation of a growing number of vortices in the sample. Shot-to-shot variations in both vortex number and position within the condensed cloud are observed, probably due to the intrinsic vortex nucleation dynamics. We discuss the possible formation of vortices and anti-vortices in the sample as well as possible mechanisms for vortex nucleation.Comment: 1 figure added, text modified, accepted for publication Phys. Rev.

pfk13-Independent Treatment Failure in Four Imported Cases of Plasmodium falciparum Malaria Treated with Artemether-Lumefantrine in the United Kingdom.

We present case histories of four patients treated with artemether-lumefantrine for falciparum malaria in UK hospitals in 2015 to 2016. Each subsequently presented with recurrent symptoms and Plasmodium falciparum parasitemia within 6 weeks of treatment with no intervening travel to countries where malaria is endemic. Parasite isolates, all of African origin, harbored variants at some candidate resistance loci. No evidence of pfk13-mediated artemisinin resistance was found. Vigilance for signs of unsatisfactory antimalarial efficacy among imported cases of malaria is recommended

The physics of dipolar bosonic quantum gases

This article reviews the recent theoretical and experimental advances in the study of ultracold gases made of bosonic particles interacting via the long-range, anisotropic dipole-dipole interaction, in addition to the short-range and isotropic contact interaction usually at work in ultracold gases. The specific properties emerging from the dipolar interaction are emphasized, from the mean-field regime valid for dilute Bose-Einstein condensates, to the strongly correlated regimes reached for dipolar bosons in optical lattices.Comment: Review article, 71 pages, 35 figures, 350 references. Submitted to Reports on Progress in Physic