GAIT TRAINING WITH AUDITORY RHYTHMS AND INSTRUCTIONS IN CHRONIC STROKE

During walking in healthy adults, characteristic movement patterns between the upper and lower body relate directly to walking velocity. In persons who suffer a stroke, walking velocity decreases as motor deficits appear in both the arm and leg opposite the side of the stroke. Recent findings indicate that treadmill walking to a metronome beat impacts arm motion, however, the effect is dependent on the severity of motor deficits. The changes in arm motion lead to changes that are indicative of improvements in overall walking function. The purpose of this project is to determine the efficacy of over-ground gait training using an external auditory rhythm directed at arm movement versus leg movement on improving movement coordination, walking velocity, and daily physical activity in persons who have suffered a stroke

Thermoelectric response of Fe1+y_{1+y}Te0.6_{0.6}Se0.4_{0.4}: evidence for strong correlation and low carrier density

We present a study of the Seebeck and Nernst coefficients of Fe$_{1+y}$Te$_{1-x}$Se$_{x}$ extended up to 28 T. The large magnitude of the Seebeck coefficient in the optimally doped sample tracks a remarkably low normalized Fermi temperature, which, like other correlated superconductors, is only one order of magnitude larger than T$_c$. We combine our data with other experimentally measured coefficients of the system to extract a set of self-consistent parameters, which identify Fe$_{1+y}$Te$_{0.6}$Se$_{0.4}$ as a low-density correlated superconductor barely in the clean limit. The system is subject to strong superconducting fluctuations with a sizeable vortex Nernst signal in a wide temperature window.Comment: 4 pages including 4 figure

Electron-impact excitation of X 1Sigma_g⁺(v[double-prime]=0) to the a[double-prime] 1Sigma_g⁺, b 1Piu, c3 1Piu, o3 1Piu, b[prime] 1Sigma_u⁺, c₄^[prime] 1Sigma_u⁺, G 3Piu, and F 3Piu states of molecular nitrogen

Measurements of differential cross sections (DCSs) for electron-impact excitation of the a[double-prime] 1Sigmag+, b 1Piu, c3 1Piu, o3 1Piu, b[prime] 1Sigmau+, c4[prime] 1Sigmau+, G 3Piu, and F 3Piu states in N2 from the X 1Sigmag+(v[double-prime]=0) ground level are presented. The DCSs were obtained from energy-loss spectra in the region of 12 to 13.82 eV measured at incident energies of 17.5, 20, 30, 50, and 100 eV and for scattering angles ranging from 2° to 130°. The analysis of the spectra follows a different algorithm from that employed in a previous study of N2 for the valence states [Khakoo et al. Phys. Rev. A 71, 062703 (2005)], since the 1Piu and 1Sigmau+ states form strongly interacting Rydberg-valence series. The results are compared with existing data

Experimental Validation of Methods for Prophylaxis against Deep Venous Thrombosis: A Review and Proposal

The experimental procedure by which the valve cusp hypoxia (VCH) hypothesis of the etiology of deep venous thrombosis (DVT) was confirmed lends itself to testing of methods of prophylaxis. Similar animal experiments could end the present exclusive reliance on statistical analysis of data from large patient cohorts to evaluate prophylactic regimes. The reduction of need for such (usually retrospective) analyses could enable rationally-based clinical trials of prophylactic methods to be conducted more rapidly, and the success of such trials would lead to decreased incidences of DVT-related mortality and morbidity. This paper reviews the VCH hypothesis (“VCH thesis”, following its corroboration) and its implications for understanding DVT and its sequelae, and outlines the experimental protocol for testing prophylactic methods. The advantages and limitations of the protocol are briefly discussed

Case Study: The Surgical Management of Angiokeratoma Resulting from Radiotherapy for Penile Cancer

Angiokeratoma is a rare, benign skin lesion and a recognised complication of radiation therapy. Here we describe a case of extensive angiokeratoma of the groin and external genitalia resulting from external beam radiation to that area in a patient with penile carcinoma. Furthermore, we outline the management of this problem by surgical reconstruction

Absorbent products for urinary/faecal incontinence: a comparative evaluation of key product designs

Background: The UK health service, nursing homes and public spend around £94 million per year on incontinence pads (absorbent products) to contain urine and/or faeces, but the research base for making informed choices between different product designs is very weak.Objectives: The aim of this trial was to compare the performance and cost-effectiveness of the key absorbent product designs to provide a more solid basis for guiding selection and purchase.A further aim was to carry out the first stage in the development of a quality of life instrument for measuring the impact of absorbent product use on users' lives.Design: The work involved three clinical trials focusing on the three biggest market sectors. Each trial had a similar crossover design in which each participant tested all products within their group in random order.Settings, participants and methods: In Trial 1, 85 women with light urinary incontinence living in the community tested three products from each of the four design categories available (total of 12 test products): disposable inserts (pads); menstrual pads; washable pants with integral pad; and washable inserts. In Trial 2a, 85 moderate/heavily incontinent adults (urinary or urinary/faecal) living in the community (49 men and 36 women) tested three (or two) products from each of the five design categories available (total of 14 test products): disposable inserts (with mesh pants); disposable diapers (nappies); disposable pull-ups (similar to toddlers' trainer pants); disposable T-shaped diapers (nappies with waist-band); and washable diapers. All products were provided in a daytime and a (mostly more absorbent) night-time variant. In these first two trials, the test products were selected on the basis of data from pilot studies. In Trial 2b, 100 moderate/heavily incontinent adults (urinary or urinary/faecal) living in 10 nursing homes (27 men and 73 women) evaluated one product from each of the four disposable design categories from Trial 2a. Products were selected on the basis of product performance in Trial 2a and, again, daytime and night-time variants were provided. The first phase of work to develop a quality of life tool for measuring the impact of using different pad designs was carried out by interviewing participants from Trials 1 and 2a.Outcome measures: Product performance was characterised using validated questionnaires, which asked the participants (in Trials 1 and 2a) or carers (all participants in Trial 2b, except for the few who could report for themselves) to evaluate various aspects of pad performance (leakage, ease of putting on, discreetness, etc.) using a five-point scale (very good–very poor) at the end of the week (or 2 weeks for Trial 2b) of product testing. In addition, participants/carers were asked to save individual used pads in bags for weighing and to indicate the severity of any leakage from them on a three-point scale (none, a little, a lot). These data were used to determine differences in leakage performance. Numbers of laundry items and pads used were recorded to estimate costs, and skin health changes were recorded by the participant or by the researchers (Trial 2b). At the end of testing, participants were interviewed and ranked their preferences (with and without costs), stated the acceptability of each design (highly acceptable–totally unacceptable) and recorded their overall opinion on a visual analogue scale (VAS) of 0–100 points (worst design–best design). This VAS score was used with product costs to estimate cost-effectiveness. In addition, a timed pad changing exercise was conducted with 10 women from Trial 2b to determine any differences between product designs.Results: Results presented are for statistically and clinically significant findings.<br/

The Attorney-Client Privilege and the Work-Product Doctrine in Michigan

In Upjohn Co v. United States, the United States Supreme Court acknowledged that the attorney-client privilege - the oldest of the privileges for confidential communications known to the common law - has the crucial purpose of encourag[ing] full and frank communication between attorneys and their clients and thereby promote[s] broader public interests in the observance of law and administration of justice. Similarly, in Hickman v Taylor, the Court stressed the importance of the work-product doctrine, noting that [n]ot even the most liberal of discovery theories can justify unwarranted inquiries into the files and the mental impressions of an attorney. It is beyond question that, at a theoretical level, the attorney-client privilege and the work-product doctrine serve significant interests and that, at a practical level, attorneys constantly encounter issues involving these principles. Nevertheless, many attorneys do not acquire their familiarity with these crucial principles in any systematic way. Law school courses and casebooks often treat these principles superficially, and busy practicing lawyers tend to research specific issues only as they arise in the course of their work. As a result, many attorneys (and perhaps some judges) may not clearly understand the significance, scope, and limits of these doctrines. This publication is an attempt to solve this problem by offering a systematic and thorough examination of the attorney-client privilege and the work-product doctrine under Michigan law. Part II of this text addresses the attorney-client privilege; Part III addresses the work-product doctrine; and Part IV addresses ethics concepts of confidences and secrets. Wherever possible, Michigan authority has been cited and quoted. In some instances, federal cases are instructive in interpreting Michigan law or in filling an apparent gap in Michigan law; under those circumstances, the text freely cites and quotes from federal authority. The goal is to provide a comprehensive examination of these principles as interpreted by the Michigan courts.https://repository.law.umich.edu/books/1117/thumbnail.jp

A case study evaluation of implementation of a care pathway to support normal birth in one English birth centre: anticipated benefits and unintended consequences

Background: The policy drive for the UK National Health Service (NHS) has focused on the need for high quality services informed by evidence of best practice. The introduction of care pathways and protocols to standardise care and support implementation of evidence into practice has taken place across the NHS with limited evaluation of their impact. A multi-site case study evaluation was undertaken to assess the impact of use of care pathways and protocols on clinicians, service users and service delivery. One of the five sites was a midwifery-led Birth Centre, where an adapted version of the All Wales Clinical Pathway for Normal Birth had been implemented. Methods: The overarching framework was realistic evaluation. A case study design enabled the capture of data on use of the pathway in the clinical setting, use of multiple methods of data collection and opportunity to study and understand the experiences of clinicians and service users whose care was informed by the pathway. Women attending the Birth Centre were recruited at their 36 week antenatal visit. Episodes of care during labour were observed, following which the woman and the midwife who cared for her were interviewed about use of the pathway. Interviews were also held with other key stakeholders from the study site. Qualitative data were content analysed. Results: Observations were undertaken of four women during labour. Eighteen interviews were conducted with clinicians and women, including the women whose care was observed and the midwives who cared for them, senior midwifery managers and obstetricians. The implementation of the pathway resulted in a number of anticipated benefits, including increased midwifery confidence in skills to support normal birth and promotion of team working. There were also unintended consequences, including concerns about a lack of documentation of labour care and negative impact on working relationships with obstetric and other midwifery colleagues. Women were unaware their care was informed by a care pathway. Conclusion: Care pathways are complex interventions which generate a number of consequences for practice. Those considering introduction of pathways need to ensure all relevant stakeholders are engaged with this and develop robust evaluation strategies to accompany implementation