Abdominal functional electrical stimulation to enhance mechanical insufflation-exsufflation

Context: Respiratory complications, attributed to the build-up of secretions in the airway, are a leading cause of rehospitalisation for the tetraplegic population. Previously, we observed that the application of Abdominal Functional Electrical Stimulation (AFES) improved cough function and increased demand for secretion removal, suggesting AFES may aid secretion clearance. Clinically, secretion clearance is commonly achieved by using Mechanical insufflation-exsufflation (MI-E) to simulate a cough. In this study the feasibility of combining AFES with MI-E is evaluated. Findings: AFES was successfully combined with MI-E at eight fortnightly assessment sessions conducted with one sub-acute participant with tetraplegia. By using the signal from a pressure sensor, integrated with the MI-E device, AFES was correctly applied in synchrony with MI-E with an accuracy of 96.7%. Acute increases in exhaled volume and peak flow were observed during AFES assisted MI-E, compared to MI-E alone, at six of eight assessment sessions. Conclusion: The successful integration of AFES with MI-E at eight assessment sessions demonstrates the feasibility of this technique. The acute increases in respiratory function observed at the majority of assessment sessions generate the hypothesis that AFES assisted MI-E may be more effective for secretion clearance than MI-E alone

A model for incorporating a clinically-feasible exercise test in paraplegic annual reviews : a tool for stratified cardiopulmonary stress performance classification and monitoring

To identify and characterize an exercise test for use in routine spinal cord injury clinical review, and (ii) to describe levels of, and factors affecting, cardiopulmonary stress performance during exercise in the chronic paraplegic population in Scotland, UK. Cross-sectional study Queen Elizabeth National Spinal Injuries Unit (Glasgow, Scotland) 48 subjects with chronic paraplegia resulting from spinal cord injury at neurological levels T2-L2 Peak oxygen uptake, peak power output, gas exchange threshold and peak heart rate were determined from an incremental arm-cranking exercise test. Using a general linear model, the effects of gender, high (injury level above T6) versus low paraplegia, time since injury, body mass and age on peak oxygen uptake and peak power output were investigated. All 48 subjects completed the arm-cranking exercise test, which was shown to be practical for fitness screening in paraplegia. Men (n=38) had a peak oxygen uptake of 1.302 +/- 0.326 l.min-1 (mean +/- s.d.) and peak power output of 81.6 +/- 23.2W, which was significantly higher than for women (n=10), at 0.832 +/- 0.277 l.min-1 and 50.1 +/- 27.8 W, respectively. There was large intersubject variability in cardiopulmonary performance during arm-cranking exercise testing, but the overall mean for the Scottish population was lower than reference values from other countries. Arm-cranking exercise tests are feasible in the clinical environment. The motivation for their implementation is threefold: (i) to determine cardiopulmonary stress performance of individual paraplegic patients, (ii) to stratify patients into cardiovascular risk categories, and (iii) to monitor the effects of targeted exercise prescription

Abdominal functional electrical stimulation to assist ventilator weaning in acute tetraplegia: a cohort study

Background Severe impairment of the major respiratory muscles resulting from tetraplegia reduces respiratory function, causing many people with tetraplegia to require mechanical ventilation during the acute stage of injury. Abdominal Functional Electrical Stimulation (AFES) can improve respiratory function in non-ventilated patients with sub-acute and chronic tetraplegia. The aim of this study was to investigate the clinical feasibility of using an AFES training program to improve respiratory function and assist ventilator weaning in acute tetraplegia.<p></p> Methods AFES was applied for between 20 and 40 minutes per day, five times per week on four alternate weeks, with 10 acute ventilator dependent tetraplegic participants. Each participant was matched retrospectively with a ventilator dependent tetraplegic control, based on injury level, age and sex. Tidal Volume (VT) and Vital Capacity (VC) were measured weekly, with weaning progress compared to the controls.<p></p> Results Compliance to training sessions was 96.7%. Stimulated VT was significantly greater than unstimulated VT. VT and VC increased throughout the study, with mean VC increasing significantly (VT: 6.2 mL/kg to 7.8 mL/kg VC: 12.6 mL/kg to 18.7 mL/kg). Intervention participants weaned from mechanical ventilation on average 11 (sd: ± 23) days faster than their matched controls.<p></p> Conclusion The results of this study indicate that AFES is a clinically feasible technique for acute ventilator dependent tetraplegic patients and that this intervention may improve respiratory function and enable faster weaning from mechanical ventilation.<p></p&gt

What drives me there? The interplay of socio-psychological gratification and consumer values in social media brand engagement

The social behavioral perspective is under-researched in the extant literature. This hinders the holistic understanding of social media brand engagement. This study examines the interplay of socio-psychological gratification variables (perceived homophily, perceived critical mass, and self-status seeking) and consumer values (personal, interpersonal, and fun) on consumer participation in social media brand engagement. The conceptual model in this study is situated on the principles of Uses and Gratifications, Critical Mass, Homophily, and Values theories. Based on an online survey of 713 Facebook users, we examine the model using structural equation modeling (with Amos 23.0). The analysis disclosed insights on the interplay of motivational factors that underlie social media brand engagement. Our findings suggest that socio-psychological gratification variables (perceived homophily, perceived critical mass, and self-status seeking) drive consumers’ engagement with brand pages and brand communities on social media. This relationship is strengthened by the consumer values. These insights serve as an important basis for researchers and practitioners to understand social media brand engagement and its outcomes

Predicting patient-specific rates of bone loss at fracture-prone sites after spinal cord injury

People with spinal cord injury (SCI) experience bone loss and have an elevated rate of fracture in the paralysed limbs. The literature suggests an exponential time course of bone loss after SCI, but true rates may vary between patients. We propose systematic evaluation of bone status in the early stages of SCI to identify fast bone losers. A case series of six patients with complete SCI were scanned using peripheral quantitative computed tomography within 5 weeks and at 4, 8 and 12 months post-injury. Bone mineral density (BMD) and bone mineral content (BMC) were measured at fracture-prone sites in the tibia and femur. Patient-specific-predictions (PSP) of expected rates of bone loss were produced by individualising published model equations according to each patient’s measured values at baseline. Wilcoxon Signed-Rank tests were used to identify changes between time-points; chi-squared tests for differences between measured and PSP values. In the lower limbs, mean values decreased significantly between baseline and 8 months post-injury, by 19–31% for trabecular BMD, 21–32% for total BMD, and 9–29% for BMC. Most subjects showed no significant differences between PSP and measured values, but individuals with significantly faster rates of bone loss than predicted should be investigated further. There was considerable intersubject variability in rates of bone loss after SCI. Patients showing the fastest bone loss could benefit from continued follow-up and possibly treatment

Comparison of blood smear microscopy to a rapid diagnostic test for in-vitro testing for P. Falciparum malaria in Kenyan school children

Objective: To compare the diagnostic performance of microscopy using Giemsastained thick and thin blood smears to a rapid malaria dipstick test (RDT) in detecting P. falciparum malaria in Kenyan school children. Design: Randomised, controlled feeding intervention trial from 1998-2001. Setting: Rural Embu district, Kenya. The area is considered endemic for malaria, with four rainy seasons per year. Chloroquine resistance was estimated in 80% of patients. Children had a spleen rate of 45%. Subjects: A sample of 515 rural Kenyan primary school children, aged 7-11 years, who were enrolled in a feeding intervention trial from 1998-2001. Main outcome measures: Percent positive and negative P. falciparum malaria status, sensitivity, specificity and positive and negative predictive values of RDT. Results: For both years, the RDT yielded positive results of 30% in children compared to microscopy (17%). With microscopy as the “gold standard,” RDT yielded a sensitivity of 81.3% in 1998 and 79.3% in 2000. Specificity was 81.6% in 1998 and 78.3% in 2000. Positive predictive value was 47.3% in 1998 and 42.6% in 2000, and negative predictive value was 95.6% in 1998 and 94.9% in 2000. Conclusion: Rapid diagnostic testing is a valuable tool for diagnosis and can shorten the interval for starting treatment, particularly where microscopy may not be feasible due to resource and distance limitations. East African Medical Journal Vol. 85 (11) 2008: pp. 544-54

Decreases in bone mineral density at cortical and trabecular sites in the tibia and femur during the first year of spinal cord injury

Background: Disuse osteoporosis occurs in response to long-term immobilization. Spinal cord injury (SCI) leads to a form of disuse osteoporosis that only affects the paralyzed limbs. High rates of bone resorption after injury are evident from decreases in bone mineral content (BMC), which in the past have been attributed in the main to loss of trabecular bone in the epiphyses and cortical thinning in the shaft through endocortical resorption. Methods: Patients with motor-complete SCI recruited from the Queen Elizabeth National Spinal Injuries Unit (Glasgow, UK) were scanned within 5. weeks of injury (baseline) using peripheral Quantitative Computed Tomography (pQCT). Unilateral scans of the tibia, femur and radius provided separate estimates of trabecular and cortical bone parameters in the epiphyses and diaphyses, respectively. Using repeat pQCT scans at 4, 8 and 12. months post-injury, changes in BMC, bone mineral density (BMD) and cross-sectional area (CSA) of the bone were quantified. Results: Twenty-six subjects (5 female, 21 male) with SCI (12 paraplegic, 14 tetraplegic), ranging from 16 to 76. years old, were enrolled onto the study. Repeated-measures analyses showed a significant effect of time since injury on key bone parameters at the epiphyses of the tibia and femur (BMC, total BMD, trabecular BMD) and their diaphyses (BMC, cortical BMD, cortical CSA). There was no significant effect of gender or age on key outcome measures, but there was a tendency for the female subjects to experience greater decreases in cortical BMD. The decreases in cortical BMD in the tibia and femur were found to be statistically significant in both men and women. Conclusions: By carrying out repeat pQCT scans at four-monthly intervals, this study provides a uniquely detailed description of the cortical bone changes that occur alongside trabecular bone changes in the first year of complete SCI. Significant decreases in BMD were recorded in both the cortical and trabecular bone compartments of the tibia and femur throughout the first year of injury. This study provides evidence for the need for targeted early intervention to preserve bone mass within this patient group

Five supernova survey galaxies in the southern hemisphere. II. The supernova rates

Based on the database compiled in the first article of this series, with 56 SN events discovered in 3838 galaxies of the southern hemisphere, we compute the rate of supernovae (SNe) of different types along the Hubble sequence normalized to the optical and near-infrared luminosities as well as to the stellar mass of the galaxies. We find that the rates of all SN types show a dependence on both morphology and colors of the galaxies, and therefore, on the star-formation activity. The rate of core-collapse (CC) SNe is confirmed to be closely related to the Star Formation Rate (SFR) and only indirectly to the total mass of the galaxies. The rate of SNe Ia can be explained by assuming that at least 15% of Ia events in spiral galaxies originates in relatively young stellar populations. We find that the rates show no modulation with nuclear activity or environment. The ratio of SN rates between types Ib/c and II shows no trend with spiral type.Comment: 13 pages, 2 figures, 5 tables, published in Astrophysics (English translation of Astrofizika

Electronic Band Structure of the Two-Dimensional Surface-State Bands of the (1×1) and (1×2) Phases of Bi/GaSb(110)

The surface-state bands of the (1×1) and (1×2) phases of Bi/GaSb(110) have been probed using angle-resolved ultraviolet photoemission spectroscopy with synchrotron radiation. Four Bi-induced surface-state bands have been identified for both the (1×1) and the (1×2) phases. The bands with the lowest binding energies (SI and SII) have been attributed to intrachain bonding in the Bi overlayer and the higher-binding-energy bands (SIII and SIV) to overlayer states involved in the back bonding of the overlayer to the substrate. Based on initial-state dispersion measurements, we conclude that the Bi chains in the epitaxial overlayer remain intact throughout the phase transition. We propose a model for the overlayer structure of the (1×2) phase of Bi/GaSb(110)