Prediction of discharge walking ability from initial assessment in a stroke inpatient rehabilitation facility population

Objectives: To (1) determine which clinical assessments at admission to an inpatient rehabilitation facility (IRF) most simply predict discharge walking ability, and (2) identify a clinical decision rule to differentiate household versus community ambulators at discharge from an IRF. Design: Retrospective cohort study. Setting: IRF. Participants: Two samples of participants (n=110 and 159) admitted with stroke. Interventions: A multiple regression determined which variables obtained at admission (age, time from stroke to assessment, Motricity Index, somatosensation, Modified Ashworth Scale, FIM, Berg Balance Scale, 10-m walk speed) could most simply predict discharge walking ability (10-m walk speed). A logistic regression determined the likelihood of a participant achieving household (= 0.4-0.8m/s; >0.8m/s) ambulation at the time of discharge. Validity of the results was evaluated on a second sample of participants. Main Outcome Measure: Discharge 10-m walk speed. Results: Admission Berg Balance Scale and FIM walk item scores explained most of the variance in discharge walk speed. The odds ratio of achieving only household ambulation at discharge was 20 (95% confidence interval [CI], 6-63) for sample I and 32 (95% CI, 10-96) for sample 2 when the combination of having a Berg Balance Scale score of <= 20 and a FIM walk item score of 1 or 2 was present. Conclusions: A Berg Balance Scale score of <= 20 and a FIM walk item score of 1 or 2 at admission indicates that a person with stroke is highly likely to only achieve household ambulation speeds at discharge from an IRF

Experimental Study into the Stability of Whitlockite in Basaltic Magmas

Apatite Ca5(PO4)3(F,Cl,OH), merrillite Ca18Na2Mg2(PO4)14, and whitlockite Ca9(Mg,Fe2+)(PO4)6[PO3(OH)] are the primary phosphate minerals found in most planetary materials including rocks from Earth, Moon, Mars, and asteroids [1-2]. For many years, the terms merrillite and whitlockite have been used interchangeably in the meteorite literature. Much of the confusion regarding the relationship between terrestrial and extraterrestrial "whitlockite" is based on the presence or absence of hydrogen in the mineral structure. Whitlockite has approximately 8500 ppm H2O, and the term "merrillite" has been adopted to identify the hydrogen-free form of whitlockite [2]. The atomic structures of merrillite and whitlockite were examined in detail by Hughes et al. [3-4]. On Earth, whitlockite has been found in rocks from evolved pegmatitic systems [2-4] and in some mantle rocks [e.g., 5]. Furthermore, terrestrial whitlockite has been shown to have some merrillite component [4]. For the meteoritic and lunar materials that have been investigated, merrillite appears to be far more common than whitlockite, and it has been proposed that the whitlockite component is unique to terrestrial samples [4]. There are some reports of "whitlockite" in the meteorite literature; however, these likely represent misidentifications of merrillite because there have been no reports of extraterrestrial whitlockite that have been verified through crystal structural studies or analyzed for their H contents. Hughes et al. [3] reported the atomic arrangement of lunar merrillite and demonstrated that the phase is similar to meteoritic merrillite and, predictably, devoid of hydrogen. In a follow-up study, Hughes et al. [4] reported the atomic arrangements of two natural samples of whitlockite, one synthetic whitlockite, and samples of synthetic whitlockite that were heated at 500degC and 1050degC for 24 h. The crystal chemistry and crystal structures of the phases were compared, and it was discovered that the latter treatment resulted in the dehydrogenation of whitlockite to form merrillite. The presence of merrillite vs. whitlockite was widely thought to serve as an indication that magmas were anhydrous [e.g., 6-7]. However, McCubbin et al., [8] determined that merrillite in the martian meteorite Shergotty had no discernible whitlockite component despite its coexistence with OH-rich apatite. Consequently, McCubbin et al., (2014) speculated that the absence of a whitlockite component in Shergotty merrillite and other planetary merrillites may be a consequence of the limited thermal stability of H in whitlockite (stable only at T less than1050degC), which would prohibit merrillite-whitlockite solid-solution at high temperatures. In the present study, we have aimed to test this hypothesis experimentally by examining the stability of whitlockite in basaltic magmas at 1.2 GPa and a temperature range of -1000- 1300degC

Renal Stone Risk During Space Flight: Assessment and Countermeasure Validation

NASA has focused its future on exploration class missions including the goal of returning to the moon and landing on Mars. With these objectives, humans will experience an extended exposure to the harsh environment of microgravity and the associated negative effects on all the physiological systems of the body. Exposure to microgravity affects human physiology and results in changes to the urinary chemical composition during and after space flight. These changes are associated with an increased risk of renal stone formation. The development of a renal stone would have health consequences for the crewmember and negatively impact the success of the mission. As of January 2007, 15 known symptomatic medical events consistent with urinary calculi have been experienced by 13 U.S. astronauts and Russian cosmonauts. Previous results from both MIR and Shuttle missions have demonstrated an increased risk for renal stone formation. These data have shown decreased urine volume, urinary pH and citrate levels and increased urinary calcium. Citrate, an important urinary inhibitor of calcium-containing renal stones binds with calcium in the urine, thereby reducing the amount of calcium available to form calcium oxalate stones. Urinary citrate also prevents calcium oxalate crystals from aggregating into larger crystals and into renal stones. In addition, citrate makes the urine less acidic which inhibits the development of uric acid stones. Potassium citrate supplementation has been successfully used to treat patients who have formed renal stones. The evaluation of potassium citrate as a countermeasure has been performed during the ISS Expeditions 3-6, 8, 11-13 and is currently in progress during the ISS Expedition 14 mission. Together with the assessment of stone risk and the evaluation of a countermeasure, this investigation provides an educational opportunity to all crewmembers. Individual urinary biochemical profiles are generated and the risk of stone formation is estimated. Increasing fluid intake is recommended to all crewmembers. These results can be used to lower the risk for stone formation through lifestyle, diet changes or therapeutic administration to minimize the risk for stone development. With human presence in microgravity a continuing presence and exploration class missions being planned, maintaining the health and welfare of all crewmembers is critical to the exploration of space

The brain recovery core: Building a system of organized stroke rehabilitation and outcomes assessment across the continuum of care

none10siThis Special Interest article describes a multidisciplinary, interinstitutional effort to build an organized system of stroke rehabilitation and outcomes measurement across the continuum of care. This system is focused on a cohort of patients who are admitted with the diagnosis of stroke to our acute facility, are discharged to inpatient and/or outpatient rehabilitation at our free-standing facility, and are then discharged to the community. This article first briefly explains the justification, goals, and purpose of the Brain Recovery Core system. The next sections describe its development and implementation, with details on the aspects related to physical therapy. The article concludes with an assessment of how the Brain Recovery Core system has changed and improved delivery of rehabilitation services. It is hoped that the contents of this article will be useful in initiating discussions and potentially facilitating similar efforts among other centers.mixedLang, Catherine E.; Bland, Marghuretta D.; Connor, Lisa Tabor; Fucetola, Robert; Whitson, Michelle; Edmiaston, Jeff; Karr, Clayton; Sturmoski, Audra; Baty, Jack; Corbetta, MaurizioLang, Catherine E.; Bland, Marghuretta D.; Connor, Lisa Tabor; Fucetola, Robert; Whitson, Michelle; Edmiaston, Jeff; Karr, Clayton; Sturmoski, Audra; Baty, Jack; Corbetta, Maurizi

Sports mega-events – three sites of contemporary political contestation

This article discusses the contemporary politics of sports mega-events, involving the Olympic Games and Fédération Internationale de Football Association (FIFA) Men’s Football World Cup Finals as well as other lower ‘order’ sports megas, taking two main forms: the promotional and the protest. There is a politics in, and a politics of, sports mega-events. The former focuses on the internal politics of the organizing bodies, such as the International Olympic Committee and FIFA. This form of politics has been written about elsewhere, and hence, there is no detailed discussion in this article about it. Instead this article offers a brief discussion of the range and number of sports mega-events since 2000, an assessment of the contemporary politics of sports mega-events, a focus on three main sites of political contestation – rights, legacy and labour, and finally, it offers conclusions about research into the politics of sports mega-events

Clinician adherence to a standardized assessment battery across settings and disciplines in a poststroke rehabilitation population

none12siObjectives: (1) To examine clinician adherence to a standardized assessment battery across settings (acute hospital, inpatient rehabilitation facilities [IRFs], outpatient facility), professional disciplines (physical therapy [PT], occupational therapy, speech-language pathology), and time of assessment (admission, discharge/monthly), and (2) to evaluate how specific implementation events affected adherence. Design: Retrospective cohort study. Setting: Acute hospital, IRF, and outpatient facility with approximately 118 clinicians (physical therapists, occupational therapists, speech-language pathologists). Participants: Participants (N=2194) with stroke who were admitted to at least 1 of the above settings. All persons with stroke underwent standardized clinical assessments. Interventions: Not applicable. Main Outcome Measures: Adherence to Brain Recovery Core assessment battery across settings, professional disciplines, and time. Visual inspections of 17 months of time-series data were conducted to see if the events (eg, staff meetings) increased adherence >= 5% and if so, how long the increase lasted. Results: Median adherence ranged from .52 to .88 across all settings and professional disciplines. Both the acute hospital and the IRF had higher adherence than the outpatient setting (P = 5% increase in adherence the following month, with 6 services (60%) maintaining their increased level of adherence for at least 1 additional month. Conclusions: Actual adherence to a standardized assessment battery in clinical practice varied across settings, disciplines, and time. Specific events increased adherence 40% of the time with those gains maintained for >1 month 60% of the time. (C) 2013 by the American Congress of Rehabilitation MedicinemixedBland, Marghuretta D.; Sturmoski, Audra; Whitson, Michelle; Harris, Hilary; Connor, Lisa Tabor; Fucetola, Robert; Edmiaston, Jeff; Huskey, Thy; Carter, Alexandre; Kramper, Marian; Corbetta, Maurizio; Lang, Catherine E.Bland, Marghuretta D.; Sturmoski, Audra; Whitson, Michelle; Harris, Hilary; Connor, Lisa Tabor; Fucetola, Robert; Edmiaston, Jeff; Huskey, Thy; Carter, Alexandre; Kramper, Marian; Corbetta, Maurizio; Lang, Catherine E

Cardiac and Vascular Responses to Thigh Cuffs and Respiratory Maneuvers on Crewmembers of the International Space Station

The transition to microgravity eliminates the hydrostatic gradients in the vascular system. The resulting fluid redistribution commonly manifests as facial edema, engorgement of the external neck veins, and a decrease in leg diameter. This experiment examined the responses to modified Valsalva and Mueller maneuvers measured by cardiac and vascular ultrasound (ECHO) in a baseline steady state and during preload reduction introduced with thigh occlusion cuffs used as a counter-measure device (Braslet cuffs) measured by cardiac and vascular ultrasound examinations. Methods: Nine International Space Station crewmember subjects (Expeditions 16 - 20) were examined in 15 experiment sessions 101 +/- 46.days after launch (mean +/- SD; 33 - 185). Twenty Seven cardiac and vascular parameters were obtained with/without respiratory maneuvers before and after tightening of the Braslet cuffs. Results: Non-physicians performed diagnostic-quality cardiac and vascular ultrasound examinations using remote guidance. Three of 27 combinations of maneuvers and Braslet or Braslet alone were identified as being significant changed when compared to baseline. Eleven of 81 differences between combinations of Mueller, Valsalva or baseline were significant and related to cardiac preload reduction or increase in lower extremity venous volume. Conclusions: Acute application of Braslet occlusion cuffs causes lower extremity fluid sequestration and exerts commensurate measurable effects on cardiac performance in microgravity. Ultrasound techniques to measure the hemodynamic effects of thigh cuffs in combination with respiratory maneuvers may serve as an invaluable tool in determining the volume status of the cardiac patient at the 'microgravity bedside'

Mapping Planetary Volcanic Deposits: Identifying Vents and Distingushing between Effects of Eruption Conditions and Local Lava Storage and Release on Flow Field Morphology

Terrestrial geologic mapping techniques are regularly used for "photogeologic" mapping of other planets, but these approaches are complicated by the diverse type, areal coverage, and spatial resolution of available data sets. When available, spatially-limited in-situ human and/or robotic surface observations can sometimes introduce a level of detail that is difficult to integrate with regional or global interpretations. To assess best practices for utilizing observations acquired from orbit and on the surface, our team conducted a comparative study of geologic mapping and interpretation techniques. We compared maps generated for the same area in the San Francisco Volcanic Field (SFVF) in northern Arizona using 1) data collected for reconnaissance before and during the 2010 Desert Research And Technology Studies campaign, and 2) during a traditional, terrestrial field geology study. The operations, related results, and direct mapping comparisons are discussed in companion LPSC abstracts [1-3]. Here we present new geologic interpretations for a volcanic cone and related lava flows as derived from all approaches involved in this study. Mapping results indicate a need for caution when interpreting past eruption conditions on other planetary surfaces from orbital data alone

Comparing and Reconciling Traditional Field and Photogeologic Mapping Techniques: Lessons from the San Francisco Volcanic Field, Arizona

Cartographic products and - specifically - geologic maps provide critical assistance for establishing physical and temporal frameworks of planetary surfaces. The technical methods that result in the creation of geologic maps vary depending on how observations are made as well as the overall intent of the final products [1-3]. These methods tend to follow a common linear work flow, including the identification and delineation of spatially and temporally discrete materials (units), the documentation of their primary (emplacement) and secondary (erosional) characteristics, analysis of the relative and absolute age relationships between these materials, and the collation of observations and interpretations into an objective map product. The "objectivity" of a map is critical cross comparison with overlapping maps and topical studies as well as its relevance to scientific posterity. However, the "accuracy" and "correctness" of a geologic map is very subject to debate. This can be evidenced by comparison of existing geologic maps at various scales, particularly those compiled through field- and remote-based mapped efforts. Our study focuses on comparing the fidelity of (1) "Apollo-style" geologic investigations, where typically non-geologist crew members follow static traverse routes established through pre-mission planning, and (2) "traditional" field-based investigations, where geologists are given free rein to observe without preplanned routes. This abstract summarizes the regional geology wherein our study was conducted, presents the geologic map created from traditional field mapping techniques, and offers basic insights into how geologic maps created from different tactics can be reconciled in support of exploratory missions. Additional abstracts [4-6] from this study discuss various exploration and science results of these efforts

Mapping Planetary Volcanic Deposits: Identifying Vents and Distinguishing between Effects of Eruption Conditions and Local Storage and Release on Flow Field Morphology

Terrestrial geologic mapping techniques are regularly used for "photogeologic" mapping of other planets, but these approaches are complicated by the diverse type, areal coverage, and spatial resolution of available data sets. When available, spatially-limited in-situ human and/or robotic surface observations can sometimes introduce a level of detail that is difficult to integrate with regional or global interpretations. To assess best practices for utilizing observations acquired from orbit and on the surface, our team conducted a comparative study of geologic mapping and interpretation techniques. We compared maps generated for the same area in the San Francisco Volcanic Field (SFVF) in northern Arizona using 1) data collected for reconnaissance before and during the 2010 Desert Research And Technology Studies campaign, and 2) during a traditional, terrestrial field geology study. The operations, related results, and direct mapping comparisons are discussed in companion LPSC abstracts. Here we present new geologic interpretations for a volcanic cone and related lava flows as derived from all approaches involved in this study. Mapping results indicate a need for caution when interpreting past eruption conditions on other planetary surfaces from orbital data alone