Efficacy of Continuous Passive Motion after Total Knee Arthroplasty in Veteran Patients

Since the early 1980s, continuous passive motion has been used as adjunct therapy in patients’ rehabilitation following total knee arthroplasty. Although existing literature challenged the benefits of continuous passive motion claiming it had no added short-term or long-term benefits after knee arthroplasty (Boese et al., 2014; Chen et al., 2012; Herbold et al., 2014; Leach et al., 2006; Maniar et al., 2012), the existing literature is difficult to generalize and apply to the veteran population at San Francisco Veterans Affairs Medical Center. This study was undertaken to determine the efficacy of continuous passive motion in helping veteran patients at San Francisco Veterans Affairs Medical Center achieve post-operative range of motion goals following total knee arthroplasty. Using a retrospective design an extensive chart review was conducted. Analysis of Variance (ANOVA) with time as a repeated measure independent variable, continuous passive motion as a between-subjects independent variable, and extension/flexion as dependent variables was conducted. For extension, time was statistically significant (p \u3c .001) but mean extension did not differ between continuous passive motion and no continuous passive motion (p = .976). Similarly, for flexion, time was statistically significant (p \u3c .001) but mean flexion did not differ between continuous passive motion and no continuous passive motion (p = .128). Therefore, this research is consistent with current literature, which claims that continuous passive motion does not have short-term benefits, particularly in the area of range of motion

Modulation of the GABAergic pathway for the treatment of fragile X syndrome.

Fragile X syndrome (FXS) is the most common genetic cause of intellectual disability and the most common single-gene cause of autism. It is caused by mutations on the fragile X mental retardation gene (FMR1) and lack of fragile X mental retardation protein, which in turn, leads to decreased inhibition of translation of many synaptic proteins. The metabotropic glutamate receptor (mGluR) hypothesis states that the neurological deficits in individuals with FXS are due mainly to downstream consequences of overstimulation of the mGluR pathway. The main efforts have focused on mGluR5 targeted treatments; however, investigation on the gamma-aminobutyric acid (GABA) system and its potential as a targeted treatment is less emphasized. The fragile X mouse models (Fmr1-knock out) show decreased GABA subunit receptors, decreased synthesis of GABA, increased catabolism of GABA, and overall decreased GABAergic input in many regions of the brain. Consequences of the reduced GABAergic input in FXS include oversensitivity to sensory stimuli, seizures, and anxiety. Deficits in the GABA receptors in different regions of the brain are associated with behavioral and attentional processing deficits linked to anxiety and autistic behaviors. The understanding of the neurobiology of FXS has led to the development of targeted treatments for the core behavioral features of FXS, which include social deficits, inattention, and anxiety. These symptoms are also observed in individuals with autism and other neurodevelopmental disorders, therefore the targeted treatments for FXS are leading the way in the treatment of other neurodevelopmental syndromes and autism. The GABAergic system in FXS represents a target for new treatments. Herein, we discuss the animal and human trials of GABAergic treatment in FXS. Arbaclofen and ganaxolone have been used in individuals with FXS. Other potential GABAergic treatments, such as riluzole, gaboxadol, tiagabine, and vigabatrin, will be also discussed. Further studies are needed to determine the safety and efficacy of GABAergic treatments for FXS

Conceptual design of thermal energy storage systems for near term electric utility applications. Volume 1: Screening of concepts

Over forty thermal energy storage (TES) concepts gathered from the literature and personal contacts were studied for their suitability for the electric utility application of storing energy off-peak discharge during peak hours. Twelve selections were derived from the concepts for screening; they used as storage media high temperature water (HTW), hot oil, molten salts, and packed beds of solids such as rock. HTW required pressure containment by prestressed cast-iron or concrete vessels, or lined underground cavities. Both steam generation from storage and feedwater heating from storage were studied. Four choices were made for further study during the project. Economic comparison by electric utility standard cost practices, and near-term availability (low technical risk) were principal criteria but suitability for utility use, conservation potential, and environmental hazards were considered

Conceptual design of thermal energy storage systems for near term electric utility applications. Volume 2: Appendices - screening of concepts

Volume 2 of this 2 volume report is represented. This volume contains three appendices: (1) bibliography and cross references; (2) taxonomy - proponents and sources; and (3) concept definitions

An eight-month climatology of marine stratocumulus cloud fraction, albedo, and integrated liquid water

As part of the FIRE/Extended Time Observations (ETO) program, extended time observations were made at San Nicolas Island (SNI) from March to October, 1987. Hourly averages of air temperature, relative humidity, wind speed and direction, solar irradiance, and downward longwave irradiance were recorded. The radiation sensors were standard Eppley pyranometers (shortwave) and pyrgeometers (longwave). The SNI data were processed in several ways to deduce properties of the stratocumulus covered marine boundary layer (MBL). For example, from the temperature and humidity the lifting condensation level, which is an estimate of the height of the cloud bottom, can be computed. A combination of longwave irradiance statistics can be used to estimate fractional cloud cover. An analysis technique used to estimate the integrated cloud liquid water content (W) and the cloud albedo from the measured solar irradiance is also described. In this approach, the cloud transmittance is computed by dividing the irradiance measured at some time by a clear sky value obtained at the same hour on a cloudless day. From the transmittance and the zenith angle, values of cloud albedo and W are computed using the radiative transfer parameterizations of Stephens (1978). These analysis algorithms were evaluated with 17 days of simultaneous and colocated mm-wave (20.6 and 31.65 GHz) radiometer measurements of W and lidar ceilometer measurements of cloud fraction and cloudbase height made during the FIRE IFO. The algorithms are then applied to the entire data set to produce a climatology of these cloud properties for the eight month period

A comparison of manual handling risks in different domestic waste collection systems using three separate evaluation methods

One of the greatest challenges for Local Authorities (LAs) is to operate sustainable systems of work. The most significant causes of physical absence is attributed to that of musculoskeletal disorders (MSDs). The study’s aim was to compare the reliability of the manual handling element of the Health and Safety Executives (HSEs) risk comparator tool for different domestic waste collection methods with self-reported pain via body-mapping and MSD ill health absence rates. Participatory body-mapping exercises were carried out in five authorities with one authority resurveyed, six months after the move from 35-50 litre containers to a wheeled bin recycling service. The lowest levels of self-reported pain were for services designed with 240l wheeled bins excluding glass; the highest levels were for services that included 100l of garden waste sacks and recycling boxes. Industry data supports previous laboratory studies showing wheeled bins to be associated with less MSD outcomes than boxes, baskets and sacks. Triangulation of data established a statistically significant correlation of 0.85 (Pearson) between average pain count (APC) and the mean MSD absence rates, with a strong correlation of 0.77 (Spearman) between APC and risk rating. The correlation is moderate, 0.49, (Spearman) between MSD absence and risk rating, reflecting possible intervening variables and a low participation rate by LAs. The contribution of this study is to improve the design of sustainable waste collection strategies to minimise MSD associated absence. In the absence of reliable absence data, body mapping should be used as a proxy method of assessing MSD risk

The identification of the domestic waste collection system associated with the least operative musculoskeletal disorders using human resource absence data

With increasing pressures around public sector costs, UK Local Authorities (LAs) and waste collection companies, are under pressure to reduce absence rates due to ill health. The identification of the ‘safest’ method of waste collection in the UK has been largely unresolved with many different types of waste and recycling receptacles used and deemed acceptable. The purpose of the study was to investigate the relationships between domestic waste collection methods and absence due to Musculoskeletal Disorders (MSDs) through the comparison of absence rates for different activity. Studies based upon ergonomic theory had suggested the use of wheeled bins is better than the use of boxes, but this has not been tested empirically. Absence data was obtained from 15 LAs who allocated a more detailed activity role to their records, allowing for activity absence rates to be calculated. The outputs were collated and analysed using SPSS to identify statistically significant relationships between types of waste collection services. The results confirm that wheeled bins are associated with less proxy measures of MSD than boxes, baskets and sacks with even lower absence rates associated with 1100 litre capacity bins, when handled by two workers. Findings also indicates that there is a level where MSD absence interventions are unlikely to be sustainable. In conclusion these findings should help LAs better understand some critical factors regarding waste collection strategies and MSD absence and inform HSE enforcement strategies. Employers should interrogate their own ill health data and seek to move to systems that create less MSDs

Using body mapping as part of the risk assessment process - a case study

This paper reports on a study undertaken to identify levels of MSD in relation to methods of waste collection. The need to quantify and eliminate ill health arising out of work is vital to reduce workplace absence leading to debate on associated relationships between the methods of waste collection and musculoskeletal disorders (MSDs). Body mapping is a participatory research tool that has been successfully used to investigate workplace ill health problems. Participatory body mapping exercises were carried out using staff at a UK District Council 2 years before and after the move from boxes and baskets to a wheeled bin recycling service. The study introduces the concept of Average Pain Count (APC). The data, supports previous studies showing wheeled bin based services (APC 2.07 & 2.80) are associated with less MSD outcomes than services including boxes, baskets and sacks (APC 4.02).The surveys provided compelling evidence to suggest that there are associations between age and self-reported pain although there appeared to be no patterns with regards length of service. These findings should help Local Authorities better understand critical factors regarding waste collection strategies and self-reported pain. There are recommendations regarding the use of body mapping and for industry practice