THE EFFECT OF THE MYOMO ROBOTIC ORTHOSIS ON REACH PERFORMANCE AFTER STROKE

Stroke affects 795,000 people yearly. Close to 85 percent of stroke survivors experience some degree of stroke-related upper extremity impairment due to spastic paresis (Nakayama, Jorgenson, Pedersen, Raaschou, & Olsen, 1994). Residual upper extremity impairments are associated with increased burden of care (Skidmore, Rogers, Chandler, & Holm, 2006) and decreased ability to garner gainful employment (Desrosiers et al., 2006). Current best evidence supports the use of a task-oriented practice regimen for the treatment of upper extremity impairment; however, many people have insufficient motor control to participate. It was the goal of this study to investigate the effect of the Myomo robotic upper extremity orthosis, a device that facilitates participation in a task-oriented practice regimen, on reach kinematic performance. Specifically, we examined two research questions: Question 1. What is the immediate effect of the Myomo orthosis on kinematic performance of reach? We predicted that before training, temporal (movement efficiency) and spatial characteristics (angular displacement, movement error, and acceleration cycles) of kinematic performance would be better with the Myomo orthosis than without the device. Question 2. What is the training effect of the Myomo orthosis plus training kinematic performance? We predicted that temporal (movement efficiency) and spatial characteristics (angular displacement, movement error, and acceleration cycles) of kinematic performance without the Myomo orthosis would be better after 16 training sessions. Findings suggest that the immediate effect of the Myomo orthosis on reaching performance (question 1) appears to be more attenuated than the training effect of the Myomo orthosis (question 2).All 6 participants demonstrated improvements in movement efficiency for one or more of three reaching targets. Five of the 6 participants demonstrated improvements in one or more of the spatial characteristics of kinematic performance. Effect size calculations suggest that the magnitude of the training effect was greatest for movement efficiency and angular displacement (medium effect size) and the least for movement error and acceleration cycles (small effect size)

An exploratory study into the effects of a 20 minute crushed ice application on knee joint position sense during a small knee bend.

Objectives The effect of cryotherapy on joint positioning presents conflicting debates as to whether individuals are at an increased risk of injury when returning to play or activity immediately following cryotherapy application at the knee. The aim of this study was to investigate whether a 20 minute application of crushed ice at the knee immediately affects knee joint position sense during a small knee bend. Design Pre and post-intervention. Setting University movement analysis laboratory. Participants Eleven healthy male participants. Main Outcome Measures Kinematics of the knee were measured during a weight bearing functional task pre and post cryotherapy intervention using three-dimensional motion analysis (Qualisys Medical AB Gothenburg, Sweden). Tissue cooling was measured via a digital thermometer at the knee. Results Results demonstrated significant reductions in the ability to accurately replicate knee joint positioning in both sagittal (P=.035) and coronal (P=.011) planes during the descent phase of a small knee bend following cryotherapy. Conclusion In conclusion a twenty minute application of crushed ice to the knee has an adverse effect on knee joint repositioning. Team doctors, clinicians, therapists and athletes should consider these findings when deciding to return an athlete to functional weight bearing tasks immediately following ice application at the knee, due to the potential increase risk of injury

Combining virtual reality and a myoelectric limb orthosis to restore active movement after stroke: a pilot study

We introduce a novel rehabilitation technology for upper limb rehabilitation after stroke that combines a virtual reality (VR) training paradigm with a myoelectric robotic limb orthosis. Our rehabilitation system is based on clinical guidelines and is designed to recruit specific motor networks to promote neuronal reorganization. The main hypothesis is that the restoration of active movement facilitates the full engagement of motor control networks during motor training. By using a robotic limb orthosis, we are able to restore active arm movement in severely affected stroke patients. In a pilot evaluation, we have successfully deployed and assessed our system with three chronic stroke patients by means of behavioral data and self-report questionnaires. The results show that our system is able to restore up to 60% of the active movement capability of patients. Further, we show that we can assess the specific contribution of the biceps/triceps movement of the paretic arm in a VR bilateral training task. Questionnaire data show enjoyment and acceptance of the developed rehabilitation system and its VR training task.info:eu-repo/semantics/publishedVersio

Muddy waters: critiquing the historical criminology method in the investigation of the Smiley Face murders theory

As an emerging trans-disciplinary field, the operational use of historical criminology is a largely under-studied area. Examination of the use of archival research in studying cases connected to Gannon and Gilbertson’s Smiley Face murders theory indicates that there is clear potential for historical criminology to be used to revisit closed or cold investigations to determine if the official findings of the case are consistent with the evidence. In the case of the Smiley Face murders theory, taking a historical criminology approach has failed to prove the hypothesis of researchers; nevertheless, use of historical research methods has had some success in forcing a re-evaluation of several cases, and should be considered an important tool in future investigations of this nature

Adoptive immunotherapy against allogeneic kidney grafts in dogs with stable hematopoietic trichimerism.

Dogs given nonmyeloablative conditioning and marrow grafts from 2 dog leukocyte antigen (DLA)-identical littermate donors developed stable trichimerism and stably accepted a subsequent kidney graft from one of the marrow donors without the need for immunosuppression. In this study, we used trichimeras to evaluate strategies for adoptive immunotherapy to solid tumors, using the kidney as a tumor surrogate. Three DLA-identical trichimeric recipients were established by simultaneously infusing marrow from 2 DLA-identical donor dogs into a DLA-identical recipient conditioned with 2 Gy of total body irradiation (TBI) and given a short course of postgraft immunosuppression. After stable hematopoietic engraftment was confirmed, a kidney was transplanted from 1 of the 2 marrow donors into each respective trichimeric recipient. Peripheral blood lymphocytes from each kidney donor were then used to sensitize the alternate marrow donor. The trichimeric recipients were given donor lymphocyte infusions (DLIs) from the sensitized dogs and monitored for chimerism, graft-versus-host disease (GVHD), and kidney rejection. After DLI, we observed both prompt rejection of the transplanted marrow and donor kidney and disappearance of corresponding hematopoietic chimerism. Presumably due to shared minor histocompatibility antigens, host chimerism also disappeared, and GVHD in skin, gut, and liver developed. The native kidneys, although exhibiting lymphocytic infiltration, remained functionally normal. This study demonstrates that under certain experimental conditions, the kidney--an organ ordinarily not involved in graft-versus-host reactions--can be targeted by sensitized donor lymphocytes

Urbanization and mortality decline

We investigate the relationship between mortality decline and urbanization, which has hitherto been proposed by demographers but has yet to be tested rigorously in a global context. Using cross-national panel data we find evidence of a robust negative correlation between crude death rates and urbanization. The use of instrumental variables suggest that this relationship is causal, while historical data from the early 20th century suggests that this relationship holds in earlier periods as well. Finally, we find robust evidence that mortality decline is correlated with urbanization through the creation of new cities rather than promoting urban growth in already-extant cities

The Long-Baseline Neutrino Experiment: Exploring Fundamental Symmetries of the Universe

The preponderance of matter over antimatter in the early Universe, the dynamics of the supernova bursts that produced the heavy elements necessary for life and whether protons eventually decay --- these mysteries at the forefront of particle physics and astrophysics are key to understanding the early evolution of our Universe, its current state and its eventual fate. The Long-Baseline Neutrino Experiment (LBNE) represents an extensively developed plan for a world-class experiment dedicated to addressing these questions. LBNE is conceived around three central components: (1) a new, high-intensity neutrino source generated from a megawatt-class proton accelerator at Fermi National Accelerator Laboratory, (2) a near neutrino detector just downstream of the source, and (3) a massive liquid argon time-projection chamber deployed as a far detector deep underground at the Sanford Underground Research Facility. This facility, located at the site of the former Homestake Mine in Lead, South Dakota, is approximately 1,300 km from the neutrino source at Fermilab -- a distance (baseline) that delivers optimal sensitivity to neutrino charge-parity symmetry violation and mass ordering effects. This ambitious yet cost-effective design incorporates scalability and flexibility and can accommodate a variety of upgrades and contributions. With its exceptional combination of experimental configuration, technical capabilities, and potential for transformative discoveries, LBNE promises to be a vital facility for the field of particle physics worldwide, providing physicists from around the globe with opportunities to collaborate in a twenty to thirty year program of exciting science. In this document we provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess.Comment: Major update of previous version. This is the reference document for LBNE science program and current status. Chapters 1, 3, and 9 provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess. 288 pages, 116 figure

The immune system as a foundation for immunologic therapy and hematologic malignancies: a historical perspective.

In this review we aim to provide a historical overview of the immunotherapeutic approaches which have been developed for the treatment of hematological malignancies. After briefly summarizing the development of the theory of cancer immune surveillance, we describe how initial studies discovering the efficacy of the immune-mediated graft-versus-tumor effects after allogeneic hematopoietic cell transplantation led to new transplantation approaches (termed non-myeloablative transplantation) relying almost exclusively on graft-versus-tumor effects for tumor eradication. We then summarize important steps in the development of tumor vaccines and autologous adoptive immunotherapy in patients with hematological malignancies. Finally, we describe historical discoveries leading to the recent success with monoclonal antibodies as treatment for lymphomas, chronic lymphocytic leukemia, and acute myeloid leukemia

Urbanisation and Mortality Decline

We investigate the relationship between mortality decline and urbanization, which has hitherto been proposed by demographers but has yet to be tested rigorously in a global context. Using cross-national panel data, we find evidence of a robust negative correlation between crude death rates and urbanization. The use of instrumental variables suggest that this relationship is causal, while historical data from the early 20th century suggest that this relationship holds in earlier periods as well. Finally, we find robust evidence that mortality decline is correlated with urbanization through the creation of new cities rather than promoting urban growth in already-extant cities

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability