Telerehabilitation for stroke patients: an overview of reviews

Background: The increasing number of survivors following stroke events are enlightening new needs to guarantee appropriate care and quality of life support at home. A potential application of telemedicine is to provide home care and rehabilitation. Within the framework of an EU FP7 project called Integrated Home Care (IHC Grant Agreement no: 222954) we performed an overview of reviews on the telefacilities for the homecare in stroke patients. Materials and methods: A broad literature research was conducted in PUBMED, Web of Science® and The Cochrane Library databases. We included and graded all the reviews according to the following criteria: published in English in peer-reviewed journals, targeting stroke as adult patients (age>18yr.) and considering a homecare setting in the intervention. Results: 6 reviews were included (i.e. 1 systematic review with meta-analysis and 5 non-systematic reviews). No conclusions can be stated on the effectiveness of telerehabilitation compared to other home treatments, due to the insufficient data available, nevertheless strong indications emerged for the inclusion of “all cause mortality” and “hospital admission” as primary outcomes. Besides “QoL”, “cost”, “adherence” and “patient acceptability” should be included as secondary outcomes, for a complete evaluation of the tele-intervention. No adverse effects were reported in all the reviews, stating that tele-interventions appear to be safe as usual care at home. Conclusion: Those indications should be considered as relevant in planning a telerehabilitation trial, in order to observe the expected effectiveness from a multidimensional point of view in the clinical, financial and social perspectives.Peer Reviewe

The variable X-ray emission of PSR B0943+10

The old pulsar PSR B0943+10 (P=1.1 s, characteristic age tau=5 Myr) is the best example of mode-switching radio pulsar. Its radio emission alternates between a highly organized state with regular drifting subpulses (B mode) and a chaotic emission pattern (Q mode). We present the results of XMM-Newton observations showing that the X-ray properties of PSR B0943+10 depend on its radio state (Hermsen et al. 2013). During the radio fainter state (Q mode) the X-ray flux is more than a factor two larger than during the B-mode and X-ray pulsations with about 50% pulsed fraction are detected. The X-ray emission of PSR B0943+10 in the B-mode is well described by thermal emission with blackbody temperature kT=0.26 keV coming from a small hot spot with luminosity of 7x10^28 erg/s, in good agreement with the prediction of the partially screened gap model, which also explains the properties of the radio emission in this mode. We derived an upper limit of 46% on the X-ray pulsed fraction in the B-mode, consistent with the geometry and viewing angle of PSR B0943+10 inferred from the radio data. The higher flux observed during the Q-mode is consistent with the appearance of an additional component with a power-law spectrum with photon index 2.2. We interpret it as pulsed non-thermal X-rays produced in the star magnetosphere. A small change in the beaming pattern or in the efficiency of acceleration of the particles responsible for the non-thermal emission can explain the reduced flux of this component during the radio B-mode.Comment: Accepted for publication in MNRA

Discovery of a strongly phase-variable spectral feature in the isolated neutron star RX J0720.4-3125

We present the discovery of a strongly phase-variable absorption feature in the X-ray spectrum of the nearby, thermally-emitting, isolated neutron star RX J0720.4-3125. The absorption line was detected performing detailed phase-resolved spectroscopy in 20 XMM-Newton observations, covering the period May 2000 - September 2012. The feature has an energy of ~750eV, an equivalent width of ~30eV, and it is significantly detected for only ~20% of the pulsar rotation. The absorption feature appears to be stable over the timespan covered by the observations. Given its strong dependence on the pulsar rotational phase and its narrow width, a plausible interpretation is in terms of resonant proton cyclotron absorption/scattering in a confined magnetic structure very close to the neutron star surface. The inferred field in such a magnetic loop is B_loop ~ 2 x 10^{14} G, a factor of ~7 higher than the surface dipolar magnetic field.Comment: 6 pages, 4 figures; ApJ Letters accepte

“Do Not Mix Apples with Oranges” to Avoid Misinterpretation of Placebo Effects in Manual Therapy: The Risk Is Resulting in a Fruit Basket. Comment on Molina-Àlvarez et al. Manual Therapy Effect in Placebo-Controlled Trials: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2022, 19, 14021

N/

Performance of electro-osmotic dewatering on different types of sewage sludge

The feasibility of pressure-driven electro-dewatering (EDW) on sludge samples taken after different biological processes, stabilisation methods or mechanical dewatering techniques was assessed. First, the influence of potential values on EDW of anaerobically and aerobically stabilised, mechanically dewatered, sludge samples was investigated. Preliminary tests carried out by applying a constant potential (10, 15 and 20 V) in a lab-scale device confirmed the possibility to reach a dry solid (DS) content of up to 42.9%, which corresponds to an increase of 15% of the dry content in dewatered sludge without the application of the electrical field. Dewatering increased with the applied potential but at the expense of a higher energy consumption. A potential equal to 15 V was chosen as the best compromise for EDW performance, in terms of DS content and energy consumption. Then, the influence of the mechanical dewatering was studied on aerobically stabilised sludge samples with a lower initial DS content: the higher initial water content led to a lower final DS content but with a considerable reduction of energy consumption. Finally, the biological process, studied by comparing sludge samples from conventional activated sludge and membrane bioreactor processes, didn’t evidence any influence on EDW. Experimental results shown that DS obtained after mechanical dewatering, volatile solids and conductivity are the main factors influencing EDW. Anaerobically digested sludge reached the highest DS content, thanks to lower organic fraction

Clinical Predictors for Upper Limb Recovery after Stroke Rehabilitation: Retrospective Cohort Study

After stroke, recovery of upper limb (UL) motor function is enhanced by a high dose of rehabilitation and is supposed to be supported by attentive functions. However, their mutual influence during rehabilitation is not well known yet. The aim of this retrospective observational cohort study was to investigate the association between rehabilitation dose and motor and cognitive functions, during UL motor recovery. Inpatients with first unilateral stroke, without time restrictions from onset, and undergoing at least 15 h of rehabilitation were enrolled. Data on dose and modalities of rehabilitation received, together with motor and cognitive outcomes before and after therapy, were collected. Fugl–Meyer values for the Upper Extremity were the primary outcome measure. Logistic regression models were used to detect any associations between UL motor improvement and motor and cognitive-linguistic features at acceptance, regarding dose of rehabilitation received. Thirty-five patients were enrolled and received 80.57 ± 30.1 h of rehabilitation on average. Manual dexterity, level of independence and UL motor function improved after rehabilitation, with no influence of attentive functions on motor recovery. The total amount of rehabilitation delivered was the strongest factor (p = 0.031) influencing the recovery of UL motor function after stroke, whereas cognitive-linguistic characteristics were not found to influence UL motor gains