Τετάρτη, 4 Μαΐου 2016

DEFICIENCY OF VITAMIN D AND ITS RELATIONSHIP WITH HYPOTHYROIDISM

2016-05-04T19-37-24Z
Source: Indo American Journal of Pharmaceutical Research
Pallavi Mahajan, Amarjeet S Bhatia.
The prevalence of vitamin D deficiency is 70%100% in the general population. It exists in epidemic proportions all over the Indian subcontinent. Calcidiol is considered as the real indicator of the total vitamin D stores and is being currently used for clinical evaluation of the vitamin D. Vitamin D is recognized to be an essential element for bone metabolism and skeletal health. Its deficiency can cause rickets in children and osteoporosis in adults. It has been identified as a risk factor for cancers, multiple sclerosis, atherosclerosis, infectious diseases and other autoimmune diseases. Vitamin D also play a role in the pathogenesis of several endocrine diseases, like autoimmune thyroid diseases, primary hyperparathyroidism, adrenal diseases, type 1 diabetes (T1DM), type 2 diabetes (T2DM), and polycystic ovary syndrome (PCOS). The present study was conducted with the aim to estimate and compare the levels of vitamin D in normal healthy adults and patients with hypothyroidism diagnosed on the basis of raised thyroid stimulating hormone levels. The mean ± standard deviation value of vitamin D was 20.53±14.42 ng/ml in patients with hypothyroidism whereas in normal healthy adults, the mean ± standard deviation value of vitamin D was 26.88±16.11 ng/ml. The decreased level of vitamin D was found in patients with hypothyroidism. Hence, further research should be done to find the relationship of vitamin D with thyroid antibodies.


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ANTIMICROBIAL ACTIVITY OF PEDALIUM MUREX (FLOWERS)

2016-05-04T19-37-24Z
Source: Indo American Journal of Pharmaceutical Research
D. Prabhakaran,*, A. Rajeshkanna, M. M. Senthamilselvi.
A large number of medicinal plants are claimed to be useful in treating skin diseases in all traditional system of medicine. The purpose of the present study was to examine the antimicrobial effect of the sample isolated from the ethylacetate fraction of flowers of Pedalium murex. This compound was shown to possess antimicrobial activity against bacteria and fungi, viz. Six bacterial strains were Salmonella typhi, Escherichia coli, Enterococcus faecalis, Bacillus cereus, Bacillus substilis, Lacto bacillus and two fungal strains Curvularia lunata and Candida albicans by using disc diffusion method. The anti bacterial activity of the compound isolated from ethyl acetate fraction is almost comparable with the standard solvent control Chloramphenicol. The anti fungal activity is almost comparable with the standard solvent control Fluconazole. From this study, it can be concluded that Pedalium murex (flowers) reveal antimicrobial activity against various human pathogenic bacteria.


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ANALYTICAL METHOD DEVELOPMENT AND VALIDATION OF PAIN RELIEF HERBAL FORMULATIONS

2016-05-04T19-37-24Z
Source: Indo American Journal of Pharmaceutical Research
Rucha J. Shah, Ajay I. Patel, Kartik V. Vikani, Nisha L. Patel.
A rapid, sensitive, precise, and Robust Gas chromatography(GC) method was developed and validated for the simultaneous estimation of Menthol, Methyl salicylate and Linseed oil in Laboratory prepared pain relief herbal formulation and marketed pain relief formulation. The determination was carried out on capillary gas chromatography using flame ionization detector. Good separation of menthol (tR= 10.368), methyl salicylate (tR= 10.795) and linseed oil (tR= 21.912 and 25.180) and terpene hydrate (tR= 13.914) was obtained. The recovery of Menthol, Methyl Salicylate and Linseed oil was found to be 98.34%, 99.1% and 102.74% respectively. The correlation coefficients of linear regression analysis (r2) were found to be 0.999, 0.999 and 0.996 respectively. Thus Proposed GC method provides a good resolution of Menthol. Methyl salicylate and Linseed oil.


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Genome-wide identification and characterization of the Dof gene family in moso bamboo ( Phyllostachys heterocycla var. pubescens)

Abstract

The Dof (DNA binding with One Finger) family of single zinc finger proteins is a family of plant-specific transcription factors. These transcription factors have a variety of important functions in different biological processes in plants. In the current study, we identified 26 Dof family genes in moso bamboo (Phyllostachys heterocycla var. pubescens). A complete overview of PhDof genes in moso bamboo is presented, including the gene structures, phylogeny, protein motifs and expression patterns. Phylogenetic analysis of the 26 PhDof proteins identified four classes constituting seven clusters (A, B1, C1, C2, D1, D2 and D3). In addition, a comparative analysis between the Dof genes in moso bamboo, Arabidopsis (Arabidopsis thaliana L.) and rice (Oryza sativa L.) was also performed, and several putative paralogous and orthologous genes were identified. The exon numbers in Dof genes ranged from one to three in many plants; however, the exon number in PhDofs ranged from one to four. The PhDof genes displayed differential expression in different parts of the shoot and at different flower development stages. This study represents the first step towards a genome-wide analysis of the Dof genes in moso bamboo. Our study provides a useful reference for cloning and functional analysis of members of the Dof gene family in moso bamboo and other species.



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Differences in motor recovery between upper and lower limbs: does stroke subtype make the difference?

imagePrevious studies comparing the patterns of recovery for upper (UL) and lower limbs (LL) reported similar patterns of motor recovery of extremities. However, the influence of clinical stroke subtypes on the difference between recovery of extremities has never been investigated. The aim of this study is to compare the time course of the UL and LL in a sample of patients who have had distinct subtypes of ischemic stroke. A total of 443 consecutive patients following ischemic stroke were assessed at admission, discharge, and 1 month after discharge with the arm and leg motor parts of the Fugl-Meyer scale. Separate analyses were carried out for the entire sample and for samples of each stroke subtype classified according to the Oxfordshire Community Stroke Project. All groups showed significant improvements in motor function (P

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Assessment of sit-to-stand movement in nonspecific low back pain: a comparison study for psychometric properties of field-based and laboratory-based methods

imageOne of the most difficult tasks associated with the management of nonspecific low back pain (LBP) is its clinical assessment. Objective functional methods have been developed for assessment. However, few studies have used daily activities such as sit-to-stand (STS). The aim was to compare the psychometric properties of two commonly used STS assessment methods. A test–retest reliability study design was used. Participants with nonspecific LBP performed the 30-s chair stand test (30CST) and the STS test in Balance Master, which measures weight transfer, rising index and centre of gravity sway velocity. The same tests were reperformed after 48–72 h. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change and coefficient of variation were calculated to compare the reliability. The correlations between the tests, the Oswestry Disability Index and pain intensity were examined for validation. The 30CST had very high intrarater reliability (ICC=0.94). The variables of STS test in Balance Master had moderate intrarater reliability (ICC=0.62–0.69). There were significant correlations between the 30CST, Oswestry Disability Index and pain intensity at activity (P

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Research on rehabilitation interventions for adults living with HIV: a scoping review

imageThe aim of this paper is to use a scoping review to investigate the extent, range, and nature of research on rehabilitation interventions for adults living with HIV. Electronic databases (MEDLINE, EMBASE, CINAHL, AMED, and PsychINFO) and reference lists of the included articles were searched. Authors were emailed when possible for unavailable articles. A total of 897 titles and abstracts were retrieved. Thirty-three articles were included. There were 27 different rehabilitation interventions delivered by 18 professions. The studies were completed in four different countries. Most studies were published in 2008. A randomized-controlled trial was the most used method. The nature of the studies was analyzed according to the three-core concepts of the International Classification of Functioning, Disability and Health: 28 studies addressed impairments; six studies addressed activity limitations; and 14 studies addressed participation restrictions. This scoping study advances the knowledge of research on rehabilitation interventions for adults living with HIV. More research on rehabilitation interventions is needed in sub-Saharan Africa and other low-income and middle-income countries to ensure that these individuals are receiving the best possible care. There is a need for the HIV field to recognize the important contribution of rehabilitation toward the HIV care continuum.

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Cardiorespiratory fitness and cognitive functioning following short-term interventions in chronic stroke survivors with cognitive impairment: a pilot study

imageThis study, a quasi-experimental, one-group pretest–post-test design, evaluated the effects on cognitive functioning and cardiorespiratory fitness of 8-week interventions (aerobic exercise alone and aerobic exercise and cognitive training combined) in patients with chronic stroke and cognitive impairment living in the community (participants: n=14, 61.93±9.90 years old, 51.50±38.22 months after stroke, n=7 per intervention group). Cognitive functions and cardiorespiratory fitness were evaluated before and after intervention, and at a 3-month follow-up visit (episodic memory: revised-Hopkins Verbal Learning Test; working memory: Brown–Peterson paradigm; attention omission and commission errors: Continuous Performance Test; cardiorespiratory fitness: peak oxygen uptake during a symptom-limited, graded exercise test performed on a semirecumbent ergometer). Friedman's two-way analysis of variance by ranks evaluated differences in score distributions related to time (for the two groups combined). Post-hoc testing was adjusted for multiple comparisons. Compared with before the intervention, there was a significant reduction in attention errors immediately following the intervention (omission errors: 14.6±21.5 vs. 8±13.9, P=0.01; commission errors: 16.4±6.3 vs. 10.9±7.2, P=0.04), and in part at follow-up (omission errors on follow-up: 3.4±4.3, P=0.03; commission errors on follow-up: 13.2±7.6, P=0.42). These results suggest that attention may improve in chronic stroke survivors with cognitive impairment following short-term training that includes an aerobic component, without a change in cardiorespiratory fitness. Randomized–controlled studies are required to confirm these findings.

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Effects of an aerobic exercise program on driving performance in adults with cardiovascular disease

imageCardiovascular disease (CVD) has been linked to decreases in driving performance and an increased crash risk. Regular exercise has been linked to improved driving performance among healthy adults. The aim of the current study was to investigate the relationship between a 12-week cardiac rehabilitation (CR) program and driving performance among individuals with CVD. Twenty-five individuals, including 12 cardiac adults and 13 healthy adults, took part in this study. Simulated driving performance was assessed using a standardized demerit-based scoring system at 0 and 12 weeks. Cardiac participants completed a 12-week CR program between evaluations. At baseline, cardiac participants had a higher number of demerit points than healthy adults (120.9±38.1 vs. 94.7±28.3, P=0.04). At follow-up, there was an improvement in both groups' driving evaluations, but the improvement was greater among the cardiac group such that there was no longer a difference in driving performance between both groups (94.6±30 vs. 86.9±34.8, P=0.51). Participation in an aerobic exercise-based CR program appears to lead to improvements in simulated driving performances of individuals with CVD.

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The effect of upper limb casting on gait pattern

imageCasting of the arm may interfere with normal walking patterns because of additional load of the cast or prevention of arm swing. This study aimed to determine the effect of applying various casts on temporospatial walking parameters, including gait velocity and cadence, step length, and single limb support. A computerized gait system was used to assess these variables for 23 healthy individuals in four walking modes: normal walking, with a cast above the elbow and a sling, and with a cast below the elbow, with and without a sling. Thirteen participants had their dominant hand casted and 10 had their nondominant hand casted. On average, casted participants took significantly smaller steps with the leg on the casted side and spent less time supported on the casted side. The least changes were noted with the arm in a cast below the elbow and no sling, and the greatest changes were noted with the arm in a cast above the elbow and in a sling. This difference was heightened when the dominant hand was casted and lessened when the nondominant hand was casted. No differences were found in walking velocity or cadence between the walking modes. Casting of the upper limb has significant effects on gait, which should be taken into consideration, especially in individuals with previous gait abnormalities.

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Experiences of working from a freestanding position as a case manager when supporting clients in the Swedish welfare system

imageThe Swedish state uses a case management function known as Personligt Ombud (PO). The role as PO differs from the traditional professional roles. It has a freestanding position in the welfare system. The aim of this study was to investigate POs' experiences of working from a freestanding position when supporting clients. Telephone interviews were conducted with 22 POs across Sweden. The interviews were recorded, transcribed, and analyzed by latent qualitative content analysis. The findings were reflected in three categories – freedom-promoted flexibility, surfing through a complex welfare system, and working for legitimacy. POs developed a holistic view to both the client as well as to the welfare system. POs experienced solely representing the client, which is a positive feature because part of the POs' role is advocating for the clients rights. The PO service differs from the PO service from other existing case management models and may need to develop strategies for decision-making and support in their own role. For example, they may use group supervision teams or 'reflective teams'. The freestanding position may also entail problems in terms of lack of legitimacy. It is important for POs to develop good platforms with the surrounding actors among others things to improve the co-ordination process. It could be interesting if the PO model would be tested in other countries that have a fragmented welfare system. The PO model may also be useful to other 'target groups' who are in need of co-ordinated rehabilitation services.

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The Mini-BESTest: a review of psychometric properties

imageThe Mini-Balance Evaluation Systems Test (Mini-BESTest) has been identified as the most comprehensive balance measure for community-dwelling adults and elderly individuals. It can be used to assess balance impairments in several other conditions, mainly Parkinson's disease and stroke. Despite increasing use of the Mini-BESTest since it was first published 5 years ago, no systematic review synthesizing its psychometric properties is available. The aim of this study was to provide a comprehensive review of the psychometric properties of the Mini-BESTest when administered to patients with balance deficits because of different diseases. A literature search was performed on articles published before July 2015 in journals indexed by MEDLINE and Scopus databases. The search produced 98 papers, 24 of which fulfilled the inclusion criteria for this review. Most papers (n=19) focused on patients affected by neurological diseases, mainly Parkinson's disease. In 21 papers, the psychometric characteristics were analyzed using Classical Test Theory methods and in only three papers was Rasch analysis carried out. This review shows the interest of researchers in the Mini-BESTest despite the short time frame since its first publication. The Mini-BESTest is used widely in both clinical practice and research. The results support the reliability, validity, and responsiveness of this instrument and it can be considered a standard balance measure. However, it would be valuable to learn more about how this scale performs in different diseases causing balance deficits and to better define the minimal clinically important difference for each disease.

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Determinants of disease-specific health-related quality of life in Turkish stroke survivors

imageStroke is a worldwide cause of morbidity and mortality that affects health-related quality of life. In this study, our objective was to identify determinants of disease-specific health-related quality of life in Turkish stroke survivors. A total of 114 consecutive patients who experienced a stroke at least 6 months earlier were studied. Health-related quality of life was measured using Stroke-specific Quality of Life (SS-QoL) consisting of 12 domains. Demographic and clinical data were collected, including age, sex, marital status, years of education, time since stroke, whether the patient received rehabilitation before enrollment, stroke etiology, whether the dominant hand was affected or not, presence of vision defect, neglect, aphasia, and dysarthria. The patients were assessed by the functional independence measure (FIM) and the Mini-Mental State Examination. A multiple linear regression analysis was carried out using a stepwise method to determine the predictors of 12 domains and the total score of the SS-QoL. The domains of work, social roles, mobility, and self-care had the lowest SS-QoL scores, whereas the highest scores were for the domains of personality, thinking, language, and vision. The total SS-QoL score was explained by the total FIM and Mini-Mental State Examination. Among the 12 domains, the mobility domain was explained the best (R2=0.50) by motor FIM, previously received rehabilitation, and age, followed by the language domain (R2=0.37) explained by the presence of aphasia and dysarthria, and previously received rehabilitation. The domains of mood (R2=0.13) and upper extremity (R2=0.19) were explained the worst. The results indicated that functional independence, age, cognitive status, and receiving a rehabilitation program were the primary determinants of the SS-QoL.

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Cross-cultural validation of the Italian version of the Cumulated Ambulation Score

imageHip fractures are common in elderly patients, and walking impairment is a frequent complication. The Cumulated Ambulation Score (CAS) is a validated functional scale used to monitor easily three basic mobility activities in patients with hip fracture. The aim of this study was to translate, cross-cultural adapt, and validate the CAS in the Italian language (CAS-I). The translation was carried out according to recommended guidelines. The final version of the CAS-I was administered to 80 geriatric patients with hip fracture admitted to a Traumatology Unit, and allowed full weight-bearing after treatment with hemiarthroplasty. Two raters evaluated each patient 2 days after surgery and then after 3 months. Statistical methods included Cronbach's α coefficient for the scale's internal consistency; the total agreement; and the κ coefficient for the inter-rater reliability. The concurrent validity of the scale was determined by comparing the total CAS-I (0–6 points) with the Index of Independence in Activities of Daily Living score (0–4 points). Internal consistency and inter-rater reliability of the CAS, evaluated with Cronbach's α and κ, respectively, were above 0.84 and 0.94. The SE of measurement for the total CAS-I (0–6 points) 2 days and 3 months after surgery were 0.03 and 0.13 points, respectively. The CAS-I showed a significant correlation with the first four items of the Activities of Daily Living score scale (r≥0.85, P

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Correlates of the timed 25 foot walk in a multiple sclerosis outpatient rehabilitation clinic

imageThe Timed 25 Foot Walk (T25FW), a test of maximum walking speed on a short distance, is commonly used to monitor ambulation status and to assess treatment outcomes in multiple sclerosis (MS). The main aim of this study was to determine how walking speed on the T25FW correlates with other clinician-reported and patient-reported measures in an outpatient MS rehabilitation clinic. We analyzed cross-sectional data systematically collected during a physiatry evaluation for the management of spasticity and walking limitations. In addition to demographic variables and the Expanded Disability Status Scale (EDSS), measures of body functions [lower extremity manual muscle testing (LE MMT), lower extremity Modified Ashworth Scale, Fatigue Severity Scale, leg pain], and measures of activity and quality of life (reported frequency of falls, Incapacity Status Scale, Rivermead Mobility Index, EQ5D health questionnaire, and Patient Health Questionnaire-9 items) were administered. A multivariate regression analysis was carried out. 199 patients were included in the analysis [age 49.41 (9.89) years, disease duration 15.40 (10.22) years, EDSS score 5.6 (1.2), and T25FW speed 70.93 (44.13) cm/s]. Both EDSS and LE MMT were correlated significantly with T25FW speed (R2=0.692, P

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Recovery of motor imagery ability in the first year after stroke

imageThe aim of this study was to examine the level and recovery of motor imagery ability (MIA) in the first year after stroke and whether the recovery of MIA is related to that of arm/hand function. Twenty-three patients with diminished arm/hand function were included. The accuracy score on the hand laterality judgment task was used to assess MIA and the Fugl-Meyer Assessment was used to evaluate the recovery of arm/hand function. The patients were assessed 3, 6, 16, 26, and 52 weeks after stroke. In the first year after stroke, the percentage of patients with moderate to good MIA improved from 78% after 3 weeks to 94% after 1 year. The recovery of MIA took place in the first 6 weeks after stroke. No correlation was found between the recovery of MIA and arm/hand function, despite the fact that the greatest improvement in both occurred in the first 6 weeks.

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The psychometric properties of the Turkish Stroke and Aphasia Quality Of Life Scale-39

imageThe Stroke and Aphasia Quality Of Life Scale (SAQOL-39) is a widely used instrument in assessing the quality of life in aphasic patients. Our purpose was to translate the SAQOL-39 into the Turkish language (SAQOL-39/TR) and assess its reliability and validity in patients who had aphasia. SAQOL-39/TR was obtained using the 'translation–backward translation' method and administered to 40 patients with aphasia. The reliability studies were performed by means of internal consistency and test–retest reliability. The validation studies were carried out by means of construct validity using within-scale analyses and analyses against the external criteria. Correlation analysis was performed between scales and the Ege Aphasia Test, the Barthel index, the 12-item General Health Questionnaire and the Brunnstrom recovery stages (BRS) of the arm, hand, and lower extremity. In the results, the scores of the SAQOL-39 were not different between groups. Cronbach's α variables were good for all domains (0.80, 0.88, 0.89, 0.82, and 0.83). Test–retest reliability was also high (0.96, 0.97, 0.91, 0.70, and 0.96). There were significant correlations with coefficients ranging from 0.36 to 0.60 among the domains of scale and other measures. Moderate–high correlations were also seen with BRS-arm, BRS-hand, and BRS-lower extremity (r, 0.27–0.58). It was found that all domains were highly related with all domains of Ege aphasia test, except praxia (P

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Effect of visual biofeedback to acquire supraglottic swallow in healthy individuals: a randomized-controlled trial

imageThe aim of this study is to evaluate the effect of visual biofeedback therapy in acquiring supraglottic swallow (SGS) in a randomized-controlled trial with healthy individuals. Eighteen individuals (mean age, 26 years) who could not close or keep closed the vocal folds before and during the swallow in SGS were allocated randomly to either a visual biofeedback group (eight individuals) or a nonbiofeedback group (10 individuals). A videoendoscope was inserted intranasally and an SGS exercise, using 4 ml of green-colored water, was performed 30 times per day up to 5 days. When the participant failed to perform SGS, the result was provided only to the participants in the visual biofeedback group. The median length of time until acquiring SGS was 1.5 days in the visual biofeedback group and 3.5 days in the nonbiofeedback group (P=0.040). We concluded that visual biofeedback effectively enabled participants to acquire SGS earlier.

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Intensive treadmill training in the acute phase after ischemic stroke

imageThe aim of the study was to (a) assess the feasibility of intensive treadmill training in patients with acute ischemic stroke, (b) test whether physical activity of the legs during training increases with time, and (c) evaluate to what extent training sessions contribute toward the overall physical activity of these patients. Twenty hospitalized patients with acute ischemic stroke trained on a treadmill twice daily for 30 min for 5 days and on day 30. Physical activity was measured as activity counts (AC) from accelerometers. A total of 196 of 224 initiated training sessions were completed. Training started 41.5±14 h after symptom onset. Only nonserious adverse events occurred in 14.7% of the sessions. An intensity of at least 50% of the individual heart rate reserve was obtained in 31% of training sessions. There was a significant increase in AC/min in the legs during training sessions with increasing number of days, with the median AC being 133% higher on day 5 than on day 1. AC in the paretic leg during 60 min of training constituted median 53% of the daytime AC. Early intensive treadmill training in acute ischemic stroke patients is thus feasible and contributes considerably toward the patients' overall physical activity.

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Bimanual dexterity assessment: validation of a revised form of the turning subtest from the Minnesota Dexterity test: Erratum

No abstract available

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Reply to “The usefulness of diffusion tensor tractography for estimating the state of corticobulbar tract in stroke patients”

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Publication date: Available online 4 May 2016
Source:Clinical Neurophysiology
Author(s): Juan Du, Fang Yang, Xinfeng Liu




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The usefulness of diffusion tensor tractography for estimating the state of corticobulbar tract in stroke patients

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Publication date: Available online 4 May 2016
Source:Clinical Neurophysiology
Author(s): Sung Ho Jang, So Min Shin




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Maturation of the P3 and concurrent oscillatory processes during adolescence

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Publication date: Available online 3 May 2016
Source:Clinical Neurophysiology
Author(s): Birgit Mathes, Ksenia Khalaidovski, Annika S. Wienke Christina Schmiedt-Fehr, Canan Basar-Eroglu
ObjectiveDuring adolescence event-related modulations of the neural response may increase. For slow event-related components, such as the P3, this developmental change may be masked due to increased amplitude levels of ongoing delta and theta oscillations in adolescents.MethodsIn a quasi-experimental cross-sectional study design, EEG was measured in 51 participants between 13 and 24 years. A visual oddball paradigm was used to elicit the P3. Our analysis focused on fronto-parietal activations within the P3 time-window and the concurrent time-frequency characteristics in the delta (∼0.5-4 Hz) and theta (∼4-7 Hz) band.ResultsThe parietal P3 amplitude was similar across the investigated age range, while the amplitude at frontal regions increased with age. The pre-stimulus amplitudes of delta and theta oscillations declined with age, while post-stimulus amplitude enhancement and inter-trial phase coherence increased. These changes affected fronto-parietal electrode sites.ConclusionsThe parietal P3 maximum seemed comparable for adolescents and young adults. Detailed analysis revealed that within the P3 time-window brain maturation during adolescence may lead to reduced spontaneous slow-wave oscillations, increased amplitude modulation and time precision of event-related oscillations, and altered P3 scalp topography.SignificanceTime-frequency analyses may help to distinguish selective neurodevelopmental changes within the P3 time window.



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Climate-mediated shifts in Neandertal subsistence behaviors at Pech de l'Azé IV and Roc de Marsal (Dordogne Valley, France)

Publication date: July 2016
Source:Journal of Human Evolution, Volume 96
Author(s): Jamie Hodgkins, Curtis W. Marean, Alain Turq, Dennis Sandgathe, Shannon J.P. McPherron, Harold Dibble
Neandertals disappeared from Europe just after 40,000 years ago. Some hypotheses ascribe this to numerous population crashes associated with glacial cycles in the late Pleistocene. The goal of this paper is to test the hypothesis that glacial periods stressed Neandertal populations. If cold climates stressed Neandertals, their subsistence behaviors may have changed—requiring intensified use of prey through more extensive nutrient extraction from faunal carcasses. To test this, an analysis of Neandertal butchering was conducted on medium sized bovid/cervid remains composed of predominately red deer (Cervus elaphus), reindeer (Rangifer tarandus), and roe deer (Capreolus caprelous) deposited during global warm and cold phases from two French sites: Pech de l'Azé IV (Pech IV, Bordes' excavation) and Roc de Marsal (RDM). Analysis of surface modification on high survival long bones and proximal and middle phalanges demonstrates that skeletal elements excavated from the cold levels (RDM Level 4, Pech IV Level I2) at each cave have more cut marks and percussion marks than elements from the warm levels (RDM Level 9, Pech IV Level Y-Z) after controlling for fragment size. At both sites, epiphyseal fragments are rare, and although this pattern can result from carnivore consumption, carnivore tooth marks are almost nonexistent (<0.1%). Alternatively, processing epiphyseal ends for bone grease may have been a Neandertal survival strategy, and epiphyses were more intensively percussed in cold levels than in warm levels at both RDM and Pech IV. The exploitation of low marrow yield elements such as phalanges does not show a consistent pattern relating to climate, but may have been a general Neandertal behavioral characteristic, suggesting that these hominids were regularly on the edge of sufficient nutrient availability even during interglacials. Overall, the faunal assemblages from Roc de Marsal and Pech IV provide some support for the hypothesis that Neandertals were processing faunal remains more heavily during glacial periods, suggesting a response to increased nutritional stress during colder time periods.



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Recent insights in the therapeutic management of patients with gastric cancer

Gastric cancer remains frequent and one of the most lethal malignancies worldwide. In this article, we aimed to comprehensively review recent insights in the therapeutic management of gastric cancer, with focus on the surgical and perioperative management of resectable forms, and the latest advances regarding advanced diseases.Surgical improvements comprise the use of laparoscopic surgery including staging laparoscopy, a better definition of nodal dissection, and the development of hyperthermic intraperitoneal chemotherapy.

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Changes in electrocorticographic beta frequency components precede spreading depolarization in patients with acute brain injury

Spreading depolarization (SD) occurs during the first two weeks after traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), malignant hemispheric stroke (MHS) and intracranial hemorrhage (ICH). In patients with SAH, focal clusters of SDs are observed in brain areas where new ischemia occurs. After SAH and TBI, SDs are associated with DIND (delayed ischemic neurological deficit) and worsened outcome (Dreier et al. 2006; Dreier et al. 2011; Hartings et al. 2011a, Hartings et al. 2011b). In patients with subacute MHS, the incidence of SDs is particularly high (Dohmen et al.

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Ileal stricture following Meckel’s diverticulitis: a rare cause of intestinal obstruction

Abstract

We report a very rare case of Meckel's diverticulitis with ileal stricture at the base of the diverticulum in a young adult as a cause of recurrent small bowel obstruction lasting for 7 years. None of the pre-operative investigations were able to diagnose the cause of obstruction. The patient had undergone appendicectomy 3 years ago but without any relief. Thereafter he was given a therapeutic trial of anti-tubercular drugs, but his symptoms rather worsened with this treatment. Finally, the diagnosis of Meckel's diverticulitis with ileal stricture was made on exploratory laparotomy. The patient recovered well following segmental ileal resection including the stricture and inflamed Meckel's diverticulum. This unusual case highlights that such a rare clinical entity should be considered as a differential diagnosis while dealing with cases of recurrent distal ileal obstruction so as to avoid misdiagnosis and mismanagement as happened in the present case.



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Quick and accurate quantification of the premature brain

The immature brain is selectively vulnerable to injury (Volpe, 2009; Bonaficio et al., 2015) and premature birth places children at increased risk of chronic neurological morbidities including epilepsy, motor impairment, and cognitive delay (Back et al., 2006; Nardou et al., 2013). In spite of the increased risks, acute brain damage can be particularly difficult to identify in premature neonates. Neurological evaluations remain limited because the underdeveloped brain lacks the sophisticated functions that can be easily tested at the bedside and thus provides little prognostic information on cortical development (Yang, 2004).

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Recent insights in the therapeutic management of patients with gastric cancer

Gastric cancer remains frequent and one of the most lethal malignancies worldwide. In this article, we aimed to comprehensively review recent insights in the therapeutic management of gastric cancer, with focus on the surgical and perioperative management of resectable forms, and the latest advances regarding advanced diseases.Surgical improvements comprise the use of laparoscopic surgery including staging laparoscopy, a better definition of nodal dissection, and the development of hyperthermic intraperitoneal chemotherapy.

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Reply to “The usefulness of diffusion tensor tractography for estimating the state of corticobulbar tract in stroke patients”

Diffusion tensor imaging (DTI) is an advanced magnetic resonance imaging technique used to demonstrate the structural integrity of white matter tracts. DTI has a unique advantage in visualizing the neural fiber tracts in the proximity of cerebral infarction by use of constructing three-dimensional images of white matter fiber tracts (Mori and van Zijl, 2002). A diffusion tensor tractography (DTT) study by Dr Jang investigated the injury of the corticobulbar tract (CBT) in stroke patients with dysarthria, and suggested that the evaluation of the CBT using DTT provides important information in stroke patients with bulbar symptoms (Kwon et al., 2016).

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The usefulness of diffusion tensor tractography for estimating the state of corticobulbar tract in stroke patients

The development of diffusion tensor tractography (DTT), which is derived from diffusion tensor imaging data, has enabled the reconstruction and estimation of the corticobulbar tract (CBT) in the live human brain (Mori et al., 1999). As a result, injury of the CBT following stroke could be estimated three dimensionally using DTT (Kwon et al., 2016). Several studies using DTT have reported on the detailed anatomical location of the CBT in the subcortical white matter, and this knowledge has enabled clinicians to presume injury of the CBT in stroke patients without DTT for the CBT (Pan et al., 2012; Yim et al., 2013).

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STarT Back Screening Tool

Link to instrument: Available from Keele University
Acronym:
SBST
Purpose:
A back-pain screening tool designed to identify prognostic indicators relevant to general practitioner decision-making concerning initial treatment options in primary care.
Description:
The SBST (full version) is composed of 9 items. Eight item are dichotomously scored (agree or disagree) and one item designed to assess distress (five response options, scores range 0 to 1).
 
Covers 8 constructs: the constructs selected for inclusion in the tool are bothersomeness referred leg pain, comorbid pain, disability, catastrophizing, fear, anxiety, and depression. Two disability (RMDQ) items were selected to achieve an appropriate level of sensitivity. Scores are produced by summing positive items (items 1–9). The psychosocial subscale score is a sum of bothersomeness, fear, catastrophizing, anxiety, and depression items (items 1, 4, 7, 8, and 9).
Area of Assessment: Activities of Daily Living, Depression, Functional Mobility, Gait, General Health, Life Participation, Mental Health, Pain, Quality of Life
Body Part: Neck, Back, Lower Extremity
ICF Domain: Body Function
Domain: ADL, Emotion, General Health, Sensory
Assessment Type: Patient Reported Outcomes
Length of Test: 06 to 30 Minutes
Time to Administer:
5 to 10 minutes
Number of Items: 9 (short form = 6 items)
Equipment Required:
None
Training Required:
None. Administration instructions can be found on the SBST website  at Keele University 
Type of training required: no training, No Training
Cost: Free
Actual Cost:
Free. The instrument can be downloaded for free from Keele University.
Age Range: Adult: 18-64 years, Elderly adult: 65+
Administration Mode: Paper/Pencil
Diagnosis: Pain
Populations Tested:

Lower Back Pain

Azimi et al (2014) (Mean age was 58.6 years (Range = 29-84). Female = 56.5% )

  • A total of 269 patients with lumbar central canal stenosis at a large teaching hospital in Tehran, Iran.

Beneciuk et al (2013) (Mean age 41.1 (13.5) and 61% Female. 128 patients (88%) completed 4-week follow-up and 111 patients (76%) completed 6-month follow-up)

  • 146 patients receiving treatment at 6 Florida outpatient physical therapy clinics.

Bruyère et al (2012) (59% female, with a mean age of 48 (13.1) within an age range of 18 to 78 years old)

  • 44 patients with low back pain (LBP) randomly selected from a Spine Unit at the Liège University Hospital Centre, a private physiotherapy clinic, and a fitness center

Bruyère et al (2014)

  • 108 patients with LBP: 60 females and 48 males with a mean age of 49.5 years within an age range of 34-59. 75.9% of the patient population had LBP for greater than 6 months.


 Hill et al (2008)

  • UK Citizens from 8 different practices; initial sample size of 200 people recruited over a 5 week period


Hill et al (2010)

  • 12 primary care back pain patients, selected from a sample of 131 total individuals, mean age of 45.2 (ranging from 29-58 years)


Hill et al (2011)

  • 851 individuals from ten general practices within the Keele General Practice Research Partnership, England, who consulted with their doctor about back pain from June 2007 to November 2008, with or without radiculopathy and excluded patients with any serious disorders or who had back surgery in the last 6 months, with a mean age of 50 (ranging from 18-87 years old)
Standard Error of Measurement (SEM):
Not Established
Minimal Detectable Change (MDC):
Not Established
Minimally Clinically Important Difference (MCID):
Not Established
Cut-Off Scores:
  • 0 to 3 = Low risk
  • 4 to 9 = Medium risk
  • High risk is determined using the distress subscale (the last five items), The distress scale ranges from 0 to 5, with scores of 4 or 5 classified as high risk.

Hill et al (2008)

  •  0-3 on overall tool scores: low risk
  • >3 on overall tool scores but <4 on psychosocial subscale: medium risk
  •  >3 on overall tool scores but 4-5 on psychosocial subscale: high risk

Hill et al (2010)

  • The tool uses validated cut-off thresholds based on average group effects (see values posted above), which do not always ensure appropriate subgroup allocation for individual patients.
  • In practice clinicians are, therefore, advised to use the instrument as an adjunct to their own decision-making rather than a replacement to their considered clinical acumen.
Normative Data:
Lower Back Pain
(Fritz, Beneciuk and George, 2013; n = 214; mean age = 44.3 (15.8) with 56.5% women; SBST categories; High risk = 19.2%, Medium risk = 47.7% and Low risk = 33.2%; patients assessed in a physical therapy setting)
  • Patients in the low risk category have significantly lower baseline numerical pain rating scale and disability questionnaire scores than high or medium risk patients (p < .001)
  • Patients in the high risk category have higher baseline numeric pain rating and disability questionnaire scores than medium or low risk patients (p < .001)

(Hill et al, 2011: n = 851; mean age = 50 with 59% women; SBST categories. High risk – 28%, Medium risk = 46%, Low risk = 26%)

  • Patient's classified as low risk had significantly lower baseline RMDQ disability scores, back pain intensity, PCS catastrophizing score, HADS anxiety and depression subscale than high or medium risk patients
  • Patient's classified as high risk had significant higher baseline RMDQ disability scores, back pain intensity, PCS catastrophizing score, HADS anxiety and depression subscales than medium or low risk patients.
Test-retest Reliability:
Low back pain:
(Hill, et al, 2008; n = 131, ages ranged from 18 to 59, patients diagnosed with non-specific lower back pain)
  • Adequate test-retest reliability (quadratic weighted kappa) = 0.73
  • Adequate test-retest reliability psychosocial subscale (quadratic weighted kappa)= .69

Bruyère et al (2014)

  • 60 patients were asked to fill in the questionnaire two weeks after baseline. The test was only performed among those who reported no change during the past 2 weeks (n=35). ICC assessed 2-way random effects model was used to test reliability between baseline and retest scores, which was .90 (Excellent) (95% CI, 0.81–0.95)
Interrater/Intrarater Reliability:

Hill et al (2010)

  • Twelve primary care back pain patients underwent a video recorded clinical assessment. The SBST was completed on the same day. Clinical experts (3 general practitioners, 3 physiotherapists, and 3 pain management specialists) individually reviewed the patient videos (4 each), blind to SBST allocation. Their task was to subgroup patients into low, medium, or high-risk groups.
  • Agreement between clinicians and the tool was poor (k=0.22). There was observed agreement with the SBST in 17 of 36 cases (47%)
  • Cohen's weighted K for interrater agreement was 0.28 (poor)
Internal Consistency:
Low back pain:
(Hill, et al, 2008; n = 131, ages ranged from 18 to 59, patients diagnosed with non-specific lower back pain) 
  • Adequate internal consistency (alpha = 0.79)
  • Adequate internal consistency for the 5 psychosocial items (alpha= 0.74)

Buryère et al (2014)

  • Internal coherence was examined using the Cronbach's alpha, which was estimated for the Psychosocial subscale of the questionnaire
  • Adequate: Cronbach's Alpha= 0.74
Criterion Validity (Predictive/Concurrent):
Lower Back Pain:
(Field and Newell, 2012; n = 404 assessed prior to treatment then at 14, 30 and 90 days post intervention, participants drawn from six chiropractic clinics in the UK)
 

Beneciuk et al (2013)

  • The STarT Back Screening Tool might provide valuable prognostic information for 6-month self-report disability.
  • 4-week changes in full-length specific psychological measures (ie, Fear-Avoidance Beliefs Questionnaire physical activity scale and 11-item version of the Tampa Scale of Kinesiophobia) predicted 6-month self-report disability and, therefore, may be more appropriate for treatment monitoring purposes.
  • Neither the STarT Back Screening Tool nor psychological measure scores improved prediction of 6-month pain intensity.

(Hill et al, 2011: n=851, age range from 18-87, patient diagnosed with back pain with or without radiculopathy)

  • For medium and high risk groups the adjusted between group mean difference in Roland and Morris Disability Questionnaire scores were significant at 4 months compared to the control group (p=0.0012, p=0.0024, respectively)
  • The adjusted between group mean difference in RMDQ scores was only significant for the medium-risk group (p=0.0253) and not the  high risk group (p=0.1547) for the 12 month follow up

(Fritz, Beneciuk and George, 2013; n = 214; mean age = 44.3 (15.8) with 56.5% women; SBST categories ; High risk = 19.2%, Medium risk = 47.7% and Low risk = 33.2%; patients assessed in a physical therapy setting)

  • Greater improvement was associated with patients categorized as high risk, however, there was no difference in predicted improvement among patients categorized as medium risk.
  • Patients categorized as high risk experienced longer median symptom duration than patients classified as medium risk 
Construct Validity (Convergent/Discriminant):
Low back Pain:
(Kongsted, Johannesen and Leboeuf-Yde, 2011, n = 475 primary care patients; mean age = 43 (range = 18 to 67) years; data collected at 19 chiropractic clinics; 59% SBST low risk, 29% medium risk and 11% high risk)
  • Patients with high SBST risk scores experienced ten-fold increase for having a high score on at least one of the following questionnaires:
    • The Major Depression Inventory
    • The Fear-Avoidance Beliefs Questionnaire
    • The Coping Strategies Questionnaire

(Wideman et al., 2012; n = 300; mean age = 54.32 (12.65) years; 59.3% female; mean SBST score = 6.06 (1.73); change assessed 4 months post-baseline)

Changes Between the SBST and other psycho-social measures
Measure
Follow-up Change Scores
No Follow-up Change Score

Global Improvement (n = 113)

No Global Improvement (n = 187)

SBST

4.91 (1.73)

2.50 (2.57)

RMDQ

9.74 (4.49)

3.86 (5.62)

PCS

10.79 (10.24)

4.94 (9.83)

TSK

8.81 (6.75)

3.55 (5.40)

HADS-Dep

3.57 (3.51)

1.36 (3.73)

 

Improved pain severity (n = 183)

Not improved pain severity (n = 117)

SBST

4.69 (1.96)

1.39 (2.07)

RMDQ

8.77 (5.18)

1.86 (4.44)

PCS

10.10 (10.03)

2.52 (9.16)

TSK

7.75 (6.37)

2.06 (4.89)

HADS-Dep

3.25 (3.43)

0.54 (3.77)

Improved disability (n = 167)

Not improved disability (n = 133)

SBST

4.60 (2.12)

1.90 (2.29)

PCS

9.54 (9.89)

4.14 (10.21)

TSK

7.66 (6.69)

2.85 (5.02)

HADS-Dep

3.18 (3.57)

0.95 (3.73)

SBST = STarT Back Screening Tool
RMDQ = Roland Morris Disability Questionnaire
PCS = Pain Catastrophizing Scale
TSK = Tampa Scale of Kinesiophobia
HADS-Dep = Hospital Anxiety and Depression Scale Depression Component
Content Validity:
Low back pain:
(Hill, et al, 2008; n = 131, ages ranged from 18 to 59, patients diagnosed with non-specific lower back pain)
  • The tests used were researched in the existing literature about low back pain and then analyzed by their prognostic constructs. All items that were used were then reviewed by an advisory board panel.
Face Validity:
Low back pain:
(Hill, et al, 2008)
  • Assessed by a clinical panel, however, no statistical induces from the original validation study were reported.
Floor/Ceiling Effects:
Low back pain:
(Hill, et al, 2008)
  • Floor and ceiling effects were not detected (defined as >15% reporting highest or lowest possible scores
  • 10.8% had tool scores of 0: Adequate
  • 5.4% had tool scores of 9: Adequate

Bruyère et al (2014)

  •  "The lowest and highest possible SBST scores were found only in 8 (7.4%) and in 3 patients (2.8%), respectively, both adequate. For the Psychological subscale, lowest and highest possible scores were found only in 24 (22.2%; poor) and in 12 patients (11.1%; adequate), respectively."
Responsiveness:
Lower Back Pain:
(Hill et al, 2008)
 
SBST Sensitivity and Specificity
Stratification
Subgroup cutoffs*
Sensitivity %
Specificity %
<1 month duration
L vs. M/H
78.0
65.0
L/M vs. H
31.3
91.8
1–3 months' duration
L vs. M/H
81.0
69.9
L/M vs. H
14.3
98.6
4–6 months' duration
L vs. M/H
80.0
73.2
L/M vs. H
35.0
98.1
7 months' to 3 years' duration

L vs. M/H

71.2
59.7

L/M vs. H

21.2
90.3
>3 years' duration

L vs. M/H

86.8
54.5
L/M vs. H
36.8
93.2
*L/M vs. H = Low/Medium risk versus High risk patients; L vs. M/H = Low risk versus Medium / High risk patients
 

Azimi et al (2014)

  • The SBST was able to detect changes after intervention(surgery), indicating improvement in all subscales.

 

Table 2

Responsiveness to change for the STarT Back Screening Tool (SBST) as indicated for patient subgroups (n = 97)

Risk group

Preoperative

Postoperative

P value*

Mean (SD)

Mean (SD)

High (n = 61)

6.3 (1.9)

1.7 (1.4)

<0.0001

Median (n = 28)

4.8 (1.5)

1.6 (1.3)

<0.0001

Low (n = 8)

1.9 (1.5)

0.8 (1.2)

0.03

Overall

4.4 (1.6)

1.6 (1.3)

<0.0001

Considerations:
  • Both long (9 item) and short (6 item) versions are available
  • Translated in more than 15 languages
  • A pediatric version is in development
  • The SBST accurately assessed pain at baseline, however the SBST was not able to demonstrate a differential risk of poor outcomes between SBST categories at 30 days (Field and Newell, 2012)

Azimi et al (2014)

  • Authors suggest performing other tests to establish stronger psychometric indexes for the SBST. As thsdfdfe test recognized clinical measures for known groups, comparing items such as walking distance is recommended.

Beneciuk et al (2013)

  • Based on the findings of this study, authors suggest a 2-phase psychological assessment process consisting of: (1) initial screening with the SBT to provide prognostic information for 6-month disability outcomes only and (2) treatment monitoring at 4 weeks with the TSK-11 and the FABQ-PA to allow for an indication of 6-month pain and disability outcomes, particularly for patients allocated to the SBT high-risk category at initial assessment.

Gusi et al (2011)

  • Conclusion: "The Spanish version of the SBST questionnaire was obtained, which was shown to be comprehensible and adapted to the general population in Spain. Due to being short and easy to use, it is a potentially useful tool for use in primary care."

(Hill et al, 2011)

  • There was a greater than anticipated loss to follow-up and a slight attrition between the individual groups

(Main et al, 2012)

  • Treatment of low back pain patients that are categorized as high-risk should integrate management of psychosocial risk factors and evidence-based pain management into the treatment program

(Bruyère et al, 2012)

  • The translation process provided useful insights into how a person interprets each questionnaire item, but it did not address construct validity, reliability, or item-response patterns necessary for a cross-cultural adaptation.

(Bruyère et al, 2014)

  • The authors conclude that, "The next step will be to assess the effectiveness of this version to identify subgroups of patients at different risk of progression to chronicity in a French-speaking population."

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Bibliography:

Azimi P, Shahzadi S, Azhari S, Montazeri A. A validation study of the Iranian version of STarT Back Screening Tool (SBST) in lumbar central canal stenosis patients. J Orthop Sci. 2014;19(2):213-7.

 

Beneciuk JM, Bishop MD, Fritz JM, et al. The STarT back screening tool and individual psychological measures: evaluation of prognostic capabilities for low back pain clinical outcomes in outpatient physical therapy settings. Phys Ther. 2013;93(3):321-33.

 

Bruyère et al. Translation validation of a new back pain screening questionnaire (the STarT Back Screening Tool) in French. Archives of Public Health. 2012;70:12.

 

Bruyère et al. Validity and reliability of the French version of the STarT Back Screening Tool for patients with low back pain. Spine:39,2;E123-E128.

Field, J. and Newell, D. (2012). "Relationship between STarT Back Screening Tool and prognosis for low back pain patients receiving spinal manipulative therapy." Chiropr Man Therap 20(1): 17-17. Find it on PubMed

Fritz, J. M., Beneciuk, J. M., et al. (2011). "Relationship between categorization with the STarT Back Screening Tool and prognosis for people receiving physical therapy for low back pain." Phys Ther 91(5): 722-732. Find it on PubMed

Gusi N, del Pozo-Cruz B, Olivares P, Hernández-Mocholi M, Hill J. The spanish version of the ''STarT back screening tool'' (SBST) in different subgroups  Aten Primaria. 2011;43(7):356-361.

Hill, J. C., Dunn, K. M., et al. (2008). "A primary care back pain screening tool: identifying patient subgroups for initial treatment." Arthritis Rheum 59(5): 632-641. Find it on PubMed

Hill J, Vohora K, Dunn K, Main C, Hay E. Comparing the STarT back screening tool's subgroup Allocation of individual patients with that of independent Clinical experts. Clin J Pain. 2010;26(9):783-787. 

 

Hill JC, Whitehurst DGT, Lewis M, et al. Comparison to stratified primary care management for low back pain with current best practice (STarT Back): a randomized controlled trial. Lancet. 2011;378:1560-71.

Kongsted, A., Johannesen, E., et al. (2011). "Feasibility of the STarT back screening tool in chiropractic clinics: a cross-sectional study of patients with low back pain." Chiropr Man Therap 19: 10. Find it on PubMed

Main CJ, Sowden G, Hill JC, Watson PJ, Hay EM. Integrating physical and psychological approaches to treatment in low back pain: the development and content of the STarT Back trial's 'high-risk' intervention. Physiotherapy. 2012;98:110-116.

Wideman, T. H., Hill, J. C., et al. (2012). "Comparing the responsiveness of a brief, multidimensional risk screening tool for back pain to its unidimensional reference standards: the whole is greater than the sum of its parts." Pain 153(11): 2182-2191. Find it on PubMed

Year published: 2008
Instrument in PDF Format: Yes


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Continuous epidural pumping of saline contributes to prevent and treat postdural puncture headache

Postdural puncture headache (PDPH) is the most common symptom of accidental dural puncture, a frequent complication of intraspinal anesthesia. We developed a postoperative intervention technique to prevent and treat PDPH in accidental dural puncture patients, including epidural pumping of saline. This retrospective study aimed to retrospectively evaluate this new technique for PDPH prevention and treatment.

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Emergency bronchoscopy for foreign-body aspiration in a child with type I mucopolysaccharidosis: a challenging airway management experience

Abstract

The mucopolysaccharidosis (MPS) is a rare lysosomal storage disease. Glycosaminoglycans (GAG) accumulate in musculoskeletal system, connective tissues. Enlarged tongue, short immobile neck, and limited mobility of the cervical spine and temporomandibular joints render the airway management potentially risky. MPS children have high anesthetic risks, especially in airway management of emergency situations. The foreign-body aspiration requiring intervention with rigid bronchoscopy is an urgent and risky clinical situation. We present our experience with a challenging airway management with a three-year-old child with MPS who needed emergency bronchoscopy due to peanut aspiration.



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EMS joins running man challenge

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EMS joins running man challenge

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Doc Vader vs. hospital administrator



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Academy Fetes Exceptional Emergency Telecommunicators at Annual Navigator Conference

Washington, D.C.–The International Academies of Emergency Dispatch® (IAED™) spotlighted the extraordinary achievements of longtime advocates and the power of the unified protocols through several awards presented during its annual NAVIGATOR conference held April 27–29. EMD Letisha Ghanbari with General Motors' OnStar received the Infor-sponsored 2016 Dispatcher of the Year ...

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Firefighter - Bullhead City Fire Department

BULLHEAD CITY FIRE DEPARTMENT 1260 HANCOCK ROAD BULLHEAD CITY, ARIZONA 86442 Updated: May 04, 2016 Job Classification: Firefighter The Bullhead City Fire Department is currently hiring for Firefighter. This position requires FireTEAM through National Testing Network (NTN) and a valid CPAT. All testing must be completed by June 17, 2016. Salary: $41,911 annually—see website for benefit information ...

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EMS joins running man challenge

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Doc Vader vs. hospital administrator



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Trends and challenges towards integration of traditional medicine in formal health care system: Historical perspectives and An Appraisal of education curricula in Sub-Sahara Africa

2016-05-04T13-05-25Z
Source: Journal of Intercultural Ethnopharmacology
Ester Innocent.
The population residing Sub Sahara Africa (SSA) continues to suffer from communicable health problems such as HIV/AIDS, Malaria, Tuberculosis, various Neglected Tropical as well as Non-Communicable Diseases. The disease burden is aggravated by shortage of medical personnel and medical supplies such as medicine and medical devices. Also, the population in most countries in this region still and has minimal access to essential medicine. For long time, human beings through observation and practical experiences learned to use different plant species that led to the emergence of traditional medicine (TM) systems. The ancient Pharaonic Egyptian traditional medicine system is one of the oldest documented form of traditional medicine practice in Africa and the pioneer of worlds medical science. However, the medical practices diffused very fast to other continents being accelerated by advancement of technologies while leaving Africa lagging behind in the integration of the practice in formal health care system. Challenging issues that drags back integration is the development of education curricula for training Traditional medicine experts as the way of disseminating the traditional medical knowledge and practices imbedded in African culture. The few African countries such as Ghana has managed to integrate TM products in the National Essential Medicine List while South Africa, Sierra Leone and Tanzania have traditional medicine products being sold over the counters due to availability of education training programs facilitated by research. This paper analyses the contribution of TM practice and products in modern medicine and gives recommendations that Africa should taken in the integration process in order to safeguard the Sub-Sahara Africa population from disease burdens


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Investigation the efficiency of various methods of volatile oil extraction from Trichodesma africanum and their impact on the anti-oxidant and anti-microbial activities

2016-05-04T13-05-25Z
Source: Journal of Intercultural Ethnopharmacology
Nidal Amin Jaradat, Abdel Naser Zaid, Aladdin Abuzant, Ramzi Shawahna.
Background: Currently, there is an increasing interest in developing more efficient techniques for the extraction of phytochemicals. Microwaves and ultrasonic extraction methods are promising techniques that can be used for this purpose. Objectives: The purpose of this study was to investigate the impact of different extraction methods on yield, antioxidant and antimicrobial activities of volatile oil extracted from Trichodesma africanum. Materials and methods: Volatile oil was extracted using microwave, ultrasonic, microwave-ultrasonic and conventional hydrodistillation methods. The extracted oil was evaluated for antioxidant and antimicrobial activities. The antioxidant activity was assessed by DPPH scavenging assay, while the antimicrobial activity was assessed by broth micro-dilution method. The antimicrobial activity of the volatile oils were examined against Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa American Type Culture Collection reference strains, as well as against Methicillin Resistant Staphylococcus aureus (MRSA) and Candida albicans clinical isolates. Results: The volatile oil obtained by the four extraction methods in this study exhibited both antioxidant and antimicrobial activities. Among the four extraction methods used, the microwave-ultrasonic method yielded the largest amount (1.8% v/w) and the yield exhibited the highest antioxidant activity in terms of inhibition (91.83% ± 1.1). The minimum inhibitory concentrations for E. coli, P. aeruginosa, S. aureus, MRSA and C. albicans were 3, 5, 6, 3, and 9, respectively.


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Therapeutic significance and pharmacological activities of Antidiarrhoeal medicinal plants mention in Ayurveda: A review

2016-05-04T13-05-25Z
Source: Journal of Intercultural Ethnopharmacology
Ashish Mishra, Ankit Seth, Santosh K Maurya.
Ethnopharmacological relevance: Diarrhoea is a serious problem affecting 35 billion people per year around the world especially children of beow 5 yr. 70% of world population uses traditional and indigenous medicine for their primary health care. The facts of these indigenous remedies are passed verbally and some times as documents. Since ancient time, Ayurveda is the main system of healing in South East Asian countries. Indian literature from ayurvedic texts and other books claim the potency of several plants in the treatment of diarrhoea. As the global prospective of Ayurvedic medicine is increasing, interest regarding the scientific basis of their action is parallely increasing. Researchers are doing experiments to establish the relation between the claimed action and observed pharmacological activities. In the present article an attempt was made to compile the scientific basis of medicinal plants used to cure diarrhoea in Ayurveda. Methods: Literature was collected via electronic search (PubMed, Sciencedirect, Medline and Google Scholar) from published articles that reports antidiarrhoeal activity of plants that were mentioned in Ayurveda classics. Results: A total of 110 plant species belonging to 59 families were reported for their antidiarrhoeal activity. Conclusion: Several Indian medicinal plants have demonstrated promising antidiarrhoeal effects but the studies on the antidiarrhoeal potentials of these plants are not taken beyond proof of concept stage. It is hoped that the article would stimulate future clinical studies because of the paucity of knowledge in this area.


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Nigerian Propolis Improves Blood Glucose, Glycated Hemoglobin (HbA1c), VLDL and HDL Levels in Rat Models of Diabetes

2016-05-04T13-05-25Z
Source: Journal of Intercultural Ethnopharmacology
Ibrahim Oladayo Mustafa.
Aim/Background: According to our previous studies, propolis of Nigerian origin showed some evidence of hypoglycemic and hypolipidemic activities in addition to its ability to ameliorate oxidative-stress induced organ dysfunction. This study was carried out to determine whether ethanolic extract of Nigerian propolis improves glycated hemoglobin (HbA1C), fasting plasma glucose, very low-density lipoprotein (VLDL) and high-density lipoprotein (HDL) concentrations in rats that have alloxan diabetes. Methods: Diabetes was induced with Alloxan (110mg/Kg). Animals were divided into 5 groups (n=5); Group 1 were non-diabetic receiving normal saline, Group 2 were diabetic but also received only normal saline. Groups 3, 4, & 5 were diabetic receiving 200mg/Kg propolis, 300mg/Kg propolis and 150mg/Kg metformin respectively for 42 days. Results: Hyperglycemia, elevated serum level of very low density lipoprotein (VLDL), elevated plasma level of glycated hemoglobin A1C (HbA1C) and decreased levels of high density lipoprotein cholesterol (HDL) were observed in the diabetic untreated animals. Nigerian propolis decreased blood glucose level and serum level of VLDL but elevated HDL level. These changes were significant (P


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An in vitro evaluation of the Native American ethnomedicinal plant Eryngium yuccifolium as a treatment for snakebite envenomation.

2016-05-04T13-05-25Z
Source: Journal of Intercultural Ethnopharmacology
Joseph Alfred Price, III.
Aim. At least seven North American tribes specifically mention use of Eryngium (typically roots) as an anti-snake venom therapy. As snake envenomation is an endemic, life threatening medical risk, is there a scientific basis for the Native American ethnomedicine? Could this be demonstrated in an assay amenable to mechanistic evaluation and high throughput screening for later isolation and possible evaluation as a source for a lead drug? Methods. Proteases, mainly collagenases, are thought to be the main pathological agents in most American snake venoms. Water extracts of four plant parts of Eryngium yuccifolium were tested for enzyme inhibition in three highly sensitive in vitro protease assays, with multiple venoms. Results. Interestingly, activity was found in all plant parts, not just the roots, in the general protease assay, also in the more specific assay for collagenases, but less so for elastases where enzymatic activity was low, and against five species of American snake venoms. Inhibition spared the activity of a mammalian elastase, suggesting it has some specificity. In dose response assays, inhibitory activity in extracts of Eyngium a were noticeably more effective than randomly chosen plants, and comparable to some others. Conclusions. All data shown here are consistent with pharmacological inhibition of proteases in at least selected venoms of common venomous snakes by Eryngium extracts. And as the genus is widely distributed in America, the ethnological practice of using this plant as an anti-snake venom treatment is supportable, may have been common, and suggests further bioactivity and phytochemical studies are warranted.


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Doc Vader vs. hospital administrator



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Determination of Risk Factors, Knowledge Level and Awareness towards Colorectal Cancers among Turkish Women

2016-05-04T12-41-49Z
Source: Journal of Behavioral Health
Gonca KARATAS BARAN, Gul PINAR. Sevil SAHIN.
Objective: This research was conducted as definitive and cross-sectional to scrutinize risk factors, knowledge levels and awareness of women at the age of 50 and above about colorectal cancers (CRC). Material-Method: In a descriptive and cross-sectional study, 196 women participating were selected by randomly at the age of 50 and above who applied to Ankara Keçiören Training and Research Hospital, Gynecology and Obstetrics Polyclinic in Turkey during June 16-July 30, 2014. A Questionnaire Form was used in data collection. Results: The age average of the women included in the research was 57.2±7.9. At least one of the CRC risk factors was present in the women. When examined according to CRC risk levels, 83.6% was at the low risk group and 16.4% was at the moderate level risk group. The average knowledge score of the women to be protected from CRC was 6.4±3.3 (min=0, max=10). 86.2% of the women indicated that they did not have CRC screening test until that moment, 85.7% indicated that they did not have adequate knowledge about CRC screening methods and 22% saw themselves risky about developing CRC. Based on the conducted analyses; CRC risk level was found higher in the women who had bowel disease history, did not have adequate knowledge about CRC, had CRC screening history, were suggested CRC screening test by their physician, and had high CRC risk perception (p


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Non Communicable Diseases in urban India: The challenges and opportunity for the physiotherapist

2016-05-04T12-40-31Z
Source: International Journal of Therapies and Rehabilitation Research
Nalin Kumar, Bhupinder Singh.
Introduction and background The Global burden of Disease (GBD) study mentions how India has been a huge contributor to the GBD. India is facing challenges to strengthen basic public health infrastructure and health care delivery system. The health systems are unprepared to address the sudden manic due to the change in the disease distribution. NCDs act as a public health burden of both the rural and urban India. India was become the diabetic capital of the world with 50 million diabetics and an estimated 77 million pre-diabetics. There is high presence of associated risk factors for NCDs in the urban areas. Physiotherapist form an integral part of the health system and this study explores if the training of physiotherapist meets the essential requirements for NCDs prevention and control. The scope of their work can be increased by investigating the increase in NCDs and the lack of health care human resource in the country. Methodology The study involves a review of literature on NCDs prevention and control and the need of training of Physiotherapist. The methodology involves selection of university curriculum of both the private and government universities offering graduate physiotherapy education (BPT). The latest curriculum was assessed of 22 universities and colleges. A policy analysis of NCDs prevention and control was done for National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) along with Health Systems review. Findings The findings of the study are congruent with the earlier findings of ODonoghue et al. (2014). The physiotherapy curriculum in INDIA does not meet the essential requirements to address the associated risk factors for NCDs. The policy analysis of NPCDS and Health Systems highlights the role of physiotherapist in India is considered as a health promotive and rehabilitative professional. A recommendation of World Health Professional Alliance (WHPA) and World Confederation of Physical Therapist (WCPT) mentions the important role of Physiotherapist in combating NCDs by prevention of the risk factors and the necessary role to combat NCDs. Interpretation There is a need for policy/program/curriculum adaptation required to provide physiotherapist with necessary skills required to address the NCDs.


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