Understanding the reorganization of the central nervous system after stroke is an important endeavor in order to design new therapies in gait training for stroke patients. Current clinical evaluation scores and gait velocity are insufficient to describe the state of the nervous system, and one aspect where this is lacking is in the quantification of gait symmetry. Previous studies have pointed out that spatiotemporal gait asymmetries are commonly observed in stroke patients with hemiparesis. Such asymmetries are known to cause long-term complications like joint pain and deformation. Recent studies also indicate that spatiotemporal measures showed that gait symmetry worsens after discharge from therapy. This study shows that muscle synergy analysis can be used to quantify gait symmetry and compliment clinical measures. Surface EMG was collected from lower limb muscles of subacute post-stroke patients (with an onset of around 14 days) from two groups, one undergoing robotic-assisted therapy (known as HAL group) and the other undergoing conventional therapy (known as Control group). Muscle synergies from the paretic and non-paretic limb were extracted with Non-Negative Matrix Factorization (NNMF) and compared with each other to obtain a gait symmetry index over therapy sessions. Gait events were tracked with motion tracking (for the HAL group) or foot pressure sensors (for the conventional therapy group). Patients from both groups were assessed over a 3-weeks long gait training program. Results indicated that there were no differences in muscle synergy symmetry for both groups of patients. However, the timing of muscle synergies were observed to be symmetrical in the HAL group, but not for the Control group. Intergroup comparisons of symmetry in muscle synergies and their timings were not significantly different. This could be due to a large variability in recovery in the Control group. Finally, stance time ratio was not observed to improve in both groups after their respective therapies. Interestingly, FIM and FMA scores of both groups were observed to improve after their respective therapies. Analysis of muscle coordination could reveal mechanisms of gait symmetry which could otherwise be difficult to observe with clinical scores.

Keywords: gait symmetry; hybrid assistive limb (HALⓇ); muscle synergy; robotic therapy; stroke.

The objective of this study was to identify and review the most-cited articles on spinal cord injury (SCI). Citation analyses showcase the relative influence of individual articles in a given field. In addition to distinguishing publications of particular quality and impact and well-developed areas of the literature, citation analyses allow for an understanding of the direction in which a field of research is headed.

A multi-disciplinary bibliographic index was used to identify the 50 SCI articles with the most lifetime citations, and the 50 SCI articles with the highest annual citation rates. Studies were categorized into one of six categories based on their primary focus: treatment, pathology/natural history, predictor of outcome, methods, epidemiology, or assessment measure.

We report that 40.0 and 56.0 % of SCI papers with the most lifetime citations and highest annual citation rates, respectively, were systematic reviews or meta-analyses, indicating that some of the most referenced papers in SCI are not primary publications. Further, there appears to be a greater international presence in SCI research. In the highest annual citation rate cohort, 14.0 % of papers were a product of international collaboration, 50.0 % were published by outside of the United States, and the average year of publication was 2005 ± 5.4; the comparable numbers for papers that comprised the highest lifetime citation cohort were, respectively, 8.0, 28.0 %, and 1998 ± 9.2. Treatment and pathology/natural history of SCI were a common research focus in both citation cohorts, consistent with ongoing efforts to better understand and manage this injury.

This comprehensive review provides a cross-sectional summary and bibliometric analysis of some of the most influential literature in SCI, and compliments existing systematic reviews and meta-analysis in the field by establishing which areas of the literature are growing and which have been well developed.

Nocardia is an opportunistic pathogen from environment, which is generally thought to infect immunosuppressed patients (ISPs), but recent studies showed it could also cause infections in immunocompetent patients (ICPs).The aim of this study was to compare the clinical characteristics, patients' outcome, Nocardia species' identification, and antibiotic susceptibility profiles of nocardiosis between ICPs and ISPs.The detailed clinical data were collected from all the nonrepetitive nocardiosis patients during 2011 and 2018, from a tertiary general hospital in Beijing, China. Then each Nocardia isolate was identified to species level by DNA sequencing. The antibiotic susceptibility testing was performed by E test method, and interpreted following CLSI M24 document. The clinical and microbiological characteristics between ICPs and ISPs were compared statistically.A total of 23 nonrepetitive nocardiosis patients with detailed clinical data were enrolled in this study. Among them, 9 were ICPs and 14 were ISPs. All the skin and soft tissue infections occurred in ICPs (33.3% vs 0%, P < .05). Bronchiectasis occurred more frequently in ICPs (44.4% vs 21.4%), whereas chronic kidney diseases and coinfection with aspergillosis occurred more frequently in ISPs (35.7% vs 0%, 35.7% vs 0%, respectively), although they did not reach the statistical significance. There were no significant differences in other clinical characteristics, Nocardia species' identification, and antibiotic susceptibility between ISPs and ICPs (P > .05).Nocardiosis could occur in both ISPs and ICPs. Skin and soft tissue infection and bronchiectasis occurred more frequently in ICPs. Chronic kidney diseases and co-infection with aspergillosis occurred more frequently in ISPs. These characteristics should be noticed by physicians in diagnosis of nocardiosis.

Using multiple, independent approaches to molecular species delimitation is advocated to accommodate limitations and assumptions of a single approach. Incongruence in delimitation schemes is a potential by-product of employing multiple methods on the same data, and little attention has been paid to its reconciliation. Instead, a particular scheme is prioritized, and/or molecular delimitations are coupled with additional, independent lines of evidence that mitigate incongruence. We advocate that incongruence within a line of evidence should be accounted for before comparing across lines of evidence that can themselves be incongruent. Additionally, it is not uncommon for empiricists working in nonmodel systems to be data-limited, generating some concern for the adequacy of available data to address the question of interest. With conservation and management decisions often hinging on the status of species, it seems prudent to understand the capabilities of approaches we use given the data we have. Here, we apply two molecular species delimitation approaches, spedeSTEM and BPP, to the Castilleja ambigua (Orobanchaceae) species complex, a relatively young plant lineage in western North America. Upon finding incongruence in our delimitation, we employed a post hoc simulation study to examine the power of these approaches to delimit species. Given the data we collected, we find that spedeSTEM lacks the power to delimit while BPP is capable, thus allowing us to address incongruence before proceeding in delimitation. We suggest post hoc simulation studies like this compliment empirical delimitation and serve as a means of exploring conflict within a line of evidence and dealing with it appropriately.

Previous studies have recommended harvesting a large number of lymph nodes (LNs) to improve the survival of patients with esophageal squamous cell carcinoma (ESCC). These studies or clinical guidelines focus on the total harvested LNs during lymphadenectomy; however, the extent of LN dissection (LND) required in patients with ESCCs remains controversial. The present study proposed a novel individualized adequate LND (ALND) strategy to compliment current guidelines to improve individualized therapeutic efficacy. For N0 cases, ALND was defined as an LN harvest of >55% of the LNs from nodal zones adjacent to the tumor location; and for N⁺ cases, ALND was defined as 8, 8, 8, 8 or 16 LNs dissected from the involved cervical, upper, middle, lower and celiac zones, respectively. Retrospective analysis of the ESCC cohort revealed that the ALND was associated with improved patient survival [hazard ratio (HR)=0.45 and 95% CI=0.30-0.66)]. Stratified analyses revealed that the protective role of ALND was prominent, with the exception of higher pN⁺ staged (pN2-3) cases (HR=0.52, 95% CI=0.23-1.18). Furthermore, ALND was associated with improved survival in local diseases (T1-3/N0-1; HR=0.50, 95% CI=0.30-0.84) and locally advanced diseases (T4/Nany or T1-3/N2-3; HR=0.32, 95% CI=0.15-0.68). These findings suggested that the proposed ALND strategy may effectively improve the survival of patients with ESCC.

OBJECTIVE

The adoption of electronic medical record (EMR) system is gradually increasing. However, various time-motion studies reveal conflicting data regarding time effectiveness on workflow due to computerization. One of the major issues for physicians is their uncertainty with EMRs' potential impact of time on workflow. A tertiary eye hospital in south India was in the process of implementing an EMR system in their ambulatory care unit. Many of the staff did not have previous computing experience and there were conflicting views on the time effectiveness of the computerized system after implementation. The management was thus interested to know the real time effectiveness of EMR in their hospital. The study compliments existing studies of this type by comparing the time efficiency of documentation time using EMR system with paper documentation in a hospital in a developing country where a transition between paper and EMR documentation was currently in progress.

METHODS

Ten randomly selected optometrists documented the time they spent during consultation with both paper and EMR documentation. The time spent was documented for a total of 200 records (100 EMR and 100 paper records). The independent-samples t-test and analysis of variance were used to compare the means of the consultation time and calculated documentation time spent between the electronic and paper records.

RESULTS

There was no statistically significant difference in the time spent for documentation between electronic and paper records. The mean time spent in documenting electronic records was 0.92min (95% CI -3.06 to 1.14) longer than in paper records.

CONCLUSIONS

EMR systems can be adopted in eye hospitals without having significant negative impact on duration of consultation and documentation for optometrists. More time-motion studies that include ophthalmologists are however needed in order to get a more complete picture of time impact of the EMR system on clinical workflow in eye hospitals.

OBJECTIVE

To evaluate patient and workforce outcomes following the implementation of the Practice Partnership Model of Care.

METHODS

Pre-test-post-test design.

METHODS

A 29-bed surgical ward at a tertiary-level regional hospital.

METHODS

Summary de-identified data from all patients and ward nursing staff in the study period.

METHODS

The Practice Partnership Model of Care has four main components: working in partnership; clinical handover at the bedside; comfort rounds; and environmental modifications. These reflect patient-centered and quality focused initiatives and use a total quality improvement framework that aims to transform care at the bedside.

METHODS

Patient outcomes: changes in patient safety (measured by numbers of medication errors and patient falls); satisfaction with care (use of the call bell system, number of complaints and compliments). Workforce outcomes: changes in staff satisfaction (measured through staff sick leave).

RESULTS

A statistically significant reduction in use of nurse call bells (p=<0.001) post-implementation. Medication errors and patient falls reduced, with an overall reduction of 4% in staff sick leave.

CONCLUSIONS

The Practice Partnership Model of Care positively affected patient and workforce outcomes, suggesting further exploration of this model in other hospital contexts is warranted.

Precision imaging is paramount to achieving success in surgical resection of many spinal tumors, whether the goal involves guiding a surgical cure for primary tumors or improving neurological decompression for metastatic lesions. Pre-operatively, image visualization is intimately involved with defining a clear target and surgical planning. Intra-operatively, image-guidance technology allows for surgeons to maximize the probability for gross total resection of spinal cord tumors and minimize damage to adjacent structures. Through this review, it is evident that spinal surgery has undergone significant advancements with the continued technological progression of different modalities of imaging guided technologies. Sophisticated imaging techniques compliment the surgeon's knowledge by providing an intraoperative reference to spinal column anatomy. This review discusses research efforts focusing on immersive imaging guided interactions with subject specific medical images that could enhance a surgeon's ability to plan and perform complex spinal oncology procedures with safety and efficiency.

OBJECTIVE

We examined the evaluations given by nurses to obstetrics and gynecology residents to estimate whether gender bias was evident.

BACKGROUND

Women receive more negative feedback and evaluations than men-from both sexes. Some suggest that, to be successful in traditionally male roles such as surgeon, women must manifest a warmth-related (communal) rather than competence-related (agentic) demeanor. Compared with male residents, female residents experience more interpersonal difficulties and less help from female nurses. We examined feedback provided to residents by female nurses.

METHODS

We examined Professional Associate Questionnaires (2006-2014) using a mixed-methods design. We compared scores per training year by gender using Mann-Whitney and linear regression adjusting for resident and nurse cohorts. Using grounded theory analysis, we developed a coding system for blinded comments based on principles of effective feedback, medical learners' evaluation, and impression management. χ examined the proportions of negative and positive and communal and agentic comments between genders.

RESULTS

We examined 2,202 evaluations: 397 (18%) for 10 men and 1,805 (82%) for 34 women. Twenty-three compliments (eg, "Great resident!") were excluded. Evaluations per training year varied: men n=77-134; women n=384-482. Postgraduate year (PGY)-1, PGY-2, and PGY-4 women had lower mean ratings (P<.035); when adjusted, the difference remained significant in PGY-2 (MWomen=1.5±0.6 compared with MMen=1.7±0.5; P=.001). Postgraduate year-1 women received disproportionately fewer positive and more negative agentic comments than PGY-1 men (positive=17.3% compared with 40%, negative=17.3% compared with 3.3%, respectively; P=.041).

CONCLUSIONS

Evidence of gender bias in evaluations emerged; albeit subtle, women received harsher feedback as lower-level residents than men. Training in effective evaluation and gender bias management is warranted.

Operative arthroscopy of the wrist compliments the physical examination and radiographic imaging to improve diagnosis and treatment of lesions about the distal ulna. This article reviews the relevant anatomy, biomechanics, and classification of acute and degenerative lesions of the triangular fibrocartilage complex (TFCC). Minimally invasive diagnostic and management techniques for TFCC tears are described in detail.

The weak symmetry relationship between the relative error and solution norm holds in our developed nonnegative least-squares truncated singular value decomposition method. By using this relationship to specify the optimal regularization parameters, we applied the proposed algorithm to recover particle size distribution from dynamic light scattering (DLS) data. Simulated results and experimental validity demonstrate that the proposed method, which compliments the CONTIN algorithm, might serve as a powerful and simple approach to the inverse problem in DLS.

Two studies tested whether people feel threatened by another individual verbally complimenting their romantic partner. Such compliments may indicate that the other person is a potential rival who will try to "poach" their mate. Across two studies, women were more threatened than men when imagining another person complimenting their partner's physical appearance. There were no sex differences in response to imagining another person complimenting their partner's sense of humor. When another person compliments one's partner's physical appearance, this indicates that they may be sexually attracted to the partner. Mediation analyses revealed that the sex difference occurs because women believe men are more open to casual sex, and therefore more vulnerable to mate poaching when another person expresses sexual interest in them.

BACKGROUND

Residency programs have been forced to curtail many educational activities to comply with duty-hour restrictions. We describe an "after hours" educational program as a forum to provide small-group education customized for each training level to compliment our formal curriculum.

METHODS

Sessions within each general surgery specialty were organized such that 1 session each month was open to either junior (R1 and R2) or senior (R3-R5) trainees and hosted by surgical faculty. Attendance was optional and limited to 15 residents per session with the format determined by the hosting faculty. Participants completed a postsession survey.

RESULTS

Fourteen sessions were held during the 2008-2009 academic year. All sessions were >90% subscribed within 1 week of announcement and attendance was 88%. The average session duration was 2.6 +/- 0.4 hours. Junior resident sessions focused on preparing R1 and R2 residents to handle common consult questions; senior resident sessions were modeled as "mock oral boards." Resident and faculty responses to the postsession questionnaire were similar and favorable with respect to the educational value of this format.

CONCLUSIONS

There is enthusiasm among faculty and trainees to provide small-group, level-specific educational programs outside of the hospital setting and the 80-hour workweek. Such a program is easily implemented, highly effective, and well received. This format has the added benefit of improving interaction between faculty and residents and increasing the camaraderie of a surgical training program.

In this paper, it is shown that the problem of automatic control is, in essence, that of disturbance rejection, with the notion of disturbance generalized to symbolize the uncertainties, both internal and external to the plant. A novel, unifying concept of disturbance rejector is proposed to compliment the traditional notion of controller. The new controller-rejector pair is shown to be a powerful organizing principle in the realm of automatic control, leading to a Copernican moment where the model-centric design philosophy is replaced by the one that is control-centric in the following sense: the controller is designed for a canonical model and is fixed; the difference between the plant and the canonical model is deemed as disturbance and rejected.

In South Africa, a national-level helpdesk was established in August 2014 as a social accountability mechanism for improving governance, allowing recipients of public sector services to send complaints, compliments and questions directly to a team of National Department of Health (NDoH) staff members via text message. As demand increases, mechanisms to streamline and improve the helpdesk must be explored. This work aims to evaluate the need for and feasibility of automated message triage to improve helpdesk responsiveness to high-priority messages. Drawing from 65 768 messages submitted between October 2016 and July 2017, the quality of helpdesk message handling was evaluated via detailed inspection of (1) a random sample of 481 messages and (2) messages reporting mistreatment of women, as identified using expert-curated keywords. Automated triage was explored by training a naïve Bayes classifier to replicate message labels assigned by NDoH staff. Classifier performance was evaluated on 12 526 messages withheld from the training set. 90 of 481 (18.7%) NDoH responses were scored as suboptimal or incorrect, with median response time of 4.0 hours. 32 reports of facility-based mistreatment and 39 of partner and family violence were identified; NDoH response time and appropriateness for these messages were not superior to the random sample (P>0.05). The naïve Bayes classifier had average accuracy of 85.4%, with ≥98% specificity for infrequently appearing (<50%) labels. These results show that helpdesk handling of mistreatment of women could be improved. Keyword matching and naïve Bayes effectively identified uncommon messages of interest and could support automated triage to improve handling of high-priority messages.

Increased consumer participation, clinical governance, accreditation, and occupational health and safety requirements have contributed to considerable changes in the demands placed upon mental health staff, and many are now expected to undertake or participate in research. However, many staff have not received formal training in research design and methodology, and the multitude of policies, procedures, and committees, designed to protect research participants, can seem like insurmountable barriers to clinicians new to the field. In response to this, a guide was developed based on self-directed learning principles, to compliment other resource material and promote effective research work. It was considered important to clarify some of the issues surrounding research development, ethics, and scholarly integrity, and to educate staff as to the appropriate approval processes, which must be followed before embarking on research work. This paper seeks to describe the process of developing a guide for novice researchers, its key characteristics, and its implications for practice. The guide 'Undertaking research: a guide for the beginner' described in this paper, provides a helpful resource that can be readily adapted and developed for a variety of workplaces and professional backgrounds. It is a strategy intended to encourage research and ongoing education and narrow the research-practice gap while placing minimum demand upon existing organizational infrastructure.

BACKGROUND

Common fetal parameters for gestational age (GA) estimation have pitfalls especially in advanced pregnancy and pregnancy complicated by fetal structural anomaly.

OBJECTIVE

To assess the relationship between umbilical cord size and gestational age of the fetus.

METHODS

A sonographic cross sectional study involving 300 pregnant women with GA between 14 weeks to 40 weeks was done in Enugu, Nigeria. Gestational ages were first estimated by use of Naegele's formula for GA estimation based on the date of onset of each subject's last menstrual period. Fetal parameters such as biparietal diameter, femur length, head circumference and abdominal circumference were measured and also used to estimate GA. Umbilical cord diameters were measured and used to compute the umbilical cord cross-sectional area.

RESULTS

The mean umbilical cord diameter and cross-sectional area were 14.5mm ± 7.2mm and 201.6mm ± 139.5mm(2) respectively. Umbilical cord growth rate of 1.0mm/week was noted between the 14(th) and 35(th) week of pregnancy. There were significant correlations (p < 0.001) between umbilical cord size and other fetal parameters for GA estimation.

CONCLUSIONS

Umbilical cord size had strong linear relationship with common fetal GA estimation parameters and could be used to compliment these parameters for GA estimation.

Metabolomics as a global analysis of a large number of cellular metabolites relies heavily on the new developments in separation science and technology. None of the existing analytical techniques can simultaneously separate and measure all the cellular metabolites due to complexity of cellular metabolome and, therefore, a combination of analytical techniques must be used. Currently NMR, GC-MS and LC-MS are most often used in metabolomics. Novel separation methods such as supercritical fluid chromatography (SFC), which can increase metabolome coverage while decreasing cost and analysis time, can provide alternative to other analytical techniques. As a result of major improvements in instrumentation and development of a new diverse column chemistries SFC-MS is increasingly used in a variety of biomedical applications and is becoming an attractive compliment to other major analytical platforms in metabolomics. Despite its potential and advantages, SFC-MS application in metabolomics is limited. Here we provide a brief overview of the latest developments of SFC-MS for metabolomics applications.

B-mode-compression sonography is the method of choice in detection of deep venous thrombosis of the lower extremity after surgery or immobilisation: It is readily available, repeatable at any time, and is the least stressing for the patient. Color-coded duplex compliments b-mode compression in selected cases, and is method of choice in follow-up exams to evaluate recanalisation. I.v.-phlebography has lost its importance and is only indicated in rare situations. Other picture-rendering methods couldn't be shown to be superior and hence did not find their way to clinical routine.

A combination of both in vivo and in vitro techniques is invaluable for studying semaphorin signaling in the avian central nervous system. Here we describe how both types of approaches can be used to compliment each other in order to unravel the role that semaphorins play during embryonic development and elucidate the functional consequences of semaphorin knockdown using RNA interference vectors. We describe and discuss specifically the use of in ovo electroporation and primary oculomotor neuron culture to identify the role of semaphorins in oculomotor neuron migration and assess functional consequences of semaphorin disruption in this system.

Consumer participation in hospitals is increasingly being advocated for as a way to contribute to improving safety and quality. This article reports on the results of a study conducted to investigate if, and how, a range of consumers would prefer to be involved in improving the quality of hospital services. Face-to-face interviews were conducted with 100 users of a hospital, telephone interviews were conducted with 2,005 members of the broader South Australian community, focus groups were conducted with 22 representatives of consumer and community groups and in-depth interviews conducted with four representatives who could not attend the focus groups. The results indicate that for users of the hospital and members of the broader community, there is a significant preference to be involved in more passive methods of participation that are initiated by the hospital, such as written and phone surveys. This is preferable to writing letters of complaint or compliment, participating in more active methods that require one-off commitment (focus groups and public planning forums) and ongoing commitment such as being members of working groups to address specific issues and hospital committees. In contrast, representatives of consumer and community groups have a strong preference to be involved in active methods of participation such as working groups to address specific issues and hospital committees. We found that there are considerable differences between age groups and educational attainment and preference for participation. If these issues are not taken into account, and a range of participation methods used, then there is the potential for some population groups to be excluded from having some input into improving the safety and quality of hospital services.

The purpose of this study was to investigate whether sinusoidally modulated visual stimuli at extremely low frequencies (ELF) of 50, 16.66, 13, 10, 8.33 and 4Hz could influence the changes in EEG activity in 33 human subjects. An improved design of visual stimulator system has addressed an issue of electrical interference from electrical signals driven by LED arrays onto simultaneously recorded EEG. A comparison between 1 and 3-Way ANOVA was performed in order to evaluate whether visual stimuli at ELFs could influence the EEG in humans to compliment the currently active medical research in seasonal affective disorder (SAD) and photic driving. The results revealed that under evaluation of 1 and 3-Way repeated-measures ANOVA tests, the Theta, Alpha2 and Gamma EEG bands exhibited a common significant difference between ELF visual stimuli.

Normal host defense mechanisms are effective in preventing central nervous system (CNS) infection. Opsonins and compliment levels are normally low in the CNS, however. The relationship of these factors to CNS infection, specifically surgical wound infection and shunt infection, is discussed.