Miracle-dz/UniFAR-FTUs huggingface dataset:
Measures of energy expenditure and comfort in an ESP wheelchair: a controlled trial using hemiplegic users'

Aim. The aim of this pilot study using hemiplegic subjects was to measure energy expenditure, hand position and ride comfort, in a standard dual handrim Sunrise Breezy wheelchair compared to one modified with a novel ergonomic self-propelled steering (ESP) mechanism kit. A previous study by Mandy et al. (Disabil Rehabil Assist Technol 2007;2:255–260) reported that the attachment of the ESP kit to a standard Sunrise Breezy wheelchair provided a more ergonomically efficient mechanism for wheelchair steering and propulsion for non-disabled individuals. Methods. Thirteen hemiplegic stroke users participated in a repeated measures trial by driving two manual wheelchairs – a standard manual dual handrim wheelchair and one fitted with the ESP steering conversion kit. Wheelchairs were randomly assigned, to participants who drove each wheelchair around a designated circuit. Oxygen consumption, carbon dioxide and heart rate were measured as indicators of ergonomic efficiency using a Cosmed analyser. Comfort for each wheelchair was measured using a validated questionnaire. Results. Oxygen consumption (O2mls/min) and exhaled carbon dioxide (CO2mls/min) were significantly lower in the modified wheelchair (p < 0.004 and p < 0.04, respectively). Time taken to complete the course was significantly faster in the ESP (p < 0.001). There was no significant difference in heart rate readings between the wheelchairs. All comfort ratings were reported to be significantly greater in the ESP (p < 0.01). Conclusions. The ESP conversion kit transforms a standard Sunrise Breezy wheelchair into one that is ergonomically more efficient and comfortable for hemiplegic subjects.
Speech-driven environmental control systems – a qualitative analysis of users' perceptions

Purpose. To explore users' experiences and perceptions of speech-driven environmental control systems (SPECS) as part of a larger project aiming to develop a new SPECS. The motivation for this part of the project was to add to the evidence base for the use of SPECS and to determine the key design specifications for a new speech-driven system from a user's perspective. Method. Semi-structured interviews were conducted with 12 users of SPECS from around the United Kingdom. These interviews were transcribed and analysed using a qualitative method based on framework analysis. Results. Reliability is the main influence on the use of SPECS. All the participants gave examples of occasions when their speech-driven system was unreliable; in some instances, this unreliability was reported as not being a problem (e.g., for changing television channels); however, it was perceived as a problem for more safety critical functions (e.g., opening a door). Reliability was cited by participants as the reason for using a switch-operated system as back up. Benefits of speech-driven systems focused on speech operation enabling access when other methods were not possible; quicker operation and better aesthetic considerations. Overall, there was a perception of increased independence from the use of speech-driven environmental control. Conclusions. In general, speech was considered a useful method of operating environmental controls by the participants interviewed; however, their perceptions regarding reliability often influenced their decision to have backup or alternative systems for certain functions.
Treatment Outcomes Among Individuals in a Musculoskeletal Pain Rehabilitation Program Related to the Prevalence and Trends in the Dispensing of Prescribed Medications

Abstract Objectives: Prescribed medication consumption for chronic, non-malignant pain may not be beneficial. This study investigated how self-reported treatment outcomes among individuals in a musculoskeletal pain rehabilitation program are related to the prevalence and trends in the dispensing of prescribed medications. Methods: Patients with musculoskeletal pain were recruited as they began a rehabilitation program. Each participant completed a self-administrated questionnaire on pain, health status and socioeconomic factors in the beginning and at the end of the rehabilitation period. Each individual’s baseline data from the rehabilitation sample was linked to the national Norwegian Prescription Database [2004–2010]. Dispensing prescribed medications in the groups of centrally acting analgesics [opioids], anxiolytics and hypnotics were studied. Results: A total of 1562 individuals participated, and there was no loss to follow-up. Controlled medications [Schedule 2] were prescribed in 36.4% [n = 569] of the sample population. Women were overrepresented in the sample. The dispensing of prescribed hypnotics is more frequent than the dispensing of prescribed analgesics and anxiolytics. Old age, low education level and living alone are related to being prescribed hypnotics and anxiolytics, while gender [female] is related to being prescribed analgesics. A reduction in pain intensity over the two observations in time [pre- and post-treatment] is related to the prescription of hypnotics, while a lack of improvement in physical capacity during the rehabilitation program is significantly related to being prescribed analgesics. The improvement in overall health is significantly related to being prescribed anxiolytics. Conclusions: Dispensing of prescribed analgesics, anxiolytics and hypnotics among individuals in rehabilitation with chronic musculoskeletal pain is associated with treatment outcomes and should be taken into account in designing the rehabilitation intervention.
A carga das neoplasias no Brasil: mortalidade e morbidade hospitalar entre 2002-2004

OBJECTIVE: To describe mortality and the hospital morbidity by neoplasias in Brazil and regions according to gender. METHODS: Data of deaths were obtained from the Mortality Information System and of hospital morbidity from the Hospital Information System. Deaths were categorized according to primary tumor sites, selected in accordance with the tenth revision of the International Classification of Diseases. The population data were drawn from the inter census estimates of the IBGE (Brazilian Institute of Geography and Statistics). The period of analysis was the triennial 2002-2004, with the most recent mortality data in Brazil. The average of this period was calculated to ensure greater stability of the rates. RESULTS: Between 2002 and 2004, 405,415 deaths from neoplasias occurred in Brazil. The highest rates of mortality were identified in the South and South-East regions. For men, cancer of the trachea, bronchi and lungs were the malignant neoplasias with the highest mortality rate while for women breast cancer was highest. Breast cancer and cancer of the uterine cervix are those requiring the largest number of in-hospital admissions. In internments, leukemia presented the highest average cost and total cost. CONCLUSION: The burden of neoplasms is extremely high in Brazil and public policies focused on the population must be given priority for an effective control of mortality and morbidity.
Gray‐Matter Atrophy after Chronic Complete Unilateral Vestibular Deafferentation

It has been shown in blind patients that the abolition of sensory input can lead to changes in white‐ and cortical gray‐matter volumes. Here the white‐ and gray‐matter changes found with whole brain voxel‐based morphometry in 16 patients with complete chronic unilateral vestibular deafferentation (UVD) due to vestibular schwannoma removal several years prior are reported on. Subtle deficits in spatial memory and navigation were previously shown in patients with right UVD. Images of the brains of right‐UVD patients were flipped, standard preprocessing steps were performed, and the data were modulated. Patients showed a gray‐matter volume reduction in the cerebellum due to schwannoma removal, in the supramarginal gyrus ipsilateral to the lesion, as well as in the postcentral and superior temporal gyrus, areas involved in the vestibular cortical network, and in the motion‐sensitive area MT/V5. There was no correlation with behavioral navigational abilities. No gray‐matter atrophy was found in the insular cortical vestibular region or the hippocampus, both of which receive bilateral vestibular projections. The thalamus and tegmentum of the mesencephalon showed gray‐matter reduction on the opposite side; this was possibly due to reduced auditory input, which is known to cross at this level. In comparison to healthy controls, no regional increases in gray‐matter volume were seen. No white‐matter changes were detected at the selected threshold.
A systematic review: the influence of real time feedback on wheelchair propulsion biomechanics

Abstract Background: Clinical guidelines recommend that, in order to minimize upper limb injury risk, wheelchair users adopt a semi-circular pattern with a slow cadence and a large push arc. Objectives: To examine whether real time feedback can be used to influence manual wheelchair propulsion biomechanics. Review methods: Clinical trials and case series comparing the use of real time feedback against no feedback were included. A general review was performed and methodological quality assessed by two independent practitioners using the Downs and Black checklist. The review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Results: Six papers met the inclusion criteria. Selected studies involved 123 participants and analysed the effect of visual and, in one case, haptic feedback. Across the studies it was shown that participants were able to achieve significant changes in propulsion biomechanics, when provided with real time feedback. However, the effect of targeting a single propulsion variable might lead to unwanted alterations in other parameters. Methodological assessment identified weaknesses in external validity. Conclusions: Visual feedback could be used to consistently increase push arc and decrease push rate, and may be the best focus for feedback training. Further investigation is required to assess such intervention during outdoor propulsion. Implications for Rehabilitation Upper limb pain and injuries are common secondary disorders that negatively affect wheelchair users’ physical activity and quality of life. Clinical guidelines suggest that manual wheelchair users should aim to propel with a semi-circular pattern with low a push rate and large push arc in the range in order to minimise upper limbs’ loading. Real time visual and haptic feedback are effective tools for improving propulsion biomechanics in both complete novices and experienced manual wheelchair users.
Wheelchair service provision education and training in low and lower middle income countries: a scoping review

Abstract Purpose: Improving access to education and training for those providing wheelchair and seating assistive technology to meet personal posture and mobility requirements, as a basic human right, is a priority. This review considers education and training available to personnel within low and lower middle income countries (LLMIC), to ascertain where gaps in knowledge exist and identify human resource education priorities. Method: A scoping review, mapping out existing scientific and grey literature within the field between 1993 and 2017 was conducted. The search strategy included use of online databases, manual analogue searches and key stakeholder informant advice. A content analysis process was applied to organize the literature retrieved and extract key themes. Results: Education and training in LLMIC appears ad hoc and limited, however, there is growing recognition as to its importance, notably by the World Health Organization and nongovernmental organizations, delivering education initiatives to a number of countries, along with the development of a credentialing test. Inconsistency exists regarding personnel responsible for wheelchair provision, with no specific professional clearly recognized to oversee the system within many LLMIC. Conclusions: Education and training is required for all stakeholders involved in wheelchair provision. Advocating for programme development to enhance personnel skills, build capacity and ensure best practice is a priority. Pilot sites, delivering and credentialing appropriate wheelchair provision education and training within context should be considered. Measuring outcomes and transferable skills should be part of education programme delivery structures. Considering a new discipline responsible for oversight of wheelchair provision should be investigated. Implications for rehabilitation Education and training is an essential step in the wheelchair provision process in the bid to obtain an appropriate wheelchair via appropriate provision services. However, it is more than education and training; its a human rights issue. Mandatory education and training needs to be a requirement for all stakeholders involved in wheelchair provision. Key wheelchair personnel need to establish their central role in this arena. The study raises awareness as to the importance of working with governments to commit to building sustainable wheelchair provision infrastructures.
Calculating the Number of People with Alzheimer's Disease in any Country Using Saturated Mutation Models of Brain Cell Loss that also Predict Widespread Natural Immunity to the Disease

The series of mutations that cause brain cells to spontaneously and randomly die leading to Alzheimer's disease (AD) is modelled. The prevalence of AD as a function of age in males and females is calculated from two very different mutation models of brain cell death. Once the prevalence functions are determined, the number of people with AD in any country or city can be estimated. The models developed here depend on three independent parameters: the number of mutations necessary for a brain cell associated with AD to spontaneously die, the average time between mutations, and the fraction of the risk population that is immune to developing the disease, if any. The values of these parameters are determined by fitting the model's AD incidence function to the incidence data. The best fits to the incidence rate data predict that as much as 74.1% of males and 79.5% of females may be naturally immune to developing AD. Thus, the development of AD is not a normal or inevitable result of the aging process. These fits also predict that males and females develop AD through different pathways, requiring a different number of mutations to cause the disease. The number of people in the USA with AD in the year 2000 is estimated to be 451,000. It is of paramount importance to determine the nature of the immunity to AD predicted here. Finding ways of blocking the mutations leading to the random, spontaneous death of memory brain cells would prevent AD from developing altogether.
Haplotype‐based analysis of ulcerative colitis risk loci identifies both IL2 and IL21 as susceptibility genes in Han Chinese

Background: The incidence of ulcerative colitis (UC) varies between Western and Eastern ethnicities. A distinct genetic background may play a role in the differences. Until now, very little was known of the UC genetics in Asian populations. Here we performed a haplotype‐based analysis of six known UC susceptibility loci in Han Chinese patients. Methods: In all, 245 UC patients and 300 healthy controls of Han Chinese descent were genotyped for 27 single nucleotide polymorphisms (SNPs), which cover the major haplotypes of the chromosome regions containing IL10, IL2/IL21, MYO9B, ECM1, MST1, and IL23R in Han Chinese. Results: In contrast to the tight linkage disequilibrium (LD) block of the IL2/IL21 region in Caucasians, IL2 and IL21 reside in two independent LD blocks in Han Chinese. The IL2 SNP rs2069762 (P = 7.0 × 10−4, odds ratio [OR] = 1.54, 95% confidence interval [CI] 1.20–1.99) and the IL21 SNP rs2055979 (P = 1.2 × 10−4, OR = 1.50, 95% CI 1.17–1.92) were independently associated with UC. We identified one risk haplotype in IL2 and another independent risk haplotype in IL21. In addition to the IL2/IL21 locus, we observed association of the TT genotype of SNP rs1545620 in MYO9B with UC (P = 0.0169; OR = 0.29, 95% CI 0.11–0.78) and association of rs17375018 in IL23R with pancolitis in Chinese UC patients (P = 0.002; OR = 2.38, 95% CI 1.41–4.02). Conclusions: Our study confirmed the association of the IL2/IL21 region with UC in Han Chinese patients, and further implied both IL2 and IL21 as genetic risk factors for UC. Han Chinese UC patients share part of their genetic susceptibility with Caucasian patients.
Evaluating GPS sampling rates for pedestrian assistant systems

Abstract In recent years, assistant systems have come to widespread use and support people in various situations e.g. in getting from A to B. For quite a time also assistant systems with special attention to older people have been developed. For example, in case of cognitive impairments where autonomous living indoors as well as outdoors is affected, assistant systems can be valuable aids. First attempts for outdoor assistance with GPS-based location systems offering the possibility to define geo-fences for raising an alert if a known area is left have been made. The quality of these systems is largely dependent on the precision of localisation which among others is influenced by the sampling rate. This paper reports on an empirical study under real world conditions to determine a suitable GPS sampling rate for movement analysis of (cognitively impaired) pedestrians. The work considers GPS measurement and interpolation errors as well as track losses as a result of low sampling rates. For the study, GPS data for different environmental settings and movement scenarios for sampling rates of 1, 2, 3, 4, 5, 10, 15, 20 and 25 s has been collected. The impact of sampling rates on movement parameters like track length and speed has been empirically measured. Additionally, the influence of smoothing approaches on data quality and whether downsampling of data has the same effect as recording with corresponding lower sampling rate has been studied. Results show that across all tested scenarios a sampling rate of 3–5 s seems to be appropriate with respect to speed and track length. Additionally, it can be argued that smoothing improves data quality of highly sampled data (up to 4 s). With downsampling, outliers are less in comparison to data sampled at the corresponding sampling rate.
Idiopathic normal pressure hydrocephalus

Hydrocephalus can present with acute or chronic symptoms at any age. Obstructive and communicating hydrocephalus are the two main types. In adults, the most common form of the latter is normal pressure hydrocephalus (NPH) with a mean age at onset of about 70 years, equally common in both sexes. This review will focus on the idiopathic variant of the disease (INPH), the typical features of which are imbalance, gait disturbance, urinary symptoms, and cognitive decline. Although the treatment is surgical, by placing a cerebrospinal fluid (CSF) shunt, neurologists are essential for diagnosing patients with gait disturbance and/or ventriculomegaly, for preoperative selection of shunt candidates, and to optimise the CSF shunt system postoperatively. Very little is known about the incidence and prevalence of INPH. In a door to door survey in people older than 65 years, 0.7% of the population had Parkinson’s disease and 0.4% NPH.1 In Sweden, between three and six shunt operations in adults per 100 000 inhabitants are done every year at the six neurosurgical centres, about 30% of which are for INPH and 20% for secondary NPH.2 The pre- and postoperative investigation of INPH is the fourth most common diagnosis after stroke, epilepsy, and headache at the neurology inpatient service at our hospital. There are few neurological conditions where treatment has such a large impact on outcome as INPH. The patients are elderly and even a small improvement in their gait or activities of daily living has the potential to substantially increase their independence. In most countries hydrocephalus is considered a “neurosurgical problem” without any need to consult the neurologist. But we believe that a multidisciplinary approach with the neurologist and neurosurgeon in fruitful cooperation is what is needed. An important issue for the general neurologist is the evaluation of patients referred because of gait …
Cesarean section and the risk of pediatric Crohn's disease

Background: Crohn's disease (CD) could involve an inappropriate immune response against normal bowel flora. Disrupted or atypical patterns of microbial bowel colonization may impair development of homeostasis between gut flora and the immune system. Perinatal microbial exposures may be particularly important in stimulating intestinal immune recognition. As birth by cesarean section is thought to represent an atypical pattern of early bowel colonization, we examined its association with pediatric CD. Methods: Some 1536 patients diagnosed with pediatric CD and 15,439 controls matched by delivery unit, week of birth, sex, and born between 1973 and 2006 were identified through Swedish registers. The association of birth by cesarean section with pediatric CD was examined using conditional logistic regression, with stratification by sex and adjustment for parental socioeconomic index and maternal infections during pregnancy. Results: Birth by cesarean section is associated with a modestly increased risk for pediatric CD among boys (odds ratio [OR] = 1.25, 95% confidence interval [CI] 1.01–1.54) but not girls, (OR = 0.99, 95% CI 0.76–1.29) and elective cesarean section is associated with a modest increased risk for the entire population (OR = 1.36, 95% CI 1.02–1.80). Conclusions: This study does not suggest that the delivery procedure should be altered, but the findings may be of etiological significance in CD, indicating a potential role for perinatal exposures associated with delivery mode. Although the sex difference may have arisen by chance, the modestly increased CD risk for boys delivered by cesarean section is consistent with sex‐specific differences in susceptibility to some exposures. (Inflamm Bowel Dis 2011;)
Visual Search Disorders in Acute and Chronic Homonymous Hemianopia

Patients with homonymous hemianopia due to occipital brain lesions show disorders of visual search. In everyday life this leads to difficulties in reading and spatial orientation. It is a matter of debate whether these disorders are due to the brain lesion or rather reflect compensatory eye movement strategies developing over time. For the first time, eye movements of acute hemianopic patients (n= 9) were recorded during the first days following stroke while they performed an exploratory visual‐search task. Compared to age‐matched control subjects their search duration was prolonged due to increased fixations and refixations, that is, repeated scanning of previously searched locations. Saccadic amplitudes were smaller in patients. Right hemianopic patients were more impaired than left hemianopic patients. The number of fixations and refixations did not differ significantly between both hemifields in the patients. Follow‐up of one patient revealed changes of visual search over 18 months. By using more structured scanpaths with fewer saccades his search duration decreased. Furthermore, he developed a more efficient eye‐movement strategy by making larger but less frequent saccades toward his blind side. In summary, visual‐search behavior of acute hemianopic patients differs from healthy control subjects and from chronic hemianopic patients. We conclude that abnormal visual search in acute hemianopic patients is related to the brain lesion. We provide some evidence for adaptive eye‐movement strategies developed over time. These adaptive strategies make the visual search more efficient and may help to compensate for the persisting visual‐field loss.