Miracle-dz/UniFAR-FTUs huggingface dataset:
Effects of sling and voluntary constraint during constraint-induced movement therapy for the arm after stroke: a randomized, prospective, single-centre, blinded observer rated study

Objective: To determine whether a combination of constraint-induced movement therapy and physiotherapy in stroke patients using different constraint regimens (sling versus voluntary constraint) changes or reduces motor deficits, the amount of functional use of the arm and whether the effects of treatment continue after 12 months. Design: Forty-seven stroke patients were stratified and randomly divided into intensive physiotherapy programmes focused on regaining arm functions. Setting: Neurorehabilitation Unit of IInd Department of Neurology at Institute of Psychiatry and Neurology in Warsaw. Subject: Patients were randomly allocated to: the sling-constraint group (n = 24) or to the voluntary-constraint group (n = 23). Interventions: Massed practice with the paretic arm (5 hours/day for 15 consecutive working days). Sling-constraint group had their arm immobilized in a hemi-sling during therapy. In addition, individual, 1-hour physiotherapy sessions were conducted in both groups. Main measures: Rivermead Motor Assessment (RMA) Arm scale, (0–15), Motor Activity Log – Quality of Movement (MAL-QOM) (0–5 for 30 daily tasks). Results: There was no significant difference between groups after therapy (MAL-QOM mean change for sling group 0.78, SD = 0.46 and for voluntary-constraint group 0.84, SD = 0.48; P = 0.687). All treated patients retained mean gains in real-world arm use (MAL-QOM) mean scores after 12 months follow-up compared with posttreatment values but there was no significant difference between groups (comparison of estimated mean change of MAL-QOM stated 0.23. 95% confidence interval = −0.04–0.50). Conclusion: Voluntary activity constraint in the intact arm is equivalent to sling, standard constraint during massed practice of paretic arm.
CT angiography in the assessment of carotid artery atherosclerosis: A comparative analysis with MR angiography with reference to contrast angiography and intravascular ultrasound

Objective: The aim of the study was to evaluate the ability of CT angiography (CTA) to detect atherosclerosis of the carotid arteries in comparison with 3D time-of-flight MR angiography (3D TOF MRA), using contrast angiography and intravascular ultrasound (IVUS) as a reference. Material and Methods: Contrast angiography and CTA were performed in 31 patients (mean age 65 years, range 45-79). The image quality was evaluated, atherosclerotic lesions were registered, and diameter stenosis degree was visually estimated from axial source images of CTA and 3D TOF MRA (21 patients), and results of interpretations were compared. The comparison of quantitative measurements was performed using IVUS as a reference. Results: Contrast angiography detected 51 lesions (mean diameter stenosis 50%, range 10-100%), and CTA detected all same lesions. CTA provided better image quality and consistency of image interpretation than 3D TOF MRA. IVUS verified 29 atherosclerotic lesions with a mean diameter stenosis of 35%, (range 4-40%). CTA yielded a sensitivity of 96% to 100% (≤⃒10% or ≤⃒20% diameter stenosis regarded as normal) for the detection of lesions with reference to IVUS. Conclusion: CTA seems feasible and accurate for the detection of atherosclerosis in carotid arteries.
When nurse knows best: some aspects of nurse/doctor interaction in a casualty department

Abstract It is commonly supposed that the working relationship between doctor and nurses is one in which the latter are subordinate to the former. An analysis of previously unpublished data from a wider study of the processes of patient categorisation in one casualty setting reveals both areas in which nurses’ work appears to move closer to the focal tasks of diagnosis and treatment in particular and also observed patterns of doctor-nurse interaction at odds with the common supposition.
A systematic review and meta-analysis of the effect of an ankle-foot orthosis on gait biomechanics after stroke

Objective: To systematically review the evidence on the effects of an ankle-foot orthosis on gait biomechanics after stroke Data sources: The following databases were searched; AMED, CINHAL, Cochrane Library (Stroke section), Medline, PubMed, Science Direct and Scopus. Previous reviews, reference lists and citation tracking of the selected articles were screened and the authors of selected trials contacted for any further unpublished data. Review methods: Controlled trials of an ankle-foot orthosis on gait biomechanics in stroke survivors were identified. A modified PEDro score evaluated trial quality; those scoring 4/8 or more were selected. Information on the trial design, population, intervention, outcomes, and mean and standard deviation values for the treatment and control groups were extracted. Continuous outcomes were pooled according to their mean difference and 95% confidence intervals in a fixed-effect model. Results: Twenty trials involving 314 participants were selected. An ankle-foot orthosis had a positive effect on ankle kinematics (P < 0.00001–0.0002); knee kinematics in stance phase (P < 0.0001–0.01); kinetics (P = 0.0001) and energy cost (P = 0.004), but not on knee kinematics in swing phase (P = 0.84), hip kinematics (P < 0.18–0.89) or energy expenditure (P = 0.43). There were insufficient data for pooled analysis of individual joint moments, muscle activity or spasticity. All trials, except one, evaluated immediate effects only. Conclusions: An ankle-foot orthosis can improve the ankle and knee kinematics, kinetics and energy cost of walking in stroke survivors.
Considerations on covariates and endpoints in multi‐arm multi‐stage clinical trials selecting all promising treatments

In early stages of drug development, there is often uncertainty about the most promising among a set of different treatments. To ensure the best use of resources in such situations, it is important to decide which, if any, of the treatments should be taken forward for further testing. In later development, it has been shown that evaluating more than one dose increases the chance of success substantially. In this work, we discuss how multi‐arm multi‐stage trials can be designed such that all promising treatments are kept in the study at the interim analyses. We first investigate the impact of deviating from the planned design and show how confidence intervals can be constructed before we consider the impact of important covariates. We show that under orthogonality, the inclusion of covariates has no effect on familywise error rate control in the strong sense. We further show that the derived methodology can be used to investigate non‐normal endpoints. Copyright © 2012 John Wiley & Sons, Ltd.
Efficacy of microcurrent therapy in infants with congenital muscular torticollis involving the entire sternocleidomastoid muscle: a randomized placebo-controlled trial

Objective: To compare the effects of a combination of therapeutic exercise and ultrasound with or without additional microcurrent therapy in infants with congenital muscular torticollis involving the entire sternocleidomastoid muscle. Design: Prospective, randomized, placebo-controlled trial. Setting: An outpatient rehabilitation clinic in a tertiary university hospital. Subjects: Infants (n = 20) with congenital muscular torticollis involving the entire sternocleidomastoid muscle. Interventions: Group 1 comprised 10 infants who received therapeutic exercise with ultrasound alone and Group 2 comprised 10 infants who received the same treatment with microcurrent therapy. Main measures: Passive cervical rotational range of motion was measured at before treatment and one, two, three, and six months after initial treatment. Thickness, cross-sectional area, and red pixel intensity on colour histograms, which were all assessed before treatment and at three months after initial treatment. Additionally, the duration of treatment was measured. Results: The mean passive cervical rotational range of motion measured at three months posttreatment was significantly greater in Group 2 (101.1°) than that in Group 1 (86.4°), and the thickness, cross-sectional area, and red pixel intensity of the affected sternocleidomastoid muscle were all less in Group 2 (7.8 mm, 100.3 mm2, and 126.1, respectively) than those in Group 1 (9.6 mm, 121.5 mm2, and 140.5, respectively). The mean duration of treatment was significantly shorter in Group 2 (2.6 months) than in Group 1 (6.3 months). Conclusions: Microcurrent therapy may increase the efficacy of therapeutic exercise with ultrasound for the treatment of congenital muscular torticollis involving the entire sternocleidomastoid muscle.
A telerehabilitation intervention for patients with Chronic Obstructive Pulmonary Disease: a randomized controlled pilot trial

Objective: First, to investigate the effects of a telerehabilitation intervention on health status and activity level of patients with Chronic Obstructive Pulmonary Disease (COPD), compared to usual care. Second, to investigate how patients comply with the intervention and whether compliance is related to treatment outcomes. Design: a randomized controlled pilot trial Subjects: Thirty-four patients diagnosed with COPD. Intervention: The telerehabilitation application consists of an activity coach (3D-accelerometer with smartphone) for ambulant activity registration and real-time feedback, complemented by a web portal with a symptom diary for self-treatment of exacerbations. The intervention group used the application for 4 weeks. The control group received usual care. Main measures: Activity level measured by a pedometer (in steps/day), health status by the Clinical COPD Questionnaire at baseline and after intervention. Compliance was expressed as the time the activity coach was worn. Results: Fourteen intervention and 16 control patients completed the study. Activity level (steps/day) was not significantly affected by the intervention over time. There was a non-significant difference in improvement in health status between the intervention (−0.34±0.55) and control group (0.02±0.57, p=0.10). Health status significantly improved within the intervention group (p=0.05). The activity coach was used more than prescribed (108%) and compliance was related to the increase in activity level for the first two feedback weeks (r=0.62, p=0.03). Conclusions: This pilot study shows the potential of the telerehabilitation intervention: compliance with the activity coach was high, which directly related to an improvement in activity levels.
Fisiopatologia do sistema extrapiramidal: Novos conceitos decorrentes dos resultados experimentais E cirúrgicos

The author gives the historical background of the surgical therapy of the extrapyramidal diseases, from Horsley (1890) to Bucy and Buchanan (1931) and other neurosurgeons who adopted the attack on the "pyramidal" tract, and, afterwards, beginning with Meyers (1940), the operations at the level of the basal ganglia. The good results of pallidectomy and thalamectomy on the parkinsonian tremor and rigidity imposed a reformulation of concepts on the physiopathology of the extrapyramidal system. The author discusses the site of the lesion responsible for the parkinsonian symptomatology, accepting the view that the dyskinesia and the rigidity are caused by a lesion of the substantia nigra, in the same way as lesions of the subthalamic nucleus are responsible for the hemiballism. The author criticizes the classificai concept of the prevailing pallidal site of the lesion and the erroneous jacksonian interpretation of the phenomena. The experimental and surgical contributions to the study of the pathological physiology of the medial pallidum and the ventrolateral nuclei of the thalamus are emphasized. The parkinsonian tremor can be regarded as the result of hyperactivity of the pontomesencephalic reticular formation (Jenkner and Ward), owing to the loss of the inhibitory drive of the locus niger, associated to the sparing of the pallidothalamic facilitation. In the periphery the tremorogenic reticulospinal impulses follow the α route. The parkinsonian rigidity would depend on the same encephalic pathologic processes, but its peripheral physiopathogenesis is controversial. Some authors believe that it results from γ hyperactivity, associated to oversensibility of the inhibitory pathways of the motoneurons (HufSchmidt's 5 system). Other investigators, however, have brought to light experimental data pointing to the partial paralisys of the γ sytem, associated to hyperactivity of the α drive. Finally, the author refers to some theories which try to explain the basic mechanism of the physiopathologic process in the extrapyramidal diseases, especially in parkinsonism: abnormal discharges of degenerating neurons (Cooper), oversensibility of the deafferented nuclei (Jenkner and Ward), imbalance between damaged and preserved neural structures (Alberts et al.).
Progressive resistance exercise in women with osteoarthritis of the knee: a randomized controlled trial

Objective: To determine the effect of a progressive resistance exercise (PRE) program on women with osteoarthritis (OA) of the knee. Methods: Eligible subjects included women aged 40 to 70 years with pain between 3 and 8 on a 10-cm pain scale. Among the 144 subjects screened, 60 met the eligibility criteria and were randomized to the experimental group (EG) or control group (CG). Subjects in the EG participated in a 12-week PRE program twice a week and CG remained on a waiting list for physical therapy. The PRE program consisted of strengthening exercises for knee extensors, knee flexors, hip abductors and hip adductors, all performed with 50% and 70% of the one-repetition maximum (1RM) using machines with free weights. Resistance was reevaluated every two weeks. Assessments of pain, muscle strength, walking distance, function and quality of life were performed at baseline, six weeks and 12 weeks by a blinded assessor. Results: Twenty-nine female subjects were randomly assigned to the EG and 31 were randomly assigned to the CG. Repeated-measures ANOVA revealed significantly better results in the EG pain (from 7.0±1.3 to 4.3±3.1 in the EG and from 7.0±1.2 to 6.6±1.5 in the CG - p<0.001), function (p<0.001), some domains of quality of life (physical function: p=0.002; physical role limitation: p=0.002; and pain: p=0.044) and muscle strength (extensors: p<0.001; flexors: p=0.002; and abductors: p<0.001). Conclusion: The PRE program was effective in reducing pain and improving function, some quality of life domains and strength in women with OA of the knee.
Bias associated with using the estimated propensity score as a regression covariate

The use of propensity score methods to adjust for selection bias in observational studies has become increasingly popular in public health and medical research. A substantial portion of studies using propensity score adjustment treat the propensity score as a conventional regression predictor. Through a Monte Carlo simulation study, Austin and colleagues. investigated the bias associated with treatment effect estimation when the propensity score is used as a covariate in nonlinear regression models, such as logistic regression and Cox proportional hazards models. We show that the bias exists even in a linear regression model when the estimated propensity score is used and derive the explicit form of the bias. We also conduct an extensive simulation study to compare the performance of such covariate adjustment with propensity score stratification, propensity score matching, inverse probability of treatment weighted method, and nonparametric functional estimation using splines. The simulation scenarios are designed to reflect real data analysis practice. Instead of specifying a known parametric propensity score model, we generate the data by considering various degrees of overlap of the covariate distributions between treated and control groups. Propensity score matching excels when the treated group is contained within a larger control pool, while the model‐based adjustment may have an edge when treated and control groups do not have too much overlap. Overall, adjusting for the propensity score through stratification or matching followed by regression or using splines, appears to be a good practical strategy. Copyright © 2013 John Wiley & Sons, Ltd.
Customers, Passwords, and Web Sites

Criminals follow money. Today, more and more money is on the Internet: millions of people manage their bank, PayPal, or other accounts - and even their stock portfolios - on line. It's a tempting target - if criminals can access one of these accounts, they can steal a lot of money. And almost all these accounts are protected only by passwords.The solutions are not easy. The never-ending stream of Windows vulnerabilities limits the effectiveness of any customer-based software solution - digital certificates, plug-ins, and so on-and the case with which Malicious software can run on Windows limits other solutions' effectiveness. Point solutions might force attackers to change tactics, but won't solve the underlying insecurities. Computer security is an arms race, and money creates very motivated attackers. Unsolved, this type of security problem will change the way people interact with the Internet. It'll prove that the naysayers were right all along - the Internet isn't safe for electronic commerce.
Laparoscopic Versus Open Live Donor Nephrectomy in Renal Transplantation

Objective: The aim of this study was to compare laparoscopic versus open live donor nephrectomy using meta-analytical techniques. Summary Background Data: Laparoscopic live donor nephrectomy has gained widespread acceptance and is increasingly performed. The body of evidence assessing the safety and efficacy of laparoscopic compared with established open techniques is growing; however, very few randomized control trials exist and individual studies often have small patient numbers with varying results. We combined the available raw data to strengthen the current literature in comparing these techniques. Methods: A literature search was performed and comparative studies published between 1997 and 2006 of open versus laparoscopic donor nephrectomy were included. Outcomes evaluated were operative and warm ischemia times, blood loss, donor complications, length of hospital stay, time to return to work, and delayed graft function. Results: Seventy-three studies matched the selection criteria and included 6594 patients, 3751 (57%) had undergone laparoscopic surgery and 2843 (43%) open nephrectomy. The open nephrectomy group had shorter operative and warm ischemia times by 52 minutes (P 0.001) and 102 seconds (P 0.001), respectively. This did not translate into higher delayed graft function or graft loss rates between the 2 groups. Patients in the laparoscopic group had a shorter hospital stay and a faster return to work by 1.58 days (P 0.001) and 2.38 weeks (P 0.001), respectively. There was a significantly higher rate of overall donor complications in the open group (P 0.007), a finding not reproduced in any subsequent sensitivity analyses. When only randomized control trials were considered, there were shorter operative times (P 0.002) for the open group but nonsignificantly different warm ischemia times. In contrast to the main analysis there were no differences in the overall complication rate, postoperative analgesia, hospital stay, or time taken to return to work. Conclusions: Laparoscopic nephrectomy in live donor transplantation is a safe alternative to the open technique. Although open nephrectomy may be associated with shorter operative and warm ischemia times, patients undergoing laparoscopic nephrectomy may benefit from a shorter hospital stay and faster return to work without compromising graft function.
A New Zealand pilot randomized controlled trial of a web-based interactive self-management programme (MSInvigor8) with and without email support for the treatment of multiple sclerosis fatigue

Objective: To pilot and compare the efficacy of an internet-based cognitive behavioural therapy self-management programme with (MSInvigor8-Plus) and without (MSInvigor8-Only) the use of email support in reducing fatigue severity and impact (primary outcomes), and depressed and anxious mood (secondary outcomes). Design: Randomized controlled trial using an independent randomization system built into the website and intention-to-treat analysis. Setting: Participants were recruited through the local Multiple Sclerosis Society and hospital neurological services in New Zealand. Subjects: A total of 39 people (aged 31–63 years), experiencing multiple sclerosis fatigue, able to walk with and without walking aids, were randomized to MSInvigor8-Only (n = 20) or to MSInvigor8-Plus (n = 19). Interventions: MSInvigor8 is an eight-session programme based on cognitive behaviour therapy principles including psycho-education, self-monitoring, and changing unhelpful activity and thought patterns. Main measures: Outcome measures included fatigue severity (Chalder Fatigue Scale) and impact (Modified Fatigue Impact Scale), and anxiety and depression (Hospital Anxiety and Depression Scale). Assessments were performed at baseline and at 10 weeks. Results: The MSInvigor8-Plus condition resulted in significantly greater reductions in fatigue severity (F [1,36] = 9.09, p < 0.01) and impact (F [1,36] = 6.03, p < 0.02) compared with the MSInvigor8-Only condition. Large between-group effect sizes for fatigue severity (d = 0.99) and fatigue impact (d = 0.81) were obtained. No significant differences were found between the groups on changes in anxiety and depression. Conclusions: MSInvigor8 delivered with email-based support is a potentially promising, acceptable, and cost-effective approach to treating fatigue in people with multiple sclerosis in New Zealand.
A systematic review of the impact of stroke on social support and social networks: associated factors and patterns of change

Objective: Identify what factors are associated with functional social support and social network post stroke; explore stroke survivors’ perspectives on what changes occur and how they are perceived. Data sources: The following electronic databases were systematically searched up to May 2015: Academic Search Complete; CINAHL Plus; E-journals; Health Policy Reference Centre; MEDLINE; PsycARTICLES; PsycINFO; and SocINDEX. Review methods: PRISMA guidelines were followed in the conduct and reporting of this review. All included studies were critically appraised using the Critical Appraisal Skills Program tools. Meta-ethnographic techniques were used to integrate findings from the qualitative studies. Given the heterogeneous nature of the quantitative studies, data synthesis was narrative. Results: Seventy research reports met the eligibility criteria: 22 qualitative and 48 quantitative reporting on 4,816 stroke survivors. The qualitative studies described a contraction of the social network, with non-kin contact being vulnerable. Although family were more robust network members, significant strain was observed within the family unit. In the quantitative studies, poor functional social support was associated with depression (13/14 studies), reduced quality of life (6/6 studies) and worse physical recovery (2/2 studies). Reduced social network was associated with depression (7/8 studies), severity of disability (2/2 studies) and aphasia (2/2 studies). Although most indicators of social network reduced post stroke (for example, contact with friends, 5/5 studies), the perception of feeling supported remained relatively stable (4/4 studies). Conclusion: Following a stroke non-kin contact is vulnerable, strain is observed within the family unit, and poor social support is associated with depressive symptoms.
Guest Editors' Introduction: Mobile Device Security

Now that handheld devices are ubiquitous and powerful enough to be considered personal computers, they're an attractive target for hacking and misuse. The guest editors of this special issue brought together a set of articles that describe challenges and problem-solving strategies for providing the level of security that users will expect in order to for them to place trust in such devices.