bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measurement Properties of Gait-Related Outcomes in Youth With Neuromuscular Diagnoses: A Systematic Review
Authors: Ammann-Reiffer Corinne , Bastiaenen Caroline H.G. , de Bie Rob A. , van Hedel Hubertus J.A. 
Published: May 2014

BackgroundSound measurement properties of outcome tools are essential when evaluating outcomes of an intervention, in clinical practice and in research.PurposeThe purpose of this study was to review the evidence on reliability, measurement error, and responsiveness of measures of gait function in children with neuromuscular diagnoses.Data SourcesThe MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched up to June 15, 2012.Study SelectionStudies evaluating reliability, measurement error, or responsiveness of measures of gait function in 1- to 18-year-old children and youth with neuromuscular diagnoses were included.Data ExtractionQuality of the studies was independently rated by 2 raters using a modified COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. Studies with a fair quality rating or better were considered for best evidence synthesis.Data SynthesisRegarding the methodological quality, 32 out of 35 reliability studies, all of the 13 measurement error studies, and 5 out of 10 responsiveness studies were of fair or good quality. Best evidence synthesis revealed moderate to strong evidence for reliability for several measures in children and youth with cerebral palsy (CP) but was limited or unknown in other diagnoses. The Functional Mobility Scale (FMS) and the Gross Motor Function Measure (GMFM) dimension E showed limited positive evidence for responsiveness in children with CP, but it was unknown or controversial in other diagnoses. No information was reported on the minimal important change; thus, evidence on measurement error remained undetermined.LimitationsAs studies on validity were not included in the review, a comprehensive appraisal of the best available gait-related outcome measure per diagnosis is not possible.ConclusionsThere is moderate to strong evidence on reliability for several measures of gait function in children and youth with CP, whereas evidence on responsiveness exists only for the FMS and the GMFM dimension E.
Response to Pediatric Physical Therapy in Infants With Positional Preference and Skull Deformation
Authors: van Wijk Renske M. , Pelsma Maaike , Groothuis-Oudshoorn Catharina G.M. , IJzerman Maarten J. , van Vlimmeren Leo A. , Boere-Boonekamp Magda M. 
Published: May 2014

Background
Pediatric physical therapy seems to reduce skull deformation in infants with positional preference. However, not all infants show improvement.

Objective
The study objective was to determine which infant and parent characteristics were related to responses to pediatric physical therapy in infants who were 2 to 4 months old and had positional preference, skull deformation, or both.

Design
This was a prospective cohort study.

Methods
Infants who were 2 to 4 months old and had positional preference, skull deformation, or both were recruited by pediatric physical therapists at the start of pediatric physical therapy. The primary outcome was a good response or a poor response (moderate or severe skull deformation) at 4.5 to 6.5 months of age. Potential predictors for responses to pediatric physical therapy were assessed at baseline with questionnaires, plagiocephalometry, and the Alberta Infant Motor Scale. Univariate and multiple logistic regression analyses with a stepwise backward elimination method were performed.

Results
A total of 657 infants participated in the study. At follow-up, 364 infants (55.4%) showed a good response to therapy, and 293 infants (44.6%) showed a poor response. Multiple logistic regression analysis resulted in the identification of several significant predictors for a poor response to pediatric physical therapy at baseline: starting therapy after 3 months of age (adjusted odds ratio [aOR]=1.50, 95% confidence interval [95% CI]=1.04–2.17), skull deformation (plagiocephaly [aOR=2.64, 95% CI=1.67–4.17] or brachycephaly [aOR=3.07, 95% CI=2.09–4.52]), and a low parental satisfaction score (aOR=2.64, 95% CI=1.67–4.17). A low parental satisfaction score indicates low parental satisfaction with the infant's head shape.

Limitations
Information about pediatric physical therapy was collected retrospectively and included general therapy characteristics. Because data were collected retrospectively, no adjustment in therapy for individual participants could be made.

Conclusions
Several predictors for responses to pediatric physical therapy in infants who were 2 to 4 months old and had positional preference, skull deformation, or both were identified. Health care professionals can use these predictors in daily practice to provide infants with more individualized therapy, resulting in a better chance for a good outcome.
Clinical Experience Using a 5-Week Treadmill Training Program With Virtual Reality to Enhance Gait in an Ambulatory Physical Therapy Service
Authors: Shema Shirley Roth , Brozgol Marina , Dorfman Moran , Maidan Inbal , Sharaby-Yeshayahu Lior , Malik-Kozuch Hila , Wachsler Yannai Orly , Giladi Nir , Hausdorff Jeffrey M. , Mirelman Anat 
Published: May 2014

BackgroundCurrent literature views safe gait as a complex task, relying on motor and cognitive resources. The use of virtual reality (VR) in gait training offers a multifactorial approach, showing positive effects on mobility, balance, and fall risk in elderly people and individuals with neurological disorders. This form of training has been described as a viable research tool; however, it has not been applied routinely in clinical practice. Recently, VR was used to develop an adjunct training method for use by physical therapists in an ambulatory clinical setting.ObjectiveThe aim of this article is to describe the initial clinical experience of applying a 5-week VR clinical service to improve gait and mobility in people with a history of falls, poor mobility, or postural instability.DesignA retrospective data analysis was conducted.MethodsThe clinical records of the first 60 patients who completed the VR gait training program were examined. Training was provided 3 times per week for 5 weeks, with each session lasting approximately 1 hour and consisting of walking on a treadmill while negotiating virtual obstacles. Main outcome measures were compared across time and included the Timed “Up & Go” Test (TUG), the Two-Minute Walk Test (2MWT), and the Four Square Step Test (FSST).ResultsAfter 5 weeks of training, time to complete the TUG decreased by 10.3%, the distance walked during the 2MWT increased by 9.5%, and performance on the FSST improved by 13%.LimitationsLimitations of the study include the use of a retrospective analysis with no control group and the lack of objective cognitive assessment.ConclusionsTreadmill training with VR appears to be an effective and practical tool that can be applied in an outpatient physical therapy clinic. This training apparently leads to improvements in gait, mobility, and postural control. It, perhaps, also may augment cognitive and functional aspects.
Three Hurdles to Technology Integration: A Case Study of Technology Integration in Bungamati
Authors: Lee Jeffrey Chih-Yih , Sparks Paul 
Published: May 2014

Integrating technology in education is an extraordinary challenge in rural villages of developing countries like Nepal. Since greater understandings of the circumstances surrounding teachers and schools could illuminate issues and opportunities for positive change, a case study of the telecenter in Bungamati, Nepal was conducted. Data, in the form of interviews, observations and related documents, were gathered and analyzed to highlight and understand the local hurdles for integrating technology in teaching. Findings were threefold: teachers lack technology integration skills; informal learning was the preferred way to learn technology; and males had greater access to technology. In this study, the researcher has drawn the following conclusions: a) teachers need technology access and training, b) administrators need a framework for integration, c) informal learning should be considered and promoted and d) there is a clear need for gender equity. Furthermore, suggestions for future studies include a need for informal learning, the use of the TPACK (Technological, Pedagogical, and Content Knowledge)framework for integration technology and more research in the area of teacher training with technology in other developing countries. DOI: http://dx.doi.org/10.3126/nelta.v18i1-2.10334 Journal of NELTA, Vol 18 No. 1-2, December 2013; 105-114
Fixation with C-2 laminar screws in occipitocervical or C1–2 constructs in children 5 years of age or younger: a series of 18 patients
Authors: Savage Jennifer G. , Fulkerson Daniel H. , Sen Anish N. , Thomas Jonathan G. , Jea Andrew 
Published: May 2014

Object
There are rare indications for upper cervical spine fusion in young children. Compared with nonrigid constructs, rigid instrumentation with screw fixation increases the fusion rate and reduces the need for halo fixation. Instrumentation may be technically challenging in younger children. A number of screw placement techniques have been described. Use of C-2 translaminar screws has been shown to be anatomically feasible, even in the youngest of children. However, there are few data detailing the clinical outcome. In this study, the authors describe the clinical and radiographic follow-up of 18 children 5 years of age or younger who had at least one C-2 translaminar screw as part of an occipitocervical or C1–2 fusion construct.

Methods
A retrospective review of all children treated with instrumented occipitocervical or C1–2 fusion between July 1, 2007, and June 30, 2013, at Riley Children's Hospital and Texas Children's Hospital was performed. All children 5 years of age or younger with incorporation of at least one C-2 translaminar screw were identified.

Results
Eighteen children were studied (7 boys and 11 girls). The mean age at surgery was 38.1 months (range 10–68 months). Indications for surgery included traumatic instability (6), os odontoideum (3), destructive processes (2), and congenital instability (7). A total of 24 C-2 translaminar screws were placed; 23 (95.8%) of 24 were satisfactorily placed (completely contained within the cortical walls). There was one medial cortex breach without neurological impingement. There were no complications with screw placement. Three patients required wound revisions. Two patients died as a result of their original condition (trauma, malignant tumor). The mean follow-up duration for the surviving patients was 17.5 months (range 3–60 months). Eleven (91.7%) of the 12 patients followed for 6 months or longer showed radiographic stability or completed fusion.

Conclusions
Use of C-2 translaminar screws provides an effective anchor for internal fixation of the upper cervical spine. In this study of children 5 years of age or younger, the authors found a high rate of radiographic fusion with a low rate of complications.
Interleukin 18: A Biomarker for Differential Diagnosis Between Adult-onset Still’s Disease and Sepsis
Authors: Priori Roberta , Colafrancesco Serena , Alessandri Cristiano , Minniti Antonina , Perricone Carlo , Iaiani Giancarlo , Palazzo Donatella , Valesini Guido 
Published: May 2014

Objective.The differential diagnosis between rheumatic diseases and infectious conditions is a great challenge in clinical practice. Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory syndrome that shares several clinical and laboratory variables with sepsis. Interleukin (IL)-18 is overexpressed in AOSD, suggesting a possible role as a disease biomarker. The aim of our study was to detect IL-18 serum levels in a cohort of patients with AOSD and sepsis and to address its possible role as a biomarker for differential diagnosis.Methods.A group of unselected patients with AOSD diagnosed according to the Yamaguchi criteria and consecutive patients with sepsis diagnosed according to the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference criteria were enrolled. The clinical and laboratory data were collected. In the AOSD group, disease activity was assessed by Pouchot’s and Rau’s criteria. IL-18 serum levels were detected by ELISA.Results.Thirty-nine patients with AOSD and 18 patients with sepsis were enrolled. Two out of 18 patients with sepsis (11.1%) also fulfilled the Yamaguchi criteria. A significant difference was found in IL-18 serum levels between patients with active and inactive disease (p < 0.001), and it positively correlated with disease activity (p = 0.0003), ferritin serum level (p = 0.016), and erythrocyte sedimentation rate (p = 0.041). IL-18 was significantly increased in patients with AOSD when compared with sepsis (p = 0.014). For a cutoff of 148.9 pg/ml, this test had a specificity of 78.3% and a sensitivity of 88.6%.Conclusion.We have demonstrated that IL-18 can be a biomarker for differential diagnosis between AOSD and sepsis.
Discrepancy Between Clinical and Radiological Responses to Tocilizumab Treatment in Patients with Systemic-onset Juvenile Idiopathic Arthritis
Authors: Aoki Chie , Inaba Yutaka , Choe Hyonmin , Kaneko Utako , Hara Ryoki , Miyamae Takako , Imagawa Tomoyuki , Mori Masaaki , Oba Mari S. , Yokota Shumpei , Saito Tomoyuki 
Published: May 2014

Objective.Tocilizumab (TCZ), an antiinterleukin-6 receptor monoclonal antibody, is clinically beneficial in patients with systemic-onset juvenile idiopathic arthritis (sJIA). We investigated the clinical and radiological outcomes of TCZ therapy in patients with sJIA.Methods.We retrospectively evaluated 2 clinical trials (NCT00144599 and NCT00144612) involving 40 patients with sJIA who received intravenous TCZ (8 mg/kg) every 2 weeks. Clinical data and radiographs of the hands and large joints were assessed before and during TCZ treatment. The Poznanski score, modified Larsen scores of the hands and large joints, and Childhood Arthritis Radiographic Score of the Hip (CARSH) were recorded.Results.After a mean duration of 4.5 years of TCZ treatment, clinical data had improved significantly, the mean Poznanski score improved from −1.5 to −1.1, the mean Larsen score of the hands deteriorated from 7.0 to 10.0, the mean Larsen score for the large joints deteriorated from 5.9 to 6.8, and the CARSH worsened from 3.9 to 6.2. The Larsen score for the large joints improved in 11 cases (28%), remained unchanged in 8 cases (20%), and worsened in 21 cases (52%). Matrix metalloproteinase 3 (MMP-3) levels remained significantly higher (278 mg/dl) in patients with worsened Larsen scores than in patients with improved or unchanged scores (65 mg/dl). Logistic regression analysis showed that older age at disease onset was a significant risk factor for radiographic progression.Conclusion.The modified Larsen score of the large joints deteriorated in half the patients who had high MMP-3 levels during TCZ treatment and who were significantly older at disease onset.
Childhood-onset Takayasu Arteritis — Experience from a Tertiary Care Center in South India
Authors: Goel Ruchika , Kumar T. Sathish , Danda Debashish , Joseph George , Jeyaseelan Visali , Surin Ajith Kumar , Bacon Paul 
Published: May 2014

Objective.To study the clinical profile and outcome of Asian Indian children with childhood-onset Takayasu arteritis (c-TA).Methods.Records were studied of patients with c-TA onset prior to age 16. Disease Extent Index-Takayasu (DEI.TAK), Indian Takayasu Arteritis Score 2010, and Takayasu Arteritis Damage Score (TADS) were calculated retrospectively from electronic records. Cumulative incidence of sustained remission was estimated using the Kaplan-Meier curve.Results.There were 40 patients with c-TA, with median age of onset of 12.5 years (range 1–16) and median diagnostic delay of 11.3 months (range 1–60). The most common presenting features were hypertension, headache, malaise, and fever. Pulseless disease was observed in 25 cases (62.5%). The majority (n = 28) had active disease with raised inflammatory markers, high baseline median DEI.TAK score of 10 (range 3–24), and high median TADS of 7 (range 1–14). Of the 34 patients followed for 21.5 months (range 3–192), remission was attained in 30. However, cumulative sustained remission was achieved in only 29% of them at 5 years. Median period of sustained remission was 22.5 months (95% CI 17.1–26.8). New areas of vessel involvement were observed in 13 patients (38%). Disease progression was arrested in the majority (n = 22, 66%) through aggressive medical management and endovascular intervention. All 11 patients with an increment in TADS of ≥ 4 during followup had persistently active or relapsing disease. There was a single fatality.Conclusion.Despite aggressive immunosuppression, damage progressed in one-third of patients with c-TA in association with persistent inflammation, warranting surveillance with clinical instruments and followup imaging.
Arthritis in Idiopathic Inflammatory Myopathy: Clinical Features and Autoantibody Associations
Authors: Klein Martin , Mann Heřman , Pleštilová Lenka , Betteridge Zoe , McHugh Neil , Remáková Martina , Novota Peter , Vencovský Jiří 
Published: May 2014

Objective.To determine the prevalence, distribution, and clinical manifestations of arthritis in a cohort of patients with idiopathic inflammatory myopathies (IIM). Associations with autoantibody status and HLA genetic background were also explored.Methods.Consecutive patients with IIM treated in a single center were included in this cross-sectional study (n = 106). History of arthritis, 68-joint and 66-joint tender and swollen joint index, clinical features of IIM, and autoantibody profiles were obtained by clinical examination, personal interview, and review of patient records. High-resolution genotyping in HLA-DRB1 and HLA-DQB1 loci was performed in 71 and 73 patients, respectively.Results.A combination of patients’ medical history and cross-sectional physical examination revealed that arthritis at any time during the disease course had occurred in 56 patients (53%). It was present at the beginning of the disease in 39 patients (37%) including 23 cases (22%) with arthritis preceding the onset of muscle weakness. On physical examination, 29% of patients had at least 1 swollen joint. The most frequently affected areas were wrists, and metacarpophalangeal and proximal interphalangeal joints. Twenty-seven out of the 29 anti-Jo1-positive patients had arthritis at any time during the course of their illness; this prevalence was significantly higher compared to patients without the anti-Jo1 autoantibody (p < 0.0001). No association of arthritis with individual HLA alleles was found.Conclusion.Our data suggest that arthritis is a common feature of myositis. It is frequently present at the onset of disease and it may even precede muscular manifestations of IIM. The most common presentation is a symmetrical, nonerosive polyarthritis affecting particularly the wrists, shoulders, and small joints of the hands. We have confirmed a strong association of arthritis with the presence of the anti-Jo1 antibody.
Changing Lives, One Note at a Time: Library Internships for Undergraduate Students
Authors: Sestrick Timothy , Terjesen Lina 
Published: May 2014

Library internships can be valuable learning opportunities for undergraduate students and excellent examples of the rich learning environment of college and university campuses. This article examines undergraduate academic library internships through the lens of an internship for music majors and discusses ways to create engaging, high-impact educational experiences that complement traditional academic settings and programs. Examples are taken from the internship programs in music, reference, and special collections and include former interns' reflections on the life-changing nature of their experiences.
Low‐cloud optical depth feedback in climate models
Authors: Gordon Neil D. , Klein Stephen A. 
Published: April 2014

AbstractThe relationship between low‐level cloud optical depth and atmospheric and surface air temperature is examined in the control climate of 13 climate models to determine if cloud optical depth‐temperature relationships found in observations are replicated in climate models and if climate model behavior found in control climate simulations provides information about the optical depth feedback in climate warming simulations forced by increasing carbon dioxide. A positive relationship between cloud optical depth and cloud temperature exists in all models for low clouds with relatively cold temperatures at middle and high latitudes, whereas a negative relationship exists for warmer low clouds in the tropics and subtropics. This relationship is qualitatively similar to that in an earlier analysis of satellite observations, although modeled regression slopes tend to be too positive and their intermodel spread is large. In the models, the cold cloud response comes from increases in cloud water content with increasing temperature, while the warm cloud response comes from decreases in physical thickness with increasing cloud temperature. The intermodel and interregional spread of low‐cloud optical depth feedback in climate warming simulations is well predicted by the corresponding spread in the relationships between optical depth and temperature for the current climate, suggesting that this aspect of cloud feedback may be constrained by observations. Because models have a positive bias relative to observations in the optical depth‐temperature relationship, shortwave cloud feedback for climate changes may be more positive than climate models currently simulate.
Temporal dynamics of oxygen isotope compositions of soil and canopy CO2 fluxes in a temperate deciduous forest
Authors: Santos E. , Wagner‐Riddle C. , Lee X. , Warland J. , Brown S. , Staebler R. , Bartlett P. , Kim K. 
Published: April 2014

AbstractPartitioning of CO2 exchange into canopy (FA) and soil (FR) flux components is essential to improve our understanding of ecosystem processes. The stable isotope C18OO can be used for flux partitioning, but this approach depends on the magnitude and consistency of the isotope disequilibrium (Deq), i.e., the difference between the isotope compositions of FR (δA) and FA (δR). In this study, high temporal resolution isotopic data were used (1) to test the suitability of existing steady state and nonsteady models to estimate H218O enrichment in a mixed forest canopy, (2) to investigate the temporal dynamics of δA using a big‐leaf parameterization, and (3) to quantify the magnitude of the C18OO disequilibrium (Deq) in a temperate deciduous forest throughout the growing season and to determine the sensitivity of this variable to the CO2 hydration efficiency (θeq). A departure from steady state conditions was observed even at midday in this study, so the nonsteady state formulation provided better estimates of leaf water isotope composition. The dynamics of δR was mainly driven by changes in soil water isotope composition, caused by precipitation events. Large Deq values (up to 11‰) were predicted; however, the magnitude of the disequilibrium was variable throughout the season. The magnitude of Deq was also very sensitive to the hydration efficiencies in the canopy. For this temperate forest during most of the growing season, the magnitude of Deq was inversely proportional to θeq, due to the very negative δR signal, which is contrary to observations for other ecosystems investigated in previous studies.