Use of an interactive video gaming program compared with conventional physiotherapy for hospitalised older adults: a feasibility trial

Author version made available in accordance with the Publisher's policyPurpose: To assess the feasibility of a physiotherapy intervention using an interactive gaming program compared with conventional physiotherapy for hospitalised older people. Methods: Randomised controlled pilot study in a geriatric rehabilitation unit within an acute public hospital. Participants were randomly allocated to physiotherapy using an interactive gaming program (N=22) or conventional physiotherapy in a ward based gym (N=22). Feasibility was assessed by comparing the effects of the intervention on clinical outcome measures (primary outcome: mobility as assessed by the Timed Up and Go Test, secondary outcomes: safety, adherence levels, eligibility and consent rates). Results: Participants (N=44) had a mean age of 85 years (SD 4.5) and the majority (80%) were women. Univariable analyses showed no significant difference between groups following intervention. However, multivariable analyses suggested that participants using the interactive gaming program improved more on the Timed Up and Go Test (P=0.048) than participants receiving conventional physiotherapy. There were no serious adverse events and high levels of adherence to therapy were evident in both groups. Only a small proportion of patients screened were recruited to the study. Conclusions: In this feasibility study the use of a commercially available interactive gaming program by physiotherapists with older people in a hospital setting was safe and adherence levels were comparable with conventional therapy. Preliminary results suggest that further exploration of approaches using games as therapy for older people could include commonly used measures of balance and function

Physiotherapy Rehabilitation for Individuals with Lower Limb Amputation: A 15-Year Clinical Series

This author accepted manuscript (post print) is made available in accordance with the publisher copyright policy.Background and Purpose Individuals with amputations are a core group in Australian rehabilitation units that have a long index length of stay. The Repatriation General Hospital (RGH) offers general rehabilitation services to the population of Southern Adelaide (a population of 350,000) and includes an on-site prosthetic manufacturing facility. Using a physiotherapy database at the RGH, we sought to answer the following questions: What are the demographic and clinical characteristics of patients admitted for lower limb prosthetic rehabilitation over 15 years? What are the times to rehabilitation outcomes? How have these changed over 15 years with changes in service delivery? Methods This paper is a retrospective observational study using a physiotherapy clinical database (1996–2010) of 531 consecutive individuals with lower limb amputation at one South Australian hospital (RGH). There were two changes in service delivery: 1) a multidisciplinary interim prosthetic programme (IPP) introduced in 1998 and 2) removable rigid dressings (RRDs) introduced in 2000. Outcome measures were patient demographics, clinical characteristics and time to rehabilitation outcome markers. Results Mean age was 68 years (standard deviation [SD]: 15), with 69% male, 80% dysvascular and 68% transtibial. The overall median inpatient rehabilitation length of stay (RLOS) was 39 days (interquartile range [IQR]: 26–57). Individuals with amputation entering rehabilitation each year had a higher number of co-morbidities (β: 0.08; 95% confidence interval: 0.05–0.11). Introduction of the IPP was associated with a significant reduction in time to initial prosthetic casting, independent walking and inpatient RLOS. Introduction of RRDs was associated with a significant reduction in time to wound healing, initial prosthetic casting and independent walking. Conclusions Individuals with amputation were typically elderly dysvascular men with transtibial amputations. Introduction of the IPP and RRDs successfully reduced time to rehabilitation outcomes including independent walking, an outcome that is rarely reported but is of significance to patients and physiotherapist

Cosmological parameters from SDSS and WMAP

We measure cosmological parameters using the three-dimensional power spectrum P(k) from over 200,000 galaxies in the Sloan Digital Sky Survey (SDSS) in combination with WMAP and other data. Our results are consistent with a ``vanilla'' flat adiabatic Lambda-CDM model without tilt (n=1), running tilt, tensor modes or massive neutrinos. Adding SDSS information more than halves the WMAP-only error bars on some parameters, tightening 1 sigma constraints on the Hubble parameter from h~0.74+0.18-0.07 to h~0.70+0.04-0.03, on the matter density from Omega_m~0.25+/-0.10 to Omega_m~0.30+/-0.04 (1 sigma) and on neutrino masses from <11 eV to <0.6 eV (95%). SDSS helps even more when dropping prior assumptions about curvature, neutrinos, tensor modes and the equation of state. Our results are in substantial agreement with the joint analysis of WMAP and the 2dF Galaxy Redshift Survey, which is an impressive consistency check with independent redshift survey data and analysis techniques. In this paper, we place particular emphasis on clarifying the physical origin of the constraints, i.e., what we do and do not know when using different data sets and prior assumptions. For instance, dropping the assumption that space is perfectly flat, the WMAP-only constraint on the measured age of the Universe tightens from t0~16.3+2.3-1.8 Gyr to t0~14.1+1.0-0.9 Gyr by adding SDSS and SN Ia data. Including tensors, running tilt, neutrino mass and equation of state in the list of free parameters, many constraints are still quite weak, but future cosmological measurements from SDSS and other sources should allow these to be substantially tightened.Comment: Minor revisions to match accepted PRD version. SDSS data and ppt figures available at http://www.hep.upenn.edu/~max/sdsspars.htm

Urachal endometrioma: a case report

<p>Abstract</p> <p>Introduction</p> <p>We discuss a rare presentation of an unusual case of endometrioma.</p> <p>Case presentation</p> <p>A 40-year-old Caucasian woman presented with subacute abdominal pain and a suprapubic mass. A final diagnosis was made after the mass was resected and histopathology confirmed an endometrioma originating from an urachal remnant. Select imaging studies and histopathology are presented in this case report.</p> <p>Conclusion</p> <p>While endometriomata are well known to arise from abdominal scars, the condition described in this case report is a rare example of an endometrioma arising from the urachus. A review of the pathological complications of the urachus is also included.</p

Exploring synergies between B- and T-cell vaccine approaches to optimize immune responses against HIV-workshop report.

The US National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institute of Health (NIH), convened a virtual workshop on August 8-9th, 2023 to explore potential synergies between HIV vaccine approaches that are designed to induce cellular or humoral immune responses. The goal of this workshop was to review data on leading vaccine candidates and to discuss the best strategies for combining these approaches to optimize immunity against HIV. Here, we summarize the findings reviewed at the workshop and discuss the knowledge gaps and priorities for future studies that will help accelerate the development of a preventive HIV vaccine

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Long-lived memory B-cell responses following BCG vaccination.

The role of T-cells in immunity against Mycobacterium tuberculosis (M. tuberculosis) infection has been extensively studied, however, that of B-cells still remains comparatively unexplored. In this study, we determined the presence and frequencies of mycobacteria-specific memory B-cells (MBCs) in peripheral blood from clinically healthy, Bacillus Calmette Guerin (BCG) vaccinated (n = 79) and unvaccinated (n = 14) donors. Purified protein derivative (PPD)-specific MBCs were present in most donors (both vaccinated and unvaccinated) but their frequencies were significantly higher in vaccinated than in unvaccinated donors. MBCs specific for other mycobacterial antigens [antigen-85A (Ag85A), antigen-85B (Ag85B), 6 kDalton early secretory antigenic target (ESAT-6) and the 10 kDalton-culture filtrate protein (CFP-10)] were less prevalent than those recognising PPD. Furthermore, PPD-specific MBCs were detected in BCG vaccinated donors without ESAT-6 and CFP-10 specific responses. Together, these results indicate that BCG vaccination induces long-lived MBC responses. Similar patterns of response were seen when we examined mycobacteria-specific antibody and T-cell responses in these donors. Our data show for the first time that BCG vaccination elicits long-lived mycobacteria-specific MBC responses in healthy individuals, suggesting a more substantial role of B-cells in the response to BCG and other mycobacterial infections than previously thought

GHOST: a time-reversible mixture model for recovering phylogenetic signal from heterotachously-evolved sequence alignments

The accuracy and reliability of phylogenetic inference is compromised by the adoption of models of sequence evolution that don't adequately reflect the dynamic nature of evolution by natural selection. Heterotachy refers to variation in the rate of evolution of a particular site across lineages on a tree. We carry out simulations, showing that phylogenetic inference using popular methods and models is unreliable when the data evolved under the influence of heterotachy. We carry out a theoretical analysis of these methods and models, concluding that their failure was inevitable given the nature of the data. To remedy this we introduce the General Heterogeneous evolution On a Single Topology (GHOST) model. We implement the GHOST model under a maximum-likelihood (ML) framework in the phylogenetic inference program IQ-TREE. We perform extensive simulation studies, showing that the GHOST model can successfully recover the tree topology, branch lengths and substitution model parameters from heterotachously-evolved sequences. We apply our model to a real dataset and identify a subtle phylogenetic signal linked to the convergent evolution of the electric organ in two geographically distinct lineages of electric fish. Furthermore, we use the model to successfully identify specific sites in the alignment that are pivotal to the effective function of the electric organ. The GHOST model and its implementation in IQ-TREE provide the most flexible mixture model currently available for performing phylogenetic inference in a ML framework. This increased flexibility better equips the GHOST model to represent the process of evolution by natural selection. We show that the GHOST model is able to highlight subtleties in evolutionary relationships that coarser models cannot. We foresee the GHOST model having potential uses in a variety of applications: helping to resolve disputed topologies; focusing the efforts of biologists by identifying alignment sites of functional importance; bringing to light evidence of convergent evolution; and investigating the coevolution that occurs between disease and immune cells, or hosts and parasites. As computing resources continue to grow and phylogenetic algorithms are revised and improved, the GHOST model will be applicable to ever larger MSAs, ultimately assisting in illuminating the history of life on earth.Thesis (Ph.D.) -- University of Adelaide, School of Mathematical Sciences, 2017

Comparing Partitioned Models to Mixture Models: Do Information Criteria Apply?

Abstract The use of information criteria to distinguish between phylogenetic models has become ubiquitous within the field. However, the variety and complexity of available models are much greater now than when these practices were established. The literature shows an increasing trajectory of healthy skepticism with regard to the use of information theory-based model selection within phylogenetics. We add to this by analyzing the specific case of comparison between partition and mixture models. We argue from a theoretical basis that information criteria are inherently more likely to favor partition models over mixture models, and we then demonstrate this through simulation. Based on our findings, we suggest that partition and mixture models are not suitable for information-theory based model comparison. [AIC, BIC; information criteria; maximum likelihood; mixture models; partitioned model; phylogenetics.]</jats:p