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A mixed-methods systematic review answering the research question: * What is the current level of knowledge regarding Acquired Brain Injury (ABI) amongst educators? * What do educators need to support children in the classroom with an Acquired Brain Injury (ABI) ?

BACKGROUND: The ReWork-Stroke program was developed to meet the need for a person-centered rehabilitation program addressing return to work after stroke and was provided by occupational therapists (OTs). OBJECTIVE: To gain knowledge on the implementation process of the ReWork-Stroke program, the mechanisms of impact, and the contextual factors that might have affected the process. METHODS: A case study design was used. Data were collected by interviews with two ReWork-Stroke providers and their logbooks of 13 clients. Content analysis was applied. RESULTS: The ReWork-Stroke program varied in duration (12–48 weeks) and was largely implemented according to plan regarding components and how they were provided. It was mostly delivered at the workplace. Mechanisms of impact were building alliances with clients, providing intervention at the workplace, informing about stroke, assigning co-workers as tutors for clients, and collaboration between stakeholders. CONCLUSIONS: The ReWork-Stroke program can be implemented according to plan and is a flexible person-centered program in which stakeholders, coordinated by an OT, plan and take actions, mostly at the workplace, for the client’s return to work. A key factor was recognizing the current work ability after stroke. Further program development includes a more structured evaluation and technical solutions for supporting stakeholders.

Ciljevi: Primarni cilj ovog istraživanja je procijeniti značajnost i relevantnost ABI prije i nakon endovaskularne intervencije u bolesnika s visokim stupnjem periferne arterijske bolesti. Ispitanici i metode: Retrospektivna monocentrična studija je provedena na Zavoda za intervencijsku radiologiju Kliničkog zavoda za dijagnostičku i intervencijsku radiologiju KBCa Split. Pacijenti (N=18) kojima je i prije i nakon endovaskularne intervencije izmjeren ABI tijekom razdoblja od 17. veljače do 8. srpnja 2022. godine uključeni su u ovu studiju. Uređaj koji se koristio za mjerenje je MESI ABPI MD. Njihove povijesti bolesti proučene su u svrhu izdvajanja sljedećih parametara: dob, spol, komorbiditeti te klinički, radiološki i angiografski nalazi. Rezultati: Većina pacijenata (83%) s izraženom perifernom arterijskom bolesti imala je teže oblike kalcifikacija stijenki arterija zdjelice i nogu. U svih pacijenata (N=18) smo ustanovili da ukoliko postoje teške kalcifikacije stijenki arterija da se one nalaze u obje noge. U pacijenata u kojih nije bilo kalcifikata također se uočila simetrija i na drugoj nozi. Time smo potvrdili našu prvu hipotezu da pacijenti s visokim stupnjem PAB imaju značajne kalcifikate na arterijama zdjelice i nogu. CTA nam nije pomogao u razlikovanju dviju vrste kalcifikata: aterosklerotskog plaka i Mönckebergove arterioskleroze zbog nedovoljno visoke rezolucije uređaja za takvu analizu stoga se podjela nije obavila u rezultatima. U 15 pacijenata (83%) s izraženim kalcifikatima arterija kojima je napravljena morfološki uspješna endovaskularna intervencija potvrđena je naša hipoteza o nepouzdanosti AB indeksa. Naime, ABI je i prije i nakon intervencije varirao od potpuno normalnih vrijednosti do ispod 0,5 u pacijenata s istim Rutherfordovim gradusom kliničkih smetnji. Zaključci: Mjerenje AB indeksa je jednostavan, neinvazivan test i metoda probira u dijagnostici periferne arterijske bolesti. AB indeks po našem istraživanju u bolesnika s teškim oblicima PAB može biti vrijedan doprinos u praćenju uspjeha endovaskularne intervencije, ali samo u bolesnika bez značajno kalcificiranih stijenki arterija. U bolesnika koji imaju kalcifikate gradusa 3 i 4 po Fanelliju, ABI je nepouzdan i ne preporuča se koristiti ga. Prije svakog intervencijskog zahvata se radi CTA na kojoj se jednostavnim mjerenjem težine kalcificirajućih lezija po Fanelliju može unaprijed odrediti treba li pacijentu odrediti AB indeks., Objectives: This study aimed to evaluate the importance and relevance of the AB index before and after endovascular intervention in patients with a high degree of peripheral vascular disease. Subjects and methods: A single-centre retrospective study was performed. Patients (N=18) who had their ABI measured before and after the intervention in time period from February 17th to July 8th 2022 were included in this study. Measuring device used for this study was MESI ABPI MD. The case files of those subjects were studied thoroughly for researched paramteres such as age, sex, comorbidities, clinical, radiological and angiographic reports. Results: The fact that the majority of patients (83%) with a high degree peripheral vascular disease had more severe forms of calcification of the walls of the arteries of the pelvis and legs stood out the most in the research. In all patients (N=18), we found that if there were severe calcifications of the artery walls, they were found in both legs. In patients who did not have calcifications, symmetry on the other leg was also confirmed. Thus, we confirmed our first hypothesis that patients with a high degree peripheral vascular disease have significant calcifications in the arteries of the pelvis and legs. CTA did not help us distinguish between two types of calcifications: atherosclerotic plaque and Mönckeberg arteriosclerosis due to the insufficiently high resolution of the device for such an analysis, therefore the division was not carried out in the results. Our hypothesis about the unreliability of the AB index was confirmed in 15 patients (83%) with pronounced arterial calcifications who underwent morphologically successful endovascular intervention. Namely, the ABI both before and after the intervention varied from completely normal values to below 0.5 in patients with the same Rutherford degree of clinical disturbances. Conclusion: AB index measurement is a simple, non-invasive test and screening method in the diagnosis of peripheral vascular disease. According to our research, the AB index in patients with severe forms of peripheral vascular disease can be a valuable contribution in monitoring the success of endovascular intervention, but only in patients without significantly calcified arterial walls. In patients with Fanelli grade 3 and 4 calcifications, ABI is unreliable and not recommended. Before each interventional procedure, a CTA is performed, on which, by simply measuring the severity of calcifying lesions according to Fanelli, it can be determined in advance whether the patient should have an AB index measured.

Investigating psychological flexibility, and other more established factors, and their roles in psychological distress, stress and quality of life of people caring for someone with an Acquired Brain Injury

This document outlines the protocol for a scoping review aimed at examining the academic outcomes of children and youth following an acquired brain injury (ABI). The purpose of the review is to examine how the construct of academic outcomes has been studied (i.e., what measurements and what methodology has been used). The review will guide future research by identifying gaps in the literature, such as inconsistency in measurement tools or age groups not studied, as well as identifying areas where further analysis is feasible (e.g., a systematic review or meta-analysis). The Scoping Review protocol will be carried out in accordance with the protocol guidelines of the Joanna Briggs Institute (Peters et al., 2020) and PRISMA-ScR (Tricco et al., 2018).

This study aims to investigate whether transcranial direct current stimulation (tDCS) can improve attention in children following acquired brain injury (ABI), and whether patients' brain connectivity affects response to tDCS. Following ABI, brain connections are damaged, leading to chronic attention problems. tDCS is a type of non-invasive brain stimulation which passes a very weak current across the head to 'wake up' the brain. Understanding individual tDCS responses allows us to develop personalised treatments for each child in the future. This pilot study will recruit up to 30 participants aged 8-17 years with chronic mild to severe ABI (>1 year since injury) and 30 similar controls (Bayesian sampling). Children will be recruited through our existing datasets. The primary outcome is Flanker task reaction time after stimulation. Brain connectivity will be assessed using High Density Electroencephalogram (HD-EEG), and resting state functional magnetic resonance imaging (MRI). Brain connectivity will be correlated with response to tDCS. Tolerability and feasibility will also be assessed.

The auditory brainstem implant (ABI) was originally developed to provide rehabilitation of retrocochlear deafness caused by neurofibromatosis type 2 (NF2). Recent studies of the ABI have investigated outcomes in non-NF2 cohorts, such as patients with cochlear nerve aplasia or cochlear ossification and more recently, intractable tinnitus. New technologies that improve the ABI-neural tissue interface are being explored as means to improve performance and decrease side effects. Innovative discoveries in optogenetics and bioengineering present opportunities to continually evolve this technology into the future, enhancing spatial selectivity of neuronal activation in the cochlear nucleus and preventing side effects through reduction in activation of non-target neuronal circuitry. These advances will improve surgical planning and ultimately improve patients’ audiological capabilities. ABI research has rapidly increased in the 21st century and applications of this technology are likely to continually evolve. Herein, we aim to characterize ongoing clinical, basic science, and bioengineering advances in ABIs and discuss future directions of this technology.

Objective: Peripheral artery disease (PAD) is underdiagnosed in primary care settings, partly because of limited accuracy of the Doppler ankle-brachial index (ABI). This study aimed to assess the diagnostic accuracy of an automated oscillometric ABI device compared with reference standard vascular laboratory Doppler ABI equipment and to examine the influence of oscillometric errors on performance.Methods: Consecutive patients who were referred to a large general hospital for an ABI measurement were invited to participate. In each patient, the oscillometric analysis was followed by the Doppler analysis. Legs with incompressible ankle arteries were excluded from analysis. ABI values were compared using the Bland-Altman method. Oscillometric errors were defined as the incapacity of the oscillometer to report a value of ABI. A receiver operating characteristic curve was constructed, and the area under the curve was computed.Results: A total of 201 patients participated. The Bland-Altman plot showed a mean difference of 0.05 +/- 0.12 (limits of agreement, -0.20 to 0.29), representing a small ABI overestimation after oscillometry. Oscillometric errors occurred more commonly in limbs with PAD than in limbs without PAD (28% and 7%, respectively; P < .001). Considering a 0.9 threshold and after oscillometric error exclusion, the oscillometric ABI showed a 74% sensitivity and a 97% specificity for a diagnosis of PAD. When oscillometric errors were considered as abnormal ABIs, sensitivity increased to 86% and specificity was maintained at 95%. The receiver operating characteristic curve showed an area under the curve of 0.96. The best oscillometric ABI cutoff point was 1.00. Using this threshold and when considering oscillometric errors as abnormal ABIs, sensitivity improved to 94% while maintaining specificity at 92%.Conclusions: Oscillometric ABI showed good diagnostic accuracy compared with the reference standard. However, the high incidence of oscillometric errors and the challenges to correctly interpret readings may limit the use of the oscillometric method in PAD diagnosis.

Aquatic macroinvertebrates are widely used as indicators of water quality. However, in the Andean region of Ecuador, little is known about how the macroinvertebrate community assemblage responds to changes in the habitat where they occur. One of the main drawbacks is taxonomy, where classifying organisms on a full taxonomic scale becomes complicated. To resolve this point, in a in a NMDS (non-metric multidimensional scaling) ordination analysis, the abundance of macroinvertebrates obtained in 12 monitoring stations in the Cajas Massif, southern Ecuador, was used. The rankings were contrasted using the trophic guilds approach versus the family taxonomic approach (the maximum taxonomic classification available). The ordering analyzes showed a more differentiated spatial organization with the trophic guilds approach than with the family-level approach. When explaining the organization of the communities, the ABI (Andean Biotic Index) and the elevation, significantly explains the organization of the community from the trophic guilds approach; although, only the elevation explains the ordering from the family scale approach. The results suggest that, from the trophic guilds approach, a better approximation of the general ecological role of the macroinvertebrate community associated with environmental services such as water quality is represented. Guilds such as shredders, scrapers, and detritivores adjust to increasing ABI (i.e. water quality). Consequently, monitoring with a focus on the trophic guilds can be used in studies of water quality and its relationship with the community.

Background: The ankle–brachial index (ABI) is a first-line examination in cardiovascular risk evaluation. Since cut-off values for normal ABI vary, the aim of the present study was to identify the cardiovascular-mortality-based estimate for the normal range of the ABI. After determining the reference range for the ABI, the corresponding toe–brachial index (TBI) and toe pressure for normal ABI were analyzed. Methods: All consecutive non-invasive pressure measurements in the vascular laboratory of a large university hospital 2011–2013 inclusive were collected and combined with patient characteristics and official dates and causes of death. Patients with an ABI range of 0.8–1.4 on both lower limbs were included in this study. Results: From 2751 patients, 868 had bilateral ABI values within the inclusion. Both ABI category ranges 0.80–0.89 and 0.90–0.99 had poorer survival compared to ABI categories 1.00–1.29 (p < 0.05). The 1-, 3-, and 5-year cardiovascular-death-free survival for respective ABI categories 0.80–0.99 vs. 1.00–1.29 were 90% vs. 96%, 84% vs. 92%, and 60% vs. 87%. The 1-, 3-, and 5-year overall survival for ABI categories 0.80–0.99 vs. 1.00–1.29 were 85% vs. 92%, 75% vs. 83%, and 42% vs. 74%. Conclusions: Borderline ABI (0.90–0.99) associates with higher overall and cardiovascular mortality compared to ABI values 1.00–1.29.

Introduction. Diabetic peripheral neuropathy (DPN) in the lower extremity caused by complications of diabetes in the microvascular which can damage nerve in the lower extremity. Then, it is necessary to be aware of the process of aterosclerosis elsewhere, both in the macro and microvascular arteries in the lower extremity. This study was conducted to assess the association of the degree of diabetic peripheral neuropathy assessed by Toronto clinical scoring system (TCSS) with the process of atherosclerosis in the blood vessels of the lower extremity, both macrovascular with ankle brachial index (ABI) and toe brachial index (TBI), as well as microvascular with transcutaneus partial oxygen pressure (TcPO2) in patients with type 2 diabetes mellitus. Methods. Cross-sectional study was carried out in patients with type 2 DM with DPN with TCSS values> 5 in the Integrated Cardiac Polyclinic, Endocrine and Metabolic Polyclinic, and Internal Medicine Polyclinics at Cipto Mangunkusumo Hospital. Data were obtained from interviews, medical records, as well as ABI, TBI and, TcPO2 examinations. Bivariate analysis of each variable was performed using Spearman test. Results. Total of 36 subjects who met the selection criteria were included in the study, the average age was 62 years (SD 9.2) with 20 (55.6%) of whom were women and the median duration of diabetes was 12 years. Based on bivariate analysis with the Spearman test, there was a statistically significant negative correlation with moderate correlation coefficient between the degree of diabetic peripheral neuropathy assessed by TCSS with ABI (r = -0.475, p = 0.003) and TBI (r = -0.421, p = 0.010). The TcPO2 examination also found a statistically significant negative correlation with moderate correlation coefficient (r = -0.399, p = 0.016). Conclusion. There is a statistically significant negative correlation between the degree of diabetic peripheral neuropaty with ABI, TBI, and TcPO2 examinations.

Geostationary (GEO) satellites such as the GOES constellation are equipped with Advanced Baseline Imager (ABI) sensors that have a very high temporal resolution with a very low spatial resolution and provide visible through infrared data every 15 minutes. In contrast, Low Earth Orbit (LEO) satellites with Global Precipitation Measurement Microwave Imager (GMI) sensors have very high spatial resolution with a low temporal resolution that provide data as infrequently as every 15 hours. The purpose of this research is to study the viability of using the ABI data to regress to a synthetic GMI dataset. Specifically, the focus is on improving the ability to make predictions on the under-represented data points within our dataset and being able to generalize well to future distributions of data. This thesis has created a sampling technique that combines over and under sampling in conjunction with a purpose-built Residual Neural Network to perform regression from multi-spectral ABI data to a single GMI channel. In doing so, we prove that it is possible to predict under-represented values more accurately in datasets when using our sampling method and to generalize well to future data. Using our approach, we predict within 5 Kelvin for 34.5% of the tail of the test data compared to only 24.4% when we used an unsampled dataset. We also are able to prevent our mean absolute error from rising by 1 Kelvin when measured across three test datasets that span a timeframe of five months. Office of Naval Research, One Liberty Center, 875 N. Randolph Street, Suite 1425 Arlington, VA 22203-1995 Lieutenant, United States Navy Approved for public release. Distribution is unlimited.

This thesis builds on the research that uses Bayesian neural networks to generate Global Precipitation Measurement Microwave Imager data collected by LEO satellites from Advanced Baseline Imager data collected by GEO satellites for the purposes of weather modeling. Specifically, this thesis investigates the efficacy of a stochastic depth (SD) implementation in residual networks (ResNet), both deterministic and probabilistic, to reduce long training times associated with Bayesian neural networks while maintaining model accuracy. We show that overall, ResNets fail to perform better with the implementation of SD with the exception of SD ResNet56 S25, utilizing a survivability probability of 0.25. This resulted in an RMSE of 2.863, a 6.83% increase in performance. In our evaluations, SD models did not train faster, with the fastest average time per epoch of 973.69 seconds compared to 960.42 seconds for the base ResNet56. We conclude that SD was unable to provide the expected performance benefits on realistic large-scale satellite data as found in research on smaller datasets. Lieutenant, United States Navy Approved for public release. Distribution is unlimited.

BackgroundPatients with lower extremity wounds from diabetes mellitus or peripheral artery disease (PAD) have a risk of amputation as high as 25%. In patients with arterial disease, revascularization decreases the risk of amputation. We aimed to determine if the early assessment of arterial perfusion correlates with the risk of amputation.MethodsWe retrospectively reviewed patients referred to the vascular clinic over 18 months with Rutherford Grade 5 and 6 chronic limb-threatening ischemia to determine if patients had a pulse exam done at the time the wound was identified and when ankle brachial index (ABI) testing to evaluate perfusion was performed. Kaplan Meier analysis was used to determine if the timing of ABI testing affected the time to revascularization, wound healing, and risk of amputation.ResultsNinety-three patients with lower extremity wounds were identified. Of these, 59 patients (63%) did not have a pulse exam performed by their primary care provider when the wound was identified. Patients were classified by when they underwent ankle brachial index testing to assess arterial perfusion. Twenty-four had early ABI (

We present a pitch discrimination test performed by five experienced adult auditory brainstem implant (ABI) users with neurofibromatosis type 2 (NF2). The ability to discriminate frequency/pitch from different channels on the implant may be an important factor in improving speech performance. The pitch discrimination ability was evaluated by using a triangle test compared to adjacent contacts and the speech perception was measured by the Swedish three-digit test. The test was easy to perform, and all patients were able to answer reliably, even though it cannot be ruled out that patients used attributes other than pitch to differentiate between sounds. Due to the limited number of patients and small variation in results, no conclusive correlations could be made regarding pitch discrimination and auditory outcome. There was a tendency for poorer ability to discriminate pitch (discrimination of tonotopically adjacent electrodes) at testing to result in poorer speech results.

Purpose Cardiovascular disease (CVD) is the first cause of death in patients with non-alcoholic fatty liver disease (NAFLD) and risk stratification is recommended by current guidelines. The aim of this study is to assess the prevalence of peripheral arterial disease (PAD) in patients with NAFLD and its association with all-cause and cardiovascular disease (CVD) mortality. Methods 9145 participants 40 years or older attended a mobile examination center visit in the 1999–2004 cycles of the National Health and Nutrition Examination Survey. PAD was defined as an ankle-brachial index (ABI) Results The overall prevalence of PAD was 5.9% (95% CI 5.0–6.9). Over a median follow-up of 13 years, 876 participants died, 208 of cardiovascular causes. Incidence rates of all-cause mortality (for 1000 person-years) were 20.2 (95% CI 18.7–21.7) and 70.0 (95% CI 60.1–81.6) for participants without and with PAD, respectively. Multivariable-adjusted Cox proportional hazard models showed that PAD was associated with a higher risk of all-cause (1.8, 95% CI 1.4–2.4) and cardiovascular mortality (HR 2.5, 95% CI 1.5–4.3) after adjustment for potential confounders including prevalent CVD. Conclusion Current guidelines strongly encourage the screening of CVD in patients with NAFLD and the use of the simple and inexpensive measurement of ABI in routine clinical practice may find indication.

Scientific literature suggests that Neuroticism is an important predictor in understanding individual differences in anxiety-related coping styles such as vigilance (positive association) and cognitive avoidance (negative association). Considering Pankseppian Affective Neuroscience (AN) theory could contribute to understand these relationships more in-depth, because the evolutionary old subcortical brain systems of FEAR, SADNESS, and ANGER might represent brain-anatomical bottom-up drivers of Neuroticism. N = 594 German participants (n = 170 males; mostly student background) and N = 332 Chinese participants (n = 72 males; mostly student background) completed the Affective Neuroscience Personality Scales (ANPS) and the Mainz Coping Inventory (Angstbewältigungsinventar; ABI) to assess individual differences in primary emotional traits and anxiety-related coping styles, respectively. As hypothesized, associations between the three emotional systems and the two coping styles cognitive avoidance and vigilance were observed. There were some differences in correlations between the Chinese and German samples, mainly regarding associations between ANGER and cognitive avoidance. Moreover, linear regression analyses revealed FEAR as a main predictor of vigilance (positive) and cognitive avoidance (negative) in the German sample. In the Chinese sample, FEAR was the main predictor of cognitive avoidance (negative), only; for vigilance SADNESS (positive) was the main predictor. Theoretical assumptions behind primary emotional traits indicate that the brain systems underlying FEAR and SADNESS indeed influence anxiety-related coping styles in a bottom-up fashion., publishedVersion

Considering the prevalence of acquired brain injury (ABI) and the concerning statistics around the associated risk of problematic substance use, impacted mental health, and suicidality (3-4 greater risk of suicidality in those with TBI), and the lack of qualitative, recent, and UK based research. This study aimed to explore what people’s reasons for living after ABI were. Individuals living with ABI were recruited via BABICM (British Association of Brain Injury and Complex Case Management) to participate in semi-structured interviews. A mixed thematic analysis was conducted on the transcripts using the themes from Knight, Norman and Simpson (2020) as a framework for a deductive analysis and then a reflexive inductive thematic analysis was conducted. The participants (four British males) had experienced a TBI (average time since injury 26 years). Two overarching themes of Lost and maintained sense of self, and ABI is a hidden disability, and five main themes Acceptance, Support networks, Experiences of low mood and suicidality, Protective factors and coping strategies, and Overcoming challenges and posttraumatic growth were identified along with several subthemes. Suicidality was a comparatively minor theme and did not underlie all the other themes as in the Knight et al. paper. The themes that emerged were focused on factors that impact recovery and rehabilitation (positively and negatively), wellbeing and mental health more generally. The data might point toward suicidality in this population being reduced or prevented through a comprehensive package of support, long-term case management, acceptance, and various protective factors.

The primary focus of the research is caregivers of people who have had an acquired brain injury (ABI); the literature review collated evidence in relation to caregiver resilience and the empirical paper focussed on partners in particular. Section one details the systematic literature review. It aimed to review all of the quantitative research exploring resilience and related constructs (RARCs: resiliency, posttraumatic growth [PTG], and hardiness) in caregivers of people with ABI. There was a particular emphasis on how authors defined their constructs, and the quantitative relationships of RARCs that were elucidated. Three databases were searched: CINAHL, MEDLINE and PsychINFO. Inclusion criteria were broad: papers must have used a measure for their RARC construct, and have used this to perform some type of statistical analysis. Twenty-six papers were included. Findings showed that resilience and resiliency were not narrowly defined, and often crossed over, or became confused with other RARCs. Generally, high RARCs scores were associated with good outcomes, and low RARCs scores were associated with poorer outcomes. Section two details the empirical paper, exploring people’s sense-making of their partner’s cognitive and emotional difficulties following ABI. Six working-age partners of people who had an ABI were interviewed and transcribed data was analysed using interpretive phenomenological analysis. Five themes were constructed: : (1) “I don’t know…it’s a weird thing to describe": The complicated nature of ABI; (2) “So you try and work around it”: The exhausting task of taking on the extra cognitive and emotional load; (3) “You’re not the partner anymore”: Finding a new relational dynamic; (4) “It’s like this ultimate patrol”: The need to protect; (5) The lack of effective support is isolating. Clinical implications were discussed. Section three appraises sections one and two critically, including further strengths, challenges, clinical implications and some of the author’s reflections through the process.

Purpose Maintaining work in the long term represents a major challenge for people with acquired brain injury (ABI) as evidenced by a high rate of premature labour market dropouts. The present study aimed to compile factors associated with working in the long term after sustaining an ABI. Materials and methods We carried out a scoping review synthesizing quantitative and qualitative research conducted between 2000 and 2021. Databases searched comprised PubMed, CINAHL Complete, PsycINFO, Scopus, and Web of Science. Results Ten quantitative and nine qualitative studies were included, all but one from high-resource countries. Quantitative research predominantly comprised longitudinal follow-ups on individuals' work status several years post ABI onset, showing an effect of injury-related and sociodemographic factors. Qualitative studies mostly dealt with work maintenance and revealed a key role of cognitive difficulties, psychological personal factors (e.g., adequate coping strategies) and environmental factors (e.g., flexible work schedules, supportive colleagues). Conclusions The factors identified in our review should receive particular attention in vocational integration and job retention programs to support work participation of people with ABI in the long term. There is a need for measures that regularly monitor and promote a good match between individuals and their work environment.Implications for RehabilitationPeople with acquired brain injury (ABI) often have long-lasting and invisible injury-related difficulties that hamper their labour market participation.Factors identified as positively associated with working in the long term, such as coping strategies and self-awareness, should be strengthened.Future interventions should educate affected persons, employers and health care professionals about long-lasting injury-related difficulties and promote a supportive work environment for people with ABI.Prolonged availability of vocational services could be beneficial for supporting work maintenance of people with ABI.

Penyakit kardiovaskular (PKV) adalah penyakit yang disebabkan oleh gangguan fungsi jantung dan pembuluh darah. PKV dapat dicegah terutama pada kelompok berisiko, diantaranya dengan penilaian risiko menggunakan Framingham Risk Score (FRS). Tujuan penelitian ini adalah untuk menganalisis risiko PKV dan korelasinya dengan Ankle Brachial Index (ABI) dan obesitas pada peserta Prolanis di Kota Bima. Pengambilan data menggunakan instrumen Framingham Risk Score , pengukuran tekanan darah, indeks massa tubuh, lingkar lengan, dan lingkar perut. Jenis penelitian ini adalah penelitian deskriptif analitik dengan rancangan cross-sectional . Pemilihan sampel ditentukan secara consecutive sampling pada semua responden yang aktif mengikuti kegiatan Prolanis dan memenuhi kriteria inklusi di lima Puskesmas di Kota Bima tahun 2018. Analisis data dengan uji parametrik Spearman . Hasil penelitian menunjukkan kelompok risiko tinggi 33 orang (40,7%), risiko sedang 28 orang (34,6%), dan risiko rendah 20 orang (24,7%). Tidak terdapat korelasi antara risiko PKV dengan ABI dan obesitas. Temuan lain dalam penelitian ini mengindikasikan adanya korelasi antara risiko PKV dengan subvariabel obesitas sentral walaupun tidak ditemukan adanya signifikansi (p> 0,05). Pada penelitian selanjutnya, disarankan jumlah sampel yang lebih banyak di komunitas dengan proporsi laki-laki dan perempuan yang berimbang. Kata Kunci: ABI, Framingham, kardiovaskuler, obesitas Abstrac t Risk of Cardio v ascular Disease a t Chronic Disease Management Program Participants i n The Community Health Centers o f Bima Town : T he Correlation w ith Ankle Brachial Index a nd Obesity. Cardiovascular disease (CVD) is a disease caused by impaired heart and blood vessel function, which can be prevented, especially in risk groups that can be risk assess ed using the Framingham Risk Score ( FRS ) . The purpose of this study was to analyze the risk of CVD and the correlation with ABI and obesity in Prolanis participants at Bima City . Data collection was done by using the instrument FRS and measuring systolic blood pressure, b ody m ass i ndex, arm circumference , and waist circumference . This study was a descriptive - analytic study with a cross-sectional design . The sample selection was determined by consecutive sampling for all respondents who actively participated in Prolanis activities and fulfilled the inclusion criteria in five community health cente r at Bima City in 2018. Data analy zed with Spearmen parametric test. The r esults of research showed h igh risk group was 33 people s (40.7%), moderate risk was 28 people s (34.6%) , and low risk was 20 people s (24.7%). There was no c orrelation between risk of CVD with ABI and o besity . Other findings in this study indicate a correlation between CVD risk and subvariable central obesity , although no significance was found (p> 0.05). In further research , it is recommended that a larger number of samples in the general community with a balanced proportion of men and women. Key wo rds: ABI, cardiovaskuler, Framingham, obesity

The increasing number of people with diabetes mellitus each year, the client has also experienced one of the complications, namely ulcers. During this time, the concern of nurses at Raden Mattaher Jambi Hospital is only an ulcer on the client, but no intervention has been made to determine the factors causing the duration of the client's ulcer resolved. The kind of is a cross-sectional. The sample in this study was 27 respondents who had criteria by what was to be studied. The sampling technique is done by accidental sampling that is taking samples by taking cases or respondents who happen to be available or available. Analysis of the data in this study was Univariate and Bivariate. It was held on April 29th until June 29th 2019 with uses observation sheets and questionnaires as aids in data collection. Statistical test results obtained p-value Semakin meningkatnya angka penderita diabetes mellitus tiap tahunnya, maka semakin meningkat pula klien mengalami salah satu komplikasinya yaitu ulkus. Selama ini, yang menjadi perhatian perawat di RSUD Raden Mattaher Jambi hanya ulkus pada klien, namun belum ada intervensi yang dilakukan guna mengetahui faktor penyebab lamanya ulkus klien teratasi. Jenis penelitian ini adalah penelitian cros sectional. Sampel dalam penelitian ini 27 responden yang memiliki kriteria sesuai dengan yang akan diteliti. Teknik pengambilan sampel dilakukan dengan cara accidental sampling yaitu pengambilan sampel dilakukan dengan mengambil kasus atau responden yang kebetulan ada atau tersedia. Analisa data dalam penelitian ini secarra Univariat dan Bivariat. Penelitian ini dilaksanakan dari 29 April-29 Juni 2019 dengan menggunakan lembar observasi dan kuesioner sebagai alat bantu dalam pengumpulan data. Hasil uji statistik diperoleh nilai p-value < 0,05, artinya ada hubungan antara nilai ABI, kadar glukosa darah dan nutrisi dengan luas ulkus diabetikum. Dapat disimpulkan bahwa nilai ABI, kadar glukosa darah dan nutrisi mempengaruhi luas ulkus diabetikum. Diharapkan kepada pihak RSUD Raden Mattaher Jambi dapat menjadikan pemeriksaan ABI sebagai Standar Prosedur Operasional dan melakukan pengontrolan kadar glukosa darah serta nutrisi sebagai faktor mempercepat penyembuhan luka.

Objectives:Aging is associated with an increased incidence of thyroid function abnormalities. Thyroid hormones have been shown to affect vascular hemodynamics and arterial stiffness. Arterial stiffness appears to be an essential risk factor for cardiovascular disease. The long-term effect of hypothyroidism on the development of the peripheral arterial disease is not well understood. Pulse wave velocity (PWV) is a simple, non-invasive marker of atherosclerosis that measures arterial stiffness. Ankle brachial index (ABI) is a non-invasive technique commonly used to detect peripheral vascular diseases. A limited number of studies evaluated hypothyroidism as a risk factor for both peripheral arterial disease and arterial stiffness in the old aged. We aimed to investigate this relationship in older patients and then compared with their younger counterparts.Materials and Methods:A total of 22 patients ≥65 years of age and 23 younger patients with hypothyroidism and 23 gender-matched, and body mass index-matched old aged individuals with euthyroidism as controls were enrolled in this study. Old aged patients with hypothyroidism were defined as group I, old aged individuals with euthyroidism were defined as group II, and younger patients with hypothyroidism were defined as group III. PWV was measured between the carotid and femoral arteries. ABI was measured by a handheld Doppler.Results:PWV was similar (0.36) in older groups (groups I and II) and was lower (p < 0.001) in group III. ABI measurements (left and right) were similar in all groups (p > 0.05). More than half of the patients with hypothyroidism had subclinical hypothyroidism, and this condition was similar in all groups (p = 0.26). We also compared patients with hypothyroidism (group I plus III) with older controls with euthyroidism (group II). Median age was higher in group II than that in group I plus III (p < 0.001). PWV was higher in group II than that in group I plus III (p < 0.001). Hypertension was more common in group II than in group I plus III (p < 0.001).Conclusion:We did not find a relationship between hypothyroidism and atherosclerosis in old aged. PWV and hypertension were higher in older patients with hypothyroidism than in younger. Aging and hypertension increased PWV. Studies with larger series are needed to increase the reliability of these results.

Article, 信州医学雑誌 67(3): 197-204(2019)

RESUMEN: La preeclampsia se encuentra asociada a un elevado riesgo cardiovascular futuro de las mujeres que la han padecido. El presente trabajo plantea que el desarrollo de preeclampsia en mujeres sin criterios de síndrome antifosfolípido, se encuentra asociado a una respuesta autoinmune que se puede objetivar mediante la detección de anticuerpos antifosfolípido no convencionales. Estos anticuerpos podrían asociarse a la disfunción endotelial generalizada que se origina en la preeclampsia y afectar negativamente al riesgo cardiovascular futuro de la madre, lo que podría objetivarse mediante el análisis de parámetros de afectación vascular como la velocidad de onda de pulso (VOP) y el índice tobillo brazo (ITB). Para ello, se llevó a cabo, tres meses después del parto, la determinación de anticuerpos antifosfolípido no convencionales, VOP e ITB en un grupo de mujeres con preeclampsia y un grupo control de mujeres cuya gestación se desarrolló sin trastornos hipertensivos del embarazo. El análisis estadístico mostró que las mujeres con preeclampsia presentan una prevalencia de anticuerpos antifosfatidilserina/protrombina IgM (aPS/PT IgM) hasta tres veces superior a la de mujeres con embarazos normales. Igualmente, se identificó una importante asociación de los anticuerpos aPS/PT IgM con el desarrollo y severidad de la preeclampsia, así como una fuerte correlación lineal positiva con la VOP y una correlación moderada e inversa con el ITB. Por ello, se propone que en aquellas pacientes que desarrollan preeclampsia, la positividad postparto para anticuerpos aPS/PT IgM se asocia con la existencia de disfunción endotelial definida como presencia de valores alterados de VOP o ITB, lo cual podría constituir un biomarcador de utilidad para la estratificación del riesgo cardiovascular, ayudando a la identificación de mujeres que podrían beneficiarse de una monitorización más estrecha. ABSTRACT: Preeclampsia is associated with a high future cardiovascular risk in women who have suffered this disease. The present work, suggests that the development of preeclampsia in women without criteria of antiphospholipid syndrome is associated with an autoimmune response that can be demonstrated by detecting unconventional antiphospholipid antibodies. These antibodies could be associated with the generalized endothelial dysfunction originated in preeclampsia and affect negatively to the future cardiovascular risk of the mother. Cardiovascular risk could be identified by analyzing parameters of vascular involvement such as pulse wave velocity (PWV) and ankle brachial index (ABI). For this purpose, three months after delivery, unconventional antiphospholipid antibodies, PWV and ABI were determined in a group of women with preeclampsia and in a control group of women whose gestation was developed without hypertensive disorders of pregnancy. Statistical analysis showed that women with preeclampsia have a prevalence of antiphosphatidylserine/prothrombin IgM antibodies (IgM aPS/PT) three times higher than those women with normal pregnancies. Likewise, an important association of IgM aPS/PT antibodies with the development and severity of preeclampsia was identified, as well as a strong positive linear correlation with PWV and a moderate and inverse correlation with ABI. Therefore, it is proposed that in those patients who develop preeclampsia, postpartum positivity for IgM aPS/PT antibodies is associated with the existence of endothelial dysfunction defined as altered values of PWV or ABI. This finding could constitute a useful biomarker for cardiovascular risk stratification, helping to identify women who could benefit from closer monitoring.

Thermodynamic information from low levels in the atmosphere is crucial for operational weather forecasts and meteorological researchers. The NOAA Unique Combined Atmospheric Processing System (NUCAPS) sounding products have been proven beneficial to fill the data gap between synoptic radiosonde observations (RAOBs). However, compared with the upper troposphere, the accuracy of NUCAPS soundings in the low levels still needs improvement. In this study, a deep neural network (DNN) is applied to fuse multiple data sources to enhance the NUCAPS temperature and moisture profiles in the lower atmosphere. The network is developed by combining satellite observations, including NUCAPS sounding retrievals and high resolution geostationary satellite observations from the Advanced Baseline Imager, and surface analysis from the Real‐Time Mesoscale Analysis (RTMA) as inputs, while collocated soundings from ECMWF re‐analysis version 5 are used as the benchmark for the training. The performance of the model is evaluated by using the independent testing data set, data from a different year, as well as collocated RAOBs, showing improvement to the temperature and moisture profiles by reducing the root‐mean‐squared‐error (RMSE) by more than 30% in the lower atmosphere (from 700 hPa to surface) in both clear sky and partially cloudy conditions. A convective event from June 18, 2017 is presented to illustrate the application of the enhanced low level soundings on high impact weather events. The enhanced soundings from fused data capture the large surface‐based convective available potential energy structures in the preconvection environment, which is very useful for severe storm nowcasting and forecasting applications.

National Oceanic and Atmospheric Administration (NOAA) and United States Environmental Protection Agency (USEPA) have been deriving surface particulate matter with a median diameter of 2.5 µm or less (PM2.5) from satellite aerosol optical depth (AOD) over Continental United States (CONUS) using a climatological PM2.5‐AOD regression relation. However, because PM2.5‐AOD relation can change over time, this method can have large errors when the relation deviates from the climatological values. In this work, the geographically weighted regression (GWR) model is used to estimate surface PM2.5 from AOD. The parameters of the regression model are derived dynamically in a daily or hourly manner using surface PM2.5 measurements and AOD from satellite. The method is evaluated using Visible Infrared Imaging Radiometer Suite (VIIRS) AOD and Advanced Baseline Imager (ABI) AOD to estimate daily and hourly PM2.5 over CONUS, and Advanced Himawari Imager AOD to estimate hourly PM2.5 over Taiwan. The algorithm performs much better than using simple climatological relationships. The estimated daily PM2.5 from VIIRS AOD has a cross validation (CV) R2 of 0.59 with surface measured PM2.5, bias of 0.09 µg/m3 and Root mean square error (RMSE) of 5.66 µg/m3. The hourly PM2.5 estimates from ABI AOD has a CV R2 of 0.44, bias of 0.04 µg/m3, and RMSE of 4.53 µg/m3. The algorithm will run in near‐real‐time at NOAA to provide air quality community PM2.5 estimates over CONUS.

Peripheral Artery Diseases (PAD) are caused by the occlusions of arteries in the peripheral locations of the circulatory system. The severity of PAD is usually assessed using the Ankle Brachial Index (ABI) and the Ultrasound Doppler. Non-contact Photoplethysmography (PPG) imaging is a recent emerging technology capable of monitoring skin perfusion. Using an off-The-shelf camera and a light source, is possible to remotely detect the dynamic changes in blood volume in the skin and derive a map correlated to the blood perfusion. The aim of this study is the evaluation of a PPG imaging system (iPPG) for the assessment of Peripheral Arterial Diseases. Reduced blood flow is simulated on 21 volunteers by increasing the pressure in a pressure cuff. For each volunteer, measurements with iPPG, ultrasound, Laser Speckle Contrast Analysis (LASCA) and ABI were acquired. Our experiments show that iPPG can detect reduced perfusion levels, and correlates well with the other measurement systems.

Background: Surgery for applying the auditory brainstem implant is an otoneurosurgery that requires careful intraoperative monitoring to optimize the placement of the electrode paddle. This study aimed to validate a new method capable of increasing the accuracy of electrode array placement, reducing channel interaction, electrical artefacts, and saturation effects, and providing the largest number of electrodes that can be activated with the lowest possible electric charge. Materials and methods: Thirty-six subjects aged between 1.42 and 69.92 years were tested during surgery for auditory brainstem implantation. We recorded auditory electrical responses of the brainstem using the implant supplier's suggested stimulation protocol and the new protocol. Results: Saturations effects and electric artefacts were noticed respectively in 81.85% and 53.25% of recordings using implant supplier's method, while in 70.34% and 24.75% of recordings using the new method, with a percentage variation of 11.51% and 28.50%. Considering the amount of charge required to activate the electrodes, with the implant supplier's method an average charge of 14 nC was needed, while with the new protocol an average charge of 8 nC was necessary. Conclusions: The new method improves the coupling between the auditory brainstem implant and the surface of the cochlear nucleus.

Se logró analizar los efectos de las actividades antrópicas en la calidad de las aguas del rio Yura, a través de la modificación de la diversidad alfa (α) y beta (β) de los macroinvertebrados bentónicos como bioindicadores, utilizando para ello los índices biológicos nPeBMWP (adaptación para los ríos de la sierra norte del Perú del Biological Monitoring Working Party) y ABI (Andean Biological Index). A efecto de alcanzar los objetivos propuestos, se utilizaron métodos estándar, considerados en las normas nacionales e internacionales; así como las recomendaciones, que sobre las metodologías han dejado los autores de investigaciones similares al presente y que aparecen como citas bibliográficas, tanto para los muestreos, así como para las determinaciones y análisis de los resultados; dando de esta manera una validez universal a los resultados. Durante seis meses, pre y postemporada de lluvia, el rio Yura fue evaluado en dos estaciones de muestreo, para medir el efecto antrópico en la calidad de sus aguas a través de la modificación de la biodiversidad alfa y beta, de los macroinvertebrados bentónicos presentes en sus aguas; utilizando para ello los Índices nPeBMWP y ABI, así como la normativa peruana vigente para la evaluación de la calidad de agua (ECA). Se concluye señalando, que tanto el índice nPeNMWP, así como el ABI son indistintamente eficaces para hacer determinaciones acerca de la calidad de las aguas de ambientes loticos. Así mismo, se tiene que las aguas del rio Yura, desde el punto de vista de calidad biológica están en una condición de buena, para ambos índices; pero de acuerdo con el nPeNMWP en la zona impactada, puente de Yura, las aguas están sometidas a un estrés debido a la actividad antrópica. Desde el punto de vista de la calidad físico química de las aguas, los valores determinados se encuentran muy por debajo de los mínimos permisibles para este tipo de estudio, hecho que se corrobora con los resultados obtenidos utilizando a los MIB como los bioindicadores.

Renal dysfunction is common after stroke. We aimed to investigate the clinical predictability of the ankle–brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) on poststroke renal deterioration. A total of 956 consecutive participants with acute ischemic stroke between 1 July 2016, and 31 December 2017 were enrolled and a final of 637 patients were recruited for final analysis. By using the group-based trajectory model (GBTM), the patients’ renal function trajectories were grouped into the low, intermediate, and high categories (LC, IC, and HC). Significant deterioration in the slope was noted in the IC (p < 0.001) and LC (p = 0.002) groups but was nonsignificant in the HC (p = 0.998) group. Abnormal ABI (ABI ≤ 0.9) was independently related to LC (adjusted odds ratio: 2.40; 95% CI, 1.16–4.95; p = 0.019) and was also independently associated with increased risks of a ≥30% decline in eGFR (adjusted hazard ratio [aHR], 2.28; 95% CI, 1.29–4.05; p = 0.005), a doubling of serum creatinine (aHR, 3.60; 95% CI, 1.93–8.34; p < 0.001) and ESRD (HR, 3.28; 95% CI, 1.23–8.74; p = 0.018). However, baPWV did not have a significant relationship with any of the renal outcomes. Patients with a lower ABI during acute stroke should receive regular renal function tests and should be closely monitored to improve poststroke renal care.

Diabetes constitutes a growing healthcare burden and diabetes-related foot problems are the leading cause of hospitalization among diabetics. Atherosclerosis is also a common disease of the lower extremities and peripheral arterial disease (PAD) has become an indicator for generalized atherosclerosis. However, PAD is less well known than coronary and cerebral artery disease, and this impairs the diagnosis and treatment of the disease and the management of risk factors. The purpose of this study is to evaluate the use of infrared thermography (IRT) in clinical work in patients with circulatory disorders compared to conventional non-invasive methods. This thesis consists of four parts. The first and second parts examined the diagnostic potential of IRT in patients with diabetes and patients with PAD. The patient groups were compared to the healthy controls. In the third part, patients were followed before and after revascularization. The fourth part separately presents the results for those patients in which transcutaneous oxygen pressure measurements were performed. Side-to-side differences and local variations in temperature are the most significant factors for identifying pathology findings in both patients with diabetes or PAD. After successful revascularization, these side-to-side differences decrease and skin temperature differences were moderate during follow-up. Diabetes-related neuropathy raises the skin temperature. Surprisingly, even if toe pressure or oxygen pressure of the tissue decreases, skin temperature rises significantly. Also, an ulcer without inflammation raises the skin temperature. The infrared image provides information for broad regions of interest rather than merely the local temperature of a small area currently in use of screening diabetic feet. IRT is a useful tool in prevention, especially in high risk patients with diabetes, allowing even asymptomatic skin temperature-related symptoms such as inflammation to be detected earlier. Individual variations in skin temperature are broad, however, and IRT might not be sufficient as a single screening measurement in a clinical use among patients with vascular disorders, but it does have the potential for providing additional information. Tiivistelmä Diabetes ja siihen liittyvät jalkaongelmat ovat merkittävä kansanterveydellinen haitta ja aiheuttavat isoimman osan diabeetikoiden sairaalahoitoa vaativista käynneistä. Myös ateroskleroosi on yleistyvä kansantauti ja alaraajojen tukkivan valtimokovettumatauti yksi ateroskleroosin kolmesta tavallisimmasta ilmenemismuodosta. Alaraajojen valtimokovettumatauti tunnetaan kuitenkin huonommin kuin sepelvaltimo- ja aivovaltimotauti ja tämä heikentää taudin diagnostiikkaa ja hoitoa sekä riskitekijöiden hallintaa. Tutkimusten tarkoitus on selvittää lämpökameran käyttöä kliinisessä työssä verenkiertohäiriöpotilailla verrattuna perinteisiin ei-invasiivisiin menetelmiin. Tämä väitöskirja koostuu neljästä osatyöstä. Ensimmäisessä ja toisessa selvitettiin lämpökamerakuvantamisen diagnostisia mahdollisuuksia diabetespotilailla ja valtimokovettumatautia sairastavilla potilailla. Potilasryhmiä verrattiin terveisiin verrokkeihin. Kolmannessa osatyössä seurattiin potilaita ennen ja jälkeen verenkierron palauttamisen. Neljännessä osatyössä esitetään erikseen potilaat, joille tehtiin kudoksen happiosapainemittaukset. Lämpötilan puolierot ja paikalliset vaihtelut ovat merkittävimmät seikat poikkeavien löydösten identifioimiseksi verenkiertohäiriöpotilaan jalassa sekä diabeetikoilla että ateroskleroosipotilailla. Onnistuneen verenkierron palauttamisen jälkeen lämpötilaerot tasoittuvat ja puoliero pienenee seurannan aikana. Sokeritautiin liittyvä neuropatia nostaa ihon lämpötilaa. Ja yllättäen vaikka varvaspaine tai kudoksen happipitoisuus laskevat, nousee ihon lämpötila merkitsevästi. Myös haava ilman tulehdusta nostaa ihon lämpötilaa. Erityisesti diabeetikon jalassa esiintyvien lämpötilojen paikalliset erot lämpökamera havaitsee laajemmin kuin nykyisin käytössä oleva yksittäisten pistemäisten lämpötilojen käyttö, jolloin oireettomatkin ihon lämpötilaan vaikuttavat taudinkuvat kuten tulehdukset voidaan havaita aikaisemmin. Kuitenkin yksilöllinen ihon lämpötilan vaihtelu on suurta ja yksittäistä kuvausta voidaan käyttää muiden tutkimusmenetelmien tukena.

This paper analyzes a previously overlooked attack surface that allows unprivileged adversaries to impact supposedly secure floating-point computations in Intel SGX enclaves through the Application Binary Interface (ABI). In a comprehensive study across 7 widely used industry-standard and research enclave shielding runtimes, we show that control and state registers of the x87 Floating-Point Unit (FPU) and Intel Streaming SIMD Extensions (SSE) are not always properly sanitized on enclave entry. First, we abuse the adversary’s control over precision and rounding modes as a novel “ABI-level fault injection” primitive to silently corrupt enclaved floating-point operations, enabling a new class of stealthy, integrity-only attacks that disturb the result of SGX enclave computations. Our analysis reveals that this threat is especially relevant for applications that use the older x87 FPU, which is still being used under certain conditions for high-precision operations by modern compilers like gcc. We exemplify the potential impact of ABI-level quality-degradation attacks in a case study of an enclaved machine learning service and in a larger analysis on the SPEC benchmark programs. Second, we explore the impact on enclave confidentiality by showing that the adversary’s control over floating-point exception masks can be abused as an innovative controlled channel to detect FPU usage and to recover enclaved multiplication operands in certain scenarios. Our findings, affecting 5 out of the 7 studied runtimes, demonstrate the fallacy and challenges of implementing high-assurance trusted execution environments on contemporary x86 hardware. We responsibly disclosed our findings to the vendors and were assigned two CVEs, leading to patches in the Intel SGX-SDK, Microsoft OpenEnclave, the Rust compiler’s SGX target, and Go-TEE.

The management of lower extremity wounds is frequently performed by means of clinical examination, representing a challenge for the clinician due to the various conditions that can potentially enter differential diagnosis. Several diagnostic techniques are available in the dermatologist’s arsenal as a support to diagnosis confirmation, including dermoscopy and ultrasonography. Recently, a novel ultrasonographic technique involving the use of ultra-high ultrasound frequencies has entered the scene, and appears a promising tool in the diagnostic workup of skin ulcerative lesions. The focus of this review is to discuss the potential role of ultra-high-frequency ultrasonography in the diagnostic workup of wounds in the light of the current applications of the technique.

Height assignment is an important problem for satellite measurements of atmospheric motion vectors (AMVs) that are interpreted as winds by forecast and assimilation systems. Stereo methods assign heights to AMVs from the parallax observed between observations from different vantage points in orbit while tracking cloud or moisture features. In this paper, we fully develop the stereo method to jointly retrieve wind vectors with their geometric heights from geostationary satellite pairs. Synchronization of observations between observing systems is not required. NASA and NOAA stereo-winds codes have implemented this method and we processed large datasets from GOES-16, -17, and Himawari-8. Our retrievals are validated against rawinsonde observations and demonstrate the potential to improve the forecast skill. Stereo winds also offer an important mitigation for the loop heat pipe anomaly on GOES-17 during times when warm focal plane temperatures cause infrared channels that are needed for operational height assignments to fail. We also examine several application areas, including deep convection in tropical cyclones, planetary boundary layer dynamics, and fire smoke plumes, where stereo methods provide insights into atmospheric processes. The stereo method is broadly applicable across the geostationary ring where systems offering similar image navigation and registration (INR) performance as GOES-R are deployed.

The Sentinel-3 series satellites belong to the European Earth Observation satellite missions for supporting oceanography, land, and atmospheric studies. The Sea and Land Surface Temperature Radiometer (SLSTR) onboard the Sentinel-3 satellites was designed to provide a significant improvement in remote sensing of skin sea surface temperature (SSTskin). The successful application of SLSTR-derived SSTskin fields depends on their accuracies. Based on sensor-dependent radiative transfer model simulations, geostationary Geostationary Operational Environmental Satellite (GOES-16) Advanced Baseline Imagers (ABI) and Meteosat Second Generation (MSG-4) Spinning Enhanced Visible and Infrared Imager (SEVIRI) brightness temperatures (BT) have been transformed to SLSTR equivalents to permit comparisons at the pixel level in three ocean regions. The results show the averaged BT differences are on the order of 0.1 K and the existence of small biases between them are likely due to the uncertainties in cloud masking, satellite view angle, solar azimuth angle, and reflected solar light. This study demonstrates the feasibility of combining SSTskin retrievals from SLSTR with those of ABI and SEVIRI.

We present the characterization of the aquatic environment, riparian ecosystem and macroinvertebrate communities in 7 basins of the west slope of the Yanachaga Chemillén National Park (PNYCh). The CERA protocol, including the Andean Biotic Index (ABI), the Fluvial Habitat Index (IHF), the Andean Creek Index (Qbr-And) were estimated and the combination of these 3 indexes allowed to calculate the Ecological Status Index of Andean Rivers (ECOSTRIAND) at each sampling point. Additionally the FBI and BMWP-Col indexes were calculated. Sampling was carried out in the 7 basins, between 1800 and 2500 meters of altitude, including the upper basins inside the PNYCh, in the middle and lower basins, both in the buffer zone of the park. We found 179 taxa, 66 families and 14 orders in all basins evaluated. Within the PNYCh, the values of IHF and Qbr-And were optimal, but to go down basins, the indexes generally were decreasing in quality. The IBA was very good in all basins and all sampling points. However, when the 3 indexes were combining, the ECOSTRIAND index decreased, changed from very good to good and regular in some basins. The final results show that the ecological status index decreased as it moves away from PNYCh, this is associated with a greater riparian forests disturbance. Finally, we discussed the legal protection of this type of forest in several countries of America and specifically in Peru., Se presenta la caracterización del ambiente acuático, el ecosistema ribereño y las comunidades de macroinvertebrados en siete cuencas del flanco oeste del Parque Nacional Yanachaga Chemillén (PNYCh). Se aplicó el protocolo CERA que incluye el Índice Biótico Andino (IBA), el Índice de Hábitat Fluvial (IHF), el Índice de quebrada Andina (Qbr-And) y la combinación de los tres índices para determinar el Índice de Estado Ecológico de Ríos Andinos (ECOSTRIAND) en cada punto de muestreo. Asimismo, se estimaron los índices FBI y BMWP-Col para comparar la calidad de agua. Los muestreos se realizaron en las siete cuencas, entre los 1800 y los 2500 m de altitud, en la parte alta dentro del PNYCh, y en las cuencas media y baja, ambas en la zona de amortiguamiento del PNYCh. En las cuencas evaluadas se colectaron 179 taxa, 66 familias y 14 órdenes. Dentro del PNYCh los valores de IHF y Qbr-And fueron óptimos y en general fueron disminuyendo en calidad al alejarse del PNYCh. El IBA fue muy bueno en todas las cuencas y en todos los puntos de muestreo. Sin embargo, al combinar los 3 índices se observó una disminución del estado ecológico (ECOSTRIAND) de Muy bueno a Bueno y Regular. Los resultados finales muestran que el índice de estado ecológico disminuye al alejarse del PNYCh y esto coincide con un mayor disturbio de los bosques ribereños. Por último, se discute la protección legal de este tipo de ecosistemas ribereños en varios países de América y específicamente en Perú.

Frontiers in neurology 11, 115 (2020). doi:10.3389/fneur.2020.00115, Published by Frontiers Research Foundation, Lausanne

The high prevalence of brain injury incidents in adolescence and adulthood demands effective models for re-learning lost cognitive abilities. Impairment in brain injury survivors’ higher-level cognitive functions is common and a negative predictor for long-term out- come. We conducted two small-scale interventions (N = 12; 33.33% female) with persons with acquired brain injuries in two municipa- lities in Sweden. Age ranged from 17 to 65 years (M = 51.17, SD = 14.53). The interventions were dialogic, inquiry-based, and inspired by the Philosophy for Children Programme, a participatory thinking skills approach with documented higher-order cognitive outcomes, such as developed argumentation skills, in other target groups. Philosophical dialogues were conducted once a week in the two groups, totalling 12 dialogues per group. Group argumentation development was measured through compared scores from struc- tured observations of filmed dialogues early and late in the inter- vention. Large positive changes in mean scores from early to late in the intervention, together with constantly high facilitator quality, suggest argumentation development in the sample due to the intervention. Validerad;2020;Nivå 2;2020-01-29 (johcin) Education for participation: Philosophizing back a “new” life after acquired brain injury

Traumatic brain injury (TBI) increases risk of depression which is distressing and can be a barrier to recovery. This program of research examined non-pharmacological interventions for people with depression following TBI. A Cochrane systematic review was conducted in order to identify studies of interventions (Gertler, Tate, & Cameron, 2015; Chapter 2, section 1). Cochrane reviews are the most stringent form of systematic review of evidence relating to treatment outcomes. The review identified six studies, three studies relating to cognitive-behavioural therapy (CBT) which were combined in a meta-analysis that showed a very small effect in favour of treatment versus control, with a wide confidence interval. Other treatment studies were evaluated but either did not favour any treatment or were low quality studies. Recent studies have reported positive findings for CBT extended by booster sessions or for acceptance and commitment therapy (Chapter 2, section 2). Chapter 3 (Gertler & Cameron, 2018) is a published journal article explaining data analytic techniques used in a Cochrane review. Chapter 4 describes a psychometric evaluation of single-item mood scales (SIMS; Gertler & Tate, 2020) that can be used to demonstrate progress in treatment. SIMS are frequently used in clinical practice but had not yet been shown to be valid when used with people with brain impairment. SIMS were demonstrated to have construct and criterion validity when applied to TBI. Chapter 5 (Gertler and Tate, 2019) is a published journal article describing a single case experimental design (SCED) trial of behavioural activation (BA) to improve participation and mood. BA was chosen because it had not been evaluated for people with TBI and was thought to be more suitable than treatments such as CBT that require abstract thinking. The authors did not find evidence in favour of BA and this was discussed in the context of recent research findings that suggested that new technologies could improve the quality of measurement and interventions. In conclusion, there is more research to do in order to improve the effectiveness of interventions for depression after TBI however, using SIMS as a measure and SCED methodology, the thesis demonstrates a model for investigating untested interventions and their active components.

Research indicates that Acquired Brain Injury (ABI) is associated with significant and chronic impairment across multiple areas of functioning including physical, cognitive, emotional and behavioural domains. Whilst impairments associated with ABI can be ameliorated, cure is seldom possible. The emergence of positive psychology reflects a paradigm shift in health and wellbeing research, highlighting the role of character strengths, positive emotions, meaning, and resilience. Positive psychology interventions have been demonstrated to improve wellbeing in a variety of populations, although research investigating the impact of positive psychotherapy for people living with ABI are sparse. Here we characterize the experience of an 8-week positive psychotherapy intervention for 13 people living with ABI including four mentors and nine participants using thematic analysis of transcripts collected during mini-groups and one-to-one interviews. Six main themes were identified including empowerment, social opportunity, coping, cultivation of positive emotion, consolidation of skills and barriers. Results indicated that wellbeing can be promoted and improved in individuals with ABI. Recent theoretical developments in wellbeing science highlight scope to improve the intervention by connecting individuals to their communities and spending time in nature.

Neisseria gonorrhoeae (NG) har successivt utvecklat resistens mot många antimikrobiella medel och betraktas som ett av de tre reella hoten bland antibiotikaresistenta bakterier. Ciprofloxacin är ett bredspektrum-antibiotikum tillhörande gruppen kinoloner som, förutom att behandla urinvägsinfektioner, används mot NG och infektioner i mage och tarm. Dock har det rapporterats att ca 30 % av NG-isolat som samlats in genom gonokock-isolatövervakningsprojekt (GISP) under 2017 var resistenta mot ciprofloxacin. På molekylnivå är resistens mot ciprofloxacin starkt associerad med en enda mutation i kodon 91 i gyras-genen (gyrA). Detta projekt har undersökt om det går att använda molekylärbiologiska metoder för att detektera NG-isolat med gyrA mutationen. Analysen gjordes med två olika PCR-system, ”7500 Fast Real-Time PCR System” från Applied Biosystems (ABI) och Panther Fusion från Hologic. Proberna som användes designades för påvisning av vildtyp gyrA (ciprofloxacin-känslig) och mutant gyrA (ciprofloxacin-resistent) hos NG. I projektet analyserades 50 NG-positiva prov (analyserade med screeningtest APTIMA COMBO2 från Hologic), från 43 patienter som provtagits under januari-februari 2020 i Region Skåne. Några patienter testades flera gånger vid olika tillfällen. NG-odling hade utförts parallellt från motsvarande tagna prov från patienterna. ABI-metoden påvisade genen hos 90 % (45/50) av NG-positiva prover (APTIMA COMBO2) medan endast 24 av de 49 proven (49 %) kunde odlas med traditionell metodik för att därefter resistensbestämmas. Av de 45 prov där gyras-genen kunde detekteras med ABI-metoden, uppvisade 28 (62 %) av proven en muterad gen och därmed en potentiell resistens för ciprofloxacin. Panther Fusion-metoden påvisade genen hos 80 % (40/50) av NG-positiva prover (APTIMA COMBO2), och såsom tidigare nämnts, kunde endast 24 av de 49 proven (49 %) odlas med traditionell metodik för att därefter resistensbestämmas. Av de 40 prov där gyras-genen kunde detekteras med Panther Fusion-metoden, uppvisade 26 av proven (65 %) en muterad gen och därmed en potentiell resistens för ciprofloxacin. En jämförelse mellan resultaten från PCR-metoderna och odlingarna visar att av de 24 odlingarna som kunde resistensbestämmas fick ABI-metoden resultat för 23 och Panther Fusion för 22. PCR-metodernas resultat överensstämde perfekt med resultaten från odling med samma 8 känsliga och 15 respektive 14 resistenta NG-isolat som odling. De båda PCR-metoderna och traditionell odling uppvisade jämförbara resultat. Av de 24 prov som kunde odlas och därmed resistensbestämmas, detekterades med ABI-metoden gyras-genen i 23 av dessa prov och i 22 av proven med Panther Fusion-metoden. Resistens mot ciprofloxacin uppvisades genom odling i 16 av de 24 odlingsbara prov, och av dessa 24 odlingsbara prov uppvisade ABI-metoden en muterad gen i 15 av proven och Panther Fusion-metoden en muterad gen i 14 av proven. Traditionell odling kunde bara genomföras på 24 av proven och PCR-metoderna identifierade signifikant fler prov innehållande vildtyp eller muterad gyras-gen, 45 respektive 40 prov. Projektet visade tydligt att PCR-metoderna kan identifiera fler prov än genom traditionell odling och kan därmed upptäcka fler prov med förväntad ciprofloxacin-resistens än vad som kan bestämmas genom traditionell odling. Neisseria gonorrhoeae (NG) has been developing a resistance towards several different antibiotics and is viewed as one of the three real threats among resistant bacteria. Ciprofloxacin is a broad-spectrum-antibiotic belonging to the group quinolone antibiotics which, in addition to being used to treat urinal infections, is used to treat NG and infections in the stomach and intestines. However, it has been reported that 30 % of NG-isolates that have been gathered through the Gonococcal Isolate Surveillance Project (GISP) throughout 2017 were resistant to ciprofloxacin. On a molecular level, resistance to ciprofloxacin is strongly associated with a single mutation in kodon 91 in the gyras-gene (gyrA). This project sought to examine if it is possible to use methods from molecular biology to detect which NG that have the gyrA-mutation. The test was done using two different PCR-systems, ”7500 Fast Real-Time PCR System” from Applied Biosystems (ABI) and Panther Fusion from Hologic. The probes used were designed to show wild type gyrA (ciprofloxacin sensitive), and mutated gyrA (ciprofloxacin resistant) in NG. In this project 50 NG-positive samples (analysed with screentest APTIMA COMBO2 from Hologic), from 43 patients that had been tested during January-February 2020 in Region Skåne, were analysed. Some patients were tested several times, within the time period. NG-cultivation had been done in parallel from corresponding samples taken from the patients. The ABI-method showed the gene in 90 % (45/50) of NG-positive samples (APTIMA COMBO2) while only 24 of the 49 samples (49 %) could be cultivated by traditional methodology, and then tested for resistance. Of the 45 samples where the gyras-gene could be detected with the ABI-method, 28 samples (62 %) exhibited a mutated gene and thus a potential resistance to ciprofloxacin. The Panther fusion-method showed the gene in 80 % (40/50) of NG-positive samples (APTIMA COMBO2), and as mentioned earlier, only 24 of the 49 samples (49 %) could be cultivated by traditional methodology to then be tested for resistance. Of the 40 samples where the gyras-gene could be detected with the Panther Fusion-method, 26 samples (65 %) exhibited a mutated gene and thus a potential resistance to ciprofloxacin. The two PCR-methods and traditional cultivation exhibited comparable results. Of the 24 samples that could be cultivated and thus tested for resistance, the ABI-method detected the gyras-gene in 23 of these samples and the Panther Fusion-method detected the gene in 22 of the samples. Cultivation exhibited resistance to ciprofloxacin in 16 of the 24 samples that could be cultivated, and of these 24 cultivatable samples the ABI method exhibited a mutated gene in 15 of the samples and the Panther Fusion-method exhibited a mutated gene in 14 of the samples. Traditional cultivation could only be done on 24 of the samples and the PCR-methods could identify significantly more samples containing either wild type or mutated gyras-gene, 45 and 40 samples, respectively. The project clearly showed that more samples can be identified with the PCR-methods than through traditional cultivation, and thereby discover more samples with expected ciprofloxacin-resistance, than can be determined through traditional cultivation.

Peripheral vascular disease is a complication of Diabetes Mellitus (DM) that causes changes in blood vessel walls. Changes in blood vessel walls result in decreased blood flow (perfusion) to the lower extremities marked by decreased ankle brachial index (ABI). Decreased of ABI is a complication that often occurs in Diabetes Mellitus Patients. Acupressure therapy stimulating the flow of energy in the body so that the body's circulatory flow touch ups. This study aimed to determine the effect of acupressure to ABI in Diabetes Mellitus patients. This study designed was quasi-experimental with pre-post test design at 64 responden. The intervention group received acupressure therapy for 7 sessions, each 2 days for 10 minutes. Acupressure done in acupoint LR3, K13, SP6, SP10 and ST36. The results of analysis statistics showed there were a significant difference in ABI between before and after acupressure therapy (p= 0.001). It was concluded that acupressure effectively increases the value of ABI in people with diabetes. Acupressure can be used as an alternative therapy that can be applied by nurses in the community to prevent complications in Diabetes Mellitus patients as a vulnerable group. Penyakit vaskuler perifer merupakan komplikasi Diabetes Melitus (DM) yang menyebabkan perubahan pada dinding pembuluh darah. Perubahan pada dinding pembuluh darah menyebabkan penurunan aliran darah (perfusi) ke ekstremitas bawah yang ditandai dengan penurunan ankle brachial index (ABI). Penurunan nilai ABI adalah komplikasi yang sering terjadi pada Diabetisi. Terapi akupresur bermanfaat dalam menstimulasi aliran energi dalam tubuh sehingga memperbaiki aliran sirkulasi tubuh. Penelitian ini bertujuan untuk mengetahui pengaruh akupresur terhadap ABI Diabetisi. Desain penelitian ini adalah quasi eksperimen dengan pendekatan pre-post test design pada 64 responden. Kelompok intervensi diberikan terapi akupresur selama 7 sesi, 2 hari sekali selama 10 menit. Akupresur dilakukan pada titik akupunktur LR3, K13, SP6, SP10 dan ST36. Hasil analisis menunjukkan terdapat perbedaan nilai ABI yang signifikan antara sebelum dan sesudah diberikan terapi akupresur (p= 0,001). Disimpulkan bahwa akupresur efektif meningkatkan nilai ABI pada diabetisi. Akupresur dapat dijadikan salah satu alternatif terapi yang dapat diterapkan perawat di masyarakat untuk mencegah terjadinya komplikasi lanjut pada Diabetisi sebagai kelompok rentan.

Background/Aims: Elevated serum uric acid (UA) was intimately correlated with vascular stiffness and abnormal ankle brachial index (ABI) in various populations. These correlations lost significance after adjustment for estimated glomerular filtration rate (eGFR), indicating that the association of UA and brachial-ankle pulse wave velocity (baPWV) or ABI might be driven by kidney function. UA is predominantly eliminated through the kidneys, and metabolic disorders can influence the clearance of UA. In this study, we aimed to explore the putative correlation between FEUA and baPWV or ABI to determine to what extent the associations with UA were affected by renal function. Methods: This cross-sectional study enrolled 2351 participants, who underwent general health screening in Hanzhong people’s hospital from March to June of 2017. BaPWV and ABI were measured using a volume-plethysmographic apparatus (BP-203RPEII; Nihon Colin, Tokyo, Japan). FEUA was divided into quartiles: Q1:FEUA≤3.07; Q2: 3.07 9.19. Results: Lower FEUA predicted a higher prevalence of high baPWV and low ABI (p for trend Conclusion: Kidney function exerted a profound influence on the relationship between UA and baPWV or ABI, revealing complex interactions among cardiovascular risk factors.

Peripheral artery disease (PAD), when present with diabetes, is associated with significant morbidity and mortality. The spectrum of PAD in diabetes includes atherosclerosis with stenotic disease; and diffuse medial calcification with non-compliant arteries, as reflected by high ankle brachial index. The clinical characteristics of a high ABI are less well characterized than that of low ABI.The aim of this study was to determine the unique clinical phenotype of patients with diabetes who have high ankle brachial index (ABI) reading. We performed a cross sectional observational study including 360 patients. Subjects were grouped according to normal (≥ 0.8 ≤ 1.3), low (1.3) result. Subjects with high ABI were characterised by higher BMI, higher waist/height ratio (WHtR), and lower serum lower vitamin D. Although reduced renal function and neuropathy was present more frequently in those with high ABI, this was also the case in those with low ABI. Similarly to those with low ABI result, a high ABI result was associated with increased risk of diabetic foot complications including amputation. When adjusted for known risk factors for PAD, higher WHtR and lower vitamin D were significant predictors of high ABI. These results suggest an association between increased WHtR and low vitamin D with high ABI; whether there is a causal relationship requires further exploration. Keywords: Diabetes, Peripheral arterial disease, ABI, Obesity, 25-hydroxyvitamin D

OBJECTIVE: To summarise the current research on the effectiveness of the Amsterdam Memory and Attention Training for Children (Amat-c).METHODS: A literature search was conducted to find articles published about the Amat-c, using PubMed, psychINFO, and PsychBITE databases. Relevant search terms included Amat-c, attention and memory, and childhood ABI.RESULTS: Our literature search identified 7 articles that described 5 separate studies including 61 children in total (mostly TBI). Only one study had a control group. All results indicated positive effects on memory and attention, although in three of the studies, these results were not statistically tested. Positive results were generally maintained six months follow up.CONCLUSIONS: This review showed that the Amat-c is effective for treating attention and memory disturbances in children with ABI. However, evidence is limited and training material is outdated. We suggest that the Amat-c should be digitised and implemented in a school setting and further evaluated.

OBJECTIVE: To summarise the current research on the effectiveness of the Amsterdam Memory and Attention Training for Children (Amat-c). METHODS: A literature search was conducted to find articles published about the Amat-c, using PubMed, psychINFO, and PsychBITE databases. Relevant search terms included Amat-c, attention and memory, and childhood ABI. RESULTS: Our literature search identified 7 articles that described 5 separate studies including 61 children in total (mostly TBI). Only one study had a control group. All results indicated positive effects on memory and attention, although in three of the studies, these results were not statistically tested. Positive results were generally maintained six months follow up. CONCLUSIONS: This review showed that the Amat-c is effective for treating attention and memory disturbances in children with ABI. However, evidence is limited and training material is outdated. We suggest that the Amat-c should be digitised and implemented in a school setting and further evaluated.