Search

Fabíola Costa,1 Dora Janela,1 Maria Molinos,1 Robert G Moulder,2 Jorge Lains,3,4 Virgílio Bento,1 Justin Scheer,5 Vijay Yanamadala,1,6,7 Fernando Dias Correia,1,8 Steven P Cohen9,10 1SWORD Health, Inc, Clinical Research, Draper, UT, USA; 2Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA; 3Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal; 4Faculty of Medicine, Coimbra University, Coimbra, Portugal; 5Department of Neurological Surgery, University of California, San Francisco, CA, USA; 6Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA; 7Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA; 8Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal; 9Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; 10Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USACorrespondence: Fernando Dias Correia, 65 E Wadsworth Park Dr Ste 230, Draper, UT, 84020, USA, Tel +1 385-308-8034, Fax +1 801-206-3433, Email fcorreia@swordhealth.comBackground: Low back pain (LBP) has a lifetime prevalence of 70– 80%. Access to timely and personalized, evidence-based care is key to prevent chronic progression. Digital solutions may ease accessibility to treatment while reducing healthcare-related costs.Purpose: We aim to report the results of a fully remote digital care program (DCP) for acute LBP.Patients and Methods: This was an interventional, single-arm, cohort study of patients with acute LBP who received a DCP. Primary outcome was the mean change in disability (Oswestry Disability Index – ODI) after 12 weeks. Secondary outcomes included change in pain (NPRS), analgesic consumption, surgery likelihood, depression (PHQ-9), anxiety (GAD-7), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI) and engagement.Results: A total of 406 patients were enrolled in the program and of those, 332 (81.8%) completed the intervention. A significant disability reduction of 55.1% (14.93, 95% CI 13.95; 15.91) was observed, corresponding to a 76.1% responder rate (30% cut-off). Disability reduction was accompanied by significant improvements in pain (61.0%), depression (55.4%), anxiety (59.5%), productivity (65.6%), fear-avoidance beliefs (46.3%), intent to pursue surgery (59.1%), and analgesic consumption (from 35.7% at baseline to 10.8% at program end). DCP-related patient satisfaction score was 8.7/10.0 (SD 1.4).Conclusion: This study demonstrated the utility of a multimodal DCP for patients with acute LBP. Very high adherence rates and patient satisfaction were observed, alongside significant reductions in all assessed outcomes, consistent with the growing body of evidence supporting the management of acute LBP with DCPs.Keywords: physical therapy, telerehabilitation, digital therapy, eHealth, musculoskeletal conditions

Justin K Scheer,1 Fabíola Costa,2 Dora Janela,2 Maria Molinos,2 Anabela C Areias,2 Robert G Moulder,3 Jorge Lains,4,5 Virgílio Bento,2 Vijay Yanamadala,2,6,7 Fernando Dias Correia2,8 1Department of Neurological Surgery, University of California, San Francisco, CA, USA; 2Sword Health, Inc, Draper, UT, USA; 3Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA; 4Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal; 5Faculty of Medicine, Coimbra University, Coimbra, Portugal; 6Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA; 7Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA; 8Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, PortugalCorrespondence: Fernando Dias Correia, Sword Health Inc, 13937 Sprague Lane Ste 100, Draper, UT, 84020, USA, Tel +1 385-308-8034, Fax +1 801-206-3433, Email fcorreia@swordhealth.comBackground: Musculoskeletal (MSK) pain is highly prevalent worldwide, resulting in significant disability, and comorbid sleep disturbances. Digital therapy for MSK pain can provide significant improvements in care access, alongside pain and disability reductions. However, studies on the effect of such programs on sleep are lacking.Purpose: To evaluate the impact on pain-related sleep impairment after a 12-week remote multimodal digital care program (DCP) for MSK conditions.Patients and Methods: This is an ad-hoc analysis of a decentralized single-arm study into engagement and clinical outcomes after a DCP for MSK rehabilitation. Patients were stratified by baseline sleep disturbance, based on sleep questions in the questionnaires: Oswestry Disability Index, Neck Disability Index, and the Quick Disabilities of the Arm, Shoulder and Hand questionnaire. Additional outcomes were pain, Generalized Anxiety Disorder 7-item scale, Patient Health 9-item questionnaire, Work Productivity, and Activity Impairment, and program engagement.&#x00A0Results: At baseline, 5749 patients reported sleep disturbance (78.0% of eligible patients). These reported significantly worse clinical outcomes at baseline than patients without sleep disturbance (all p< 0.001). Patients with comorbid sleep disturbance showed improvements in sleep, with a significant proportion reporting full recovery at program completion: 56% of patients with upper limb conditions (including 10% of patients with severe sleep disturbance at baseline), and 24% with spine conditions. These patients also reported significant improvements in all clinical outcomes at program completion. Engagement and satisfaction were high, and also higher than in patients without sleep impairment.Conclusion: This is the first study of its kind investigating the effect of a completely remote DCP for MSK pain on sleep. Patients reporting comorbid sleep disturbance had significant improvement in sleep, alongside pain, mental health and work productivity at program completion. The results suggest that a DCP for MSK pain can improve sleep disturbances in patients with upper limb and spine conditions.Keywords: pain, physical therapy, eHealth, telerehabilitation, remote care

Measurements of the effect of long duration UV irradiation (up to 2905 min) of flight quality diamondlike carbon charge state conversion surfaces for application in space research in the presence of a hydrocarbon atmosphere were done. An isopropanol atmosphere was used for simulating the hydrocarbon gaseous environment for an instrument on a satellite in space. Charge state conversion surfaces are used in neutral particle sensing instruments where neutral atoms have to be ionized prior to the analysis. A narrow-band (126±5 nm) discharge lamp and a broad-band deuterium lamp (112-370 nm) were used as sources of UV radiation. The UV irradiation of a surface results in the desorption of some volatiles present on the surface and the decomposition of others. Desorption of volatiles, mostly water, is observed for both UV sources. The decomposition of the hydrocarbons and the subsequent build-up of a hydrocarbonaceous layer is only observed for the broad-band UV lamp, which is more representative for the space environment. Unfortunately, the hydrocarbonaceous layer cannot be removed thermally, i.e., it is permanent, and causes a degradation of the performance of the charge state conversion surfaces. With the present measurements we can quantify the UV influence at which the degradation of the conversion surfaces becomes noticeable. [ABSTRACT FROM AUTHOR]

Molecular oxygen and hydrogen ions were scattered off hydrogen terminated diamondlike carbon (DLC) charge state conversion surfaces at incident grazing angles. The energy range of the scattered particles was 390–1000 eV, and the surface roughness of the DLC surface was of the order of 1 Å rms. For all surfaces almost equal angular scattering and negative ion fractions were found within the uncertainties of the measurement. This result supports the fact that charge state conversion with DLC surfaces is a reliable technology for neutral particle sensing instruments. Furthermore, these instruments can work in the laboratory as well as in the harsh environment on board a satellite.The surfaces measured here are used in the IBEX-lo sensor, a neutral particle sensing instrument on the NASA IBEX mission, which is scheduled for launch into orbit around Earth in July 2008. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the propulsion asymmetries of wheelchair athletes while sprinting on an instrumented, dual‐roller ergometer system. Eighteen experienced wheelchair rugby players (8 low point (LP) (class ≤1.5) and 10 high point (HP) (class ≥2.0)) performed a 15‐second sprint in their sports wheelchair on the instrumented ergometer. Asymmetry was defined as the difference in distance and power output (PO) between left and right sides when the best side reached 28 m. Propulsion techniques were quantified based on torque and velocity data. HP players covered an average 3 m further than the LP players (P = .002) and achieved faster sprint times than LP players (6.95 ± 0.89 vs 8.03 ± 0.68 seconds, P = .005) and at the time the best player finished (5.96 seconds). Higher peak POs (667 ± 108 vs 357 ± 78 W, P = .0001) and greater peak speeds that were also evident were for HP players (4.80 ± 0.71 vs 4.09 ± 0.45 m/s, P = .011). Greater asymmetries were found in HP players for distance (1.86 ± 1.43 vs 0.70 ± 0.65 m, P = .016), absolute peak PO (P = .049), and speed (0.35 ± 0.25 vs 0.11 ± 0.10 m/s, P = .009). Although HP players had faster sprint times over 28 m (achieved by a higher PO), high standard deviations show the heterogeneity within the two groups (eg, some LP players were better than HP players). Quantification of asymmetries is important not only for classifiers but also for sports practitioners wishing to improve performance as they could be addressed through training and/or wheelchair configuration. [ABSTRACT FROM AUTHOR]

Mobility loss is the leading cause of adult disability (38%). Most research focuses on physical or epidemiology factors and the acute onset stage. Less studied are psychosocial and long-term disability issues. But, consensus is growing that theory and interventions need grounding in self-defined concerns and desired outcomes. We report findings from a community sample (N=157) of persons with mobility loss, stratified by trajectory (adult-onset, lifelong, lifelong + new adult losses), and severity (mild 'limp' vs. severe 'wheel chair'). Narrative and structured anthropology measures were conducted to identify self-defined, chapters, themes and transitions. Analysis revealed (1) trajectory and severity specific meanings and concerns, but also shared themes, (2) few self-defined chapters and transitions predicted by objective factors, as well as factors not predicted by those. and (3) partial support for theories of: disablement; continuity; or coping. We discuss method and conceptual limits to further theory development. [NIH #R01HD34940]

The Imager for Low Energetic Neutral Atoms test facility at the University of Bern was developed to investigate, characterize, and quantify physical processes on surfaces that are used to ionize neutral atoms before their analysis in neutral particle-sensing instruments designed for space research. The facility has contributed valuable knowledge of the interaction of ions with surfaces (e.g., fraction of ions scattered from surfaces and angular scattering distribution) and employs a novel measurement principle for the determination of secondary electron emission yields as a function of energy, angle of incidence, particle species, and sample surface for low particle energies. Only because of this test facility it was possible to successfully apply surface-science processes for the new detection technique for low-energetic neutral particles with energies below about 1 keV used in space applications. All successfully flown spectrometers for the detection of low-energetic neutrals based on the particle-surface interaction process use surfaces evalu-ated, tested, and calibrated in this facility. Many instruments placed on different spacecraft (e.g., Imager for Magnetopause-to-Aurora Global Exploration, Chandrayaan-1, Interstellar Boundary Explorer, etc.) have success-fully used this technique. [ABSTRACT FROM AUTHOR]

We report on the design and experimental verification of a novel charged particle detector and an energy spectrometer with variable geometric factor functionality. Charged particle populations in the inner heliosphere create fluxes that can vary over many orders of magnitude in flux intensity. Space missions that plan to observe plasma fluxes, for example when travelling close to the Sun or to a planetary magnetosphere, require rapid particle measurements over the full three-dimensional velocity distribution. Traditionally, such measurements are carried out with plasma instrumentation with a fixed geometrical factor, which can only operate in a limited range of flux intensity. Here we report on the design and testing of a prototype sensor, which is capable of measuring particle flux with high angular and energy resolution, yet has a variable geometric factor that is controlled without moving parts. This prototype was designed in support of a proposal to make fast electron measurements on the Solar Probe Plus (SP+) mission planned by NASA. We simulated the ion optics inside the instrument and optimized the performance to design and build our prototype. This prototype was then tested in the MEFISTO facility at the University of Bern and its performance was verified over the full range of azimuth, elevation, energy and intensity. [ABSTRACT FROM AUTHOR]

Injury to the triangular fibrocartilage complex associated with distal radius fracture may cause symptoms of ulnar instability. Assessed by a radioulnar stress test, increased laxity of the distal radioulnar joint has in two previous studies been depicted to be associated with poorer outcome. This prospective study of 40 adults investigates the correlation of this test with functional outcome as measured by DASH. No clinically significant difference was found in relation to this test at two and five years after injury. Therefore using this test alone to decide whether or not to perform an acute repair of the TFCC cannot be recommended. [ABSTRACT FROM PUBLISHER]

Lesions of the triangular fibrocartilage complex (TFCC) are commonly associated with distal radius fractures and may adversely affect the functional outcome. This prospective study evaluated computed tomography, using the radioulnar ratio (RUR), to detect laxity of the distal radioulnar joint in 48 consecutive patients with acute distal radius fractures and compared the results with a radioulnar stress test. We found the clinical stress test to be reliable in chronic cases, but the RUR method of questionable value in both acute and chronic cases. [ABSTRACT FROM PUBLISHER]

Abstract: A-priori, rapid variations of solar activity that directly impact on the terrestrial environment should be expected to influence airglow brightness in the mesopause region via the photodissociative production of atomic oxygen, as it does on the time scale of the solar cycle. To find out whether this is supported by our midlatitude data, we analyze the strongest geoeffective solar activity events, in times when data from the Argentine airglow spectrometer were obtained. An alternative interaction path involving geomagnetic perturbations mediated by the solar wind can also be expected to affect the mesopause region. Daily mean values of different solar and geomagnetic activity indices, and more than 1400 nights of airglow brightness and rotational temperature measurements (mostly from El Leoncito, 31.8°S) are available for this study. The diagnostic value of this investigation is augmented by using information corresponding to two different nominal altitudes (87km for the OH(6–2) band, and 95km for the O2 b(0–1) band). Our approach ranks the (solar and airglow) events by their respective strength, which automatically provides emphasis on the more important cases. We conclude that if an airglow response to strong solar events exists, it is only short-lived and should therefore most easily be detectable by daytime observations. On the other hand, we did not find signatures in our airglow data that could convincingly be related to geomagnetic storms. [Copyright &y& Elsevier]

Individuals with disabilities constitute a marginalized group in health services research, and their experiences within the health-care system are not well understood. This article examines the access barriers to primary, specialist, and rehabilitative care, and their consequences for individuals' health, functioning, well-being, and health services utilization. The findings are based on an in-depth analysis of 30 qualitative interviews. Access problems are grouped into environmental, structural, and process barriers. The findings highlight the complex nature of access barriers for people with disabilities and underscore the importance of disability literacy in the health service delivery process. [ABSTRACT FROM AUTHOR]