Objectives: The World Health Organization Quality of Life-BREF Scale (WHOQOL-BREF) is a generic QOL measure with four domains covering Physical, Psychological, Social and Environment. Providing the ...opportunity to contrast QoL with other conditions, or with population norms, the current study had three aims: 1) can the established domains of the WHOQOL-BREF be validated within a large ALS/MND population; 2) can a total score be validated and 3) can they provide interval level measurement? Methods: Data were obtained from the Trajectories of Outcomes in Neurological Conditions study. Internal construct validity was determined by fit of the data to the Rasch measurement model. Results: 636 participants with ALS/MND were included. All domains, except the Social domain, showed satisfactory fit to the Rasch model. All were unidimensional, and showed no Differential Item Functioning by age, gender, or onset type. Finally, a total score was validated from a bi-factor perspective. Conclusions: The WHOQOL-BREF is valid for use in populations with ALS/MND and can be analyzed to yield interval level measurement: It offers a range of domains that reflect QOL, which can be used for parametric analysis and for comparison with other conditions or general populations, two advantages for its inclusion as a trial outcome measure and for observational studies.
We report a cluster of atypical Guillain-Barré syndrome in 10 adults temporally related to a cluster of four children with acute flaccid paralysis, over a 3-month period in South Wales, United ...Kingdom. All adult cases were male, aged between 24 and 77 years. Seven had prominent facial diplegia at onset. Available electrophysiological studies showed axonal involvement in five adults. Seven reported various forms of respiratory disease before onset of neurological symptoms. The ages of children ranged from one to 13 years, three of the four were two years old or younger. Enterovirus testing is available for three children; two had evidence of enterovirus D68 infection in stool or respiratory samples. We describe the clinical features, epidemiology and state of current investigations for these unusual clusters of illness.
Background and purpose
Differentiation between acute flaccid myelitis (AFM) and Guillain–Barré syndrome (GBS) can be difficult, particularly in children. Our objective was to improve the diagnostic ...accuracy by giving recommendations based on a comparison of clinical features and diagnostic criteria in children with AFM or GBS.
Methods
A cohort of 26 children with AFM associated with enterovirus D68 was compared to a cohort of 156 children with GBS. The specificity of the Brighton criteria, used for GBS diagnosis, was evaluated in the AFM cohort and the specificity of the Centers for Disease Control and Prevention (CDC) AFM diagnostic criteria in the GBS cohort.
Results
Children with AFM compared to those with GBS had a shorter interval between onset of weakness and nadir (3 vs. 8 days, p < 0.001), more often had asymmetric limb weakness (58% vs. 0%, p < 0.001), and less frequently had sensory deficits (0% vs. 40%, p < 0.001). In AFM, cerebrospinal fluid leukocyte counts were higher, whereas protein concentrations were lower. Spinal cord lesions on magnetic resonance imaging were only found in AFM patients. No GBS case fulfilled CDC criteria for definite AFM. Of the AFM cases, 8% fulfilled the Brighton criteria for GBS, when omitting the criterion of excluding an alternate diagnosis.
Conclusions
Despite the overlap in clinical presentation, we found distinctive early clinical and diagnostic characteristics for differentiating AFM from GBS in children. Diagnostic criteria for AFM and GBS usually perform well, but some AFM cases may fulfill clinical diagnostic criteria for GBS. This underlines the need to perform diagnostic tests early to exclude AFM in children suspected of atypical GBS.
A child with acute onset flaccid weakness may pose a diagnostic challenge for clinicians, with both acute flaccid myelitis (AFM) and Guillain–Barré syndrome (GBS) included in the differential diagnosis. We provide distinguishing features and recommendations, which may help clinicians in making the right diagnosis. In cases of atypical GBS, the diagnosis of AFM needs to be excluded early in the disease course, as AFM may fulfill the current clinical, cerebrospinal fluid, and nerve conduction studies diagnostic criteria for GBS.
Flight of fantasy Donahue, Neil H; Kirchner, Doris
2003., 20031201, 2003, 2003-12-15
eBook
During the Nazi era many German writers chose, or were forced into, exile. Many others stayed and, after the end of this period, claimed to have retreated into "Inner Emigration". The nature of this ...kind of emigration and the underlying motives of these writers have been hotly debated to this day. Though the reception of Inner Emigration has often been confounded by disputes over the term itself, the issue is ultimately not a matter of nomenclature, but of more far-reaching issues of literary evaluation, moral discernment and the writing of history. This volume presents, for the first time, to an English-speaking readership the complexity of Inner Emigration through the analysis of problematic individual cases of writers who, under constant pressure from a watchful dictatorship to conform and to collaborate, were caught between conscience and compromise.
The paper examines the legacy of the debate over perfectly contestable markets, the usefulness of several variations on the theory of imperfectly contestable markets including consideration of the ...problems associated with identifying contestable markets, and the contribution of conte'stability theory to the understanding of industry structure and appropriate industry policy. TTie debate surrounding contestability theory prompted economists to critically reassess the neoclassical theory of the firm, particularly with respect to: impediments to potential competition; the complementary role of potential and actual competition in affecting the conduct of incumbent firms; and the role and direction of appropriate industry regulation. The major problems identified by the debate are the difficulty in determining the extent to which markets may be imperfectly contestable and the framing of policy approaches appropriate to specific industry contexts.
Analysis of Moving-Coil Actuator Jet Injectors for Viscous Fluids Williams, Rhys Matthew James; Ruddy, Bryan P.; Hogan, N. Catherine ...
IEEE transactions on biomedical engineering,
2016-June, 2016-06-00, 2016-6-00, 20160601, Letnik:
63, Številka:
6
Journal Article
Recenzirano
Objective: A jet injector is a device that can be used to deliver liquid drugs through the skin using a fluid jet, without the use of a needle. Most jet injectors are designed and used for the ...delivery of inviscid liquids, and are not optimized for the delivery of viscous drug compounds. To better understand the requirements for delivering viscous drugs, we have developed a mathematical model of the electromechanics of a moving-coil actuated jet injector as it delivers viscous fluids. Methods: The model builds upon previous work by incorporating the nonlinear electrical properties of the motor, compliant elements of the mechanical piston and ampoule system, and the effect of viscosity on injector characteristics. The model has been validated by monitoring the movement of the piston tip and measurements of the jet force. Results: The results of the model indicate that the jet speed is diminished with increasing fluid viscosity, but overshoot and ringing in the jet speed is unaffected. However, a stiffer ampoule and piston will allow for a better control of the jet speed profile during an injection, and reduce ringing. Conclusion: We identified that the piston friction coefficient, the compliance of the injector components, and the viscous properties of the fluid are important determinants of performance when jet-injecting viscous fluids. Significance: By expanding upon previous jet injector models, this study has provided informative simulations of jet injector characteristics and performance. The model can be used to guide the design of future jet injectors for viscous fluids.
The aim of this study was to assess annual changes in the continuous summary physical performance score (CSPPS) and the quartile summary physical performance (QSPPS) score, evaluate how these changes ...relate to self-reported changes in physical function and to examine clinically meaningful changes in CSPPS and QSPPS.
This was a longitudinal study of an elderly cohort of men and women (age>65) reporting at least two domains of disability from 5 centers in the US and Europe. Subjects completed assessments of mobility, ability to perform activities of daily living (ADLs), and the physical component of the SF-36 at both baseline and at 1- year, as well as a self-report of change in function over the year. Timed physical performance tests including walking speed, repeated chair stands and balance were used to calculate QSPPS and CSPPS at baseline and one year.
Regardless of the tool used to evaluate clinical significance (ADL, SF- 36 PF, mobility disability, self-rating of physical performance) or a determination of the small meaningful change estimates based on effect size, it appears that a change of approximately 3 points in the CSPPS or 0.6 points in the QSPPS is clinically meaningful.
In this cohort with moderate to severe disability, an annual change of approximately 3 points in CSPPS and 0.6 points in QSPPS are clinically meaningful and these changes are evident at one year.
Carl Sternheim's development as a dramatist and his political views were strongly influenced by German nationalism and war aims in 1914. His cynicism became more pointed and his political views more ...radical as he attempted to get his plays passed by the censors. Sternheim's previous success was tarnished by censors who would not allow his older plays to be performed. 'Das leidende Weib' was completed on Oct 18, 1914, and, after it was modified to get approval from the censors, critics still responded negatively.
Previous investigations into the chiral inversion of 2‐arylpropionic acids by the fungus Verticillium lecanii have suggested that the mechanism of inversion is similar to that found in mammalian ...systems. The purpose of this investigation was to determine whether chiral inversion could be demonstrated in cell extracts and if the cofactor requirements were the same.
Cell extracts were produced by homogenization of a concentrated cell suspension in either buffer A (100 mM sodium phosphate buffer pH 7.4; 10 mM magnesium chloride) or buffer B (100mM sodium phosphate buffer pH 7.4; 10mM magnesium chloride; 0.1% Triton X‐100 v/v), followed by filtration through a 5‐μm nitrocellulose filter. Assays were set up in the presence of ATP and coenzyme A and either R,S‐, R‐ or S‐2‐phenylpropionic acid as substrates and it was found that bidirectional chiral inversion occurred using the pure enantiomers after 16 h incubation only using the cell extracts produced in buffer B. This chiral inversion process was found to occur only when an exogenous coenzyme A supply was present suggesting that the chiral inversion process is similar to the mammalian system where coenzyme A plays a key role.
The ability to invert the chirality of the substrate was lost on filtering the cell extract through a 0.45‐μm filter and direct evidence was obtained for the presence of active mitochondria in the 5‐muMm filtrate, suggesting that this may be the site of the inversion reaction in V. lecanii.
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