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Results From a Randomized Controlled Trial to Address Balance Deficits After Traumatic Brain Injury
No full textObjective: To evaluate the efficacy of an in-home 12-week physical therapy (PT) intervention that utilized a virtual reality (VR) gaming system to improve balance in individuals with traumatic brain injury (TBI). Setting: Home-based exercise program (HEP). Participants: Individuals (N=63; traditional HEP n=32; VR n=31) at least 1 year post-TBI, ambulating independently within the home, not currently receiving PT services. Main Outcome Measures: Primary: Community Balance and Mobility Scale (CB&M); Secondary: Balance Evaluation Systems Test (BESTest), Activities-Specific Balance Confidence Scale (ABC), Participation Assessment with Recombined Tools-Objective (PART-O). Results: No significant between-group differences were observed in the CB&M over the study duration (P=.9983) for individuals who received VR compared to those who received a HEP to address balance deficits after chronic TBI nor in any of the secondary outcomes: BESTest (P=.8822); ABC (P=.4343) and PART-O (P=.8822). However, both groups demonstrated significant improvements in CB&M and BESTest from baseline to 6, 12, and at 12 weeks follow-up (all P\u27s \u3c.001). Regardless of treatment group, 52% of participants met or exceeded the minimal detectable change of 8 points on the CB&M at 24 weeks and 38% met or exceeded the minimal detectable change of 7.81 points on the BESTest. Conclusion: This study did not find that VR training was more beneficial than a traditional HEP for improving balance. However, individuals with chronic TBI in both treatment groups demonstrated improvements in balance in response to these interventions which were completed independently in the home environment
On healthcare by popular appeal: critical assessment of benefit and risk in cannabidiol based dietary supplements
No full textIntroduction: In recent decades, federal legislation in the U.S. has recognized a new paradigm of pharmacotherapy in which ideology and popular demand, as opposed to sound clinical evidence, drives the marketing of ostensible herbal therapeutics as ‘dietary supplements’. This vogue of democratizing medicine has more recently manifested in the ongoing legalization of cannabis products at the state level, where an arbitrary variety of definitions, restrictions, and assumed therapeutic uses are applied to a family of phytochemicals with no definitive evidence of efficacy or safety. With the recent publication of clinical trials submitted to the FDA in efforts to gain approval of the cannabidiol based therapeutic Epidiolex, a rare opportunity exists to examine high-quality data for a drug which has in recent years been marketed as a greatly unregulated dietary supplement. Areas covered: A critical analysis is offered of data regarding efficacy, dosing, exposure, adverse events, drug–drug interactions, and non-specific effects associated with CBD–all of which raise questions regarding the wisdom of assuming the safety and efficacy of cannabinoids in particular and dietary supplements in general. Expert opinion: Ongoing lack of meaningful regulation of cannabinoid supplements continues to put consumers at undue risk without clear evidence of therapeutic value
Adverse Childhood Experiences as a Determinant of Public Service Motivation
No full textThe wounded healer archetype predicts that people who suffer negative experiences in childhood would be motivated to enter helping fields as a way of self-healing. Developmental traumatology, however, suggests that people who have negative experiences in childhood may have their development stunted, particularly when it comes to caring for others. To test these competing theories, researchers test the effect of adverse childhood experiences (ACEs) on public service motivation (PSM) and find negative experiences in childhood are associated with a lower willingness to help others. However, some evidence suggests that a curvilinear relationship exists such that extreme levels of ACEs result in more PSM
The State of Journalism and Press Freedom in Postgenocide Rwanda
No full textNews media played a prominent role in perpetuating the 1994 Rwandan genocide. Since then, Rwanda has undergone impressive social and economic growth, but the media landscape during this redevelopment remains understudied. Qualitative interviews with Rwandan journalists reveal that reporters censor themselves to promote peace and reunification. Short-term, prioritizing social good over media rights might help unify the country, but ultimately it could limit development and reinforce existing authoritarian power structures. Findings suggest that McQuail’s development media theory and Hachten’s developmental concept maintain relevance but point to the need for a new or revised media development paradigm
Ultrasound-guided percutaneous electrical nerve stimulation of the radial nerve for a patient with lateral elbow pain: A case report with a 2-year follow-up
No full textt BACKGROUND: Patients with lateral elbow pain are often diagnosed with lateral epicondylalgia. Lateral elbow pain is often associated with dysfunction of the wrist extensor muscles; however, in some cases, it can also mimic signs and symptoms of radial nerve dysfunction. t CASE DESCRIPTION: In this case report, a 43-year-old man, who was originally referred with a diagnosis of lateral epicondylalgia as a result of playing table tennis and who previously responded favorably to manual therapy and exercise, presented to the clinic for treatment. An exacerbation while participating in a table tennis match resulted in a return of his lateral epicondylalgia symptoms, which did not respond favorably to the same interventions used in his prior course of therapy. Further examination revealed sensitization of the radial nerve, which was treated with 2 sessions of ultrasound-guided percutaneous electrical nerve stimulation and 4 weeks of a low-load, concentric/ eccentric exercise program for the wrist extensors. t OUTCOMES: Following this intervention, the patient experienced clinically meaningful improvement in pain intensity (numeric pain-rating scale), function (Patient-Rated Tennis Elbow Evaluation), and related disability (Disabilities of the Arm, Shoulder and Hand questionnaire). The patient progressively exhibited complete resolution of pain and function, which was maintained at 2 years. t DISCUSSION: This case report demonstrates the outcomes of a patient with lateral elbow pain who did not respond to manual therapy and exercise. Once radial nerve trunk sensitivity was identified and the intervention, consisting of ultrasound-guided percutaneous electrical nerve stimulation targeting the radial nerve combined with a low-load exercise program, was applied, a full resolution of pain and function occurred rapidly. Future clinical trials should examine the effect of percutaneous electrical nerve stimulation in the management of nerve-related symptoms associated with musculoskeletal pain conditions
Colloidal Drug Aggregate Stability in High Serum Conditions and Pharmacokinetic Consequence
No full textColloidal drug aggregates have been a nuisance in drug screening, yet, because they inherently comprise drug-rich particles, they may be useful in vivo if issues of stability can be addressed. As the first step toward answering this question, we optimized colloidal drug aggregate formulations using a fluorescence-based assay to study fulvestrant colloidal formation and stability in high (90%) serum conditions in vitro. We show, for the first time, that the critical aggregation concentration of fulvestrant depends on media composition and increases with serum concentration. Excipients, such as polysorbate 80, stabilize fulvestrant colloids in 90% serum in vitro for over 48 h. Using fulvestrant and an investigational pro-drug, pentyloxycarbonyl-(p-aminobenzyl) doxazolidinylcarbamate (PPD), as proof-of-concept colloidal formulations, we demonstrate that the in vivo plasma half-life for stabilized colloids is greater than their respective monomeric forms. These studies demonstrate the potential of turning the nuisance of colloidal drug aggregation into an opportunity for drug-rich formulations
Amputee Locomotion: Joint Moment Adaptations to Running Speed Using Running-Specific Prostheses after Unilateral Transtibial Amputation
No full textObjective The objective of this study was to investigate three-dimensional lower extremity joint moment differences between limbs and speed influences on these differences in individuals with lower extremity amputations using running-specific prostheses. Design Eight individuals with unilateral transtibial amputations and 8 control subjects with no amputations ran overground at three constant velocities (2.5, 3.0, and 3.5 m/sec). A 2 × 2 × 3 (group × leg × speed) repeated-measures analysis of variance with Bonferroni adjustments determined statistical significance. Results The prosthetic limb generated significantly greater peak ankle plantarflexion moments and smaller peak ankle varus, knee stance extension, knee swing flexion, knee internal rotation, hip stance flexion, hip swing flexion, hip swing extension, hip valgus, and hip external rotation moments than the intact limb did. The intact limb had greater peak hip external rotation moments than control limbs did, but all other peak moments were similar between these limbs. Increases in peak hip stance and knee swing flexion moments associated with speed were greater in the intact limb than in the prosthetic limb. Conclusion Individuals with amputation relied on the intact limb more than the prosthetic limb to run at a particular speed when wearing running-specific prostheses, but the intact joints were not overloaded relative to the control limbs
Priority effects and nonhierarchical competition shape species composition in a complex grassland community
No full textNiche and fitness differences control the outcome of competition, but determining their relative importance in invaded communities—which may be far from equilibrium—remains a pressing concern. Moreover, it is unclear whether classic approaches for studying competition, which were developed predominantly for pairs of interacting species, will fully capture dynamics in complex species assemblages. We parameterized a population-dynamic model using competition experiments of two native and three exotic species from a grassland community. We found evidence for minimal fitness differences or niche differences between the native species, leading to slow replacement dynamics and priority effects, but large fitness advantages allowed exotics to unconditionally invade natives. Priority effects driven by strong interspecific competition between exotic species drove single-species dominance by one of two exotic species in 80% of model outcomes, while a complex mixture of nonhierarchical competition and coexistence between native and exotic species occurred in the remaining 20%. Fungal infection, a commonly hypothesized coexistence mechanism, had weak fitness effects and is unlikely to substantially affect coexistence. In contrast to previous work on pairwise outcomes in largely native-dominated communities, our work supports a role for nearly neutral dynamics and priority effects as drivers of species composition in invaded communities
Individuals with low back pain improve in standing tolerance and sagittal plane muscle activation following exercise intervention
No full textBACKGROUND: Healthy individuals who develop low back pain (LBP) during standing (standing intolerant) respond favorably to stabilization-based exercise interventions. People with clinical LBP meeting clinical prediction rules for stabilization-based exercise share characteristics with standing intolerant individuals. OBJECTIVE: To investigate the impact of stabilization-based exercise on standing tolerance, muscle activation and clinical measures in individuals with LBP meeting clinical prediction rules for stabilization-based exercise. METHODS: Participants with and without LBP completed testing pre- and post-6 weeks of progressive home exercise intervention. Testing included clinical examination and electromyography during sagittal and frontal plane movements. LBP was also assessed by visual analogue scale (VAS) during standing. Outcomes included clinical findings, muscle sequencing, and VAS in standing. RESULTS: The LBP group had non-significant decreases in Oswestry Disability Index (-2.1%, p= 0.22), baseline VAS (-7.1 mm, p= 0.11), lumbopelvic reversal (p= 0.06) and positive active hip abduction test (p= 0.06). Significant improvements were seen in standing VAS (-5.6 mm, p\u3c 0.001). The LBP group had beneficial changes in activation strategies in standing flexion (p\u3c 0.05) following intervention, with no changes during frontal plane movement strategies. CONCLUSIONS: Individuals with LBP meeting clinical prediction rules for stabilization-based exercise demonstrated increased standing tolerance and sagittal plane muscle sequencing following a 6-week intervention