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To characterize strength asymmetries in the upper and lower extremities in persons with multiple sclerosis (PwMS) with severe disability, and examine associations between asymmetries and functional, symptomatic, and participatory outcomes.

Cross-sectional.

University research laboratory.

25 PwMS with Expanded Disability Status Scale scores between 6.0-8.0.

Bilateral strength and asymmetry scores for muscle groups at the ankle, knee, and shoulder joints in addition to grip strength.

Significant differences were observed between all contralateral strength measures, with asymmetry scores ranging between 20-32%. A high prevalence of asymmetry (i.e., score>10%) was observed for all strength measures, with 92% of participants having four or more affected measures. learn more Significant associations were observed between dorsiflexion asymmetry and physical health-related quality of life (ρ= -0.69; p<0.001), and between shoulder flexion asymmetry and lower extremity function (ρ= -0.62; p=0.001). Plantarflexion (ρ= 0.61; p=0.003) and knee flexion (ρ= 0.63; p=0.002) asymmetry were significantly associated with lower extremity functional asymmetry.

A high prevalence of asymmetry in the upper and lower extremities was observed, with asymmetry scores exceeding those previously reported in PwMS with mild-to-moderate disability. link2 Rehabilitation strategies should consider a full body approach to address strength asymmetries.

A high prevalence of asymmetry in the upper and lower extremities was observed, with asymmetry scores exceeding those previously reported in PwMS with mild-to-moderate disability. Rehabilitation strategies should consider a full body approach to address strength asymmetries.This paper is aimed to demonstrate the merits of a metaheuristic swarm-based optimization technique, WOA (Whale optimization algorithm), in alleviating the low-frequency torsional oscillations called SSR (Sub-synchronous resonance). The demonstration has been performed using the modified IEEE FBM (IEEE first benchmark model) aggregated with Type-2 WPP (Wind power plant). The Plant is further interlinked to the grid with series compensated lines. Use of WOA for the optimal tuning of the controller suggested in the literature to control one of the degrees of freedom, i.e., Pitch angle and external resistance connected to the rotor, has been demonstrated. The effectiveness of the proposed WOA based controller has been examined using a time-domain approach based on the dynamic response of the different segments of the test system using the Matlab software for the three different cases viz., with Type-2 WPP only, Type-2 WPP with the controller suggested in the literature and with the proposed WOA based controller. The eigenvalues, together with simulation results, reveal the potential of the proposed WOA based controller in damping the low-frequency torsional oscillations using Type-2 wind turbines.A new adaptive impedance, augmented with backstepping control, time-delay estimation, and a disturbance observer, was designed to perform passive-assistive rehabilitation motion. This was done using a rehabilitation robot whereby humans' musculoskeletal conditions were considered. This control scheme aimed to mimic the movement behavior of the user and to provide an accurate compensation for uncertainties and torque disturbances. Such disturbances were excited by constraints of input saturation of the robot's actuators, friction forces and backlash, several payloads of the attached upper-limb of each patient, and time delay errors. The designed impedance control algorithm would transfer the stiffness of the human upper limb to the developed impedance model via the measured user force. In the proposed control scheme, active rejection of disturbances would be achieved through the direct connection between such disturbances from the observer's output and the control input via the feedforward loop of the system. Furthermore, the computed control input does not require any precise knowledge of the robot's dynamic model or any knowledge of built-in torque-sensing units to provide the desirable physiotherapy treatment. Experimental investigations performed by two subjects were exhibited to support the benefits of the designed approach.To solve the control problem of nonstrict feedback nonlinear systems, a backstepping technique based controller design method is developed by integrating a robust control law with the excellent parameter identification algorithm of indirect adaptive framework. Each of unknown system functions that contain whole states is approximated by adding together a bounded time-varying parameter and a fuzzy approximator related to the current step and previous states only in the backstepping design procedure, which solves the algebraic loop problem existing in nonstrict feedback systems. Then the command filter is combined with the adaptive backstepping to construct the robust control law by which the differentiation operation of the virtual control signal can be avoided. Subsequently the swapping scheme is used to convert the studied system into a linear time-varying form. Both the weight vector of the fuzzy logic system and the bounded time-varying parameter are estimated by a least-squares identification algorithm under relaxed excitation conditions, so that the accurate value of system functions can be obtained. All signals in the closed-loop system are proved to be bounded. A simulation example is put forward to verify effectiveness of the presented method.

This study investigated viscosity and thermal kinetics of 10 selected preheated restorative resin composites and the effect of ultrasound energy on film thickness.

A range of different resin composites was tested Charisma Diamond, IPS Empress Direct, Enamel Plus HRi, Essentia, Estelite Omega, Filtek Z100, Filtek Z350 XT, Gradia, TPH Spectrum and VisCalor. A flowable resin composite (Opallis Flow) and two resin cements (RelyX Veneer, Variolink Esthetic LC) also were tested. Viscosity (Pa s) was measured at 37 °C and 69 °C (preheating temperature) using a rheometer. Film thickness (μm) was measured before and after application of ultrasound energy. Temperature loss within resin composite following preheating (°C/s) was monitored. Data were statistically analyzed (α = 0.05).

Viscosity at 69 °C was lower than at 37 °C for all materials except the flowable resin composite. Preheating reduced viscosity between 47% and 92% for the restorative resin composites, which were generally more viscous than the flowable materials. Film thickness varied largely among materials. All preheated resin composites had films thicker than 50 μm without ultrasound energy. Application of ultrasound reduced film thickness between 21% and 49%. Linear and nonlinear regressions did not identify any relationship between filler loading, viscosity, and/or film thickness. All materials showed quick temperature reduction following preheating, showing maximum temperature loss rates after approximately 10 s.

Distinct restorative resin composites react differently to preheating, affecting viscosity and film thickness. The overall performance of the preheating technique depends on proper material selection and use of ultrasound energy for reducing film thickness.

Distinct restorative resin composites react differently to preheating, affecting viscosity and film thickness. link3 The overall performance of the preheating technique depends on proper material selection and use of ultrasound energy for reducing film thickness.

The objective of this study was to assess the rate of discordance between clinical and pathologic tumor size for women with stage IB1 cervical cancer (FIGO 2009 criteria), assess risk factors for discordance, and determine the impact of discordance on oncologic outcomes.

This was a secondary analysis of a prior multi-institutional retrospective review of patients diagnosed with stage IB1 (FIGO 2009 staging) cervical cancer undergoing radical hysterectomy between 2010 and 2017. Demographic, clinicopathologic, and oncologic data were collected. Pathologic upstaging was defined as having a preoperative diagnosis of stage IB1 cervical cancer with pathology demonstrating a tumor size >4cm. Demographic and clinicopathologic data was compared using chi-square, fisher exact or 2-sided t-test. Survival was estimated using the Kaplan-Meier method.

Of the 630 patients, 77 (12%) were upstaged. Patients who were upstaged had lower rates of preoperative conization (p<.001) or preoperative tumor sizes ≤2cm (p< and those with tumors less then 2 cm had lower risks of upstaging. Improvement in preoperative assessment of tumor size may better inform primary treatment decisions.

To identify factors that influence contraceptive initiation among women with medical conditions.

We conducted an exploratory cross-sectional survey of women 18-45 years old with medical conditions who received contraception consultation from complex family planning specialists at five University of California Medical Centers from June 2014-June 2015. We asked survey participants about factors that influence their decision of choosing and initiating a contraceptive method, how they accessed family planning specialists and the impact of this consultation on their contraceptive method choice.

Among 97 participants, 61 (63%) had one medical condition, 28 (29%) had two medical conditions, and 8 (8%) had three or four medical conditions. A majority of participants initiated long-acting reversible contraceptive methods including an intrauterine device (n=54, 56%) and the contraceptive implant (n=17, 18%). The most common reason for initiating contraception was to avoid pregnancy in the immediate future for peralist for contraceptive care.

Prehospital management of severe traumatic brain injury (TBI) focuses on preventing secondary brain injury. Therefore, hypotension should be prevented, or if present, should be promptly treated in order to maintain optimal cerebral perfusion pressure. Fluid resuscitation is a traditional mainstay in the prehospital treatment of hypotension, however, the choice of fluid type that is to be administered in the prehospital setting is the subject of an on-going debate. This systematic review and meta-analysis was therefore performed to assess the effect of different fluid types on outcome in patients with severe TBI.

PubMed, Embase and Web of Science were searched for articles up to March 2020. Studies comparing two or more prehospital administered fluid types with suspected or confirmed severe TBI were deemed eligible for inclusion. Studied outcomes were mortality and (extended) Glasgow Outcome Scale (GOS). The meta-analysis tested for differences in survival between hypertonic saline (HTS) and normotonic cryrate a survival or neurological benefit for one specific fluid type administered in the prehospital setting.

This systematic review and meta-analysis did not demonstrate a survival or neurological benefit for one specific fluid type administered in the prehospital setting.

Accurate identification of child physical abuse is crucial during the evaluation of injured children. Retinal hemorrhages (RH) are used for diagnosis, but clear criteria for screening with direct fundoscopic exam are lacking. We sought to identify key factors associated with RH to guide evaluations.

Electronic medical records for patients <1 year of age presenting to a Level I Pediatric Trauma Center with unwitnessed head injury from January 2015 to December 2018 were retrospectively reviewed. Multivariable logistic regression was used to identify factors associated with RH.

Two hundred and seventy-six patients were included; 63% underwent direct fundoscopic examination, of which 23% were positive and 77% were negative for RH. Unscreened patients tended to be older and have isolated skull fractures. Multivariable regression analysis revealed that abnormal GCS and subdural hemorrhage were positively associated with a diagnosis of retinal hemorrhage, while isolated skull fracture was negatively associated.