Effects of Telerehabilitation-Based Structured Home Program on Activity, Participation and Goal Achievement in Preschool Children with Cerebral Palsy: A Triple-Blinded Randomized Controlled Trial.

A home program is implemented as an evidence-based mode of delivering services for physiotherapy and rehabilitation. Telerehabilitation is a method applied in physiotherapy modalities for children. This study aims to determine the effectiveness of usual care plus a Telerehabilitation-Based Structured Home Program on preschool children with cerebral palsy (CP) compared to usual care. Forty-three children aged 3-6 years (mean age 4.66 ± 1.08 years) with CP were randomly assigned to the Telerehabilitation-Based Structured Home Program and usual care groups. Their motor function was assessed with the Gross Motor Function Measure (GMFM); performance and satisfaction were evaluated with the Canadian Occupational Performance Measure (COPM); goal achievement was assessed with the Goal Attainment Scale (GAS); and activity and participation were evaluated with Pediatric Evaluation of Disability Inventory (PEDI). Participants were evaluated at baseline, immediately post-intervention (12 weeks) and at follow-up (24 weeks). There was a statistically significant difference between pre- and post-test GMFM, COPM, GAS and PEDI scores in the intervention and control groups (p < 0.001). The Telerehabilitation-Based Structured Home Program showed statistically significant changes in activity, participation and goal achievement after 12 weeks of intervention (p < 0.001). However, significant results were not obtained in the usual care group. The Telerehabilitation-Based Structured Home Program may be an effective method for preschool children with CP. (Registration number: NCT04807790; no = KA-20124/26.01.2021).

A penalty-based algorithm proposal for engineering optimization problems.

This paper presents a population-based evolutionary computation model for solving continuous constrained nonlinear optimization problems. The primary goal is achieving better solutions in a specific problem type, regardless of metaphors and similarities. The proposed algorithm assumes that candidate solutions interact with each other to have better fitness values. The interaction between candidate solutions is limited with the closest neighbors by considering the Euclidean distance. Furthermore, Tabu Search Algorithm and Elitism selection approach inspire the memory usage of the proposed algorithm. Besides, this algorithm is structured on the principle of the multiplicative penalty approach that considers satisfaction rates, the total deviations of constraints, and the objective function value to handle continuous constrained problems very well. The performance of the algorithm is evaluated with real-world engineering design optimization benchmark problems that belong to the most used cases by evolutionary optimization researchers. Experimental results show that the proposed algorithm produces satisfactory results compared to the other algorithms published in the literature. The primary purpose of this study is to provide an algorithm that reaches the best-known solution values rather than duplicating existing algorithms through a new metaphor. We constructed the proposed algorithm with the best combination of features to achieve better solutions. Different from similar algorithms, constrained engineering problems are handled in this study. Thus, it aims to prove that the proposed algorithm gives better results than similar algorithms and other algorithms developed in the literature.

The effects of postural control and upper extremity functional capacity on functional Independence in preschool-age children with spastic cerebral palsy: a path model.

PURPOSE: To investigate the effects of postural control and upper extremity functional capacity on functional independence and identify whether quality of upper extremity skills mediates the effects of postural control on functional independence in preschool-age children with spastic cerebral palsy (CP). METHODS: 106 children with CP -mean age 43.4 ± 11.3 (24-71 months)- were included in this cross-sectional study. Postural control, upper extremity functional capacity, and functional independence in activities of daily living were evaluated using the Early Clinical Assessment of Balance (ECAB), Quality of Upper Extremity Skills Test (QUEST), and the Functional Independence Measure of Children (WeeFIM), respectively. A path model was used to evaluate the total, direct, and indirect effects. RESULTS: According to the path model, ECAB (direct effect; r = 0.391, p < 0.01, indirect effect; r = 0.398) and QUEST (direct effect; r = 0.493, p < 0.01) had an impact on WeeFIM. In addition, QUEST had mediating effects on the relationship between ECAB and WeeFIM. The path model explained 71% of the variation in functional independence of the participants. CONCLUSION: In the management of CP in preschool-age children, the focus should be on improving not only upper extremity capacity but also postural control to help improve functional independence in activities of daily living.

Investigating the effect of macro-scale estimators on worldwide COVID-19 occurrence and mortality through regression analysis using online country-based data sources.

OBJECTIVE: To investigate macro-scale estimators of the variations in COVID-19 cases and deaths among countries. DESIGN: Epidemiological study. SETTING: Country-based data from publicly available online databases of international organisations. PARTICIPANTS: The study involved 170 countries/territories, each of which had complete COVID-19 and tuberculosis data, as well as specific health-related estimators (obesity, hypertension, diabetes and hypercholesterolaemia). PRIMARY AND SECONDARY OUTCOME MEASURES: The worldwide heterogeneity of the total number of COVID-19 cases and deaths per million on 31 December 2020 was analysed by 17 macro-scale estimators around the health-related, socioeconomic, climatic and political factors. In 139 of 170 nations, the best subsets regression was used to investigate all potential models of COVID-19 variations among countries. A multiple linear regression analysis was conducted to explore the predictive capacity of these variables. The same analysis was applied to the number of deaths per hundred thousand due to tuberculosis, a quite different infectious disease, to validate and control the differences with the proposed models for COVID-19. RESULTS: In the model for the COVID-19 cases (R2=0.45), obesity (ß=0.460), hypertension (ß=0.214), sunshine (ß=-0.157) and transparency (ß=0.147); whereas in the model for COVID-19 deaths (R2=0.41), obesity (ß=0.279), hypertension (ß=0.285), alcohol consumption (ß=0.173) and urbanisation (ß=0.204) were significant factors (p<0.05). Unlike COVID-19, the tuberculosis model contained significant indicators like obesity, undernourishment, air pollution, age, schooling, democracy and Gini Inequality Index. CONCLUSIONS: This study recommends the new predictors explaining the global variability of COVID-19. Thus, it might assist policymakers in developing health policies and social strategies to deal with COVID-19. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT04486508).

Analyzing Exposures to Electromagnetic Fields in an Intensive Care Unit.

OBJECTIVE: In this study, we conducted a numerical analysis of exposure to electromagnetic fields (EMFs) in a hospital's intensive care unit that is one of the most crucial one in terms of hazardous areas among all service units. This is a new study for measuring exposure to EMFs in an intensive care unit as well as other healthcare services in Turkey. METHODS: We measured the EMFs in the intensive care unit with a SRM-3006 (selective radiation metre), which was used for measurement of the absolute and the limit values of high frequency EMFs. The measurement points were chosen to represent the highest levels of exposure to which a person might be subjected. We obtained a dataset that included 5929 observations, with 96 extreme values, through measuring the magnetic field in terms of V/m. RESULTS: The measurements show the frequency varies from 47 MHz to 2.5 GHz as 17 frequency ranges at the measurement point as well. According to these findings, the referenced maximum safety limit was not exceeded. However, it was also found that mobile telecommunication was the most critical cause of magnetic fields. CONCLUSION: Further studies need to be performed with different frequency antennas to assess the EMFs in intensive care units.

Work stress and emotional exhaustion in nurses: the mediating role of internal locus of control.

BACKGROUND: Burnout is a major problem for nursing. There is a strong relationship between work stress and emotional exhaustion. Although studies report a negative correlation between the internal locus of control and emotional exhaustion and work stress, the number of studies available on the subject is limited. PURPOSE: This study intends to examine the extent to which the relationship between work stress and emotional exhaustion is mediated by nurses' internal locus of control. METHODS: The study adopted a cross-sectional survey design. The data were analyzed using structural equation modeling techniques. The study sample consisted of 347 nurses who worked in a university hospital in Izmir, Turkey and who agreed to participate in the study. The Work-Related Strain Inventory was used to evaluate the nurses' work stress level, Maslach Burnout Inventory was used to evaluate their emotional exhaustion levels, and the Locus of Control Scale was used to evaluate the internal locus of control. The variables of the study were based on the Neuman Systems Model. RESULTS: Work stress was positively related to internal locus of control (ß3 = .21, p < .001), which was, in turn, negatively associated with emotional exhaustion (ß = -.03, p > 0.1). Internal locus of control was negatively related to emotional exhaustion (ß = -.14, p < .001). Work stress is directly (ß = .87, p < .001) and indirectly related to emotional exhaustion (mediated by internal locus of control ß = .84, p < .001). Work stress is directly (ß = .87, p < .001) and indirectly related to emotional exhaustion (mediated by internal locus of control, ß = .84, p < .001). CONCLUSION: Although the relationship between emotional exhaustion and work stress was mediated, the impact of internal locus of control was limited. It is recommended that different variables be included in future studies so that they can mediate the relationship between work stress and emotional exhaustion.