Impact of Rehabilitation Intensity on 3-Year Mortality among Children with Moderate to Severe Cerebral Palsy: A Population-Based Cohort Study.

Though numerous studies demonstrated the positive effect of rehabilitation on cerebral palsy (CP) children, there was no literature addressing the role of rehabilitation on mortality among children with CP. Therefore, we aimed to evaluate the impact of rehabilitation intensity on mortality among children with moderate to severe CP. This retrospective cohort study was conducted by National Health Insurance Research Database in Taiwan. Children (<12 years) with newly diagnosed moderate to severe CP between 1 January 2000 and 31 December 2013 were included. All patients were followed up for 3 years after CP diagnosis or death or until 31 December 2013. The intensity of rehabilitation therapy within 6 months after CP diagnosis was categorized into <6 times and ≥6 times. The Cox proportional hazard analysis was used to determine the association between rehabilitation intensity and all-cause mortality after adjusting age, sex, other demographic factors and comorbidities. Among 3936 severe CP children, 164 (4.2%) died during the 3-year follow-up period. The mortality rate was higher among patients receiving rehabilitation < 6 times within 6 months than those ≥6 times within 6 months after adjusting demographic profile and comorbidities (adjust HR (aHR): 1.96, 95% CI 1.33-2.89, p < 0.001). We found that patients who were younger (aHR: 0.84, 95% CI 0.76-0.92, p < 0.001), who were receiving inpatient care more than twice in 1 year before their CP diagnosis (aHR: 2.88; 95% CI: 1.96-4.23; p < 0.001), and who have pneumonia (aHR: 1.41, 95% CI 1.00-1.96, p = 0.047), epilepsy (aHR: 1.41, 95% CI: 1.02-1.95, p = 0.039) and dysphagia (aHR: 1.55, 95% CI: 1.06-2.26, p = 0.024) have higher risk of mortality. Rehabilitation ≥ 6 times within 6 months has a potentially positive impact on pediatric CP survival. Besides having a younger age, being hospitalized more than twice within a year before diagnosis and having pneumonia, epilepsy and dysphagia were modifiable risk factors in clinical practice for these children.

The Applications of Landing Strategies in Badminton Footwork Training on a Backhand Side Lateral Jump Smash.

Previous research in badminton has associated unilateral landings following overhead strokes with the occurrence of knee injuries. Smashing involves tensing the abdomen muscles while swinging the racket rapidly and maintaining one's balance while performing coordinated movements and steps; this process puts stress on the player's lower limbs. However, few studies have compared the effects of different stroke training while performing various types of badminton strokes. This study investigated the influence of different stroke training on the smash action of badminton players. Three stroke training conditions were considered: shadow, target striking, and smashing. Sixteen male experienced badminton players were recruited for this study. One-way repeated-measures ANOVA with Bonferroni correction was used to identify the differences. At the initial contact with the ground, the knee flexion and knee valgus angles under the smash condition were significantly higher than target and shadow conditions. Under the smash condition, hip abduction was significantly higher than under the target and shadow conditions. Moreover, the hip abduction under the target condition was significantly higher than under the shadow condition. At the maximum knee flexion, the hip abduction under the smash and target conditions was significantly higher than under the shadow condition. Regarding the time from the moment of initial contact to the peak of vertical ground reaction force it was shorter under the smash condition than the target and shadow conditions. The vertical ground reaction force was higher under the smash condition than under the target and shadow conditions. The 50 ms impulse was higher under the smash condition than under the target and shadow conditions. The main findings of this study are that under the smash condition, the motion in the frontal plane increased, which produced higher loads on the joints in the lower limbs. Player performed the same footwork under the three conditions, but the landing strategies differed because of unique swing motions and techniques. The condition under which a player hits a shot to a target area can affect the landing. The results of this study suggest that target practice is more effective for improving the landing technique employed during actual shots than shadow practice.

Dielectrophoretic Crossover Frequency of Single Particles: Quantifying the Effect of Surface Functional Groups and Electrohydrodynamic Flow Drag Force.

We present a comprehensive comparison of dielectrophoretic (DEP) crossover frequency of single particles determined by various experimental methods and theoretical models under the same conditions, and ensure that discrepancy due to uncertain or inconsistent material properties and electrode design can be minimized. Our experiment shows that sulfate- and carboxyl-functionalized particles have higher crossover frequencies than non-functionalized ones, which is attributed to the electric double layer (EDL). To better understand the formation of the EDL, we performed simulations to study the relationship between initial surface charge density, surface ion adsorption, effective surface conductance, and functional groups of both functionalized and nonfunctionalized particles in media with various conductivities. We also conducted detailed simulations to quantify how much error may be introduced if concurrent electrohydrodynamic forces, such as electrothermal and electro-osmotic forces, are not properly avoided during the crossover frequency measurement.

Influences of Lateral Jump Smash Actions in Different Situations on the Lower Extremity Load of Badminton Players.

Badminton atypical actions and hitting movements often occur during the game; therefore, many special footwork methods have been developed to facilitate the rapid movements required to hit the shuttlecock, including quick turning and jumping and quick directional change movements. Studies have shown that the majority of badminton sport injuries occur in the lower extremity joints of athletes. The purpose of this study was to investigate the influences of hitting motion and unanticipated hitting direction on landing mechanics after backhand lateral jump smashing and landing to analyze joint stiffness and torque changes in three lower extremity joints. Recruited sixteen badminton athletes.The capture frequency of the Vicon Motion System (300Hz), Kistler force platform (1500Hz) and Vicon Nexus Version 1.8.5 software were used simultaneously to capture the kinematic and kinetic parameter of backhand side lateral jump smash footwork. The swing actions were divided into two situations, shadow (footwork and racket swinging practice without targets) and hitting (footwork and stroke shuttlecock) actions, whereas the directions were divided into directional and non-directional. Two-way repeated measures ANOVA with the LSD correction was used to compare the differences among the four conditions. The significance level was set to a = 0.05. Results shown that, at the peak of torque, the ankle plantar flexion of the non-directional shadow (p < 0.05) were greater than that of directional shadow (p < 0.05); meantime, ankle torque change of non-directional shadow (p < 0.05) and directional hitting (p < 0.05) was lower than that of non-directional hitting, but the non-directional hitting was larger compared to non-directional shadow (p < 0.05) at the maximum vertical GRF. The hip extension at peak of torque of directional hitting were larger than that of non-directional shadow (p < 0.05). The shadow actions hip flexion angle was larger than that of directional hitting at initial contact, but the non-directional hitting hip abduction was has the significant difference among all the conditioning. The hip flexion angle of non-directional shadow was larger than that of directional hitting (p < 0.05), the hip abduction angle of the non-directional hitting was greater than that of non-directional shadow (p < 0.05) at the peak VGRF. Elite badminton players execute different training movements; the joint stiffness was in the same state. In the hitting actions has greater ankle and hip joint torque than shadow actions. The badminton player was change joint range of motion to adjust lower limbs stiffness.

Comparison of Single Intra-Articular Injection of Novel Hyaluronan (HYA-JOINT Plus) with Synvisc-One for Knee Osteoarthritis: A Randomized, Controlled, Double-Blind Trial of Efficacy and Safety.

BACKGROUND: Viscosupplementation has been widely used for the treatment of knee osteoarthritis. Because we found no well-controlled trial comparing single-injection regimens of hyaluronan for knee osteoarthritis, we compared the efficacy and safety of a single intra-articular injection of a novel cross-linked hyaluronan (HYA-JOINT Plus) with a single injection of Synvisc-One in patients with knee osteoarthritis. METHODS: In a prospective, randomized, controlled, double-blind trial with a 6-month follow-up, 132 patients with knee osteoarthritis (Kellgren-Lawrence grade 2 or 3) were randomized to receive 1 intra-articular injection of 3 mL of HYA-JOINT Plus (20 mg/mL) (n = 66) or 6 mL of Synvisc-One (8 mg/mL) (n = 66). The primary outcome was the change from baseline in the visual analog scale (VAS) (0 to 100 mm) pain score at 6 months. Secondary outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC, Likert scale), Lequesne index, timed "Up & Go" (TUG) test, single-limb stance (SLS) test, use of rescue analgesics, and patient satisfaction. RESULTS: A total of 121 patients were available for the intention-to-treat analysis at 6 months. Both groups had a significant improvement in the VAS, WOMAC, and Lequesne index scores at each follow-up visit (p < 0.001). Patients who received HYA-JOINT Plus experienced a significantly greater improvement in the VAS pain score at 1, 3, and 6 months compared with those treated with Synvisc-One (adjusted mean difference: -12.0, -8.5, and -6.6; p = 0.001, 0.033, and 0.045, respectively). There were no significant between-group differences in any of the secondary outcomes except the WOMAC stiffness scores at 6 months, which favored HYA-JOINT Plus treatment (p = 0.043). The TUG time did not change significantly in either group during the study (p > 0.05), but the SLS time improved significantly in both the HYA-JOINT Plus and the Synvisc-One group (p = 0.004 and p = 0.022, respectively). No significant between-group differences were observed with respect to patient satisfaction or consumption of analgesics. No serious adverse events occurred following the injections. CONCLUSIONS: A single injection of either HYA-JOINT Plus or Synvisc-One is safe and effective for 6 months in patients with knee osteoarthritis. HYA-JOINT Plus is superior to Synvisc-One in terms of reducing the VAS pain score at 1, 3, and 6 months and the WOMAC stiffness score at 6 months, with similar safety. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Regulation of autophagic activation by Rta of Epstein-Barr virus via the extracellular signal-regulated kinase pathway.

Autophagy is an intracellular degradation pathway that provides a host defense mechanism against intracellular pathogens. However, many viruses exploit this mechanism to promote their replication. This study shows that lytic induction of Epstein-Barr virus (EBV) increases the membrane-bound form of LC3 (LC3-II) and LC3-containing punctate structures in EBV-positive cells. Transfecting 293T cells with a plasmid that expresses Rta also induces autophagy, revealing that Rta is responsible for autophagic activation. The activation involves Atg5, a key component of autophagy, but not the mTOR pathway. The expression of Rta also activates the transcription of the genes that participate in the formation of autophagosomes, including LC3A, LC3B, and ATG9B genes, as well as those that are involved in the regulation of autophagy, including the genes TNF, IRGM, and TRAIL. Additionally, treatment with U0126 inhibits the Rta-induced autophagy and the expression of autophagy genes, indicating that the autophagic activation is caused by the activation of extracellular signal-regulated kinase (ERK) signaling by Rta. Finally, the inhibition of autophagic activity by an autophagy inhibitor, 3-methyladenine, or Atg5 small interfering RNA, reduces the expression of EBV lytic proteins and the production of viral particles, revealing that autophagy is critical to EBV lytic progression. This investigation reveals how an EBV-encoded transcription factor promotes autophagy to affect viral lytic development.

Determinants of middle-school students asking parents for fruits and vegetables: a theory-based salient belief elicitation.

OBJECTIVE: Despite the benefits of fruit and vegetable intake, many young Americans do not consume them at adequate levels. The present study sought to determine the beliefs that children have about asking their parents to have fruits and vegetables available at home in order to better understand the role children may play in influencing their own fruit and vegetable consumption. DESIGN: An instrument utilizing the Reasoned Action Approach, with closed-ended questions on demographic and behavioural variables and open-ended questions eliciting the belief structure underlying asking parents to make fruits and vegetables available, was distributed. Thematic and frequency analyses were performed for open-ended questions. Statistical analyses were conducted to assess differences between children who had v. had not asked for fruits and vegetables. SETTING: Three middle schools in rural Indiana, U.S.A. SUBJECTS: A sub-sample of sixty students aged 12­15 years from a larger study of 344 students. RESULTS: Qualitative analysis identified benefits (i.e., make me healthier; make parents happy), disadvantages (i.e., will upset my parents) and strategies (i.e., asking when you are at the store) that could be used to improve fruit and vegetable intake. Findings also revealed that students who asked their parents for fruits and vegetables were significantly more likely to perform several healthy eating and physical activity behaviours. CONCLUSIONS: Data suggest that young people's view of parental reactions is critical. While additional research is necessary, the findings support a role for children in shaping their own environment and suggest multilevel interventions that simultaneously address parents and children.

Sympatric spawning but allopatric distribution of Anguilla japonica and Anguilla marmorata: temperature- and oceanic current-dependent sieving.

Anguilla japonica and Anguilla marmorata share overlapping spawning sites, similar drifting routes, and comparable larval durations. However, they exhibit allopatric geographical distributions in East Asia. To clarify this ecological discrepancy, glass eels from estuaries in Taiwan, the Philippines, Indonesia, and China were collected monthly, and the survival rate of A. marmorata under varying water salinities and temperatures was examined. The composition ratio of these 2 eel species showed a significant latitude cline, matching the 24 °C sea surface temperature isotherm in winter. Both species had opposing temperature preferences for recruitment. A. marmorata prefer high water temperatures and die at low water temperatures. In contrast, A. japonica can endure low water temperatures, but their recruitment is inhibited by high water temperatures. Thus, A. japonica glass eels, which mainly spawn in summer, are preferably recruited to Taiwan, China, Korea, and Japan by the Kuroshio and its branch waters in winter. Meanwhile, A. marmorata glass eels, which spawn throughout the year, are mostly screened out in East Asia in areas with low-temperature coastal waters in winter. During summer, the strong northward currents from the South China Sea and Changjiang River discharge markedly block the Kuroshio invasion and thus restrict the approach of A. marmorata glass eels to the coasts of China and Korea. The differences in the preferences of the recruitment temperature for glass eels combined with the availability of oceanic currents shape the real geographic distribution of Anguilla japonica and Anguilla marmorata, making them "temperate" and "tropical" eels, respectively.

Beliefs Underlying the Decision to Eat Breakfast: The Role of Theory-based Behavioral Analysis in the Development of Policy, Communication and Educational Interventions for Healthy Eating.

Policy, communication, and education efforts to influence any social or health outcome are more effective if based on an understanding of the underlying behaviors and their determinants. This conceptual paper outlines how behavioral theory can help design interventions for one healthy eating behavior, eating breakfast. More specifically, the paper illustrates how a prominent health behavior theory, the Reasoned Action Approach, can be used to guide formative research to identify factors underlying people's decisions. Select findings are presented from three studies of beliefs underlying eating breakfast: online surveys with 1185 undergraduates from a large university in Indiana; in-depth interviews with 61 adults from four Indiana worksites; and 63 in-depth interviews with students from three middle schools in rural Indiana. Analyses of data from the undergraduates demonstrated the role of self-efficacy. Analyses of data from the working adults revealed the importance of normative beliefs about what employers believed. Analyses comparing consequences perceived by adults with those perceived by middle school students found that both groups believed that eating breakfast would provide energy but only middle school students believed that eating breakfast would improve alertness. For each finding, the theory is presented, the finding is described, implications for interventions are suggested, and the need for additional research is outlined. In sum, theory-based behavioral research can help develop interventions at intrapersonal, interpersonal, and environmental levels that are warranted to encourage healthy eating.

Definitive toxicology and biodistribution study of a polyvalent DNA prime/protein boost human immunodeficiency virus type 1 (HIV-1) vaccine in rabbits.

A toxicity and immunogenicity study, evaluating the safety of a polyvalent DNA prime/protein boost HIV-1 vaccine (DP6-001), was examined in rabbits. Animals were primed with a cocktail of six different DNA plasmids expressing five HIV-1 env genes and one gag gene followed by boosting with five gp120 proteins homologous to the DNA vaccines. The vaccine was shown to be immunogenic as evident from the induction of high-titered anti-Env and anti-Gag antibodies. There was an absence of detectable adverse effects on key toxicology parameters. Although plasmids persisted in the injection sites following single administration for 64 days, no evidence of integration into the host genomic DNA was observed. These studies demonstrate that a novel polyvalent DNA prime/protein boost vaccine lacks signs of toxicity and DNA integration in a rabbit model, and immunogenicity and toxicology data support clinical testing of the vaccine in humans.

Effectiveness of coping strategies used by hospitals in response to implementation of a case-based payment system by the National Health Insurance program.

BACKGROUND AND PURPOSE: The introduction of the case-based payment system by the Bureau of National Health Insurance resulted in greatly increased pressure on the health care industry in Taiwan. This study examined the relationship between the coping strategies adopted and the results attained by accredited teaching hospitals and non-teaching regional hospitals when responding to this regulatory change. METHODS: A cross-sectional survey was conducted using a structured questionnaire to assess the hospitals' characteristics, and coping strategies at the technical, managerial and institutional levels in response to the case-based payment system, and to compare these strategies with self-evaluation of the effectiveness of these strategies. The questionnaire was sent in early October 2000 to the superintendents of the 129 hospitals that were accredited at the medical center, regional hospital, and district teaching hospital levels in the year 2000. Factor analysis was applied to group the strategies into categories and stepwise regression analysis was used to explore the relationship between the reported coping strategies adopted and their effectiveness as evaluated by participants. RESULTS: Among the selected hospitals, 89 responded with complete data, a 69% response rate. The following 7 factors were extracted from 30 coping strategies: information and financial analysis; service shifting and unbundling; service integration and quality improvement; service specialization and strengthening; education and training; financial incentives; and claim submission skill. After adjusting for accreditation level or ownership status, 2 main findings were noted. First, hospitals that implemented financial incentives strategies such as holding physicians responsible for all or part of the shortfall between actual claim submissions and actual reimbursements, and reducing or withholding payment to physicians beyond the standard length of stay, tended to increase medical revenue (odds ratio, 1.21). Second, hospitals that implemented service integration and quality improvement strategies, such as implementing a discharge plan, implementing clinical pathways and periodic review of quality indicators, attained higher patient satisfaction rate (odds ratio, 1.40). CONCLUSIONS: This study suggests that hospitals confronting the implementation of a case based-payment system may benefit by adopting financial incentives strategies and by efforts to improve service integration and quality.