The effect of a neck-specific exercise program on cervical kinesthesia for patients with chronic whiplash-associated disorders: a case-control study.

INTRODUCTION: Cervical kinesthesia is an important part of movement control and of great importance for daily function. Previous research on kinesthesia in whiplash-associated disorders (WAD) has focused on grades I-II. More research is needed on WAD grade III. The aim of this study was to investigate cervical kinesthesia in individuals with WAD grades II-III before and after a neck-specific exercise intervention and compare them to healthy controls. METHODS: A prospective, case-control study with a treatment arm (n = 30) and a healthy control arm (n = 30) was conducted in Sweden. The WAD group received a neck-specific exercise program for 12 weeks. The primary outcome to evaluate kinesthesia was neck movement control (the Fly test). Secondary outcomes were neck disability, dizziness and neck pain intensity before and after the Fly test. Outcomes were measured at baseline and post-treatment. The control arm underwent measurements at baseline except for the dizziness questionnaire. A linear mixed model was used to evaluate difference between groups (WAD and control) and over time, with difficulty level in the Fly test and gender as factors. RESULTS: Between-group analysis showed statistically significant differences in three out of five kinesthetic metrics (p = 0.002 to 0.008), but not for the WAD-group follow-up versus healthy control baseline measurements. Results showed significant improvements for the WAD-group over time for three out of five kinaesthesia metrics (p < 0.001 to 0.008) and for neck disability (p < 0.001) and pain (p = 0.005), but not for dizziness (p = 0.70). CONCLUSIONS: The exercise program shows promising results in improving kinesthesia and reducing neck pain and disability in the chronic WAD phase. Future research might benefit from focusing on adding kinesthetic exercises to the exercise protocol and evaluating its beneficial effects on dizziness or further improvement in kinesthesia. IMPACT STATEMENT: Kinesthesia can be improved in chronic WAD patients without the use of specific kinesthetic exercises. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03664934), first registration approved 11/09/2018.

A Wearable Personalised Sonification and Biofeedback Device to Enhance Movement Awareness.

Movement sonification has emerged as a promising approach for rehabilitation and motion control. Despite significant advancements in sensor technologies, challenges remain in developing cost-effective, user-friendly, and reliable systems for gait detection and sonification. This study introduces a novel wearable personalised sonification and biofeedback device to enhance movement awareness for individuals with irregular gait and posture. Through the integration of inertial measurement units (IMUs), MATLAB, and sophisticated audio feedback mechanisms, the device offers real-time, intuitive cues to facilitate gait correction and improve functional mobility. Utilising a single wearable sensor attached to the L4 vertebrae, the system captures kinematic parameters to generate auditory feedback through discrete and continuous tones corresponding to heel strike events and sagittal plane rotations. A preliminary test that involved 20 participants under various audio feedback conditions was conducted to assess the system's accuracy, reliability, and user synchronisation. The results indicate a promising improvement in movement awareness facilitated by auditory cues. This suggests a potential for enhancing gait and balance, particularly beneficial for individuals with compromised gait or those undergoing a rehabilitation process. This paper details the development process, experimental setup, and initial findings, discussing the integration challenges and future research directions. It also presents a novel approach to providing real-time feedback to participants about their balance, potentially enabling them to make immediate adjustments to their posture and movement. Future research should evaluate this method in varied real-world settings and populations, including the elderly and individuals with Parkinson's disease.

Quantifying the Impact of Motions on Human Aiming Performance: Evidence from Eye Tracking and Bio-Signals.

Working on a moving platform can significantly impede human performance. Previous studies on moving vehicles have often focused on the overall impact on general task performance, whereas our study's emphasis is on precise hand movements, exploring the interaction between body motion and the escalation of task difficulty. We recruited 28 participants to engage in reciprocal aiming tasks, following Paul Fitts's setting, under both in-motion and stationary conditions. The task index of difficulty (ID) was manipulated by varying the width of the targets and the distance between the targets. We measured participants' movement time (MT), performance errors, and monitored their eye movements using an eye-tracking device, heart rate (HR), and respiration rate (RR) during the tasks. The measured parameters were compared across two experimental conditions and three ID levels. Compared to the stationary conditions, the in-motion conditions degraded human aiming performance, resulting in significantly prolonged MT, increased errors, and longer durations of eye fixations and saccades. Furthermore, HR and RR increased under the in-motion conditions. Linear relationships between MT and ID exhibited steeper slopes under the in-motion conditions compared to the stationary conditions. This study builds a foundation for us to explore the control mechanisms of individuals working in dynamic and demanding environments, such as pilots in airplanes and paramedics in ambulances.

Predictions of PM2.5 using air pollutants and meteorological factors with COVID-19 cases in Malaysia and Indonesia: a comparative study using feature selection and robust regression.

The study examines the relationship between air quality, meteorological factors, and COVID-19 cases in Cheras, Kuala Lumpur, and Kelapa Gading, North Jakarta. Analyzing data from 2020 and 2021, the research found notable correlations: COVID-19 cases in Cheras were positively associated with relative humidity (RH) and carbon monoxide (CO) but negatively with ozone (O3) and RH in different years. In Kelapa Gading, COVID-19 cases were positively correlated with pollutants like sulfur dioxide (SO2) and CO, while ambient temperature (AT) showed a negative correlation. The enforcement of social restrictions notably reduced air pollution, affecting COVID-19 spread. Predictive models for PM2.5 levels using robust regression techniques showed strong performance in Kuala Lumpur (R² > 0.9) but exhibited overfitting tendencies in Jakarta, suggesting the need for a longer study period for more accurate results.

Protocol of identical exercise programs with and without specific breathing techniques for the treatment of chronic non-specific low back pain: randomized feasibility trial with two-month follow-up.

BACKGROUND: Chronic low back pain (CLBP) is a leading cause of disability globally. Exercise therapies are one of the commonly prescribed treatment options for CLBP. The specific exercise therapies for CLBP most commonly target movement dysfunction, but seldom brain-based pain modulation. Exercise therapies with specific breathing techniques (SBTs) have been shown to influence and enhance brain-based structural and functional pain modulation. AIMS AND OBJECTIVES: To assess the feasibility of the SBTs protocol, eligibility criteria, randomization, and dropout rates. To quantify the changes in patient outcome measures and choose the most relevant measure for larger-scale study. To quantify self-adherence levels to home exercise and monitor and record possible pain medication and other treatment modality usage, and adverse events during exercise. DESIGN: A parallel randomised analyst-blinded feasibility trial with two-month follow-up. OUTCOME MEASURES: Feasibility related to aims and objectives. Multiple pain- and health-related patient-reported outcome measures of pain intensity, disability, central sensitization, anxiety, kinesiophobia, catastrophising, self-efficacy, sleep quality, quality of life, and health and well-being status. Exercise adherence, pain medication and other treatment modality usage, and possible adverse events related to exercises will be monitored and recorded. METHODS: Thirty participants will be randomized to movement control exercise with SBTs (15 subjects in experimental group) or movement control exercise without SBTs (15 subjects in control group) in private chiropractic practice setting with two-month follow-up. Trial registration number; NCT05268822. DISCUSSION: The clinical difference in effectiveness between practically identical exercise programs in uniform study settings with or without SBTs has not been studied before. This study aims to inform feasibility and help determine whether progression to a full-scale trial is worthwhile.

Improving Balance and Movement Control in Fencing Using IoT and Real-Time Sensorial Feedback.

Fencing, a sport emphasizing the equilibrium and movement control of participants, forms the focal point of inquiry in the current study. The research endeavors to assess the efficacy of a novel system designed for real-time monitoring of fencers' balance and movement control, augmented by modules incorporating visual feedback and haptic feedback, to ascertain its potential for performance enhancement. Over a span of five weeks, three distinct groups, each comprising ten fencers, underwent specific training: a control group, a cohort utilizing the system with a visual real-time feedback module, and a cohort using the system with a haptic real-time feedback module. Positive outcomes were observed across all three groups, a typical occurrence following a 5-week training regimen. However, noteworthy advancements were particularly discerned in the second group, reaching approximately 15%. In contrast, the improvements in the remaining two groups were below 5%. Statistical analyses employing the Wilcoxon signed-rank test for repeated measures were applied to assess the significance of the results. Significance was solely ascertained for the second group, underscoring the efficacy of the system integrated with visual real-time feedback in yielding statistically noteworthy performance enhancements.

Movement control during one-leg standing is important for the bone mineral density maintenance or improvement.

INTRODUCTION: Both hip fracture and bone mineral density (BMD) decline on the non-fractured side are more likely to occur within 1 year. However, there are no longitudinal study reports on the factors associated with BMD maintenance or improvement within the first year after hip fracture. This study aimed to investigate the factors influencing the neck BMD maintenance or improvement in patients with hip fractures from within 2 weeks-6 months after surgery. MATERIALS AND METHODS: Patients were hip fracture after surgery and were divided into two groups: Among neck BMD changes (6 months minus 2 weeks after surgery) were calculated. Based on among neck BMD change, patients were classified into the BMD maintenance or improvement (change ≥ 0) and the BMD decrease groups (change < 0). Propensity score matching was performed to adjust for confounding factors. To predict the factors affecting neck BMD, hierarchical logistic regression analysis was performed. The dependent variable was the BMD maintenance or improvement group and the BMD decrease group. The independent variables were basic and medical information, and physical functions. RESULTS: The hierarchical logistic regression analysis results showed that movement control during one-leg standing affected femoral neck BMD independently from age, sex. The odds ratio for movement control during one-leg standing was 8.22. The discrimination rate of the model was 69.7%. CONCLUSION: This study suggested that adequate movement control during one-leg standing is important to maintain or improve neck BMD.

Cloze enough? Hemodynamic effects of predictive processing during natural reading.

Evidence accrues that readers form multiple hypotheses about upcoming words. The present study investigated the hemodynamic effects of predictive processing during natural reading by means of combining fMRI and eye movement recordings. In particular, we investigated the neural and behavioral correlates of precision-weighted prediction errors, which are thought to be indicative of subsequent belief updating. Participants silently read sentences in which we manipulated the cloze probability and the semantic congruency of the final word that served as an index for precision and prediction error respectively. With respect to the neural correlates, our findings indicate an enhanced activation within the left inferior frontal and middle temporal gyrus suggesting an effect of precision on prediction update in higher (lexico-)semantic levels. Despite being evident at the neural level, we did not observe any evidence that this mechanism resulted in disproportionate reading times on participants' eye movements. The results speak against discrete predictions, but favor the notion that multiple words are activated in parallel during reading.

The use of eye-movement recording in patients with anti-Hu antibody-associated paraneoplastic neurological syndromes to objectively determine extent and course of disease.

BACKGROUND AND PURPOSE: Paraneoplastic neurological syndromes with Hu-antibodies (Hu-PNS) are immune-mediated disorders in patients with malignancies, most frequently small cell lung cancer, affecting both the peripheral and central nervous system (CNS). In Hu-PNS, brainstem and cerebellar involvement are common. Here, we assessed whether eye-movement disturbances can be used for diagnosis and monitoring of CNS involvement in Hu-PNS. METHODS: Twenty-nine patients with Hu-PNS (17 females; mean age, 63.2 years,) and 14 healthy age-matched controls (seven females; mean age, 60.2 years) were included. Saccadic and smooth pursuit eye movements in response to visual stimuli were recorded with video-oculography. Eye movements were scored quantitatively (number of correction saccades, saccadic intrusions, and saccades during fixation period) and qualitatively by two eye-movement experts. In 20 patients, up to three follow-up measurements were made during subsequent hospital visits with fixed 4-week intervals. Disease course was assessed using the modified Rankin Scale. RESULTS: Eye movements were disturbed in 26 of 29 Hu-PNS patients, with horizontal eye movements being in general more impaired. Moreover, in 12 of the 14 Hu-PNS patients without clinical CNS involvement, eye movements were disturbed. Changes in eye-movement control over a period of up to 12 weeks were significantly correlated with the clinical response to treatment (ρ = 0.52, p = 0.02). CONCLUSIONS: Hu-PNS often affects eye-movement control, also in the absence of CNS signs or symptoms. Eye-movement recordings in Hu-PNS patients might be a useful tool to objectively monitor progression and treatment efficacy in Hu-PNS patients.

Association between movement control during one-leg standing and femoral BMD in patients with hip fractures.

INTRODUCTION: Prior studies have focused only on the temporal component of one-leg standing, no reports have examined the relationship between the qualitative components of one-leg standing and femoral BMD. Thus, this study investigated whether quality (i.e., movement control) of one-leg standing also associated femoral BMD. MATERIALS AND METHODS: A total of 80 patients with unilateral hip fracture were included in a cross-sectional study. Basic and medical information and physical functions including movement control during one-leg standing were assessed at admission and 2 weeks after surgery, respectively. Hierarchical multiple regression analysis was performed to identify predictors of femoral BMDs on the non-fractured side. Dependent variables included femoral neck and total hip BMDs in models 1 and 2, respectively. RESULTS: Hierarchical multiple regression analysis (standardized partial regression coefficients) in model 1 identified age (- 0.18), sex (0.38), body mass index (BMI) (0.41), movement control during one-leg standing on the non-fractured side (0.19), and life-space assessment (0.17) as factors associating femoral neck BMD. Meanwhile, hierarchical multiple regression analysis (standardized partial regression coefficients) in model 2 identified age (- 0.12), sex (0.36), BMI (0.37), and movement control during one-leg standing on the non-fractured side (0.25) as factors associating total hip BMD. The coefficients of determination adjusted for degrees of freedom (R2) were 0.529 and 0.470 for models 1 and 2, respectively. CONCLUSION: Our results suggest that improving movement control during one-leg standing may be important for maintaining and improving femoral BMD on the non-fractured side.

Proprioceptive accuracy after uni-joint and multi-joint patterns of arm-raising movements directed to overhead targets.

AIM: To determine the effect of arm-raising pattern on upper limb proprioceptive accuracy for movements made to overhead targets. MATERIALS AND METHODS: Sixteen healthy young adults were tested in standing with arms at the sides, made dominant arm-raising movements to an unseen overhead stop, randomly placed at one of five different overhead targets. Movements were made either as a uni-joint shoulder flexion movement in an arc, or as an unconstrained arm raising that was a series of multi-joint movements involving the shoulder, elbow, and wrist. RESULTS: Overall proprioceptive accuracy for discrimination between the five unseen overhead targets was not different after arm-raising with either a uni-joint or mult-joint pattern (F1, 15 = 0.50, p = 0.49, partial η2 = 0.03). Better performers with one pattern also tended to perform well with the other (r = 0.70, p = 0.003). Trend analysis across the 4 pairwise scores for discriminations between the target positions (171.8°-173.6°, 173.6°-175.4°, 175.4°-177.2°, and 177.2°-179.0°) showed worsening discrimination towards the more distant targets (F1, 15 = 8.44, p = 0.01, partial η2 = 0.36). However, this linear trend of falling discrimination accuracy was not different between the two movement patterns (p = 0.27). CONCLUSION: Proprioceptive accuracy did not differ between simple uni-joint and more complex multi-joint arm-raising movement patterns, and the further the extent of the overhead target movement, the worse proprioceptive discrimination sensitivity for both movement patterns. Upper limb proprioceptive accuracy was therefore movement extent dependent, but movement pattern independent.

Sensorimotor and body perception assessments of nonspecific chronic low back pain: a cross-sectional study.

BACKGROUND: Low back pain (LBP) is one of the most common musculoskeletal disorders, causing significant personal and social burden. Current research is focused on the processes of the central nervous system (particularly the sensorimotor system) and body perception, with a view to developing new and more efficient ways to treat chronic low back pain (CLBP). Several clinical tests have been suggested that might have the ability to detect alterations in the sensorimotor system. These include back-photo assessment (BPA), two-point discrimination (TPD), and the movement control tests (MCT). The aim of this study was to determine whether the simple clinical tests of BPA, TPD or MCT are able to discriminate between nonspecific CLBP subjects with altered body perception and healthy controls. METHODS: A cross-sectional study was conducted. At one point in time, 30 subjects with CLBP and 30 healthy controls were investigated through using BPA, TPD and MCT on the lower back. Correlations among the main covariates and odds ratios for group differences were calculated. RESULTS: MCT showed an odds ratio for the presence of CLBP of 1.92, with a statistically significant p-value (0.049) and 95%CI. The TPD and BPA tests were unable to determine significant differences between the groups. CONCLUSIONS: Of the three tests investigated, MCT was found to be the only suitable assessment to discriminate between nonspecific CLBP subjects and healthy controls. The MCT can be recommended as a simple clinical tool to detect alterations in the sensorimotor system of nonspecific CLBP subjects. This could facilitate the development of tailored management strategies for this challenging LBP subgroup. However, further research is necessary to elucidate the potential of all the tests to detect alterations in the sensorimotor system of CLBP subjects. TRIAL REGISTRATION: No trial registration was needed as the study contains no intervention. The study was approved by the Swiss Ethics Commission of Northwest and Central Switzerland (EKNZ) reference number 2015-243.

Cervico-thoracic pain and associated impairments in air force personnel: a cross-sectional study.

BACKGROUND: Pain and impaired function in the cervical region are common in Air Force personnel (AFP), but evidence is limited regarding the thoracic region. This cross-sectional cohort study examined associations between cervico-thoracic pain and physical performance among Swedish AFP and explored possible differences and similarities in test performance between fighter pilots (FP), helicopter pilots (HP) and rear crew (RC). METHODS: AFP (n = 73) from one airbase performed eight tests of movement control of the spine, active cervical range of motion (ROM) in all six directions and isometric strength and endurance of the cervical flexors and extensors. The association between test performance and cervico-thoracic pain (based on the 'Musculoskeletal screening protocol' questionnaire) were analysed in a multiple binary logistic regression model. RESULTS: For AFP with cervico-thoracic pain (30%), movement control was impaired in the 'neck flexion test' (OR [95%CI] =3.61 [1.06-12.34]) and the 'forward lean test' (OR [95%CI] =3.43[1.04-11.37]), together with reduced flexion ROM (OR [95%CI] =0.93 [0.87-0.99]). Test performance was in general similar between the three groups, but FP and HP could control the 'forward lean test' to a significantly higher degree than RC (p = 0.000). Further, FP showed significantly greater ROM in lateral flexion to the right compared to HP and RC (mean: 40.3°, 36.2° and 33.4°, respectively, p = 0.000), and they showed higher, although not significant, flexor strength than RC (p = 0.026). CONCLUSIONS: The impaired function associated with cervico-thoracic pain highlights the need for a deeper understanding of such relationships when designing tools to systematically optimize the physical performance and prevent pain among AFP. Studies with a longitudinal design are warranted to examine any causative associations between pain and impairments.

Correlations between control of COVID-19 transmission and influenza occurrences in Malaysia.

OBJECTIVES: The transmission of COVID-19 has sent Malaysia into cycles of tightening and relaxation of movement control, which are still continuing currently in line with local fluctuations of new COVID-19 cases. During movement control, measures comprising physical distancing, hand cleaning or sanitizing, and sanitization of premises are consistently implemented while self-isolation and travel restrictions are adaptively enforced. This study aims to examine if the control of COVID-19 transmission has an effect on the national influenza occurrences as some measures for COVID-19 control are similar to those for influenza. STUDY DESIGN: For this study, data of weekly new cases of influenza and COVID-19 were obtained from official platforms for non-parametric statistical analysis. METHODS: This study compared the influenza occurrences before and after the onset of COVID-19 using the Mann-Whitney U-test and explored Spearman's correlations between COVID-19 and influenza incidences after the onset of COVID-19. RESULTS: It shows that influenza incidences before and after the onset of COVID-19 were significantly different and that influenza cases have significantly reduced after the onset of COVID-19. The weekly cases of influenza and COVID-19 were significantly and negatively correlated. CONCLUSIONS: This study underscores the co-benefits of COVID-19 control measures and alleviates the concern for the risk of COVID-19 and influenza co-infection.

Air pollution impacts from COVID-19 pandemic control strategies in Malaysia.

Mitigation measures and control strategies relating to novel coronavirus disease 2019 (COVID-19) have been widely applied in many countries in order to reduce the transmission of this pandemic disease. A Movement Control Order (MCO) was implemented in Malaysia starting from the March 18, 2020 as a pandemic control strategy which restricted all movement and daily outdoor activities. To investigate the impact of MCO, air pollutants: particulate matter with an aerodynamic diameter less than 10 µm (PM10), particulate matter with an aerodynamic diameter less than 2.5 µm (PM2.5), sulphur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3) and carbon monoxide (CO) in nine major cities in Malaysia were measured before and during the implementation of the MCO. The non-carcinogenic health risk assessments of the air pollutants are also determined using the United States Environmental Protection Agency (USEPA) Health Risk Assessment method. Overall, NO2 recorded an average percentage reduction of 40% with the highest reduction observed at Kota Kinabalu (62%). The largest reductions of PM10, PM2.5, SO2, O3 and CO were recorded at Kota Kinabalu (17%), Kuantan (9.5%), Alor Star (38%), Kota Bharu (15%), and Ipoh (27%) respectively. All cities had hazard quotient (HQ) values of <1 suggesting no non-carcinogenic health effects. The highest HQ was observed for PM2.5 during the MCO period (4.53E-02) in Kuala Lumpur. An average hazard index (HI) value of 1.44E-01 (before the MCO) and 1.40E-01 (during the MCO) showed higher human health risks before the MCO than during the MCO. This study gives confidence to regulatory bodies that the reduction of human activities significantly reduces air pollution and increases human health and so good air pollution control strategies can provide crucial impacts, especially in reducing air pollution and improving human health.

Effects of the Proprioceptive Neuromuscular Facilitation Technique on Scapula Function in Office Workers with Scapula Dyskinesis.

Background and Objectives; Proprioceptive neuromuscular facilitation (PNF) are effective in improving and maintaining Range of motion(ROM), increasing muscular strength and power, and increasing athletic performance, especially after exercise. The scapula patterns defined in PNF are activated within the upper extremity patterns and scapula motions together. Proper function of the upper extremities requires both motion and stability of the scapula. The purpose of this study was to compare the effects of scapula stabilization exercise training involving muscle strengthening, muscle balance, and movement control exercises on office workers with scapula dysfunction. Materials and Methods: A total of 42 office workers with scapula dyskinesis were recruited and randomly divided into three groups: muscle strengthening exercise group (n = 14), muscle balance exercise group (n = 14), and movement control exercise group (n = 14). The participants underwent 18 sessions (25 min/session, 3 days a week for 6 weeks) of training involving the three types of exercises. Results: The measurement outcomes included the scapula index, measured using a digital Vernier caliper; scapula function, evaluated using the Disability of the Arm, Shoulder, and Hand (DASH) outcome questionnaire (pain and performing, work ability, and sports and art activities); and scapulohumeral movements (scapula upward rotation at humeral abduction angles of 0°, 45°, 90°, 135°, and 180°), evaluated using inclinometers. After the exercise intervention, the scapula index (p = 0.002), DASH pain and performing score (p = 0.000), DASH work ability score (p = 0.000), DASH sports and art activity score (p = 0.027), and scapulohumeral movements (scapula upward rotation at 0° (p = 0.013) and 45° (p = 0.043) humeral abduction) showed significantly greater improvements in the movement control group than in the muscle strengthening and muscle balance groups. Conclusions: Thus, proprioceptive neuromuscular facilitation can be used as a rehabilitation intervention for scapula position and movement, pain reduction, and functional improvement in office workers with scapula dyskinesis.

Surface water quality status and prediction during movement control operation order under COVID-19 pandemic: Case studies in Malaysia.

Global concerns have been observed due to the outbreak and lockdown causal-based COVID-19, and hence, a global pandemic was announced by the World Health Organization (WHO) in January 2020. The Movement Control Order (MCO) in Malaysia acts to moderate the spread of COVID-19 through the enacted measures. Furthermore, massive industrial, agricultural activities and human encroachment were significantly reduced following the MCO guidelines. In this study, first, a reconnaissance survey was carried out on the effects of MCO on the health conditions of two urban rivers (i.e., Rivers of Klang and Penang) in Malaysia. Secondly, the effect of MCO lockdown on the water quality index (WQI) of a lake (Putrajaya Lake) in Malaysia is considered in this study. Finally, four machine learning algorithms have been investigated to predict WQI and the class in Putrajaya Lake. The main observations based on the analysis showed that noticeable enhancements of varying degrees in the WQI had occurred in the two investigated rivers. With regard to Putrajaya Lake, there is a significant increase in the WQI Class I, from 24% in February 2020 to 94% during the MCO month of March 2020. For WQI prediction, Multi-layer Perceptron (MLP) outperformed other models in predicting the changes in the index with a high level of accuracy. For sensitivity analysis results, it is shown that NH3-N and COD play vital rule and contributing significantly to predicting the class of WQI, followed by BOD, while the remaining three parameters (i.e. pH, DO, and TSS) exhibit a low level of importance.

Effect of the Movement Control Order on the Incidence of Complicated Appendicitis During the COVID-19 Pandemic: A Cross-Sectional Study.

BACKGROUND: Appendicitis is common and delayed presentation results in complicated appendicitis with increased morbidity. This study investigates the effect of the Movement Control Order (MCO) during the COVID-19 pandemic on the presentation and severity of appendicitis. METHODS: A cross-sectional study including 193 patients diagnosed with appendicitis was conducted at four hospitals in Pahang, Malaysia. Those who presented between 1 February 2020 and 17 March 2020 were included in the pre-MCO group and those between 18 March 2020 and 30 April 2020 in the MCO group. The definitions of simple and complicated appendicitis were based on the Sunshine Appendicitis Grading Score. The primary outcome was the incidence of complicated appendicitis, and the secondary outcomes were length of stay, a composite of surgical morbidities and a composite of organ failure. RESULTS: A total of 105 patients in the pre-MCO group and 88 in the MCO group were analysed. The incidence of complicated appendicitis was 33% and it was higher in the MCO than in the pre-MCO group (44% versus 23%, P = 0.002). The MCO period was independently associated with complicated appendicitis in the logistic regression (P = 0.001). It was also associated with prolonged length of stay (3.5 days versus 2.4 days, P < 0.001) and higher overall surgical morbidity (19% versus 5%, P = 0.002). CONCLUSION: The MCO imposed during the COVID-19 pandemic was associated with a higher incidence of complicated appendicitis and surgical morbidity.

The small scale functional topology of movement control: Hierarchical organization of local activity anticipates movement generation in the premotor cortex of primates.

How neurons coordinate their collective activity for behavioural control is an open question in neuroscience. Several studies have progressively proven, on various scales, that the patterns of neural synchronization change accordingly with behavioural events. However, the topological features of the neural dynamics that underlie task-based cognitive decisions on the small scale level are not understood. We analysed the multiunit activity (MUA) from a multielectrode (96 channels) array of the dorsal premotor cortex (PMd) in rhesus monkeys during a countermanding reaching task. Within the framework of graph theory, we found that in the local PMd network motor execution is preceded by the emergence of hubs of anti-correlation that are organized in a hierarchical manner. Conversely, this organization is absent when monkeys correctly inhibit programmed movements. Thus, we interpret the presence of hubs as reflecting the readiness of the motor plan and the irrevocable signature of the onset of the incoming movement.

Posterior parietal cortex contains a command apparatus for hand movements.

Mountcastle and colleagues proposed that the posterior parietal cortex contains a "command apparatus" for the operation of the hand in immediate extrapersonal space [Mountcastle et al. (1975) J Neurophysiol 38(4):871-908]. Here we provide three lines of converging evidence that a lateral region within area 5 has corticospinal neurons that are directly linked to the control of hand movements. First, electrical stimulation in a lateral region of area 5 evokes finger and wrist movements. Second, corticospinal neurons in the same region of area 5 terminate at spinal locations that contain last-order interneurons that innervate hand motoneurons. Third, this lateral region of area 5 contains many neurons that make disynaptic connections with hand motoneurons. The disynaptic input to motoneurons from this portion of area 5 is as direct and prominent as that from any of the premotor areas in the frontal lobe. Thus, our results establish that a region within area 5 contains a motor area with corticospinal neurons that could function as a command apparatus for operation of the hand.