The Effect of Active Physical Training Interventions on Reactive Postural Responses in Older Adults: A Systematic Review.

BACKGROUND: A variety of physical interventions have been used to improve reactive balance in older adults. PURPOSE: To summarize the effectiveness of active treatment approaches to improve reactive postural responses in community-dwelling older adults. DESIGN: Systematic review guided by PRISMA guidelines. STUDY SELECTION: A literature search included the databases PubMed, OVID, CINAHL, ClinicalTrials.gov, OTseeker, and PEDro up to December 2017. Randomized controlled trials that evaluated quantitative measures of reactive postural responses in healthy adults following participation in an active physical training program were included. DATA SYNTHESIS: Of 4,481 studies initially identified, 11 randomized controlled trials covering 313 participants were selected for analysis. Study designs were heterogeneous, preventing a quantitative analysis. Nine of the 11 studies reported improvements in reactive postural responses. CONCLUSIONS: Several clinically feasible training methods have the potential to improve reactive postural responses in older adults; however, conclusions on the efficacy of treatment methods are limited because of numerous methodological issues and heterogeneity in outcomes and intervention procedures.

The Kv1.1 null mouse, a model of sudden unexpected death in epilepsy (SUDEP).

OBJECTIVE: Kv1.1 potassium channel null mouse (NULL) exhibits spontaneous seizure-related bradycardia, dies following seizure, and has been proposed as a model for vagus-mediated SUDEP. We characterized the cardiac events surrounding sudden unexpected death in epilepsy (SUDEP) in NULL during terminal asystole for comparison to patients with epilepsy who exhibit bradycardia and terminal or nonterminal asystole during/following seizure and explored the contribution of vagal-mediated bradycardia to SUDEP. METHODS: Electrocardiography (ECG) studies of 27 freely moving telemetered NULL mice was evaluated surrounding seizure-associated death. Chronic unilateral vagal section and, in a separate set of experiments, electrical stimulation of the cervical vagi in NULL and wild-type (WT) littermates assessed the role of the vagus nerve in seizure-related death. Seizure activity indicated by intense myogenic activity on the ECG recording correlated with visual and video recording. RESULTS: All NULL died following seizures, which were preceded by normal rhythm. Bradycardia followed seizure and led to slow ventricular escape rhythm (70-150 bpm) and asystole. The sequence from seizure to asystole was complete within approximately 3 min and was similar to that reported in individuals exhibiting ictal and postictal bradycardia/asystole. To address the singular role of vagus nerves in seizure-related asystole, cervical vagus nerves were stimulated in the absence of seizure. Heart rate was reduced 3 min to values similar to that following seizure but never produced asystole, suggesting activation of the vagi alone is insufficient for SUDEP. Nevertheless, unilateral chronic section of the vagus nerve increased survival time compared to nonsectioned NULL animals, supporting a role for the vagus nerve in seizure-associated death. SIGNIFICANCE: The Kv1.1 null mouse is a potential model for SUDEP in patients who experience ictal and postictal bradycardia. It offers the opportunity for evaluation of the combination of factors, in addition to vagal activation, necessary to produce a terminal asystole following seizure. It is notable that long-term studies that evaluate electroencephalography (EEG) and cardiorespiratory events surrounding nonfatal seizures may provide indices predictive of terminal seizure.

Multidisciplinary care for patients with persistent symptoms following concussion: a systematic review.

PURPOSE: To systematically characterize and assess the effectiveness of multidisciplinary care for patients with persistent post-concussion symptoms (PPCS). MATERIALS AND METHODS: Only studies describing multidisciplinary treatment, defined as intervention provided by no less than 2 healthcare disciplines, each with independent scopes of practice, for patients with PPCS were considered. RESULTS: A total of 8 of the 1357 studies identified were included. The studies were comprised of heterogenous patient populations, care delivery systems, healthcare providers, treatment approaches, and outcomes. CONCLUSIONS: Findings suggest multidisciplinary care, using a needs-based approach with individual- or group-based interventions, may be more beneficial than usual care to; 1) immediately reduce concussion-related symptom complaints and improve mood and quality of life in adolescents following sports-related concussion (SRC) and, 2) may produce immediate and lasting improvements in symptom complaints of young, primarily female, adults following a non-SRC. Future studies should clearly describe the decision-making processes used to deliver care through a needs-based approach and prioritize the inclusion of objective, performance-based measures to assess outcomes.Implications for RehabilitationMultidisciplinary care using a needs-based approach with the individual- and group-based interventions, may be more beneficial than usual care.Younger populations, particularly females, seem to benefit most from multidisciplinary care to decrease the burden of post-concussion symptoms.Multidisciplinary care teams should consider providing psychological support and education combined with cognitive retraining and pharmacologic intervention to address persistent post-concussion symptoms.

Metagenome Sequences from Tidal Marsh and Marine Sediment from the Great Bay Estuary of New Hampshire.

Tidal marsh and estuarine marine microbial sediment metagenomes from the Great Bay Estuary of New Hampshire were sequenced and found to be dominated by Proteobacteria, Bacteroidetes, Firmicutes, and Actinobacteria. Both types of sediment contained many unclassified bacterial sequences, including the mollusk pathogen Perkinsus marinus, and detectable xenobiotic degradation and nitrogen transformation genes.

Clinical decision-making to address poor outcomes in persistent horizontal semicircular canal benign paroxysmal positional vertigo: A case study.

BACKGROUND: Horizontal semicircular canal BPPV (HSC-BPPV) can occur in 10-30% of BPPV cases. Lower success rates are reported for HSC-BPPV. The apogeotropic form of HSC-BPPV is more difficult to treat, as 5-40% of cases are described to be refractory to repositioning maneuvers. PURPOSE: To describe the assessment and treatment of a patient presenting with HSC-BPPV and to demonstrate the potential use of Forced-Prolonged Positioning (FPP) as a home exercise program (HEP) for persistent HSC-BPPV in an elderly patient. CASE DESCRIPTION: An 89-year-old female referred to physical therapy with a diagnosis of BPPV. She experienced dizziness with positional changes and was found to have apogeotropic form of HSC-BPPV. INTERVENTION: To supplement maneuvers performed in the clinic, the patient was provided instructions for the FPP as her HEP. With continued symptoms and positive positional tests by week four of treatment, the patient was instructed to switch the FPP with the opposing ear directed toward the floor. OUTCOME: Following 2 weeks of performing FPP on the opposite side, the patient reported symptoms had resolved and positional testing confirmed resolution of HSC-BPPV. DISCUSSION: There is a potential benefit of using FPP as a HEP to supplement maneuvers used in the clinic to improve outcomes in patients with HSC-BPPV that are refractory to traditional repositioning maneuvers. Prescribing the FPP maneuver as a HEP is feasible, and clinicians should consider the FPP technique as a HEP to adjunct repositioning maneuvers performed in the clinic to address persistent HSC-BPPV.

Outcomes Following a Vestibular Rehabilitation and Aerobic Training Program to Address Persistent Post-Concussion Symptoms.

PURPOSE: To describe changes in adults with persistent symptoms and disability following a concussion after completing a supervised home exercise vestibular rehabilitation (VR) program combined with aerobic training. METHOD: Participants included 14 consecutive individuals referred for VR within the context of a comprehensive concussion center. Outcome measures were administered at initial evaluation, 3 mos, and 6 mos. Outcome measures included: Rivermead Post-Concussion Questionnaire symptom (RPQ-3) and function (RPQ-13) subcategories, Dizziness Handicap Inventory (DHI), Activities-specific Balance Confidence Scale (ABC), functional gait assessment (FGA), return to work/study (RTW), and return to activity (RTA). RESULTS: At 6 months, all clinical outcome measures were found to be statistically significant or approaching statistical significance: RPQ-3 (p<0.001), RPQ-13 (p<0.004), DHI (p<0.001), ABC (p<0.007), FGA (p<0.001). For return to meaningful activity, associations between time of measure and both RTW (p<0.019) and RTA (p<0.001) were found to be statistically significant or approach statistical significance. CONCLUSION: Following 6 months of participation in a supervised home exercise VR program with aerobic training, significant improvements were observed in participants' report of concussion-related symptoms, function, and return to meaningful activities.

Fluoroalkylated silicon-containing surfaces-estimation of solid-surface energy.

The design of robust omniphobic surfaces, which are not wetted by low-surface-tension liquids such as octane (γlv=21.6 mN/m) and methanol (γlv=22.7 mN/m), requires an appropriately chosen surface micro/nanotexture in addition to a low solid-surface energy (γsv). 1H,1H,2H,2H-Heptadecafluorodecyl polyhedral oligomeric silsesquioxane (fluorodecyl POSS) offers one of the lowest solid-surface energy values ever reported (γsv≈10 mN/m) and has become the molecule of choice for coating textured surfaces. In this work, we synthesize and evaluate a series of related molecules that either retain the POSS cage and differ in fluoroalkyl chain length or that retain the fluorodecyl chains surrounding a linear or cyclic molecular structure. The solid-surface energy (γsv) of these molecules was estimated using contact angle measurements on flat spin-coated silicon wafer surfaces. Zisman analysis was performed using a homologous series of n-alkanes (15.5≤γlv≤27.5 mN/m), whereas Girifalco-Good analysis was performed using a set of polar and nonpolar liquids with a wider range of liquid surface tension (15.5≤γlv≤72.1 mN/m). The hydrogen-bond-donating, hydrogen-bond-accepting, polar, and nonpolar (dispersion) contributions to the solid-surface energy of each compound were determined by probing the surfaces using a set of three liquid droplets of either acetone, chloroform, and dodecane or diiodomethane, dimethyl sulfoxide, and water.