Delayed onset facilitates subsequent retrieval of words during language comprehension.

Prior research has shown that during language comprehension, memory representations associated with premodified words (e.g., the injured and dangerous bear) are retrieved faster from memory than those associated with unmodified words (e.g., the bear). Current explanations attribute this effect to the semantic richness of modified words. However, it is not clear whether the presence of modifying words are in fact necessary for a retrieval benefit. Premodifiers necessarily delay the onset of the target word (i.e., bear), and temporal delays may heighten attention to upcoming stimuli, and/or strengthen encoding by producing free time during encoding, facilitating subsequent retrieval. We therefore examined whether a simple delay in the onset of the target can produce a retrieval benefit. Our results show that delayed onset facilitates the subsequent retrieval of target words in the absence of any modifying information. These results lend support to models of language comprehension according to which delays may enhance attention to upcoming words, and also to models of working memory based on which free time replenishes encoding resources, strengthening the memory trace of encoded information and facilitating its retrieval at a subsequent point. Our results also contribute to current memory-based theories of sentence comprehension by showing that retrieval from memory may be affected by nonlinguistic factors such as delay-induced attention enhancement, or free time during encoding.

Optimal policy of ordering blood units in the hospital according to compatibility and priority transfers between blood groups under uncertainty conditions: A case study.

In spite of significant advancements in medicine, there is still a shortage of human blood in the world. At present, there is no alternative chemical process or product that can produce blood, and only humans are capable of doing so. It is for this reason that blood is such an important component of our healthcare system. Due to the perishability of blood, managing blood inventories can be challenging. The challenge is to maintain a high level of supply while minimizing loss due to expiration. The purpose of this study is to present a mathematical model that reduces inventory costs, determines the optimal ordering policy in hospitals, and prevents the loss of blood units. To determine the optimal inventory level and order volume, a mixed integer programming model is presented in both deterministic and non-deterministic conditions. In order to address the uncertainty in the problem, a robust optimization approach is used. This model minimizes the transfer of blood groups and transmission between hospitals by considering compatibility and priority. A sensitivity analysis has also been conducted on the model. Based on a case study, it is demonstrated that the costs of buying, storing, ordering, and wasting two important RBCs and platelets can be reduced.

The safety and efficacy of umbilical cord blood mononuclear cells in individuals with spastic cerebral palsy: a randomized double-blind sham-controlled clinical trial.

INTRODUCTION: The current multi-center, randomized, double-blind study was conducted among children with cerebral palsy (CP) to assess the safety and efficacy of umbilical cord blood mononuclear cell (UCB-MNC). We performed the diffusion tensor imaging to assess the changes in the white matter structure. METHODS: Males and females aged 4 to 14 years old with spastic CP were included. Eligible participants were allocated in 4:1 ratio to be in the experimental or control groups; respectively. Individuals who were assigned in UCB-MNC group were tested for human leukocyte antigen (HLA) and fully-matched individuals were treated with UCB-MNCs. A single dose (5 × 106 /kg) UCB-MNCs were administered via intrathecal route in experimental group. The changes in gross motor function measure (GMFM)-66 from baseline to one year after treatment were the primary endpoints. The mean changes in modified Ashworth scale (MAS), pediatric evaluation of disability inventory (PEDI), and CP quality of life (CP-QoL) were also evaluated and compared between groups. The mean changes in fractional anisotropy (FA) and mean diffusivity (MD) of corticospinal tract (CST) and posterior thalamic radiation (PTR) were the secondary endpoints. Adverse events were safety endpoint. RESULTS: There were 72 included individuals (36 cases in each group). The mean GMFM-66 scores increased in experimental group; compared to baseline (+ 9.62; 95%CI: 6.75, 12.49) and control arm (ß: 7.10; 95%CI: 2.08, 12.76; Cohen's d: 0.62) and mean MAS reduced in individuals treated with UCB-MNCs compared to the baseline (-0.87; 95%CI: -1.2, -0.54) and control group (ß: -0.58; 95%CI: -1.18, -0.11; Cohen's d: 0.36). The mean PEDI scores and mean CP-QoL scores in two domains were higher in the experimental group compared to the control. The imaging data indicated that mean FA increased and MD decreased in participants of UCB-MNC group indicating improvements in white matter structure. Lower back pain, headaches, and irritability were the most common adverse events within 24 h of treatment that were related to lumbar puncture. No side effects were observed during follow-up. CONCLUSIONS: This trial showed that intrathecal injection of UCB-MNCs were safe and effective in children with CP. TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov ( NCT03795974 ).

Translation and validation of stroke impact scale-16 in Urdu for Pakistan.

Objective: To translate and validate the Urdu version of stroke impact scale-16 for Pakistani society. METHODS: The prospective cohort study was conducted from February 2018 to February 2020 after approval from the ethics review board of The University of Lahore, Lahore, Pakistan, and copmprised patients with mild to moderate stroke who were recruited from five public and two private hospitals of the Punjab province. Established guidelines were followed to translate the Stroke Impact Scale-16. The patients were concurrently evaluated on Barthel Index, Stroke Rehabilitation Assessment of Movement, Modified Rivermead Mobility Index, Modified Rankin Scale, Short Form 36 Health Survey Questionnaire and the Hospital Anxiety and Depression Scale to assess the validity of Stroke Impact Scale-16, and spearmen correlation coefficient was used to determine the correlation among the scales. Analysis of variance was employed to determine the discriminant validity. Intraclass correlation coefficient, weighted kappa, Cronbach's alpha and item-total correlation were calculated to establish the stability and consistency of Stroke Impact Scale-16. Data was analysed using SPSS 25. RESULTS: Of the 90 patients, 50(55.5%) were females and 40(45.5%) were males. The subjects were aged 50-80 years. The correlation of Stroke Impact Scale-16 was strong with the established tools and ranged from 0.78 to 0.91. The discriminant validity was also significant (p<.001) across all Modified Rankin Scale levels. The Intraclass correlation coefficient was 0.94 and Cronbach's alpha was 0.91 for test-retest reliability and internal consistency, respectively. All corrected item-total correlation values exceeded the priori minimum standard (>0.40) and ranged from 0.51 to 0.68. The weighted kappa for item reliability also achieved priori criteria (>0.40) and ranged from 0.53 to 0.88. Conclusion: With slight modifications, the Urdu version of Stroke Impact Scale-16 was found to have satisfactory psychometric properties and can be used in clinical and research settings for stroke survivors in Pakistan.

Effect of median nerve neuromobilization on functional status in patients with carpal tunnel syndrome: A double blinded randomized control trial.

Objectives: To measure additional benefits of neuromobilisation along with conventional treatment in improving the functional status in patients having carpal tunnel syndrome. METHODS: The prospective, double-blind randomised controlled trial was conducted from August 2018 to June 2019 at the Physiotherapy outdoor clinic of Mayo Hospital, Lahore, Pakistan, and comprised patients of either gender aged 20-45 years with <3-month history of carpal tunnel syndrome. The patients were randomised into control group 1 and experimental group 2. Group 1 received conservative treatment including ultrasound therapy, wrist splinting, and tendon-gliding exercises, while Group 2 additionally received neuromobilisation. Functional limitation was measured using the Functional Status Scale and the Symptom Severity Scale of the Boston Carpal Tunnel Syndrome Questionnaire. Patients had 2 sessions per week for 6 weeks. Clinical data was noted at baseline, after 3 weeks of treatment and finally at the end of the 6-week intervention. Data was analysed using SPSS 21. RESULTS: Of the 66 patients, there were 33(50%) in Group 1; 3(9.1%) males, 30(90.9%) females, overall mean age 37.79 ±5.91 years. The remaining 33(50%) were in Group 2; 2(6.1%) males, 31(93.9%) females, overall mean age 35.58 ±7.15 years. Both the groups showed significant improvement (p <0.05), but the addition of neuromobilisation in Group 2 showed better results compared to Group 1(p<0.05). CONCLUSIONS: The addition of neuromobilisation to routine physical therapy was found to have significantly decreased the symptoms of carpal tunnel syndrome and improved the functional status of the patients. Registration No: ChiCTR2000029377(http://www.chictr.org.cn/showproj.aspx?proj=48704).

Reliability of hand-held dynamometer in measuring gluteus medius isometric muscle strength in healthy population.

Objectives: To determine the inter-rater and intra-rater reliability of the hand-held dynamometer in measuring isometric gluteus medius muscle strength in asymptomatic healthy population. Methods: It was a cross sectional study conducted at the department of physiotherapy, Sindh Institute of Physical Medicine and Rehabilitation from March 2021 to April 2021. Thirty healthy subjects aged 18 to 25 years of both sexes and no previous or current complaints of hip or knee pain were included through non-probability purposive sampling technique. The strength of the unilateral isometric gluteus medius muscle was measured using a hand-held dynamometer by two raters at the same day and a week later. Pearson Correlation coefficient was calculated to see the relationship of muscle strength measured by each rater within and between day's sessions. Intra-class correlation was calculated with 95% confidence interval and Standard error of measurements using reliability analysis. Results: In the present study there were thirty participants studied by two raters, the mean age of participants was 21.53 (SD=±1.40) years, the mean BMI was 24.05 (SD=±1.12) kg/m2 and 70% participants were female and 30% were males. This study showed the mean muscle measurement of participants within days was 12.92 (SD=±0.94), with intra-class correlation ICC (2,2) 0.94 and SEM 0.12 and mean muscle measurement of patients between days was 12.99 (SD=±0.91), with intra-class correlation ICC (2,2) 0.90 and SEM 0.12.. Conclusion: Hand-held dynamometer has shown excellent inter-rater and intra-rater reliability in measuring isometric strength of Gluteus Medius muscle among healthy population. It is convenient to be used in clinical settings and can be a useful outcome tool to assess strength in interventional studies.

Neural sensitivity to phonological characteristics is stable across the lifespan.

Aging is often associated with declines in language production. For example, compared to younger adults, older adults experience more tip-of-the-tongue (TOT) states, show decreased speed and accuracy in naming objects, and have more pauses and fillers in speech, all of which indicate age-related increases in retrieval difficulty. While prior work has suggested that retrieval difficulty may be phonologically based, it is unclear whether there are age-related differences in the organization of phonological information per se or whether age-related difficulties may arise from accessing that information. Here we used fMRI to investigate the neural and behavioral basis of phonological neighborhood denisty (PND) effects on picture naming across the lifespan (N=91, ages 20-75). Consistent with prior work, behavioral results revealed that higher PND led to faster picture naming times and higher accuracies overall, and that older adults were less accurate in their responses. Consistent with the behavioral analyses, fMRI analyses showed that increasing PND was associated with decreased activation in auditory and motor language regions, including bilateral superior temporal gyri and bilateral precentral gyri. Interestingly, although there were age-related increases in functional activation to picture naming, there were no age-related modulations of neural sensitivity to PND. Overall, these results suggest that having a large cohort of phonological neighbors facilitates language production, and although aging is associated with increases in language production difficulty, sensitivity to phonological features during language production is stable across the lifespan.

The effects of whole body vibration on gait after chronic stroke: A Randomized Controlled Clinical Trial.

OBJECTIVE: To determine the effects of whole body vibration therapy on gait in chronic stroke patients. METHODS: The randomised, assessor-blinded, controlled clinical study was conducted at the Physiotherapy Department, Lahore General Hospital, Lahore, Pakistan, from November 2017 to April 2019, and comprised chronic stroke patients wh were randomly divided into two equal groups, with group A reciving routine physiotherapy and group B reciving whole-body vibration therapy. Both the groups received 12 sessions each. Vibration therapy was given with an amplitude of 3mm and frequency of 20Hz. Sessions comprised 5 bouts of 120 seconds with 60s rest intervals for 6 days/week for 2 weeks in erect standing position. The outcome measure was the score of timed up and go test and 10-meter walk test before and after intervention. Data was analysed using SPSS 21. RESULTS: Of the 64 patients, there were 32(50%) in each of the two groups. Significant difference was seen post-intervention in both the groups (p<0.05) although both groups were statistically same in terms of Timed Up and go Test, 10 Meter walk Test Slow Speed and 10 Meter walk Test Fast Speed (p>0.05). CONCLUSIONS: Walking speed improved with both treatments i.e. whole-body vibration therapy and routine physiotherapy in chronic stroke survivors. CLINICAL TRIAL NUMBER: Identifier: IRCT20190328043131N1:https://www.irct.ir/user/trial/38832/view.

When phonological neighborhood density both facilitates and impedes: Age of acquisition and name agreement interact with phonological neighborhood during word production.

The number of similar-sounding words that a target word has, or its Phonological Neighborhood Density (PND), has been shown to influence word production. However, reported results are sometimes inconsistent, with studies showing facilitation, inhibition, and null effects of phonological neighbors. These mixed results may be due to the influence of other factors beyond PND. We investigated the potential interactions between a broad measure of PND (bPND), and age of acquisition (AoA), frequency, and name agreement in order to see if the effect of bPND varies as a function of these three variables. We examined the effect of bPND on the latency of picture naming and observed significant interactions between bPND and AoA such that bPND facilitated lexical retrieval for words that were acquired early, but inhibited retrieval for words acquired later in life. We hypothesize that lexical retrieval difficulty ultimately depends on the activation level of the target word's phonological representations relative to the activation levels of its neighbors' phonological representations. When phonological features of the target word are weakly activated (i.e., late AoA), and bPND is high, the neighbors' activation may overshadow the target's, impeding target retrieval. However, when the target's phonological representation is strongly activated, the activation of the neighbors might not exceed that of the target, thereby supporting phonological retrieval. We also observed interactions between bPND and name agreement such that increasing bPND led to faster reaction times (RTs), particularly when name agreement was lower, suggesting that bPND may also facilitate word retrieval when lexical competition is high.

The effectiveness of routine physiotherapy with and without neuromobilization on pain and functional disability in patients with shoulder impingement syndrome; a randomized control clinical trial.

BACKGROUND: The objective of the study was to compare the effects of neuromobilization (NM) techniques and routine physiotherapy on pain and functional disability in patients having shoulder impingement syndrome (SIS). Present study was aimed to discover evidence based conservative and cost effective remedy on pain and functional disability. STUDY DESIGN: Single blinded randomized control clinical trial. METHODS: A total of 80 patients with SIS were randomly assigned into care and experimental groups (40 in each group). After the baseline assessment routine physiotherapy was executed on both groups, while NM was applied additionally to experimental group. Pain and functional disability score were evaluated by Visual Analogue Scale and University of California at Los Angeles rating score at baseline, 5th and 11th week. Differences in outcome between groups were evaluated with clinical improvement. RESULTS: The experimental group compared with care group at 11th week had lower mean pain score 2.15(1.66-2.64) vs 4.90(4.41-5.40); between group difference, 1.82; 95% (CI), - 2.38 to - 1.25; P < 0.001 and Partial ƞ2 = 0.33, similarly functional disability score 28.58(27.32-29.83) vs 20.10(18.84-21.36); between group difference,5.62; 95%CI, (4.32-6.92); P< 0.001 and Partial ƞ2 = 0.49 respectively. In experimental group NM was a more effective technique to reduce the pain severity and disability in SIS patients as compare to care group. CONCLUSION: Neuromobilization techniques in addition to routine physiotherapy were significantly effective for the treatment of SIS. TRIAL REGISTRATION: IRCT20190121042445N1 , Registered 19 February 2019.

The effectiveness of routine physiotherapy with and without neuromobilization in patients with shoulder impingement syndrome.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of neuromobilization (NM) on the pain and active forward flexion in participants with shoulder impingement syndrome (SIS). METHODS: A randomized control trial was conducted in Social Security Hospital, Gujranwala. The duration of study was September 2016 to March 2018. A sample of 80 participants was selected and allocated in to two groups using computer generator method in simple random sampling technique. Consent was taken from patients with SIS for this trial. At the first session, participants were randomly assigned to either control group (n=40) or experimental group (n=40). After the baseline assessment routine physiotherapy was executed for both groups, while NM was provided to experimental group. Pain and active forward flexion (AFF) were evaluated at baseline, 5th week and 11th week. The data were entered and analyzed using SPSS (version 22.0). RESULTS: The experimental group compared with control group at 11th week had lower mean pain score 2.15 (1.66-2.64) vs 4.90 (4.41-5.40); between group difference, 1.82; 95% confidence interval (CI), -2.38 to -1.25; P ˂0.001 and Partial ƞ2=0.33, similarly with AFF 147.13 (142.46-151.79) vs 123.45(118.79-128.11); between group difference ,19.35; 95% CI, (12.86-25.83); P ˂ 0.001 and Partial ƞ2=0.30. Over all pain and AFF were improved among experimental group relative to control group at 11th week. CONCLUSIONS: In an experimental setting, the delivery of neuromobilization led to significantly different outcomes in participants of SIS than in control group.

Effects of routine physiotherapy with and without neuromobilization in the management of internal shoulder impingement syndrome: A randomized controlled trial.

BACKGROUND & OBJECTIVE: Routine physiotherapy has been advocated was an effective treatment for internal shoulder impingement syndrome. However, there is lack of best exercise treatment and lots of studies are under consideration. The objective of the study was to compare the effects of Neuromobilization and routine physiotherapy on pain in patients having shoulder internal impingement syndrome. METHODS: This is a single blinded randomized control clinical trial that was conducted at Social Security Hospital Gujranwala in which 80 patients with SIS were participated. The duration of study was from September 2016 to March 2018. Patients were recruited after giving an informed consent and were randomly assigned to either control or experimental group which was treated with routine physiotherapy and routine physiotherapy plus neuromobilization respectively; pain was assessed by Numeric Rating Scale at base line, 5th and 11th week. RESULTS: The experimental group compared with control group at 11th week had lower mean pain score 2.15(1.66-2.64) vs 4.90(4.41-5.40); between group difference, 1.82; 95% (CI), -2.38 to -1.25; P < 0.001 and Partial Ŋ2=0.33. These results show that pain score is much improved in experimental group. CONCLUSION: Neuromobilization along with physical therapy is more effective as compared to physiotherapy alone.

Phonological versus semantic prediction in focus and repair constructions: No evidence for differential predictions.

Evidence suggests that the language processing system is predictive. Although past research has established prediction as a general tendency, it is not yet clear whether comprehenders can modulate their anticipatory strategies in response to cues based on sentence constructions. In two visual world eye-tracking experiments, we investigated whether focus constructions (not the hammer but rather the …) and repair disfluencies (the hammer uh I mean the …) would lead listeners to generate different patterns of predictions. In three offline tasks, we observed that participants preferred semantically related continuations (hammer - nail) following focus constructions and phonologically related continuations (hammer - hammock) following disfluencies. However, these offline preferences were not evident in participants' predictive eye-movements during online language processing: Semantically related (nail) and phonologically related words (hammock) received additional predictive looks regardless of whether the target word appeared in a disfluency or in a focus construction. However, significantly less semantic and phonological activation was observed in two "control" linguistic contexts in which predictive processing was discouraged. These findings suggest that although the prediction system is sensitive to sentence construction, is it not flexible enough to alter the type of prediction generated based on preceding context.

Response to a Supervised Structured Aerobic Exercise Training Program in Patients with Type 2 Diabetes Mellitus - Does Gender Make a Difference? A Randomized Controlled Clinical Trial.

OBJECTIVE: Because of the globally increasing occurrence of diabetes mellitus (DM) in the population, exercise is becoming vitally important for prevention and disease management, along with medical and dietary interventions. This study was designed to test the hypothesis that women with DM would respond similarly to men with DM following supervised structured aerobic exercise training (SSAET) program. METHODS: This randomized, single blind, controlled clinical trial was conducted on 102 patients with T2DM with ranging in age from 40 to 70 years. All the participants were randomly allocated to either an experimental or a control group. The experimental group participated in an SSAET program, routine medication, and dietary plan, while the control group was treated with routine medication and dietary plan, for 25 weeks. Assessments of physical and biochemical variables were carried out at baseline and after 25 weeks' intervention and gender-based response to the SSAET program was analyzed. RESULTS: Both the male and female patients responded to 25 weeks of SSAET, routine medication, and dietary plan equally in the experimental group, whereas in the control group IL-6 and NOS-1 showed slight differences. All male and female patients in the experimental group treated with SSAET, routine medication, and dietary plan showed significant improvement in all variables (P < 0.05), while in the control group, deterioration or no change was noted except in HDL and LDL. CONCLUSION: SSAET is equally effective in both male and female patients with T2DM when compared with a non-exercise control group, but no gender-based difference was found. (Trial ID ISRCTN16466697/ http://orcid.org/0000-0002-6682-9896).

Effects of supervised structured aerobic exercise training programme on level of Exertion, dyspnoea, VO2 max and Body Mass Index in patients with type 2 diabetes mellitus.

OBJECTIVE: To determine the effects of supervised structured aerobic exercise training programme on level of exertion, dyspnoea, maximum oxygen consumption, and body mass index in type 2 diabetics. METHODS: The randomised, controlled trial was carried out at Riphah Rehabilitation and Research Centre, Islamic International medical College Trust, Pakistan Railways General Hospital, Rawalpindi, Pakistan, from January 2015 to June 2016, and comprised type 2 diabetics. Sedentary individuals of both genders, aged40-70 years, diagnosed on World Health Organisation's criteria were included. Participants were randomly divided into two groups, i.e. A (experimental) and B (control), by toss and trial method. Intervention in the experimental group were supervised structured aerobic exercise training programme, routine medication and dietary, while the control group was treated by routine medication and dietary plan for 25 weeks at 3 days per week for both groups. Level of exertion, dyspnoea, maximum oxygen consumption and body mass index were assessed and documented at baseline (0 week) and at the completion of intervention (after 25 weeks). SPSS20 was used for data analysis. RESULTS: Of the 102 participants, there were 51(50%) in each group. Pre- and post-intervention analysis showed that a 25-week training programme, routine medication, and dietary plan significantly improved level of exertion, dyspnoea, maximum oxygen consumption and body mass index (p<0.05)) in the experimental group compared to the control group treated with routine medication, and dietary plan. CONCLUSIONS: The supervised structured aerobic exercise training programme along with routine medication and dietary plan positively influenced level of exertion, dyspnoea, maximum oxygen consumption and body mass index than routine medication and dietary plan in patients with type 2 diabetes.

Effectiveness of core stabilization exercises and routine exercise therapy in management of pain in chronic non-specific low back pain: A randomized controlled clinical trial.

BACKGROUND & OBJECTIVE: Low back pain is a frequent problem faced by the majority of people at some point in their lifetime. Exercise therapy has been advocated an effective treatment for chronic low back pain. However, there is lack of consensus on the best exercise treatment and numerous studies are underway. Conclusive studies are lacking especially in this part of the world. Thisstudy was designed to compare the effectiveness of specific stabilization exercises with routine physical therapy exerciseprovided in patients with nonspecific chronic mechanical low back pain. METHODS: This is single blinded randomized control trial that was conducted at the department of physical therapy Orthopedic and Spine Institute, Johar Town, Lahore in which 120 subjects with nonspecific chronic low back pain participated. Subjects with the age between 20 to 60 years and primary complaint of chronic low back pain were recruited after giving an informed consent. Participants were randomly assigned to two treatment groups A & B which were treated with core stabilization exercise and routine physical therapy exercise respectively. TENS and ultrasound were given as therapeutic modalities to both treatment groups. Outcomes of the treatment were recorded using Visual Analogue Scale (VAS) pretreatment, at 2nd, 4th and 6th week post treatment. RESULTS: The results of this study illustrate that clinical and therapeutic effects of core stabilization exercise program over the period of six weeks are more effective in terms of reduction in pain, compared to routine physical therapy exercise for similar duration. This study found significant reduction in pain across the two groups at 2nd, 4th and 6th week of treatment with p value less than 0.05. There was a mean reduction of 3.08 and 1.71 on VAS across the core stabilization group and routine physical therapy exercise group respectively. CONCLUSION: Core stabilization exercise is more effective than routine physical therapy exercise in terms of greater reduction in pain in patients with non-specific low back pain.

Effects of supervised structured aerobic exercise training program on high and low density lipoprotein in patients with type II diabetes mellitus.

BACKGROUND AND OBJECTIVE: Hyperlipidemia and dyslipidemia are very common conditions among patients with Type-2 diabetes mellitus (T2DM) and associated with increased risk of coronary heart diseases. Physical activity and exercises along with medical management and dietary plan are common strategies to use for the management of deranged lipid profile in patients with T2DM. We aimed to determine the effects of supervised structured aerobic exercise training (SSAET) program on high and low density lipoprotein in patients with T2DM. METHODS: This randomized control trial study was conducted at Riphah Rehabilitation Research Centre (RRRC), Pakistan Railway General Hospital (PRGH) Rawalpindi from 1st January 2015 to 30th March 2016. The inclusion criteria was Type-2 diabetes patients of both gender aged between 40 to 70 years. Patients with severe complications like coronary artery diseases (CAD), and other serious complications like diabetic foot, and severe knee and hip osteoarthritis (OA) were excluded from the study. A total of 195 patients diagnosed with T2DM were screened out and 102 were selected for the study as per the inclusion criteria. All participants were randomly assigned into two groups, experimental 'A' (n=51) and control 'B' (n=51). Patients in group A were treated with SSAET program of 25 weeks at 3 days a week in addition to routine medical management, while patients in Group-B were on their routine medications and dietary plan. Serum LDL, and HDL were tested at baseline and after 25 weeks. The data was analysed through SPSS 20. RESULTS: Mean and standard deviation of LDL in group A (n=51) was 118.56±19.17 (pre) and 102.64±13.33 (post), while the mean and standard deviation for Group-B (n=51) was 116.50±18.45 (Pre) and 109.88±17.13 (post). Both groups showed improvement but, Group-A treated with SSAET along with RMM showed significantly higher (P Value ≤ 0.05) improvement as compared with group B treated with RMM alone. Mean and standard deviation of HDL in Group-A was 42.70±8.06 (pre) and 47.47±7.16 (post), while the mean and standard deviation of group B is 43.37±8.15 (Pre) and 44.41±7.91 (post). Both groups showed improvement but Group-A treated with SSAET program along with RMM showed significantly higher (P Value ≤ 0.05) improvement than group B treated with RMM alone. CONCLUSION: SSAET program along with RMM is more effective strategy for the management of deranged lipid profile in patients with T2DM.

Effects of supervised structured aerobic exercise training program on fasting blood glucose level, plasma insulin level, glycemic control, and insulin resistance in type 2 diabetes mellitus.

OBJECTIVE: To determine the effects of supervised structured aerobic exercise training (SSAET) program on fasting blood glucose level (FBGL), plasma insulin level (PIL), glycemic control (GC), and insulin resistance (IR) in type 2 diabetes mellitus (T2DM). METHODS: Riphah Rehabilitation and Research Centre (RRRC) was the clinical setting for this randomized controlled trial, located at Pakistan Railways General Hospital (PRGH), Rawalpindi, Pakistan. Study duration was 18 months from January 1, 2015 to June 30, 2016. Patients of both genders ranging 40-70 years of age with at least one year of history of T2DM were considered eligible according to WHO criteria, while patients with other chronic diseases, history of smoking, regular exercise and diet plan were excluded. Cohorts of 195 patients were screened out of whom 120 fulfilled the inclusion criteria. Amongst them 102 agreed to participate and were assigned to experimental (n=51) and control (n=51) groups. Experimental group underwent SSAET program, routine medication and dietary plan, whereas the control group received routine medication and dietary plan, while both group received treatment for 25 weeks. The blood samples were taken at baseline and on the completion of 25 weeks. The investigation of fasting blood glucose level, plasma insulin level, and glycemic control was conducted to calculate IR. RESULTS: Patients with T2DM in experimental group (n=51) treated with SSAET program, routine medication and dietary plan significantly improved FBGL (pre-mean= 276.41±25.31, post-mean=250.07±28.23), PIL (pre-mean=13.66±5.31, post-mean=8.91±3.83), GC (pre-mean=8.31±1.79, post-mean 7.28±1.43), and IR (pre-mean=64.95±27.26, post-mean 37.97±15.58), as compared with patients in control group treated with routine medication and dietary plan in whom deteriorations were noted in FBGL (pre-mean=268.19±22.48, post-mean=281.41±31.30), PIL(pre-mean=14.14±5.48, post-mean=14.85±5.27) GC (pre-mean=8.15±1.74, post-mean=8.20±1.44, and IR (pre-mean=64.49±23.63. post-mean=70.79 ±23.30). Statistically at the baseline the results were not significant (p>0.05), but at the completion of 25 weeks intervention all the variable showed significant results (p<0.05. CONCLUSION: It is concluded that a 25 weeks SSAET program along with routine medical management is more effective treatment in the management of fasting blood glucose level, glycemic control, plasma insulin level and insulin resistance as compared with routine medical management and dietary plan in the management of T2DM.

Finite element analysis of miniscrew placement in mandibular alveolar bone with varied angulations.

SUMMARY BACKGROUND: Titanium miniscrews are increasingly used as orthodontic anchorage. Various factors are known to affect the stability of miniscrew. Placement angle is one of the most controversial issues in this area. Thus, the aim of this finite element study was to evaluate the influence of placement angle and direction of force on the stability of miniscrews. MATERIALS AND METHODS: Finite element analysis was performed using miniscrews inserted into 1mm of cortical bone and 10mm of trabecular bone at angles of 30, 60, 90, 120, and 150 degrees to the alveolar bone. Force of 2 Newton (N) was applied to the heads of the miniscrews in two directions of 0 and 30 degrees. RESULTS: The finite element analysis showed that inserting miniscrews at 90 degree angle would provide better anchorage than 30, 60, 120, and 150 degree angles at either direction of force. The least trabecular bone von Mises stress was 5.6MPa at 90 degrees at both directions of force and the least cortical bone stress was 31.2MPa at 90 degrees at both directions of force. CONCLUSIONS: Insertion of miniscrews at angles less than or greater than 90 degrees to the alveolar process bone might decrease the anchorage stability of the miniscrew.

The effect of noun phrase length on the form of referring expressions.

The length of a noun phrase has been shown to influence choices such as syntactic role assignment (e.g., whether the noun phrase is realized as the subject or the object). But does length also affect the choice between different forms of referring expressions? Three experiments investigated the effect of antecedent length on the choice between pronouns (e.g., he) and repeated nouns (e.g., the actor) using a sentence-continuation paradigm. Experiments 1 and 2 found an effect of antecedent length on written continuations: Participants used more pronouns (relative to repeated nouns) when the antecedent was longer than when it was shorter. Experiment 3 used a spoken continuation task and replicated the effect of antecedent length on the choice of referring expressions. Taken together, the results suggest that longer antecedents increase the likelihood of pronominal reference. The results support theories arguing that length enhances the accessibility of the associated entity through richer semantic encoding.