Enhancing upper-limb neurorehabilitation in chronic stroke survivors using combined action observation and motor imagery therapy.

Introduction: For people who have had a stroke, recovering upper-limb function is a barrier to independence. When movement is difficult, mental practice can be used to complement physical therapy. In this within-participants study we investigated the effects of combined action observation and motor imagery (AO + MI) therapy on upper-limb recovery in chronic stroke survivors. Methods: A Graeco-Latin Square design was used to counterbalance four mental practice conditions (AO + MI, AO, MI, Control) across four cup-stacking tasks of increasing complexity. Once a week, for five consecutive weeks, participants (n = 10) performed 16 mental practice trials under each condition. Each trial displayed a 1st person perspective of a cup-stacking task performed by an experienced model. For AO, participants watched each video and responded to an occasional color cue. For MI, participants imagined the effort and sensation of performing the action; cued by a series of still-images. For combined AO + MI, participants observed a video of the action while they simultaneously imagined performing the same action in real-time. At three time points (baseline; post-test; two-week retention test) participants physically executed the three mentally practiced cup-stacking tasks, plus a fourth unpractised sequence (Control), as quickly and accurately as possible. Results: Mean movement execution times were significantly reduced overall in the post-test and the retention test compared to baseline. At retention, movement execution times were significantly shorter for combined AO + MI compared to both MI and the Control. Individual participants reported clinically important changes in quality of life (Stroke Impact Scale) and positive qualitative experiences of AO + MI (social validation). Discussion: These results indicate that when physical practice is unsuitable, combined AO + MI therapy could offer an effective adjunct for neurorehabilitation in chronic stroke survivors.

Influence and Action Mechanisms of Governmental Relations Embeddedness for Fostering Green Production Demonstration Household: Evidence from Shaanxi, Sichuan, and Anhui Province, China.

As an innovative tactic, the core aspects of green products should be comprehensively demonstrated and firmly promoted to enhance their adoption. For doing so, continuous governmental support and interventions through distinct sets of networking and relationships could be crucial for synthesizing and diffusing the extent of green production demonstration households. Interestingly, the structural relationship between these two has not yet been evaluated comprehensively by the existing literature. Therefore, the study empirically analyzes the impact and mechanism of government relationships embedded in fostering green production demonstration households. The study compiles the empirical data from 963 farmers which were collected from the major tea-producing areas of Shaanxi, Sichuan, and Anhui provinces, China. In order to craft the findings, first we constructed the ordered Probit for benchmark regression analysis. Meanwhile, the Ordinary Standard Error Ordered Probit model, Ordered Logit model, and multivariate linear model were constructed for the robustness test. Third, the Extended Ordered Probit model and Bootstrap mediation effect model were used to test the path diagram. Finally, robustness testing and endogeneity processing test were used to explore the reliability of the findings. The results showed that: (i) Government relationship embedding has a positive effect on fostering green production demonstration households. In particular, factors such as relationships with general government staff, professional and technical personnel, and village cadre are most significant. (ii) Seemingly, the heterogeneity analysis shows that the farmers with large operating scales and low family economic status have a relatively stronger impact. (iii) Further mechanism research results show that government relations are embedded through government identification (policy identification, government trust), improving farmers' behavioral ability (production knowledge reserve, self-efficacy), and strengthening farmers' perceived value of green production (self-interest perception, altruistic values). Therefore, the government should strengthen the interactive mechanism embedded with farm households and extend support for green production demonstration zones. The farmers' information-sharing facilities and platforms should be modernized and highlighted according to the local conditions and long-term targeted strategies.

A neural signature for combined action observation and motor imagery? An fNIRS study into prefrontal activation, automatic imitation, and self-other perceptions.

INTRODUCTION: Research indicates that both observed and imagined actions can be represented in the brain as two parallel sensorimotor representations. One proposal is that higher order cognitive processes would align these two hypothetical action simulations. METHODS: We investigated this hypothesis using an automatic imitation paradigm, with functional near-infrared spectroscopy recordings over the prefrontal cortex during different motor simulation states. On each trial, participants (n = 14) observed a picture of a rhythmical action (instructed action) followed by a distractor movie showing the same or different action. Participants then executed the instructed action. Distractor actions were manipulated to be fast or slow, and instructions were manipulated during distractor presentation: action observation (AO), combined action observation and motor imagery (AO+MI) and observe to imitate (intentional imitation). A pure motor imagery (MI) condition was also included. RESULTS: Kinematic analyses showed that although distractor speed effects were significant under all instructions (shorter mean cycle times in execution for fast compared to slow trials), this imitation bias was significantly stronger for combined AO+MI than both AO and MI, and stronger for intentional imitation than the other three automatic imitation conditions. In the left prefrontal cortex, cerebral oxygenation was significantly greater for combined AO+MI than all other instructions. Participants reported that their representation of the self overlapped with the observed model significantly more during AO+MI than AO. CONCLUSION: Left prefrontal activation may therefore be a neural signature of AO+MI, supporting attentional switching between concurrent representations of self (MI, top-down) and other (AO, bottom-up) to increase imitation and perceived closeness.

The effect of stage IV childbirth care module through the preceptorship method.

OBJECTIVE: This study aims to determine the effect of the module through the preceptorship method on the improvement of stage IV childbirth care skills of D-III Midwifery students in childbirth care courses. METHODS: This study used a Quasi Experiment (pre-test post-test control group design). The population of all students who program the subject of childbirth care is 141 students. The sampling technique used total sampling. The sample was 141 semester II students at Program study of D-III Midwifery, STIKES Pelamonia Kesdam VII Wirabuana. Previously, a pre-test was carried out on stage IV childbirth care skills then divided into modules. After that, the preceptorship method was carried out for three meetings with 2×50min at each meeting. At the end of the meeting, a post-test was conducted. Data were analyzed using Mann-Whitney. RESULTS: This study indicates a significant effect, the value (p=0.000, p<0.05) in improving the skills of D-III midwifery students in semester II regarding stage IV delivery care in the module group and the preceptorship method compared to the demonstration and module groups. CONCLUSION: The results of data analysis and evaluation results on the module and preceptorship method significantly increase stage IV childbirth care skills for D-III midwifery students.

[Identification of Dredging Depths Based on Sediment Vertical Distribution Profiles of Total Nitrogen and Total Phosphorus and Their Adsorption-desorption Equilibria].

A dredging demonstration project in the Baiyangdian Lake included open waters and fishing ponds to reduce the internal release of nitrogen and phosphorus from bottom sediments. The dredging depth design was determined by both the sediment vertical distribution profile of total nitrogen and phosphorus, and the sediment adsorption-desorption equilibrium method. The determined dredging depths were very similar and coincident. The dredging depth for the demonstration area of open waters in Nanliuzhuang was identified as(50±10) cm; and the dredging depths for fishing ponds were(30±10) cm in both the Nanliuzhuang and Caiputai demonstration areas. The equilibrium nitrogen(NH4+-N) and phosphorus(SRP) concentrations at zero net sorption or desorption(ENC0 and EPC0) were significantly positively correlated with both exchangeable and total nitrogen and phosphorus in the sediments. The total nitrogen and phosphorus in the sediments were also used to predict the risk of their release from the bottom sediments to the overlying water column. The sediment layers with ENC0 and EPC0 values greater than the NH4+-N and SRP in the overlying water column indicated the sediments act as a source of dissolved nitrogen and phosphorus to the overlying water column in the Nanliuzhuang and Caiputai demonstration areas. Accordingly, the sediment layers with both total nitrogen concentrations greater than 750 mg·kg-1 and total phosphorus concentrations greater than 500 mg·kg-1 should be identified as dredging layers.

Marine Bioactive Peptides in Supplements and Functional Foods - A Commercial Perspective.

Many bioactive peptides have been described from marine sources and much marine biomass is still not explored or utilized in products. Marine peptides can be developed into a variety of products, and there is a significant interest in the use of bioactive peptides from marine sources for nutraceuticals or functional foods. We present here a mini-review collecting the knowledge about the value chain of bioactive peptides from marine sources used in nutraceuticals and functional foods. Many reports describe bioactive peptides from marine sources, but in order to make these available to the consumers in commercial products, it is important to connect the bioactivities associated with these peptides to commercial opportunities and possibilities. In this mini-review, we present challenges and opportunities for the commercial use of bioactive peptides in nutraceuticals and functional food products. We start the paper by introducing approaches for isolation and identification of bioactive peptides and candidates for functional foods. We further discuss market-driven innovation targeted to ensure that isolated peptides and suggested products are marketable and acceptable by targeted consumers. To increase the commercial potential and ensure the sustainability of the identified bioactive peptides and products, we discuss scalability, regulatory frameworks, production possibilities and the shift towards greener technologies. Finally, we discuss some commercial products from marine peptides within the functional food market. We discuss the placement of these products in the larger picture of the commercial sphere of functional food products from bioactive peptides.

Motor imagery during action observation enhances imitation of everyday rhythmical actions in children with and without developmental coordination disorder.

Children with developmental coordination disorder (DCD) exhibit deficits both in imitation and motor imagery (MI) compared to typically developing children. Combined action observation and motor imagery (AO + MI) instructions can however enhance automatic imitation in both groups. In the present study we investigated the effects of AO + MI instructions on intentional imitation in children both with (n = 13) and without DCD (n = 12). On each trial participants observed and/or imagined before executing a familiar rhythmical pantomime action. These target actions were either habitually fast (tooth brushing or window wiping) or habitually slow (paint brushing or face washing), in the vertical or horizontal plane. Within each habitual speed, the target action speed was subtly manipulated across trials (fast vs. slow). Instruction condition was manipulated across three blocks of 16 trials: (1) observe before imitating the target action; (2) observe then imagine the action before imitating; (3) observe while imagining the same action before imitating (AO + MI). Kinematic analyses revealed typically developing children imitated the observed cycle times significantly better than children with DCD. A main effect of instruction showed imitation improved for AO + MI compared to the other two instructions. Within-group analyses found a significant advantage in DCD for AO + MI compared to observe then imagine. In typically developing children, imitation was significantly enhanced for AO + MI compared to observe then imitate. Combined AO + MI instructions therefore represent a promising new approach to refining performance of everyday rhythmical actions in children both with and without DCD, with implications for movement therapy and sports training.

Motor imagery during action observation enhances automatic imitation in children with and without developmental coordination disorder.

Developmental coordination disorder (DCD) is a neurodevelopmental condition characterized by uncoordinated movement relative to age. While action observation (AO) and motor imagery (MI) can both independently enhance movement skills in children, we report the first study to assess the effects of combined action observation and motor imagery (AO + MI) on automatic imitation in children aged 7-12 years both with DCD (n = 12) and without DCD (n = 12). On each trial, participants planned to execute an instructed rhythmical action (face washing or paint brushing). Before responding, participants observed a rhythmical distractor showing the same or a different action with a subtle speed manipulation across trials (fast vs. slow). Automatic imitation was quantified as an imitation bias in subsequent response cycle times. Across blocks of trials, participants engaged in AO, MI, or combined AO + MI during the distractor phase or intentionally imitated the distractor speeds. Although there were no between groups differences, combined AO + MI instructions produced a significantly greater imitation bias (115%) than both AO (109%) and MI (109%), with intentional imitation yielding the strongest effects overall (128%). Within groups analyses revealed a significant bias for AO and MI in both groups. Combined AO + MI effects were significantly greater than AO in typically developing children and were greater than both AO and MI in children with DCD. These results demonstrate a clear capacity for different forms of motor simulation in children both with and without DCD. Moreover, combined AO + MI instructions represent an advantageous method for training movements in children with different motor abilities compared with separate AO and MI instructions.

Evaluation of the effectiveness of four different training techniques in the development of non-stress testing application skills: A randomised controlled trial.

BACKGROUND: A range of teaching methods are employed to upgrade students' skills, lower anxiety levels and improve satisfaction in nursing and midwifery education. AIM: This study was conducted to evaluate the effect of different training techniques on the development of students' non-stress test (NST) application skills, satisfaction with education and reduction of their anxiety levels. METHOD: The study was designed as a single-blind randomised controlled trial and carried out in four groups (n = 82), namely, video demonstration (VD), simulation with birth model (SBM), hybrid simulation (HS) and control (CG). A student information form, the NST skills evaluation form and the Spielberger State Anxiety Inventory were used to collect the study data. RESULTS: Satisfaction with education was higher in the HS and SBM groups compared to the CG and VD groups (p < 0.001). No differences were found between the groups in terms of students' anxiety levels (p > 0.05). While there were no differences between the groups in the preparation phase in terms of NST skill scores (p > 0.05), the differences between the groups in the application and evaluation stages of the procedure were significant (p < 0.001). The highest score regarding the total score medians of NST skills belonged to the HS group, and the differences between the groups were found to be statistically significant (p < 0.001). CONCLUSION: The findings of this study indicated that simulation techniques enhanced the students' clinical practice skills and satisfaction with their education.

[Study on the effectiveness of implementation: the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases].

Objective: To assess the implementation and impact of programs carried out by the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases. Methods: Both sociological and epidemiological methods were used to collect qualitative and quantitative data in November and December, 2016 in order to conduct on process and outcome evaluation of the above mentioned objective. In the meantime, case study was also conducted. Results: All the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases were found well implemented across the country, with health education and health promotion, surveillance and safeguard measures in particular. A government-led and inter-sector coordination and communication mechanism had been well established, with more than 16 non-health departments actively involved. 28.7% of the residents living in the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases were aware of the key messages related to chronic diseases. Among the residents, 72.1% of them consumed vegetables and 53.6% consumed fruits daily, with another 86.9% walked at least 10 minutes per day. Over 70% of the patients with hypertension or diabetes reported that they were taken care of by the Community Health Centers, and above 50% of them were under standardized management. Residents, living in the National Demonstration Areas under higher ranking of implementation scores, were more likely to be aware of relevant knowledge on chronic disease control and prevention (OR=6.591, 95%CI: 5.188-8.373), salt reduction (OR=1.352, 95%CI: 1.151-1.589), oil reduction (OR=1.477, 95%CI: 1.249-1.746) and recommendation on physical activities (OR=1.975, 95%CI: 1.623- 2.403). Conclusion: The implementation of programs carried out by the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases had served a local platform for the control and prevention of non-communicable diseases, and thus become an important 'carrier' for chronic disease prevention and control programs in China.

[Study on the overall implementation status of the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases].

Objective: To understand the current overall status of implementation on the National Demonstration Areas of Comprehensive Prevention and Control of Non-communicable Diseases. Methods: According to the scheme design of the questionnaires, all the National Demonstration Areas were involved in this study. For each National Demonstration Areas, eight departments were selected to complete a total of 12 questionnaires. Results: Scores related to the implementation of the National Demonstration Areas accounted for 71.8% of the total 170 points. Based on the scores gathered from this study, the 23-items-index-system that represented the status of project implementation was classified into seven categories. Categories with higher percentile scores would include: monitoring (88.0%), safeguard measures (75.0%), health education and health promotion (75.0%). Categories with lower percentile scores would include: the national health lifestyle actions (67.7%), community diagnosis (66.7%), discovery and intervention of high-risk groups (64.7%), and patient management (60.9%). There were significant differences noticed among the eastern, central and western areas on items as safeguard measures, health education/promotion, discovery and intervention of high-risk groups. In all, the implementation programs in the eastern Demonstration Areas seemed better than in the central or western regions. As for the 23 items, five of the highest scores appeared on policy support, mortality surveillance, tumor registration, reporting system on cardiovascular/cerebrovascular events, and on tobacco control, respectively. However, the lowest five scores fell on healthy diet, patient self-management program, oral hygiene, setting up the demonstration units and promotion on basic public health services, respectively. The overall scores in the eastern region was higher than that in the central or the western regions. The scores in the central and western regions showed basically the same. Conclusions: The overall status of implementation on the National Demonstration Areas was satisfactory. Future attention should be focusing on patient management as well as discovery and intervention of high-risk groups, which also presented the lowest scores, in this survey.

An efficient cardiac mapping strategy for radiofrequency catheter ablation with active learning.

OBJECTIVE: A major challenge in radiofrequency catheter ablation procedures is the voltage and activation mapping of the endocardium, given a limited mapping time. By learning from expert interventional electrophysiologists (operators), while also making use of an active-learning framework, guidance on performing cardiac voltage mapping can be provided to novice operators or even directly to catheter robots. METHODS: A learning from demonstration (LfD) framework, based upon previous cardiac mapping procedures performed by an expert operator, in conjunction with Gaussian process (GP) model-based active learning, was developed to efficiently perform voltage mapping over right ventricles (RV). The GP model was used to output the next best mapping point, while getting updated towards the underlying voltage data pattern as more mapping points are taken. A regularized particle filter was used to keep track of the kernel hyperparameter used by GP. The travel cost of the catheter tip was incorporated to produce time-efficient mapping sequences. RESULTS: The proposed strategy was validated on a simulated 2D grid mapping task, with leave-one-out experiments on 25 retrospective datasets, in an RV phantom using the Stereotaxis Niobe® remote magnetic navigation system, and on a tele-operated catheter robot. In comparison with an existing geometry-based method, regression error was reduced and was minimized at a faster rate over retrospective procedure data. CONCLUSION: A new method of catheter mapping guidance has been proposed based on LfD and active learning. The proposed method provides real-time guidance for the procedure, as well as a live evaluation of mapping sufficiency.

The Catalonia WHO Demonstration Project of Palliative Care: Results at 25 Years (1990-2015).

In 2015, the World Health Organization (WHO) Demonstration Project on Palliative Care in Catalonia (Spain) celebrated its 25th anniversary. The present report describes the achievements and progress made through this project. Numerous innovations have been made with regard to the palliative care (PC) model, organization, and policy. As the concept of PC has expanded to include individuals with advanced chronic conditions, new needs in diverse domains have been identified. The WHO resolution on "Strengthening of palliative care as a component of comprehensive care throughout the life course," together with other related WHO initiatives, support the development of a person-centered integrated care PC model with universal coverage. The Catalan Department of Health, together with key institutions, developed a new program in the year 2011 to promote comprehensive and integrated PC approach strategies for individuals with advanced chronic conditions. The program included epidemiologic research to describe the population with progressive and life-limiting illnesses. One key outcome was the development of a specific tool (NECPAL CCOMS-ICO(©)) to identify individuals in the community in need of PC. Other innovations to emerge from this project to improve PC provision include the development of the essential needs approach and integrated models across care settings. Several educational and research programs have been undertaken to complement the process. These results illustrate how a PC program can respond and adapt to emerging needs and demands. The success of the PC approach described here supports more widespread adoption by other key care programs, particularly chronic care programs.

Analysis of 51 cases of primary small intestinal tumor imaging findings / 中国现代医生

Objective To investigate image diagnostic methods and imaging demonstration of primary small intestine tumor. Methods A total of 51 cases of patients with primary small intestine tumors, who were confirmed by pathology from 2002 to 2014, were collected. Their inspection methods and imaging findings were reviewed retroactively. Results There were 15 cases (29.41%) of benign small intestinal tumor and 36 cases (70.59%) of malignant small intestine tu-mors. The positive ratio of CT enterography, upper gastrointestinal endoscopy, double-balloon enteroscopy, capsule en-doscopy, MRI enterography, full gastrointestinal contrast and low tension of small bowel enema were 68.89%(31/45), 71.43%(22/35), 80.00%(4/5), 66.67%(2/3), 60.00%(9/15), 25.00%(3/12), 60.00%(6/10) respectively. Conclusion In order to diagnose small intestinal tumor more effectively, imaging features of small intestinal tumor, advantages and disadvantages of various methods should be mastered, and it is necessary to combine all kinds of inspection methods.