A comprehensive STPA-PSO framework for quantifying smart glasses risks in manufacturing.

The integration of cutting-edge technologies, such as wearables, in complex systems is crucial for enhancing collaboration between humans and machines in the era of Industry 5.0. However, this increased interaction also introduces new challenges and risks, including the potential for human errors. A thorough analysis of the literature reveals an absence of studies that have quantified these risks, underscoring the utmost importance of this research. To address the above gap, the present study introduces the STPA-PSO methodology, which aims to quantify the risks associated with the use of smart glasses in complex systems, with a specific focus on human error risks. The proposed methodology leverages the Systems-Theoretic Process Analysis (STPA) approach to proactively identify hazards, while harnessing the power of the Particle Swarm Optimization (PSO) algorithm to accurately calculate and optimize risks, including those related to human errors. To validate the effectiveness of the methodology, a case study involving the assembly of a refrigerator was conducted, encompassing various critical aspects, such as the Industrial, Financial, and Occupational Health and Safety (OHS) aspects. The results provide evidence of the efficacy of the STPA-PSO approach in assessing, quantifying, and managing risks during the design stage. By proposing a robust and comprehensive risk quantification framework, this study makes a significant contribution to the advancement of system safety analysis in complex environments, providing invaluable insights for the seamless integration of wearables and ensuring safer interactions between humans and machines.

HPV-Related Multiphenotypic Sinonasal Carcinoma: A Clinicoradiological Series of 3 Cases With Full Endoscopic Surgical Outcome.

Context: Human papillomavirus (HPV)-related multiphenotypic sinonasal carcinoma (HMSC), formerly known as HPV-related carcinoma with adenoid cystic like features, is a rare tumor subtype with unusual correlation between radiological, histopathological, and surgical findings. The shared histological characteristics with other sinonasal tumors make the diagnosis challenging. Optimal surgical and oncological treatments for this rare condition remains to be clearly defined. Methods: The objective of the study was to describe the unique characteristics and endoscopic surgical treatment of this rare tumor. In this retrospective case series, all patients with an HMSC diagnosis treated in our tertiary center were selected. Results: Three HMSC cases were identified, including 2 male and 1 female patients. All cases originated from the posterior nasal cavity. One case presented with a tumor of 8.9 cm × 6.4 cm × 8.7 cm, which is the largest tumor volume described to date. All patients received exclusively endoscopic surgical treatment, followed by adjuvant radiation therapy. No patient showed clinical or radiological sign of disease recurrence, or regional or distant metastasis, with a follow-up ranging from 9 months to 4 years. In 2 cases, initial diagnoses incorrectly suggested adenoid cystic or basaloid squamous cell carcinoma. HPV-DNA testing confirmed the presence of HPV in all cases, with identification of strains 16 and 18. Conclusion and Relevance: HMSC represents a newly identified diagnosis that constitutes a significant challenge for both clinicians and pathologists. It is crucial to acknowledge its indolent clinical course and the apparent contradiction between aggressive radiological features and the noninvasive nature of surgical findings. Skull base surgeons should be aware that, despite these complexities, endoscopic treatment is achievable in the majority of cases. This understanding is essential for the effective management of HMSC.

Prefrontal engagement predicts the effect of museum visit on psychological well-being: an fNIRS exploration.

Recent research suggests that museum visits can benefit psychological well-being by reducing symptoms of stress and anxiety. However, these reported relaxing effects remain inconsistent between studies. Shedding light on the underlying cerebral mechanisms of museum visits might support a better understanding of how it affects psychological well-being. This study aimed to investigate the prefrontal engagement evoked by artwork analysis during a museum visit and to determine if these prefrontal substrates are associated with the museum's effect on psychological well-being in older adults. Nineteen adults aged between 65 and 79, toured a Baroque-style exhibit at the Montreal Museum of Fine Arts for approximately 20 minutes while equipped with a near-infrared spectroscopy system measuring the prefrontal cortex's hemodynamic activity. For each painting, participants received the instruction to either (1): analyze the painting and produce a personal interpretation of its signification (analytic condition) or (2) visualize the painting without any specific thoughts (visualization condition). Questionnaires measuring stress, anxiety, and well-being were administered before and after the visit. Sixteen older women (71.5 ± 4 years) were included in the analyses. Results showed that, at the group level, the analytic condition was associated with an increased activation pattern in the left ventrolateral prefrontal region, typically related to attentional processes (not observed in the visualization condition). The activation associated with the analytic condition predicted pre-/post-visit reductions in self-reported anxiety and stress in the sample of older women. These observations suggest that the level of engagement of attentional processes during artwork analysis may play a major role in the effect of a museum's visit on self-reported symptoms of anxiety.

SARS-CoV-2 Infection, A Risk Factor for Pituitary Apoplexy? A Case Series and Literature Review.

Introduction: Pituitary apoplexy (PA) is a rare phenomenon, characterized by a hemorrhagic or ischemic event of the pituitary gland, most often in association with a pituitary lesion. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the strain of virus responsible for the internationally recognized global pandemic COVID-19. Multiple clinical manifestations associated with this virus have been described, ranging from asymptomatic, mild flu symptoms to acute respiratory distress syndrome, end-organ failure leading to death. Cases of patients with concomitant COVID-19 infections and PA are being further recognized in the literature, but the causal association between the 2 entities remains speculative. Objectives: The objectives of this case series are 3-fold: to describe additional cases of patients with concomitant COVID-19 infection and PA (1), to review the current evidence regarding this potential complication associated with a COVID-19 infection (2), and to discuss physiopathological hypotheses, treatments, and prognoses of this newly recognized association (3). Method: We conducted an electronic chart review of patients treated for PA with concomitant COVID-19 infection from March 2020 to December 2021. A literature review was performed using MEDLINE, Web of Science, and Embase databases to identify other cases of COVID-19-associated PA. Results: From March 2020 to December 2021, 3 patients presented to our center with PA following a symptomatic COVID-19 infection. Two of these patients developed PA symptoms days following the viral infection, whereas the third patient developed PA after a 2-month period. The 2 first patients were managed surgically because of persistent visual symptoms. Results from our literature review yielded 12 other cases of COVID-19-associated PAs. Conclusions: The association between COVID-19 infection and PA has been increasingly reported in the literature. With the addition of the 3 cases described in our article, a total of 15 cases have been published. Many contributing mechanisms may lead to PA following COVID-19 infection. Coagulopathy is probable major contributing cause responsible for hemorrhage or infarction of the pituitary gland. Our case series provides further arguments that PA may be a direct manifestation of a COVID-19 infection.

Seated postural organization during bilateral upper limb symmetric and asymmetric pushing tasks in individuals after stroke compared to healthy controls.

BACKGROUND: Asymmetric weight distribution in sitting has been reported in people after stroke. However, postural strategies used during bilateral symmetric and asymmetric movements performed while seated require more evidence to inform rehabilitation strategies. RESEARCH QUESTIONS: How do symmetric and asymmetric effort levels exerted during upper limb (UL) pushing movements affect seated postural organization parameters (weight bearing (WB) between hands and hemibody sides, and forward trunk displacement) of stroke compared to healthy individuals? How are these parameters associated? METHODS: Using an instrumented exerciser, 19 post-stroke individuals were compared to 17 healthy individuals when executing four bilateral UL pushing movements in a seated position: symmetrical pushing at 30 % and 15 % of their maximal force (MF) and asymmetrical pushing with 15 % of their MF for one UL vs. 30 % of the MF for the other UL and vice versa. Anterior and vertical forces of the push, as well as vertical forces under each foot and thigh were compared between groups, sides and conditions. Forward trunk displacement was compared between groups and conditions. Correlations were used to determine the association between trunk displacement, hands and hemibody vertical forces. RESULTS: Increasing pushing effort caused increased WB on thighs and decreased on WB on feet during the 30 % MF symmetric condition compared to the 15 % MF and asymmetric conditions (p < 0.05). Individuals post-stroke showed WB asymmetry and greater forward trunk displacement when compared to healthy persons (p < 0.05). For both groups, hemibody WB and trunk displacement showed moderate association (r > - 0.5) in the asymmetric condition executed with more resistance on the paretic or non-dominant hand. SIGNIFICANCE: Individuals post-stroke presented a similar WB pattern to that of healthy persons during symmetric and asymmetric bilateral UL movements with greater forward trunk displacement and asymmetry. Increased effort and asymmetric force between both UL had effects on seated postural organization strategy.

Reaction of human walking to transient block of vision: analysis in the context of indirect, referent control of motor actions.

Human locomotion may result from monotonic shifts in the referent position, R, of the body in the environment. R is also the spatial threshold at which muscles can be quiescent but are activated depending on the deflection of the current body configuration Q from R. Shifts in R are presumably accomplished with the participation of proprioceptive and visual feedback and responsible for transferring stable body balance (equilibrium) from one place in the environment to another, resulting in rhythmic activity of multiple muscles by a central pattern generator (CPG). We tested predictions of this two-level control scheme. In particular, in response to a transient block of vision during locomotion, the system can temporarily slow shifts in R. As a result, the phase of rhythmical movements of all four limbs will be changed for some time, even though the rhythm and other characteristics of locomotion will be fully restored after perturbation, a phenomenon called long-lasting phase resetting. Another prediction of the control scheme is that the activity of multiple muscles of each leg can be minimized reciprocally at specific phases of the gait cycle both in the presence and absence of vision. Speed of locomotion is related to the rate of shifts in the referent body position in the environment. Results confirmed that human locomotion is likely guided by feedforward shifts in the referent body location, with subsequent changes in the activity of multiple muscles by the CPG. Neural structures responsible for shifts in the referent body configuration causing locomotion are suggested.

Biomedical Research and Informatics Living Laboratory for Innovative Advances of New Technologies in Community Mobility Rehabilitation: Protocol for Evaluation and Rehabilitation of Mobility Across Continuums of Care.

BACKGROUND: Rapid advances in technologies over the past 10 years have enabled large-scale biomedical and psychosocial rehabilitation research to improve the function and social integration of persons with physical impairments across the lifespan. The Biomedical Research and Informatics Living Laboratory for Innovative Advances of New Technologies (BRILLIANT) in community mobility rehabilitation aims to generate evidence-based research to improve rehabilitation for individuals with acquired brain injury (ABI). OBJECTIVE: This study aims to (1) identify the factors limiting or enhancing mobility in real-world community environments (public spaces, including the mall, home, and outdoors) and understand their complex interplay in individuals of all ages with ABI and (2) customize community environment mobility training by identifying, on a continuous basis, the specific rehabilitation strategies and interventions that patient subgroups benefit from most. Here, we present the research and technology plan for the BRILLIANT initiative. METHODS: A cohort of individuals, adults and children, with ABI (N=1500) will be recruited. Patients will be recruited from the acute care and rehabilitation partner centers within 4 health regions (living labs) and followed throughout the continuum of rehabilitation. Participants will also be recruited from the community. Biomedical, clinician-reported, patient-reported, and brain imaging data will be collected. Theme 1 will implement and evaluate the feasibility of collecting data across BRILLIANT living labs and conduct predictive analyses and artificial intelligence (AI) to identify mobility subgroups. Theme 2 will implement, evaluate, and identify community mobility interventions that optimize outcomes for mobility subgroups of patients with ABI. RESULTS: The biomedical infrastructure and equipment have been established across the living labs, and development of the clinician- and patient-reported outcome digital solutions is underway. Recruitment is expected to begin in May 2022. CONCLUSIONS: The program will develop and deploy a comprehensive clinical and community-based mobility-monitoring system to evaluate the factors that result in poor mobility, and develop personalized mobility interventions that are optimized for specific patient subgroups. Technology solutions will be designed to support clinicians and patients to deliver cost-effective care and the right intervention to the right person at the right time to optimize long-term functional potential and meaningful participation in the community. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/12506.

Rehabilitation Supported by Technology: Protocol for an International Cocreation and User Experience Study.

BACKGROUND: Living labs in the health and well-being domain have become increasingly common over the past decade but vary in available infrastructure, implemented study designs, and outcome measures. The Horizon 2020 Project Virtual Health and Wellbeing Living Lab Infrastructure aims to harmonize living lab procedures and open living lab infrastructures to facilitate and promote research activities in the health and well-being domain in Europe and beyond. This protocol will describe the design of a joint research activity, focusing on the use of innovative technology for both rehabilitation interventions and data collection in a rehabilitation context. OBJECTIVE: With this joint research activity, this study primarily aims to gain insight into each living lab's infrastructure and procedures to harmonize health and well-being living lab procedures and infrastructures in Europe and beyond, particularly in the context of rehabilitation. Secondarily, this study aims to investigate the potential of innovative technologies for rehabilitation through living lab methodologies. METHODS: This study has a mixed methods design comprising multiple phases. There are two main phases of data collection: cocreation (phase 1) and small-scale pilot studies (phase 2), which are preceded by a preliminary harmonization of procedures among the different international living labs. An intermediate phase further allows the implementation of minor adjustments to the intervention or protocol depending on the input that was obtained in the cocreation phase. A total of 6 small-scale pilot studies using innovative technologies for intervention or data collection will be performed across 4 countries. The target study sample comprises patients with stroke and older adults with mild cognitive impairment. The third and final phases involve Delphi procedures to reach a consensus on harmonized procedures and protocols. RESULTS: Phase 1 data collection will begin in March 2022, and phase 2 data collection will begin in June 2022. Results will include the output of the cocreation sessions, small-scale pilot studies, and advice on harmonizing procedures and protocols for health and well-being living labs focusing on rehabilitation. CONCLUSIONS: The knowledge gained by the execution of this research will lead to harmonized procedures and protocols in a rehabilitation context for health and well-being living labs in Europe and beyond. In addition to the harmonized procedures and protocols in rehabilitation, we will also be able to provide new insights for improving the implementation of innovative technologies in rehabilitation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/34537.

Cocreating a Harmonized Living Lab for Big Data-Driven Hybrid Persona Development: Protocol for Cocreating, Testing, and Seeking Consensus.

BACKGROUND: Living Labs are user-centered, open innovation ecosystems based on a systematic user cocreation approach, which integrates research and innovation processes in real-life communities and settings. The Horizon 2020 Project VITALISE (Virtual Health and Wellbeing Living Lab Infrastructure) unites 19 partners across 11 countries. The project aims to harmonize Living Lab procedures and enable effective and convenient transnational and virtual access to key European health and well-being research infrastructures, which are governed by Living Labs. The VITALISE consortium will conduct joint research activities in the fields included in the care pathway of patients: rehabilitation, transitional care, and everyday living environments for older adults. This protocol focuses on health and well-being research in everyday living environments. OBJECTIVE: The main aim of this study is to cocreate and test a harmonized research protocol for developing big data-driven hybrid persona, which are hypothetical user archetypes created to represent a user community. In addition, the use and applicability of innovative technologies will be investigated in the context of various everyday living and Living Lab environments. METHODS: In phase 1, surveys and structured interviews will be used to identify the most suitable Living Lab methods, tools, and instruments for health-related research among VITALISE project Living Labs (N=10). A series of web-based cocreation workshops and iterative cowriting processes will be applied to define the initial protocols. In phase 2, five small-scale case studies will be conducted to test the cocreated research protocols in various real-life everyday living settings and Living Lab infrastructures. In phase 3, a cross-case analysis grounded on semistructured interviews will be conducted to identify the challenges and benefits of using the proposed research protocols. Furthermore, a series of cocreation workshops and the consensus seeking Delphi study process will be conducted in parallel to cocreate and validate the acceptance of the defined harmonized research protocols among wider Living Lab communities. RESULTS: As of September 30, 2021, project deliverables Ethics and safety manual and Living lab standard version 1 have been submitted to the European Commission review process. The study will be finished by March 2024. CONCLUSIONS: The outcome of this research will lead to harmonized procedures and protocols in the context of big data-driven hybrid persona development among health and well-being Living Labs in Europe and beyond. Harmonized protocols enable Living Labs to exploit similar research protocols, devices, hardware, and software for interventions and complex data collection purposes. Economies of scale and improved use of resources will speed up and improve research quality and offer novel possibilities for open data sharing, multidisciplinary research, and comparative studies beyond current practices. Case studies will also provide novel insights for implementing innovative technologies in the context of everyday Living Lab research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34567.

Perspectives, satisfaction, self-efficacy, and barriers to aerobic exercise reported by individuals with chronic stroke in a developing country.

PURPOSE: To describe the perspectives, satisfaction, and self-efficacy towards aerobic exercise and to investigate the barriers to aerobic exercise identified by individuals with stroke in a developing country. MATERIALS AND METHODS: A cross-sectional study was performed with 15 individuals (55 ± 12 years, 69 ± 77 months post-stroke), who received a 12-week vigorous intensity aerobic treadmill training (three 30-min sessions/week). To assess participants' perspectives, satisfaction, self-efficacy, and barriers to aerobic exercise, a standardized interview and the Short Self-Efficacy for Exercise scale were employed. RESULTS: Participants considered aerobic exercise important (100% (IQR 20%), out of 100), recognized that it improves recovery (93%) and heart health (100%) and were satisfied with the training (80%). Self-efficacy was high (4 (IQR 1), out of 5). The main barriers were lack of information (86.7%), fear of falling (80%), lack of equipment (73.3%) or support (66.7%-73.3%), cognitive (66.7%) and physical impairments (60%) and severe weather conditions (60%). Most of them preferred to exercise in groups (93%). CONCLUSIONS: Individuals with stroke in a developing country considered aerobic exercise important. However, they perceived barriers related to safety, individual ability, social support, and aerobic exercise. It is necessary to improve education of these individuals, family members, and health care professionals regarding aerobic exercises.IMPLICATIONS FOR REHABILITATIONIndividuals after stroke in developing countries consider aerobic exercise important and recognized that it improves stroke recovery and health, although they perceived barriers related to safety, individual ability, social support, and aerobic exercise itself.It is important to improve education to stroke survivors, family members and healthcare professionals in developing countries about the possibilities, risks, and benefits of aerobic exercises.Rehabilitation professionals should provide aerobic exercise for individuals after stroke in groups.Rehabilitation professionals might use cycle ergometers or partial body weight support to overcome fear of falling and facilitate implementation of aerobic exercise after stroke.

Bilateral motor coordination during upper limb symmetric pushing movements at two levels of force resistance in healthy and post-stroke individuals.

BACKGROUND: Impairments of the upper limb (UL) are common after a stroke and may affect bilateral coordination. A better understanding of UL bilateral coordination is required for designing innovative rehabilitation strategies. OBJECTIVE: To assess bilateral coordination after stroke using time-distance, velocity and force parameters during an UL bilateral task performed by simultaneously pushing handles on a bilateral exerciser at two levels of force. METHODS: Two groups were included to assess bilateral coordination on a newly designed bimanual exerciser- One group of individuals at least 3 months post-stroke (n = 19) with moderate impairment and one group of healthy individuals (n = 20). Participants performed linear movements by pushing simultaneously with both hands on instrumented handles. The task consisted of two one-minute trials performed in sitting at two levels of participants' maximum force (MF): 30% and 15%, with visual feedback. Time-distance parameters, spatial, velocity and force profiles were compared between groups, between levels of resistance and the first part (0-50%) and entire duration of the pushing cycles (0-100%). RESULTS: The mean pushing time was longer at 30% MF compared to 15% MF in the stroke group. Spatial profiles, represented by hand positions on the rail, revealed that the paretic hand lagged slightly behind throughout the cycle. For velocity, both groups displayed good coordination. It was less coupled at 30% than 15% MF and a trend was observed toward more lag occurrence in the stroke group. Except for lower forces on the paretic side in the stroke group, the shape of the force profiles was similar between groups, sides and levels of resistance. For all parameters, the coordination was good up to 75% of the pushing cycle and decreased toward the end of the cycle. CONCLUSIONS: Individuals after stroke presented with overall spatial and temporal coupling of the UL during bilateral pushing movements. The relay of information at different levels of the nervous system might explain the coordinated pushing movements and might be interesting for training UL coordination.

Evaluation of Fatigue and Workload among Workers Conducting Complex Manual Assembly in Manufacturing.

OCCUPATIONAL APPLICATIONSWe conducted a study to evaluate fatigue and workload among workers performing complex assembly tasks. We investigate several predictors of fatigue, including subjective workload estimates, sleep duration, the shift being worked, and production levels. High levels of fatigue were reported in one-third of the shifts evaluated. The main predictors of high fatigue were workload estimates, working evening shifts, and baseline fatigue. Among the six dimensions of workload, only mental demand and frustration were predictors of high fatigue. Mental demand was also rated highest. Participants reported less than seven hours of sleep in 60% of the nights evaluated. These results suggest that managers and supervisors should consider cognitive workload as a key contributing factor to fatigue in complex manual assembly. Similarly, work schedule planning should consider shift duration, start times, and end times, because of the negative influence on fatigue and the potential disruptions on sleep among workers.

TECHNICAL ABSTRACTBackground: General fatigue and mental workload have been studied extensively in safety-critical contexts; wherein human performance degradation can lead to catastrophic outcomes. In the manufacturing sector, the physical demands of a job have received most of the attention because of the presence of biomechanical loads and the incidence of musculoskeletal disorders. However, in complex manual assembly, cognitive and chronobiology aspects of work can contribute to fatigue and degrade worker performance.Purpose: We aimed to evaluate self-reported levels of fatigue and workload among a group of workers performing complex assembly tasks. We also sought to investigate several predictors of fatigue, including workload estimates, sleep duration, the shift being worked, and production levels.Methods: Fourteen assembly line workers participated in a two-week study. They evaluated their levels of fatigue at the beginning and end of each shift using the Samn-Perelli Fatigue Scale. They also evaluated their workload according to the NASA-TLX scale at the end of each shift.Results: High levels of fatigue (fatigue score ≥ 5) were reported in approximately one-third of 114 work shifts evaluated. Binary logistic regression indicated that fatigue scores at the beginning of the shift, NASA-TLX scores, and working evening shifts were significant predictors of high levels of fatigue. Among the six dimensions measured by NASA-TLX, only mental demand and frustration were predictors of high fatigue. Mental demand was also rated highest by the workers. Participants reported less than seven hours of sleep in 60% of the nights evaluated.Conclusions: These results suggest that cognitive load can contribute to fatigue in complex manual assembly work. Circadian and homeostatic processes related to shift duration, start times, and end times are also potential contributing factors. Similarly, existing work schedules may be contributing to sleep disruptions among workers.

Postural organization and inter-limb coordination are altered after stroke when an isometric maximum bilateral pushing effort of the upper limbs is performed.

BACKGROUND: Postural strategies of the trunk and the lower limbs are linked to upper limb motor activities. The objective was to analyze the postural organization at the lower limbs as well as the inter-limb coordination during isometric maximal bilateral pushing of upper limbs. METHODS: Fifteen individuals after stroke and 17 healthy participants were assessed with an instrumented exerciser paired with an instrumented sitting surface while they executed isometric bilateral pushes with the upper limbs. The anteroposterior, vertical and mediolateral forces were recorded at the handles, the thighs and the feet. Force values at maximal bilateral pushing efforts at each segment and inter-limb coordination between sides were compared. FINDINGS: During the isometric pushes, the paretic maximal forces at the handles for stroke participants were lower than the nonparetic side and lower than both sides of the control participants (p < 0.036). The control and stroke participants had moderate to good coordination for the anteroposterior forces (hands and thighs). While they used similar postural strategies to the controls except for a decreased weight on the paretic foot, vertical forces were less coordinated at the handles and feet in the stroke group (p < 0.050). The inter-trial variability was also higher in the stroke group. INTERPRETATION: Bilateral pushing with gradual efforts induces impaired postural strategies and coordination between limbs in individuals after stroke. It may reveal to be a promising strategy to assess and train post-stroke individuals in a clinical setting. Also, providing feedback would help better control symmetry during efforts.

Endoscopic Endonasal Resection of a Pontine Brainstem Cavernoma.

Surgical treatment of brainstem cavernoma is controversial.1 With modern surgical technique, safe and complete removal of selected brainstem cavernoma is possible.2 The choice of optimal corridor must consider various factors, including eloquent structures of the brainstem, cavernoma shape and location, as well as the presence of an exophytic portion to the lesion.3,4 The endoscopic endonasal approach, with its refinement through the last decade, could offer an optimal corridor for the removal of ventral brainstem cavernomas. This video exemplifies the key surgical steps, advantages of the technique, and relevant anatomy for the endoscopic endonasal removal of a ventrally exophytic pontine cavernoma.

Surgical treatment of isolated sphenoid sinusitis - A case series and review of literature.

INTRODUCTION: Isolated sphenoid opacification is a rare pathology. Unlike other sinusitis, the treatment is most often surgical. Only few studies reporting the recurrence rates with long-term follow-ups are available in the literature. In our experience, isolated sphenoid sinusitis tends to have a significant recurrence rate after a first surgical intervention. This study aims to describe our experience with patients operated for isolated sphenoid sinusitis and to compare our reoperation and complication rates with those reported in the literature. METHODS: We conducted an electronic chart review of patients operated at the CHU de Québec between 2007 and 2018 for isolated sphenoid sinusitis. RESULTS: 29 patients were analyzed. All patients had a sphenoidectomy with a transnasal approach. The reoperation rate was 10.3% (3/29) and the mean recurrence time was 15 (9-26) months. Among the patients reoperated, 2 patients had a fungus ball and one had a mucocele. Both patients with fungal balls had reossification of their sphenoidal ostium whereas the patient with the mucocele rather had a mucosal closure. No patient encountered any serious post-operative complication. Median duration of follow-up was 44 months (IQR: 25-68) for the 29 patients analyzed in our study. CONCLUSION: Reoperation rates reported in the literature are probably underestimated. Our series emphasizes the importance of long-term follow-up for these pathologies. Highly inflammatory and chronic conditions such as fungal diseases could be linked to an increase in the occurrence of relapses.

Reliability and minimal detectable change of the mini-BESTest in adults with spinal cord injury in a rehabilitation setting.

Background: The mini-Balance Evaluation Systems Test (mini-BESTest) is a valid tool for assessing standing balance in people with spinal cord injury (SCI). Its reliability has not yet been investigated with this population. Objective: To assess the test-retest and inter-rater reliability of the mini-BESTest in adults with SCI in a rehabilitation setting. Methods: Twenty-three participants admitted in a rehabilitation center following an SCI (mean age = 52.2 years, SD = 14.5; 13/23 tetraplegia; 14/23 traumatic injury) and able to stand 30 seconds without help were recruited. They were evaluated twice with the mini-BESTest to establish the test-retest reliability (interval of 1 to 2 days). One of the two sessions was video-recorded to establish the inter-rater reliability (3 physiotherapists). Intraclass correlation coefficients (ICC2,1), weighted kappa (Kw) and Kendall's W were used to determine reliability of total score and individual items. Minimal detectable changes (MDC) were computed. Results. The mini-BESTest total scores showed excellent test-retest (ICC = 0.94) and inter-rater (ICC = 0.96) reliability. Reliability of 50% of the individual items was acceptable to excellent (Κw and W = 0.35-1.00). The MDC of the mini-BESTest total score was 4 points. Conclusion: The mini-BESTest is a reliable tool to assess standing balance in adults with an SCI. A minimal change of 4 points on the total scale is needed to be confident that the change is not a measurement error between two sessions or two raters.

Efficacy of task-specific circuit training on physical activity levels and mobility of stroke patients: A randomized controlled trial.

BACKGROUND: Impaired mobility is related to low physical activity (PA) levels observed after stroke. Therapeutic approaches, such as task-specific circuit training (TSCT), used to improve mobility in individuals with stroke, could also improve PA levels. OBJECTIVE: To investigate the efficacy of TSCT, focused on both upper (UL) and lower (LL) limbs, in improving PA levels and mobility (primary outcomes), as well as muscle strength, exercise capacity, and quality of life (secondary outcomes) in subjects with stroke. METHODS: A randomized controlled trial with 36 subjects with chronic stroke was conducted. Experimental group: TSCT, involving both UL and LL. CONTROL GROUP: global stretching, memory exercises, and education sessions. Both groups received 60 minute sessions/week over 12 weeks. Outcomes were measured at baseline, post-intervention and 16 week follow-up. RESULTS: No changes were found for primary and secondary outcomes (0.11≤p≤0.99), except for quality of life, which improved in the experimental group post-intervention and 16 week follow-up (p = 0.02). CONCLUSION: TSCT focused on both UL and LL was not effective on PA levels and mobility of individuals with chronic stroke, however, improvements in quality of life were observed. Since this is the first study to investigate this combined training aimed at improving PA levels, future studies are necessary to better understand the impact of this type of intervention.

Recovery of Sensorimotor Functional Outcomes at Discharge from In-Patient Rehabilitation in Three Stroke Units in the Province of Quebec.

Purpose: This study aimed to portray the characteristics, process variables, and sensorimotor outcomes of patients who had received their usual post-stroke in-patient rehabilitation in three stroke rehabilitation units in Quebec in 2013-2014. Method: We assessed patients (n = 264) at admission and discharge with a subset of a standardized assessment toolkit consisting of observational and performance-based assessment tools. Results: The patients, with a mean age of 60.3 (SD 15.4) years, were admitted 27.7 (SD 8.4) days post-stroke onset. They had a mean admission FIM score of 83.0 (SD 24.0), a mean length of stay of 48.4 (SD 31.1) days, a mean FIM discharge score of 104.0 (SD 17.0), and a mean FIM efficiency score of 0.44 (SD 0.29). All patient outcomes were significantly improved (p < 0.001) and clinically meaningful at discharge (moderate to large Glass's Δ effect sizes) with the improvements greater than or equal to the minimal detectable change at the 95% confidence level in 34%-75% of the patients. Improvements were larger on five of seven outcomes in a sub-group of patients with more severe stroke. Conclusions: The use of a combination of observational and performance assessment tools was essential to capture the full range of disabilities. We have documented significant and clinically meaningful improvements in functional independence, disability, and upper and lower extremity functions after usual post-stroke in-patient rehabilitation in the province of Quebec and provided baseline data for future studies.

Objectif : décrire les caractéristiques, le processus de réadaptation et les résultats sensorimoteurs de patients ayant reçu les services de réadaptation habituels après un accident vasculaire cérébral (AVC) dans trois unités de réadaptation du Québec en 2013 et 2014. Méthodologie : évaluation des patients (n = 264) à l'admission et au congé à l'aide du sous-ensemble d'une trousse d'évaluation standardisée composée d'outils d'évaluation fondés sur l'observation et la performance. Résultats : les patients, qui avaient un âge moyen de 60,3 ans (ÉT 15,4), ont été hospitalisés en réadaptation 27,7 jours (ÉT 8,4) après leur AVC. Leur mesure d'autonomie fonctionnelle (MAF) à l'admission était de 83,0 (ÉT 24,0), et leur séjour en réadaptation a duré 48,4 jours (ÉT 31,1); leur score de MAF au congé était de 104,0 (ÉT 17,0), pour un score d'efficacité de la MAF de 0,44 (ÉT 0,29). Tous les résultats cliniques des patients s'étaient considérablement améliorés (p < 0,001) et étaient cliniquement significatifs au congé (effet de taille delta de Glass de modéré à grand), et ces améliorations étaient supérieures ou égales au changement minimal décelable à un niveau de confiance de 95 % chez 34 % à 75 % des patients. Ces améliorations pour cinq des sept mesures étaient plus élevées dans le sous-groupe de patients ayant un AVC plus grave. Conclusion : une combinaison d'outils d'évaluation d'observation et de performance s'est avérée essentielle pour saisir tout l'éventail d'incapacités. Les auteures ont constaté des améliorations importantes et cliniquement significatives de l'autonomie fonctionnelle, de l'incapacité et de la fonction des membres supérieurs et inférieurs après l'hospitalisation en réadaptation habituelle des patients ayant un AVC dans la province de Québec et ont fourni des données de référence en vue de prochaines études.

Effects of aerobic training on physical activity in people with stroke: A randomized controlled trial.

BACKGROUND: Individuals with stroke have low physical activity levels and spend high amount of time in low-energy expenditure activities. OBJECTIVE: To investigate the effects of aerobic treadmill training on physical activity levels and time spent in low-energy expenditure activities (primary outcomes), as well as on cardiorespiratory fitness, endurance, depression, mobility, quality of life and participation (secondary outcomes) after stroke. METHODS: A randomized controlled trial, with 22 adults with chronic stroke was performed. Experimental group: aerobic treadmill training at 60-80% of heart rate reserve. CONTROL GROUP: outdoor-overground walking below 40% of heart rate reserve. Both groups: three 40 min sessions/week over 12 weeks. Outcomes were measured at baseline, post-training, and 16-week follow-up. RESULTS: No changes in the primary outcomes were found for any of the groups. The experimental group showed greater improvements in quality of life at 16-week follow-up (13 points;95% CI:3.5-23). Both groups improved depression (2.2 points;95% CI:0.01-4.3), endurance (Six-minute walk test:31 m;95% CI:5.6-57, Incremental shuttle-walk test:55 m;95% CI:3.8-107), and mobility (0.12 m/s;95% CI:0.02-0.2). CONCLUSION: Aerobic treadmill training improved quality of life. Aerobic treadmill training or outdoor-overground walking improved depression, endurance and mobility. Further studies are needed to clarify the effects of aerobic training on physical activity levels and time spent in low-energy expenditure activities after stroke.