Feasibility and effect of interactive telerehabilitation on balance in individuals with chronic stroke: a pilot study.

BACKGROUND: Stroke survivors need continuing exercise intervention to maintain functional status. This study assessed the feasibility and efficacy of an interactive telerehabilitation exergaming system to improve balance in individuals with chronic stroke, compared to conventional one-on-one rehabilitation. METHODS: In this prospective case-control pilot study, 30 Taiwanese individuals with chronic stroke were enrolled and randomly allocated to an experimental group and a control group. All participants received intervention 3 times per week for 4 weeks in the study hospital. The experiment group underwent telerehabilitation using a Kinect camera-based interactive telerehabilitation system in an independent room to simulate home environment. In contrast, the control group received conventional one-on-one physiotherapy in a dedicated rehabilitation area. The effectiveness of interactive telerehabilitation in improving balance in stroke survivors was evaluated by comparing outcomes between the two groups. The primary outcome was Berg Balance Scale (BBS) scores. Secondary outcomes were performance of the Timed Up and Go (TUG) test, Modified Falls Efficacy Scale, Motricity Index, and Functional Ambulation Category. RESULTS: Comparison of outcomes between experimental and control groups revealed no significant differences between groups at baseline and post-intervention for all outcome measures. However, BBS scores improved significantly in both groups (control group: p = 0.01, effect size = 0.49; experimental group: p = 0.01, effect size = 0.70). Completion times of TUG tests also improved significantly in the experimental group (p = 0.005, effect size = 0.70). CONCLUSION: The Kinect camera-based interactive telerehabilitation system demonstrates superior or equal efficacy compared to conventional one-on-one physiotherapy for improving balance in individuals with chronic stroke. Trial registration ClinicalTrials.gov. NCT03698357. Registered October 4, 2018, retrospectively registered.

Exploring Managers' Opinions on Planning and Designing Adult Day Care Centers.

OBJECTIVE: To explore managers' opinions on planning and design of location, building type, spatial layout, and interior design of adult day care centers (ADCCs). BACKGROUND: The planning and design of new ADCCs affect subsequent service users and workflows. Studies explore the factors affecting such planning and design using qualitative methods and from the perspective of users. Quantitative methods are rarely employed to explore factors affecting planning and opinions on the design of ADCCs from administrators' perspective. METHODS: Stratified sampling was used to collect data from managers of ADCCs in Taiwan. A mixed-method approach with an analytic hierarchy process was used to quantify the relative importance of factors affecting location and building type selections. Participants responded to open-ended interview questions followed by focus group interviews to examine the key points for spatial layout and interior design. RESULTS: The managers deemed support and attitudes from local residents (group weight = .208) and authorities (group weight = .187) as their first two critical location selection criteria. Regarding their opinions on the conditions of building type, those that prioritized the products and technologies of facility design were deemed the most critical (group weight = .193), followed by those that valued daylight quality (group weight = .161). Six key points of spatial layout and interior design were obtained from the focus group interviews. CONCLUSIONS: This study provides a reference for the effective planning of operations, including geographical location, building type, spatial layout, and interior refurbishment and design.

Up-regulation of PER3 Expression Is Correlated with Better Clinical Outcome in Acute Leukemia.

BACKGROUND: Altered expression of circadian clock genes has been linked to various types of cancer. This study aimed to investigate whether these genes are also altered in acute myeloid leukemia (AML) and acute lymphoid leukemia (ALL). MATERIALS AND METHODS: The expression profiles of nine circadian clock genes of peripheral blood (PB) leukocytes from patients with newly-diagnosed AML (n=41), ALL (n=23) and healthy individuals (n=51) were investigated. RESULTS: In AML, the expression of period 1 (PER1), period 2 (PER2), period 3 (PER3), cryptochrome 1 (CRY1), cryptochrome 2 (CRY2), brain and muscle aryl hydrocarbon receptor nuclear translocator (ARNT)-like 1 (BMAL1), and timeless (TIM) was significantly down-regulated, while that of CK1ε was significantly up-regulated. In ALL, the expression of PER3 and CRY1 was significantly down-regulated, whereas those of CK1ε and TIM were significantly up-regulated. Recovery of PER3 expression was observed in both patients with AML and those with ALL who achieved remission but not in patients who relapsed after treatment. CONCLUSION: Circadian clock genes are altered in patients with acute leukemia and up-regulation of PER3 is correlated with a better clinical outcome.

Relationship of urinary phthalate metabolites with serum thyroid hormones in pregnant women and their newborns: a prospective birth cohort in Taiwan.

BACKGROUND: The purpose of this study was to examine the relationship of phthalates exposure with thyroid function in pregnant women and their newborns. METHODS: One hundred and forty-eight Taiwanese maternal and infant pairs were recruited from E-Da hospital in southern Taiwan between 2009 and 2010 for analysis. One-spot urine samples and blood samples in the third trimester of pregnant women and their cord blood samples at delivery were collected. Nine phthalate metabolites in urine were determined by triple quadrupole liquid chromatography tandem mass spectrometry, whereas serum from pregnant women and their cord blood were used to measure thyroid profiles (thyroid-stimulating hormone [TSH], thyroxine, free thyroxine, and triiodothyronine) by radioimmunoassay. RESULTS: Median levels of urinary mono-n-butyl phthalate, mono-ethyl phthalate, and mono-(2-ethyl-5-oxohexyl) phthalate (µg/g creatinine) were the three highest phthalate metabolites, which were 37.81, 34.51, and 21.73, respectively. Using Bonferroni correction at a significance of < 0.006, we found that urinary mono-benzyl phthalate (MBzP) levels were significantly and negatively associated with serum TSH in cord blood (ß = -2.644, p = 0.003). CONCLUSIONS: Maternal urinary MBzP, of which the parental compound is butylbenzyl phthalate, may affect TSH activity in newborns. The alteration of thyroid homeostasis by certain phthalates in the early life, a critical period for neurodevelopment, is an urgent concern.

Findings of 2731 suspected phthalate-tainted foodstuffs during the 2011 phthalates incident in Taiwan.

BACKGROUND/PURPOSE: This study aims to investigate what kinds of food products were contaminated by phthalates, mainly di-(2-ethylhexyl)phthalate (DEHP) and/or di-isononyl phthalate (DINP), during the 2011 phthalates incident in Taiwan, and whether the DEHP and/or DINP concentrations of some affected foods decreased after this incident. METHODS: During May-October, 2011, 2731 food items were sent by individual citizens or companies to a government-accredited laboratory for the analyses of six main phthalate chemicals, including DEHP, DINP, di-isodecyl phthalate, di(n-octyl)phthalate, di-n-butyl phthalate, and butyl benzyl phthalate. A concentration of ≥1 ppm for any of the six phthalate chemicals in the foods studied was defined as positive. RESULTS: The overall positive rate was 16.2%. The positive rate of possibly affected foods was similar between sanctioned and non-sanctioned foods categorized as "Others" by the government (16.0% vs. 16.4%). There were 33 food items, most of which belonged to the Others category, sent twice by companies on different dates. Of these, the positive rates of affected foods significantly decreased from 39.4% for DEHP and 72.7% for DINP at the first analyses to 3.0% for DEHP and 9.1% for DINP at the second, respectively (p < 0.0001). CONCLUSION: Besides the government-sanctioned foods, foods from the Others category were still affected by phthalate contamination. Thus, vigilant scrutiny of food safety in modern life is necessary.