Information entropy facilitates (not impedes) lexical processing during language comprehension.

It is well known that contextual predictability facilitates word identification, but it is less clear whether the uncertainty associated with the current context (i.e., its lexical entropy) influences sentence processing. On the one hand, high entropy contexts may lead to interference due to greater number of lexical competitors. On the other hand, predicting multiple lexical competitors may facilitate processing through the preactivation of shared semantic features. In this study, we examined whether entropy measured at the trial level (i.e., for each participant, for each item) corresponds to facilitatory or inhibitory effects. Trial-level entropy captures each individual's knowledge about specific contexts and is therefore a more valid and sensitive measure of entropy (relative to the commonly employed item-level entropy). Participants (N = 112) completed two experimental sessions (with counterbalanced orders) that were separated by a 3- to 14-day interval. In one session, they produced up to 10 completions for sentence fragments (N = 647). In another session, they read the same sentences including a target word (whose entropy value was calculated based on the produced completions) while reading times were measured. We observed a facilitatory (not inhibitory) effect of trial-level entropy on lexical processing over and above item-level measures of lexical predictability (including cloze probability, surprisal, and semantic constraint). Extra analyses revealed that greater semantic overlap between the target and the produced responses facilitated target processing. Thus, the results lend support to theories of lexical prediction maintaining that prediction involves broad activation of semantic features rather than activation of full lexical forms.

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.

Exploring the relationships among safety leadership, safety climate, psychological contract of safety, risk perception, safety compliance, and safety outcomes.

Background: Recently, two types of safety compliance behaviors including deep compliance and surface compliance were differentiated. The current study aimed to investigate the relationships among safety leadership, safety climate, psychological contract of safety (PCS), risk perception, and deep compliance and surface compliance behavior of workers. In addition, the effects of both deep and surface compliance on safety outcomes were considered. Methods: Workers' perceptions in terms of safety leadership, safety climate, PCS, risk perception, deep compliance, and surface compliance were measured by appropriate questionnaires. Three questions were asked to measure undesired safety outcomes. Structural equation modeling and correlation analysis were applied to examine the research model and relationships among variables. Results and discussion: The results of the current study showed that deep compliance was positively predicted by safety leadership, safety climate, and PCS and negatively predicted by risk perception. Surface compliance was positively predicted by safety leadership and safety climate and negatively predicted by risk perception. Surface compliance is not significantly predicted by PCS. With regard to the adverse safety outcomes, the results showed that both deep and surface compliance were negatively associated with adverse safety outcomes, however, deep compliance had a stronger negative correlation with adverse safety outcomes than surface compliance.

Machine learning model optimization for removal of steroid hormones from wastewater.

In the past few decades, there has been a significant focus on detecting steroid hormones in aquatic environments due to their influence on the endocrine system. Most compounds of these pollutants are the natural steroidal estrogens, i.e., estrone (E1), 17ß-Estradiol (E2), and the synthetic estrogen 17α-Ethinylestradiol (EE2). The Moving-Bed Biofilm Reactor (MBBR) technique is appropriate for eliminating steroid hormones. This study centers on creating a model to estimate the effectiveness of the MBBR system regarding its ability to eliminate E1, E2, and EE2. The results were modeled with artificial neural networks (ANNs). The Particle Warm Optimization (PSO) and Levenberg Marquardt (LM) algorithms were selected for network training. The models incorporated five input parameters, encompassing the COD loading rate, initial levels of E1, E2, and EE2 steroid hormones, and Hydraulic Retention Time (HRT). The optimum removal conditions (three steroid hormones and COD) were determined using the optimized ANN based on both PSO and LM algorithms. The optimal transfer functions for the hidden and output layers were identified as tan-sigmoid and linear, respectively. The best ANN structures (Neurons in input, hidden, and output layers) and correlation coefficients (R) were 5:9:4, with R = 0.9978, and 5:10:4, with R = 0.9982 for the trained networks with LM and PSO algorithms, respectively. Eventually, the input parameters' importance was ranked using sensitivity analysis (SA) through Pearson correlation and developed ANNs.

Concepts in Space: Enhancing Lexical Search With a Spatial Diversity Prime.

Informed by theories of embodied cognition, in the present study, we designed a novel priming technique to investigate the impact of spatial diversity and script direction on searching through concepts in both English and Persian (i.e., two languages with opposite script directions). First, participants connected a target dot either to one other dot (linear condition) or to multiple other dots (diverse condition) and either from left to right (rightward condition) or from right to left (leftward condition) on a computer touchscreen using their dominant hand's forefinger. Following the spatial prime, they were asked to generate as many words as possible using two-letter cues (e.g., "lo" → "love," "lobster") in 20 s. We hypothesized that greater spatial diversity, and consistency with script direction, should facilitate conceptual search and result in a higher number of word productions. In both languages, word production performance was superior for the diverse prime relative to the linear prime, suggesting that searching through lexical memory is facilitated by spatial diversity. Although some effects were observed for the directionality of the spatial prime, they were not consistent across experiments and did not correlate with script direction. This pattern of results suggests that a spatial prime that promotes diverse paths can improve word retrieval from lexical memory and lends empirical support to the embodied cognition framework, in which spatial relations play a crucial role in the conceptual system.

Biological 2,4,6-trinitrotoluene removal by extended aeration activated sludge: optimization using artificial neural network.

Serious health issues can result from exposure to the nitrogenous pollutant like 2,4,6-trinitrotoluene (TNT), which is emitted into the environment by the munitions and military industries, as well as from TNT-contaminated wastewater. The TNT removal by extended aeration activated sludge (EAAS) was optimized in the current study using artificial neural network modeling. In order to achieve the best removal efficiency, 500 mg/L of chemical oxygen demand (COD), 4 and 6 h of hydraulic retention time (HRT), and 1-30 mg/L of TNT were used in this study. The kinetics of TNT removal by the EAAS system were described by the calculation of the kinetic coefficients K, Ks, Kd, max, MLSS, MLVSS, F/M, and SVI. Adaptive neuro fuzzy inference system (ANFIS) and genetic algorithms (GA) were used to optimize the data obtained through TNT elimination. ANFIS approach was used to analyze and interpret the given data, and its accuracy was around 97.93%. The most effective removal efficiency was determined using the GA method. Under ideal circumstances (10 mg/L TNT concentration and 6 h), the TNT removal effectiveness of the EAAS system was 84.25%. Our findings demonstrated that the artificial neural network system (ANFIS)-based EAAS optimization could enhance the effectiveness of TNT removal. Additionally, it can be claimed that the enhanced EAAS system has the ability to extract wastewaters with larger concentrations of TNT as compared to earlier experiments.

The Effects of Spinal Manipulation Added to Exercise on Pain and Quality of Life in Patients with Thoracic Spinal Pain: A Randomized Controlled Trial.

Background: There are not enough reliable studies available in physiotherapy to determine the effects of spinal manipulative therapy added to exercise on thoracic spinal pain and quality of life. Objective: To investigate the effects of spinal manipulation on pain and quality of life in subjects with thoracic spinal pain. Study Design. It was an open-label "randomized controlled trial." Study Settings. Department of Physiotherapy, Services Hospital, Lahore, Pakistan. Participants. There were one hundred subjects with an age group between 18 and 60 years fulfilling the inclusion criteria. These subjects were divided equally into two groups; an experimental and a control group. Methods: In the experimental group (n = 50), thoracic spinal manipulation was applied along with thoracic muscle strengthening exercises. In the control group (n = 50) thoracic muscle exercises alone were given. Pain was measured by visual analogue scale (VAS) and quality of life with SF-36. Measurements were taken at baseline, immediately after session, after 8th session, and later as follow-ups at 12 weeks. Repeated measure ANOVA and independent sample T-test were used for within and between-group comparisons. Results: Mean age of subjects in control group was 38.56 ± 12.44 and in experimental group was 36.02 ± 11.32. Both groups demonstrated significant improvement in VAS score, and all domains of SF 36 but between-group comparison showed greater improvement in VAS of the experimental group compared to the baseline (P < 0.05), but between-group comparison of 8th session to follow-up has shown that effects of exercise persist while health-related quality of life in spinal manipulation group was significantly reduced after discontinuation of treatment. After the 8th session, spinal manipulation group showed notable results in terms of pain (mean diff 1.14 (0.62, 1.65) 95% CI and all aspects of SF 36 (P value <0.05). However, after week 12 of follow-up, no significant difference (P value >0.05) was observed among the study groups for pain and quality of life. Conclusion: Spinal manipulation added to thoracic exercise was more effective than thoracic exercise alone for improving pain and quality of life at the end of 8th session of care. However, the inclusion of spinal manipulation was not found effective at the 12-week follow-up. This trial is registered with IRCT20190327043125N1.

Acute adverse events following immunization with DTP-HB-Hib pentavalent vaccine in the first year of life.

Background: Since November 2014, the pentavalent (Diptheria+Tetanus+Pertussis and Hepatitis B and Hib or DTP-HBHib) vaccine has been integrated into the Iranian national vaccination programme. Aims: We conducted a prospective study in Zahedan in the southeast of the Islamic Republic of Iran to determine the incidence of adverse events following immunization (AEFI) with the pentavalent vaccine in children aged under one year. Methods: Using cluster sampling, 1119 children aged 2-10 months at 15 public health clinics were invited, through their parents, to participate in the study. The parents were trained to register and report any AEFIs in a questionnaire. They were instructed to return the child to the clinic for further examination by a physician if they observed any complications within 3 days of vaccination. Results: The most commonly reported AEFIs were fever (50.94%), mild (41.46%) and severe (1.70%) injection site complications, persistent crying for 3 hours or more (1.88%), hypotonic hyporesponsive episode (0.36%), vomiting (1.88%), diarrhoea (2.95%), and sterile abscess (0.62%). There were no cases of convulsion, purulent abscess or rash. The work experience of vaccinators (OR = 1.85; 95% CI: 1.4-2.46) showed a significant statistical association with the incidence of mild local complications at the injection site. Those with a history of Bacillus Calmette-Guérin (BCG) lymphadenitis (OR = 3.89; 95% CI:1.04-14.49) had a higher risk of severe local complications at the injection site. Conclusions: The observed incidence of serious AEFIs following pentavalent vaccine injection in the study population was within the expected range. However, some of the relationships observed in this study require further research.

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.

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.

Comparative Efficacy of Routine Physical Therapy with and without Neuromobilization in the Treatment of Patients with Mild to Moderate Carpal Tunnel Syndrome.

Background: Median nerve mobilization is a relatively new technique that can be used to treat carpal tunnel syndrome. But literature about additional effects of neuromobilization for the management of carpal tunnel syndrome is scarce. Objective: To examine and compare the role of median nerve neuromobilization at the wrist as compared to routine physical therapy in improving pain numeric pain rating scale (NPRS), range of motion (Ballestero-Pérez et al., 2017), muscle strength, and functional status. Methods: A sample size of 66 patients was recruited using convenient sampling and distributed randomly in two groups. After assessing both groups using ROM, manual muscle strength, pain at NPRS, and functional status on the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), which consists of two further scales (the symptom severity scale (SSS) and the functional status scale (FSS)), Group 1 received conservative treatment including ultrasound therapy two days a week for six weeks, using a pulsed mode 0.8 W/cm2 and frequency 1 MHz, wrist splinting, and tendon gliding exercises, while Group 2 received both conservative treatments including ultrasound, splinting, and tendon gliding exercises as well as a neuromobilization technique. Treatment was given for 6 weeks, 2 sessions/week, and patients were reassessed at the end of the 3rd and 6th weeks. Results: Although both groups improved significantly in terms of all the outcome measures used, the neuromobilization groups showed a statistically more significant increase in flexion, extension, decrease in pain, decrease in SSS, decrease in FSS, and BCTQ as compared to the routine physical therapy group. Conclusions: The addition of neuromobilization in the rehabilitation program of carpal tunnel syndrome has better effects on treatment outcomes.

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.

Virtual Reality Training Using Nintendo Wii Games for Patients With Stroke: Randomized Controlled Trial.

BACKGROUND: Stroke is a leading cause of disability. It is difficult to devise an optimal rehabilitation plan once stroke survivors are back home. Conventional rehabilitative therapies are extensively used in patients with stroke to recover motor functioning and disability, but these are arduous and expensive. Virtual reality (VR) video games inspire patients to get involved in their therapeutic exercise routine in a fun way. VR in the form of games provides a fruitful, secure, and challenging learning environment for motor control and neural plasticity development in rehabilitation. The effects of upper limb sensorimotor functioning and balance are the main focus of this trial. OBJECTIVE: The aim of this study is to compare the effects of VR training and routine physical therapy on balance and upper extremity sensorimotor function in patients with stroke. METHODS: It was a single assessor-blinded randomized clinical trial. A total of 74 participants with their first chronic stroke were included and rehabilitated in a clinical setting. The lottery method was used to randomly assign patients to either the VR group (n=37) or the routine physical therapy group (n=37). The VR group received a 1-hour session of VR training for 3 weekdays over 6 weeks, and the routine physical therapy group received different stretching and strengthening exercises. The outcome measuring tools were the Berg Balance Scale for balance and the Fugl-Meyer Assessment (upper extremity) scale for sensorimotor, joint pain, and range assessment. The assessment was done at the start of treatment and after the 6 weeks of intervention. Data analysis was done using SPSS 22. RESULTS: The trial was completed by 68 patients. A significant difference between the two groups was found in the Berg Balance Scale score (P<.001), Fugl-Meyer Assessment for motor function (P=.03), and Fugl-Meyer Assessment for joint pain and joint range (P<.001); however, no significant difference (P=.19) in the Fugl-Meyer Assessment for upper extremity sensation was noted. CONCLUSIONS: VR training is helpful for improving balance and function of the upper extremities in the routine life of patients with stroke; although, it was not found to be better than conventional training in improving upper limb sensation. VR training can be a better option in a rehabilitation plan designed to increase functional capability. TRIAL REGISTRATION: Iranian Registry of Clinical Trials RCT20190715044216N1; https://www.irct.ir/user/trial/40898/view.

A Comparison Study of the Tehran Norms to the Reference Norms on Children Performance of the Bayley III.

Objectives: The Bayley Scales of Infant and Toddler Development (3rd ed.; Bayley III) are widely used to assess cognitive, language, and motor development of children aged 1-42 months. It is unclear whether or not the reference norms of the Bayley III are acceptable for use in other populations or lead to over- or underestimating the developmental status of target children. This study aimed to compare the Tehran norms to the reference norms. Materials & Methods: We used Bayley III norms to assess cognitive, language, and motor development of 1,674 healthy children from health care centers in Tehran. Differences between the scaled scores were calculated based on the Tehran and reference norms. A one-sample multivariate analysis of variance (MANOVA) was used to control the mean difference scores over all subtests. When MANOVA showed significant differences between the scaled scores based on the Tehran and reference norms, we used univariate analysis to see which subtest and age group led to these significant differences. Finally, the proportions of children with low scores (scaled scores <7 or -1 SD and <4 or -2 SD) based on 2 norms were compared using the McNemar test to determine the over- or underestimation of developmental delay. Results: The scaled scores based on the Tehran norms varied across values based on the reference norms in all subtests. The mean differences were significant in all 5 subtests (p < .05) with large effect sizes for receptive and expressive communication, fine and gross motor subtests of .20, .23, .14, and .25, respectively, as well as with a small effect size for the cognition subtest of .02. Large effect sizes for all age groups were found for cognition, expressive communication, and fine motor subtests. More children scored below 1 and 2 SD using the Tehran norms. Using the reference norms resulted in underestimation of developmental delay regarding cognitive, receptive and expressive communication, and fine and gross motor skills. Conclusion: Population-specific norms should be used to identify children with low scores for referral and intervention. The Tehran norms differed from the reference norms for all subtests, and these differences were clinically significant.

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).

Neural sensitivity to semantic neighbors is stable across the adult lifespan.

As we age, language reflects patterns of both stability and change. On the one hand, vocabulary and semantic abilities are largely stable across the adult lifespan, yet lexical retrieval is often slower and less successful (i.e., slower picture naming times, increased tip of the tongue incidents). Although the behavioral bases of these effects have been well established, less is known about the brain regions that support these age-related differences. We used functional Magnetic Resonance Imaging (fMRI) to examine the neural basis of picture naming. Specifically, we were interested in whether older adults would be equally sensitive to semantic characteristics, specifically the number of semantic near neighbors. Near neighbors, defined here as items with a high degree of semantic feature overlap, were of interest as these are thought to elicit competition among potential candidates and increase naming difficulty. Consistent with prior reports, pictures with more semantic near neighbors were named more slowly and less accurately for all adults. Additionally, this interference for naming times was larger as age increased, starting around 30 years old. In contrast to the age-related behavioral slowing, the neural basis of these effects was stable across adulthood. Across all adults, a number of language-relevant regions including left posterior middle temporal gyrus and left inferior frontal gyrus, pars triangularis were sensitive to the number of near neighbors. Our results suggest that although middle-aged and older adults' picture naming is more slowed by increased semantic competition, the brain regions supporting semantic processes remain stable across the adult lifespan.

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 ).

Greater entropy leads to more explicit referential forms during language production.

Speakers can refer to previously-mentioned words (e.g., the actor) using attenuated referring expressions such as pronouns (he), or elaborated referential forms such as repeating the original word (the actor). Predictability is theorized to influence form of reference during language production: More attenuated forms may be used to refer to more predictable words, presumably because predictable words are already active in memory, and therefore require less linguistic signal during subsequent reference. However, the reported results are mixed. The current study examines the effect of entropy, an information-theoretic metric that captures the predictability of all, not just one, referential candidate, on the production of referential forms. A meta-analysis combining data from multiple experiments (492 participants, 405 items) revealed that greater entropy leads to more explicit referential forms, suggesting that entropy might intensify the competition between referential candidates during language production, reducing total memory activation.

A Novel Virtual Reality Training Strategy for Poststroke Patients: A Randomized Clinical Trial.

Stroke patients suffer impairments including sensory, motor, visual, and cognitive areas, as well as gait and balance manifestations making activities of daily living difficult. In such conditions, virtual reality training can be a potential rehabilitation tool in comparison to conventional physical therapy to cater to the burden of this disability; hence, this randomized clinical trial compared the effects of virtual reality training and conventional physical therapy on balance and lower extremity function in stroke patients. The sample of 68 poststroke participants from Kanaan Physical Therapy and Spine Clinic, Lahore, Pakistan, were divided into N = 34 cases each using the lottery method with one group given virtual reality training and the other received conventional physical therapy. Each group received 60 minutes intervention, 3 days per week for 6 weeks. The Berg balance scale and the Fugl-Meyer assessment-lower extremity scale were employed for data collection preintervention, immediate postintervention, and 6 weeks postintervention. The statistically significant differences between virtual reality and conventional physical therapy groups for the Berg Balance score (p < 0.001), Fugl-Meyer assessment (FMA)-lower extremity domains of FMA-motor function (p < 0.001), FMA-joint pain, and joint range (p < 0.001); however, there is no significant difference (p=0.202) for time vs. group interaction and significant (p < 0.001) for the time main effect for FMA sensation. Hence, virtual reality training is more effective to restore balance and lower extremity function compared to conventional physical therapy in stroke patients. The results of the study have significant implications for the clinicians with better case management enhancing quality of life of patients along with the dearth of local literature, thus providing base for future research from a developing country's perspective.

Effects of intensive multiplanar trunk training coupled with dual-task exercises on balance, mobility, and fall risk in patients with stroke: a randomized controlled trial.

OBJECTIVE: We determined whether an exercise regime comprising high-intensity training, multiplanar trunk movements, and dual-task practice could improve trunk control, balance, functional mobility, and reduce fall risk in patients with hemiplegic stroke. METHODS: In this randomized controlled trial, 74 patients (mean age 61.71 years) were randomly assigned to the experimental and comparison groups. Primary outcome was trunk impairment scale (TIS) scores. Secondary outcomes were scores on the Berg balance scale, 10-meter walk test, Timed-up-and-go test, timed-Up-Go-cognitive, and Stroke Impact Scale-16 to measure between-group changes from baseline. We used linear mixed modeling to identify changes over time within and between groups on each scale and whether changes persisted at 6- and 12-month follow-ups. RESULTS: We observed significantly increased mean TIS scores from baseline to 3 months post-treatment (7.74); the increased scores were maintained at 6- and 12-month follow-ups (8.60 and 8.43, respectively). In the experimental group, all secondary outcomes showed significant and clinically meaningful results. Fall risk between groups was significantly reduced at 6 and 12 months. CONCLUSIONS: Intensive multiplanar trunk movements coupled with dual-task practice promoted trunk control, balance, and functional recovery in patients with stroke, reduced fall risk, and improved independent mobility.Trial registration: #IRCT20200127046275N1.