Patterns of healthcare use among children with immigrant and non-immigrant backgrounds in 2019 and 2020: evidence from the CRIAS cohort study in the metropolitan area of Lisbon, Portugal.

BACKGROUND: International migrant families may face various barriers in the access and use of health services. Evidence on immigrant children's health care or prevention facilities' utilisation patterns is scarce in Portugal. Therefore, the objectives of this study were to compare health services use between immigrant and non-immigrant children in the Metropolitan Area of Lisbon in 2019-2020 with the aim of informing public policies towards equitable access to, and use of health services. METHODS: The CRIAS (Health Trajectories of Immigrant Children) prospective cohort study enrolled 420 children (51.6% immigrant) born in 2015 and attending primary health care (PHC) services in 2019. We compared primary health care facilities and hospital paediatric emergency department (ED) utilisation patterns in the public National Health Service, together with reported private practitioners use, between immigrant and non-immigrant children in 2019 and 2020. The Pearson chi-squared test, Fisher-Freeman-Halton Exact test, two-proportion z-test and Mann‒Whitney U test were used to examine the differences between the two groups. RESULTS: In 2019, no significant differences in PHC consultations attendance between the two groups were observed. However, first-generation immigrant children (children residing in Portugal born in a non-European Union country) accessed fewer routine health assessments compared to non-immigrant children (63.4% vs. 79.2%). When children were acutely ill, 136 parents, of whom 55.9% were parents of non-immigrant children, reported not attending PHC as the first point of contact. Among those, nearly four times more non-immigrant children sought healthcare in the private sector than immigrant children (p < 0.001). Throughout 2019, immigrant children used ED more often than non-immigrant children (53.5% vs. 40.4%, p = 0.010), as their parents reported difficulties in accessing PHC. In 2020, during the COVID-19 pandemic, fewer immigrant children accessed PHC compared to non-immigrant children (70% vs. 80%, p = 0.018). Both non-immigrant and immigrant children reduced ED use by 2.5 times, with a higher decrease among immigrant children (46% vs. 34%). In both 2019 and 2020, over 80% of immigrant and non-immigrant children used ED for conditions classified as having low clinical priority. CONCLUSION: Beyond identifying health care use inequalities between immigrant and non-immigrant children, the study points to urgent needs for public policy and economic investments to strengthen PHC for all children rather than for some.

Exploratory analysis reveals arthropod consumption in 10 lemur species using DNA metabarcoding.

Arthropods (insects, spiders, etc.) can fulfill major nutritional requirements for primates, particularly in terms of proteins, fats, vitamins, and minerals. Yet, for many primate species we know very little about the frequency and importance of arthropod consumption. Traditional methods for arthropod prey identification, such as behavioral observations and fecal dissections, offer limited taxonomic resolution and, as a result, underestimate true diversity. Metabarcoding arthropod DNA from primate fecal samples provides a promising but underused alternative. Here, we inventoried arthropod prey diversity in wild lemurs by sequencing two regions of the CO1 gene. Samples were collected opportunistically from 10 species of lemurs inhabiting three national parks in southern Madagascar using a combination of focal animal follows and live trapping. In total, we detected arthropod DNA in 98 of the 170 fecal samples analyzed. Although all lemur species included in these analyses showed evidence of arthropod consumption, those within the family Cheirogaleidae appeared to consume the highest frequency and diversity of arthropods. To our knowledge, this study presents the first evidence of arthropod consumption in Phaner pallescens, Avahi peyrierasi, and Propithecus verreauxi, and identifies 32 families of arthropods as probable food items that have not been published as lemur dietary items to date. Our study emphasizes the importance of arthropods as a nutritional source and the role DNA metabarcoding can play in elucidating an animal's diet.

Coupling of state-resolved rovibrational coarse-grain model for nitrogen to stochastic particle method for simulating internal energy excitation and dissociation.

We propose to couple a state-resolved rovibrational coarse-grain model to a stochastic particle method for simulating internal energy excitation and dissociation of a molecular gas. A coarse-grained model for a rovibrational reaction mechanism of an ab initio database developed at the NASA Ames Research Center for the N2-N system is modified based on variably spaced energy bins. The thermodynamic properties of the modified coarse-grained model allow us to closely match those obtained with the full set of rovibrational levels over a wide temperature range, while using a number of bins significantly smaller than the complete mechanism. The chemical-kinetic behavior of equally and variably spaced bin formulations is compared by simulating internal energy excitation and dissociation of nitrogen in an adiabatic, isochoric reactor. We find that the variably spaced formulation is better suited for reproducing the dynamics of the full database at conditions of interest in the Earth atmospheric entry. Also in this paper, we discuss the details of our particle method implementation for the uniform rovibrational collisional bin model and describe changes to the Direct Simulation Monte Carlo (DSMC) collision algorithm, which become necessary to accommodate our state-resolved reaction mechanism for excitation and dissociation reactions. The DSMC code is then verified against equivalent master equation calculations. In these simulations, state-resolved cross sections are used in analytical form. These cross sections verify micro-reversibility relations for the rovibrational bins and allow for fast execution of the DSMC code. In our verification calculations, we obtain very close agreement for the concentrations profiles of N and N2, as well as the translational and rovibrational mode temperatures obtained independently through both methods. In addition to macroscopic moments, we compare discrete internal energy populations predicted at selected time steps via DSMC and the master equations. We observe good agreement between the two sets of results within the limits imposed by statistical scatter, which is inherent to particle-based DSMC solutions. As future work, the rovibrational coarse-grain model coupled to the particle method will allow us to study 3D reentry flow configurations.

Pareto genealogies arising from a Poisson branching evolution model with selection.

We study a class of coalescents derived from a sampling procedure out of N i.i.d. Pareto(α) random variables, normalized by their sum, including ß-size-biasing on total length effects (ß < α). Depending on the range of α we derive the large N limit coalescents structure, leading either to a discrete-time Poisson-Dirichlet (α, -ß) Ξ-coalescent (α ε[0, 1)), or to a family of continuous-time Beta (2 - α, α - ß)Λ-coalescents (α ε[1, 2)), or to the Kingman coalescent (α ≥ 2). We indicate that this class of coalescent processes (and their scaling limits) may be viewed as the genealogical processes of some forward in time evolving branching population models including selection effects. In such constant-size population models, the reproduction step, which is based on a fitness-dependent Poisson Point Process with scaling power-law(α) intensity, is coupled to a selection step consisting of sorting out the N fittest individuals issued from the reproduction step.

Rovibrational internal energy transfer and dissociation of N2(1Σg+)-N(4S(u)) system in hypersonic flows.

A rovibrational collisional model is developed to study energy transfer and dissociation of N(2)((1)Σ(g)(+)) molecules interacting with N((4)S(u)) atoms in an ideal isochoric and isothermal chemical reactor. The system examined is a mixture of molecular nitrogen and a small amount of atomic nitrogen. This mixture, initially at room temperature, is heated by several thousands of degrees Kelvin, driving the system toward a strong non-equilibrium condition. The evolution of the population densities of each individual rovibrational level is explicitly determined via the numerical solution of the master equation for temperatures ranging from 5000 to 50,000 K. The reaction rate coefficients are taken from an ab initio database developed at NASA Ames Research Center. The macroscopic relaxation times, energy transfer rates, and dissociation rate coefficients are extracted from the solution of the master equation. The computed rotational-translational (RT) and vibrational-translational (VT) relaxation times are different at low heat bath temperatures (e.g., RT is about two orders of magnitude faster than VT at T = 5000 K), but they converge to a common limiting value at high temperature. This is contrary to the conventional interpretation of thermal relaxation in which translational and rotational relaxation timescales are assumed comparable with vibrational relaxation being considerable slower. Thus, this assumption is questionable under high temperature non-equilibrium conditions. The exchange reaction plays a very significant role in determining the dynamics of the population densities. The macroscopic energy transfer and dissociation rates are found to be slower when exchange processes are neglected. A macroscopic dissociation rate coefficient based on the quasi-stationary distribution, exhibits excellent agreement with experimental data of Appleton et al. [J. Chem. Phys. 48, 599-608 (1968)]. However, at higher temperatures, only about 50% of dissociation is found to take place under quasi-stationary state conditions. This suggest the necessity of explicitly including some rovibrational levels, when solving a global kinetic rate equation.

Conservation and divergence in sorgoleone production of sorghum species.

Sorgoleone-358 is an important allelochemical of the oily droplets exuded from root hairs of various species in the Sorghum genus. Due to its hydrophobic nature, sorgoleone-358 can be strongly adsorbed onto soil organic matter, resulting in increased sorgoleone soil persistence. Because of the herbicidal activity of sorgoleone on many small-seeded weeds, concerns have been raised that sorghum residues may have a detrimental effect on emergence of wheat used as a double crop in the southeastern United States. Laboratory experiments were conducted to evaluate root exudate production and its sorgoleone-358 content for 36 cultivated sorghum cultivars as well as eight shattercane [Sorghum bicolor (L.) Moench ssp. arundinaceum (Desv.) de Wet & Harlan] accessions and one johnsongrass [S. halepense (L.) Pers.] accession. Using a capillary growing mat system, root exudate was extracted with dichloromethane and subjected to chromatography analysis to determine sorgoleone-358 content. Root biomass of 7- to 12-d-old seedlings averaged 18.8 mg g-1 seed, and root exudate production ranged from 0.2 and 4.8 mg g-1 root fresh weight (RFW). The amount of sorgoleone produced varied greatly among sorghum accessions. Sorgoleone-358 amount in the root exudate averaged 0.5 mg g-1 RFW and varied from 0.13 to 1.05 mg g-1 for shattercane cultivar S7 and cultivated sorghum cultivar 992123, respectively. Regarding volume of root biomass, sorgoleone-358 levels averaged 0.49 mg g-1 (range, 0.06-1.46 mg g-1 ) for sorghum cultivar AAS3479 and shattercane cultivar S2, respectively. Segregation of commercial sorghum cultivars according to their maturity group did not show any difference in root biomass and dry extract production, but early-maturing cultivars produced on average 18% less sorgoleone-358 compared with medium- and late-maturing cultivars. These results suggest that sorgoleone production may be genetically constitutive because sorghum growing conditions were identical across cultivars.

Selective Dorsal Root Rhizotomy for Spastic Cerebral Palsy: A Longitudinal Case-Control Analysis of Functional Outcome.

BACKGROUND: The benefit of selective dorsal rhizotomies (SDR) on motor function relative to the cerebral palsy (CP) natural history remains unknown. OBJECTIVE: To determine the functional benefit of SDR over the longitudinal CP natural history. METHODS: Retrospective, single-center, case-control study of patients post-SDR after 1990. Inclusion criteria were the following: diagnosis of spastic CP, at least 1 preoperative and 1 postoperative Gross Motor Function Measure (GMFM-88), at least 1 yr of postoperative follow-up. GMFM-88 assessments were performed at 1, 2, 3, 5, 10, and 15 yr postoperatively and converted to GMFM-66. Cases were stratified by preoperative Gross Motor Function Classification System (GMFCS) and matched against their expected natural history using published reference centiles. After age 12, our cohort and matched controls were also fitted to published nonlinear mixed models of GMFM-66 evolution over time. RESULTS: Analysis included 190 patients. Median follow-up, 5.3 yr (range: 1-16.9), median age at surgery, 4.6 yr, and 81.6% of patients grouped as GMFCS II or III pre-op. SDR patients performed statistically significantly better than their expected natural history (P < .0005). At 21 yr old, a modeled benefit of 8.435 was observed for GMFCS I (P = .0051), 0.05 for GMFCS II (P = .9647), 6.31 for GMFCS III (P < .0001), and 1.191 for GMFCS IV patients (P = .0207). CONCLUSION: These results support the use of SDR in carefully selected spastic CP children.

Optical limiting properties of nonlinear multimode waveguide arrays.

An experimental investigation of the transmission of multimode capillary waveguide arrays containing a liquid nonlinear absorber shows an enhanced nonlinear response relative to that found in a single waveguide and to the same length of bulk material. Comparison of the nonlinear response of arrays with different pitch to diameter (d/Lambda) ratios confirm that both the intensity distribution within an individual waveguide and coupling between the elements of the array influence the overall nonlinear response.

Contraceptive efficacy of intrauterine devices.

To compare the contraceptive efficacy of various types of intrauterine devices (IUD; copper devices, Nova-T, intrauterine contraceptive systems, levonorgestrel-releasing devices), we reviewed all relevant publications on this subject that have been published over the last 2 decades. The first point to be highlighted by this review is the excellent effectiveness of IUDs, with a global cumulative pregnancy rate <2% at 5 years, whatever the type of device used. We observed a large variation in efficacy rate according to the type of IUD and also according to study design. Nevertheless, of all the types of IUDs, the levonorgestrel-releasing IUD and to a lesser extent the TCu380A IUD seem to be the most effective, with a cumulative pregnancy rate at 5 years of <0.5% for the levonorgestrel-releasing IUD and between 0.3% and 0.6% for the TCu380A IUD.

Emission Spectroscopic Boundary Layer Investigation during Ablative Material Testing in Plasmatron.

Ablative Thermal Protection Systems (TPS) allowed the first humans to safely return to Earth from the moon and are still considered as the only solution for future high-speed reentry missions. But despite the advancements made since Apollo, heat flux prediction remains an imperfect science and engineers resort to safety factors to determine the TPS thickness. This goes at the expense of embarked payload, hampering, for example, sample return missions. Ground testing in plasma wind-tunnels is currently the only affordable possibility for both material qualification and validation of material response codes. The subsonic 1.2MW Inductively Coupled Plasmatron facility at the von Karman Institute for Fluid Dynamics is able to reproduce a wide range of reentry environments. This protocol describes a procedure for the study of the gas/surface interaction on ablative materials in high enthalpy flows and presents sample results of a non-pyrolyzing, ablating carbon fiber precursor. With this publication, the authors envisage the definition of a standard procedure, facilitating comparison with other laboratories and contributing to ongoing efforts to improve heat shield reliability and reduce design uncertainties. The described core techniques are non-intrusive methods to track the material recession with a high-speed camera along with the chemistry in the reactive boundary layer, probed by emission spectroscopy. Although optical emission spectroscopy is limited to line-of-sight measurements and is further constrained to electronically excited atoms and molecules, its simplicity and broad applicability still make it the technique of choice for analysis of the reactive boundary layer. Recession of the ablating sample further requires that the distance of the measurement location with respect to the surface is known at all times during the experiment. Calibration of the optical system of the applied three spectrometers allowed quantitative comparison. At the fiber scale, results from a post-test microscopy analysis are presented.

Long-term functional outcome after selective posterior rhizotomy.

OBJECT: Selective posterior rhizotomy (SPR) is a well-recognized treatment for children with spastic cerebral palsy (CP). Few investigators have used quantitative outcome measures to assess the surgical results beyond 3 years. The authors analyzed data obtained from the McGill Rhizotomy Database to determine the long-term functional outcome of children who had undergone selective dorsal rhizotomy accompanied by intraoperative electrophysiological monitoring. METHODS: The study population was composed of children with spastic CP who underwent SPR and were evaluated by a multidisciplinary team preoperatively, and at 6 months and 1 year postoperatively. Quantitative standardized assessments of lower-limb spasticity, passive range of motion, muscle strength, and ambulatory function were obtained. Of the 93 patients who met the entry criteria for the study, 71 completed the 3-year and 50 completed the 5-year assessments, respectively. Statistical analysis demonstrated significant improvements in spasticity, range of motion, and functional muscle strength at 1 year after SPR. The preoperative, 1-, 3-, and 5-year values for the global score of the Gross Motor Function Measure were 64.6, 70.8, 80, and 85.6, respectively. The greatest improvement occurred in the dimensions reflecting lower-extremity motor function, where the mean change was 10.1% at 1 year, 19.9% at 3 years, and 34.4% at the 5-year follow-up review in comparison with the baseline value. This was associated with a lasting improvement in alignment and postural stability during developmental positions, as well as increased ability to perform difficult transitional movements. CONCLUSIONS: The results of this study support the presence of significant improvements in lower-limb functional motor outcome 1 year after SPR, and the improvements persist at 3 and 5 years. The authors conclude that SPR in conjunction with intraoperative stimulation is valuable for permanently alleviating lower-limb spasticity while augmenting motor function.

Functional performance following selective posterior rhizotomy: long-term results determined using a validated evaluative measure.

OBJECT: Selective posterior rhizotomy (SPR) may result in considerable benefit for children with spastic cerebral palsy. To date, however, there have been few studies in which validated functional outcome measures have been used to report surgical results beyond 3 years. The authors analyzed data obtained from the McGill Rhizotomy Database to determine long-term functional performance outcomes in patients who underwent lumbosacral dorsal rhizotomy performed using intraoperative electrophysiological monitoring. METHODS: The study population was composed of children with debilitating spasticity who underwent SPR and were evaluated by a multidisciplinary team preoperatively and at 6 months and 1 year postoperatively. Quantitative standardized assessments of activities of daily living (ADL) were obtained using the Pediatric Evaluation of Disability Inventory (PEDI). Of 57 patients who met the entry criteria for the study, 41 completed the 3-year assessments and 30 completed the 5-year assessments. Statistical analysis demonstrated significant improvement in the mobility and self-care domains of the functional skills dimension at 1 year after SPR. The preoperative and 1-, 3-, and 5-year postoperative scaled scores for the mobility domain were 56, 64, 77.2, and 77.8, respectively. The scaled score for the self-care domain increased from 59 presurgery to 67.9, 81.6, and 82.4 at the 1-, 3-, and 5-year postoperative assessments, respectively. CONCLUSIONS: The results of this study support the presence of significant improvements in functional performance, based on PEDI scores obtained 1 year after SPR. The improvements persisted at the 3- and 5-year follow-up examinations. The authors conclude that SPR performed using intraoperative stimulation is valuable in the augmentation of motor function and self-care skills essential to the performance of ADL.

Transport properties of partially ionized and unmagnetized plasmas.

This work is a comprehensive and theoretical study of transport phenomena in partially ionized and unmagnetized plasmas by means of kinetic theory. The pros and cons of different models encountered in the literature are presented. A dimensional analysis of the Boltzmann equation deals with the disparity of mass between electrons and heavy particles and yields the epochal relaxation concept. First, electrons and heavy particles exhibit distinct kinetic time scales and may have different translational temperatures. The hydrodynamic velocity is assumed to be identical for both types of species. Second, at the hydrodynamic time scale the energy exchanged between electrons and heavy particles tends to equalize both temperatures. Global and species macroscopic fluid conservation equations are given. New constrained integral equations are derived from a modified Chapman-Enskog perturbative method. Adequate bracket integrals are introduced to treat thermal nonequilibrium. A symmetric mathematical formalism is preferred for physical and numerical standpoints. A Laguerre-Sonine polynomial expansion allows for systems of transport to be derived. Momentum, mass, and energy fluxes are associated to shear viscosity, diffusion coefficients, thermal diffusion coefficients, and thermal conductivities. A Goldstein expansion of the perturbation function provides explicit expressions of the thermal diffusion ratios and measurable thermal conductivities. Thermal diffusion terms already found in the Russian literature ensure the exact mass conservation. A generalized Stefan-Maxwell equation is derived following the method of Kolesnikov and Tirskiy. The bracket integral reduction in terms of transport collision integrals is presented in Appendix for the thermal nonequilibrium case. A simple Eucken correction is proposed to deal with the internal degrees of freedom of atoms and polyatomic molecules, neglecting inelastic collisions. The authors believe that the final expressions are readily usable for practical applications in fluid dynamics.

Hip joint osteochondroma: systematic review of the literature and report of three further cases.

The aim of this study is to systematically review the literature with regards to surgical treatment of patients with hip joint osteochondromas, and to report our surgical management of three paediatric patients who had femoral neck or acetabular osteochondromas in association with acetabular dysplasia. We performed a systematic review using PubMed and Embase databases for all studies that reported surgical treatments for patients with peritrochanteric or acetabular osteochondroma with or without acetabular dysplasia. We also retrospectively reviewed three patients who were diagnosed with a hip osteochondroma in association with actetabular dysplasia. These patients were known to have hereditary multiple exostoses (HME). The systematic review revealed 21 studies that met our inclusion criteria. All studies were case reports and retrospective in nature and failed to conclude a uniform treatment plan. The three reported cases illustrate successful excision of hip osteochondromas and treatment of acetabular dysplasia. Early excision of hip osteochondromas might prevent acetabular dysplasia in HME patients. Routine radiographic pelvic survey at the time of diagnosis of HME is recommended for early detection of hip osteochondromas and acetabular dysplasia in these children.

Long-term functional benefits of selective dorsal rhizotomy for spastic cerebral palsy.

OBJECT: Large-scale natural history studies of gross motor development have shown that children with spastic cerebral palsy (CP) plateau during childhood and actually decline through adolescence. Selective dorsal rhizotomy (SDR) is a well-recognized treatment for spastic CP, but little is known about long-term outcomes of this treatment. The purpose of this study was to assess the durability of functional outcomes in a large number of patients through adolescence and into early adulthood using standardized assessment tools. METHODS: The authors analyzed long-term follow-up data in children who had been evaluated by a multidisciplinary team preoperatively and at 1, 5, 10, and 15 years after SDR. These evaluations included quantitative, standardized assessments of lower-limb tone (Ashworth Scale), Gross Motor Function Measure (GMFM), and performance of activities of daily living (ADLs) by the Pediatric Evaluation of Disability Inventory in children who had been stratified by motor severity using the Gross Motor Function Classification System (GMFCS). In addition, group-based trajectory modeling (GBTM) was used to identify any heterogeneity of response to SDR among these treated children, and to find which pretreatment variables might be associated with this heterogeneity. Finally, a chart review of adjunct orthopedic procedures required by these children following SDR was performed. RESULTS: Of 102 patients who underwent preoperative evaluations, 97, 62, 57, and 14 patients completed postoperative assessments at 1, 5, 10, and 15 years, respectively. After SDR, through adolescence and into early adulthood, statistically significant durable improvements in lower-limb muscle tone, gross motor function, and performance of ADLs were found. When stratified by the GMFCS, long-lasting improvements for GMFCS Groups I, II, and III were found. The GBTM revealed 4 groups of patients who responded differently to SDR. This group assignment was associated with distribution of spasticity (diplegia was associated with better outcomes than triplegia or quadriplegia) and degree of hip adductor spasticity (Ashworth score < 3 was associated with better outcomes than a score of 3), but not with age, sex, degree of ankle plantar flexion spasticity, or degree of hamstring spasticity. In a sample of 88 patients who had complete records of orthopedic procedures and botulinum toxin (Botox) injections, 52 (59.1%) underwent SDR alone, 11 (12.5%) received only Botox injections in addition to SDR, while 25 patients (28.4%) needed further lower-extremity orthopedic surgery after SDR. CONCLUSIONS: In the majority of patients, the benefits of SDR are durable through adolescence and into early adulthood. These benefits include improved muscle tone, gross motor function, and performance of ADLs, as well as a decreased need for adjunct orthopedic procedures or Botox injections. The children most likely to display these long-term benefits are those in GMFCS Groups I, II, and III, with spastic diplegia, less hip adductor spasticity, and preoperative GMFM scores greater than 60.

Clinical outcome of pediatric calcaneal fractures treated with open reduction and internal fixation.

The results of displaced intra-articular calcaneal fractures treated with open reduction and internal fixation in skeletally immature children at one institution were reviewed. Six children with seven displaced intra-articular calcaneal fractures treated with open reduction and internal fixation were reviewed at an average of 30 months after surgery (range 18-48 months). All children were treated by one of two surgeons and followed by the same surgeon. The preoperative workup included computed tomography scans, which showed that all had displaced intra-articular fractures and five had comminuted fractures. At follow-up all children were pain-free with normal activities. All were able to return to full activities at an average of 10 months after surgery. All had normal ankle range of motion, but five had decreased subtalar range of motion. There were no postoperative complications, shoe wear problems, or peroneal tendinitis. This study demonstrates that open reduction and internal fixation for displaced intra-articular fractures in children yields encouraging results.

Impact of selective posterior rhizotomy on fine motor skills. Long-term results using a validated evaluative measure.

Suprasegmental effects following selective posterior rhizotomy have been frequently reported. However, few studies have used validated functional outcome measures to report the surgical results beyond 3 years. The authors analyzed data obtained from the McGill Rhizotomy Database to determine the long-term impact of lumbosacral dorsal rhizotomy on fine motor skills. The study population comprised children with debilitating spasticity who underwent SPR and were evaluated by a multidisciplinary team preoperatively, at 6 months and 1 year postoperatively. Quantitative standardized assessments of upper extremity function were obtained using the fine motor skills section of the Peabody Developmental Motor Scales (PDMS) test. Of 70 patients who met the entry criteria for the study, 45 and 25 completed the 3- and 5-year assessments, respectively. Statistical analysis demonstrated significant improvements in grasping, hand use, eye-hand coordination, and manual dexterity at 1 year after SPR. More importantly, all improvements were maintained at 3 and 5 years following SPR. This study supports that significant improvements in upper extremity fine motor function using the PDMS evaluative measure are present after SPR and that these suprasegmental benefits are durable.