Three-dimensional, task-specific robot therapy of the arm after stroke: a multicentre, parallel-group randomised trial

BACKGROUND: Arm hemiparesis secondary to stroke is common and disabling. We aimed to assess whether robotic training of an affected arm with ARMin--an exoskeleton robot that allows task-specific training in three dimensions-reduces motor impairment more effectively than does conventional therapy. METHODS: In a prospective, multicentre, parallel-group randomised trial, we enrolled patients who had had motor impairment for more than 6 months and moderate-to-severe arm paresis after a cerebrovascular accident who met our eligibility criteria from four centres in Switzerland. Eligible patients were randomly assigned (1:1) to receive robotic or conventional therapy using a centre-stratified randomisation procedure. For both groups, therapy was given for at least 45 min three times a week for 8 weeks (total 24 sessions). The primary outcome was change in score on the arm (upper extremity) section of the Fugl-Meyer assessment (FMA-UE). Assessors tested patients immediately before therapy, after 4 weeks of therapy, at the end of therapy, and 16 weeks and 34 weeks after start of therapy. Assessors were masked to treatment allocation, but patients, therapists, and data analysts were unmasked. Analyses were by modified intention to treat. This study is registered with ClinicalTrials.gov, number NCT00719433. FINDINGS: Between May 4, 2009, and Sept 3, 2012, 143 individuals were tested for eligibility, of whom 77 were eligible and agreed to participate. 38 patients assigned to robotic therapy and 35 assigned to conventional therapy were included in analyses. Patients assigned to robotic therapy had significantly greater improvements in motor function in the affected arm over the course of the study as measured by FMA-UE than did those assigned to conventional therapy (F=4.1, p=0.041; mean difference in score 0.78 points, 95% CI 0.03-1.53). No serious adverse events related to the study occurred. INTERPRETATION: Neurorehabilitation therapy including task-oriented training with an exoskeleton robot can enhance improvement of motor function in a chronically impaired paretic arm after stroke more effectively than conventional therapy. However, the absolute difference between effects of robotic and conventional therapy in our study was small and of weak significance, which leaves the clinical relevance in question.

{\it Hox\/} genes and specification of regional identity in the axial skeleton: Analysis of the individual and combined mutant phenotypes of the paralogous group 4 murine {\it Hox\/} genes; {\it hoxa\/}-4, {\it hoxb\/}-4 and {\it hoxd\/}-4

The Hox gene products are transcription factors involved in specifying regional identity along the anteroposterior body axis. In Drosophila, where these genes are known as HOM-C (Homeotic-complex) genes and where they have been most extensively studied, they are expressed in restricted domains along the anteroposterior axis with different anterior limits. Genetic analysis of a large number of gain- and loss-of-function alleles of these genes has revealed that these genes are important in specifying segmental identity at their anterior limits of expression. Furthermore, there is a functional dominance of posterior genes over anterior genes, such that posterior genes can dominantly specify their developmental programs in spite of the expression of more anterior genes in the same segment. In the mouse, there are four clusters of HOM-C genes, called Hox genes. Thus, there may be up to four genes, called paralogs, that are more highly homologous to each other and to their Drosophila homolog than they are to the other mouse Hox genes. The single mutants for two paralogous genes, hoxa-4 and hoxd-4, presented in this dissertation, are similar to several other mouse Hox mutants in that they show partial, incompletely penetrant homeotic transformations of vertebrae at their anterior limit of expression. These mutants were then bred with hoxb-4 mutants (Ramirez-Solis, et al. 1993) to generate the three possible double mutant combinations as well as the triple mutant. The skeletal phenotypes of these group 4 Hox compound mutants displayed clear alterations in regional identity, such that a nearly complete transformation towards the morphology of the first cervical vertebra occurs. These results suggest a certain degree of functional redundancy among paralogous genes in specifying regional identity. Furthermore, there was a remarkable dose-dependent increase in the number of vertebrae transformed to a first cervical vertebra identity, including the second through the fifth cervical vertebrae in the triple mutant. Thus, these genes are required in a larger anteroposterior domain than is revealed by the single mutant phenotypes alone, such that multiple mutations in these genes result in transformations of vertebrae that are not at their anterior limit of expression. ^

Impacts of a word-picture training on reading in youth with mixed intellectual disabilities. A waiting-list control group comparison

Individuals with intellectual disabilities (ID) often struggle with learning how to read. Reading difficulties seem to be the most common secondary condition of ID. Only one in five children with mild or moderate ID achieves even minimal literacy skills. However, literacy education for children and adolescents with ID has been largely overlooked by researchers and educators. While there is little research on reading of children with ID, many training studies have been conducted with other populations with reading difficulties. The most common approach of acquiring literacy skills consists of sophisticated programs that train phonological skills and auditory perception. Only few studies investigated the influence of implicit learning on literacy skills. Implicit learning processes seem to be largely independent of age and IQ. Children are sensitive to the statistics of their learning environment. By frequent word reading they acquire implicit knowledge about the frequency of single letters and letter patterns in written words. Additionally, semantic connections not only improve the word understanding, but also facilitate storage of words in memory. Advances in communication technology have introduced new possibilities for remediating literacy skills. Computers can provide training material in attractive ways, for example through animations and immediate feedback .These opportunities can scaffold and support attention processes central to learning. Thus, the aim of this intervention study was to develop and implement a computer based word-picture training, which is based on statistical and semantic learning, and to examine the training effects on reading, spelling and attention in children and adolescents (9-16 years) diagnosed with mental retardation (general IQ  74). Fifty children participated in four to five weekly training sessions of 15-20 minutes over 4 weeks, and completed assessments of attention, reading, spelling, short-term memory and fluid intelligence before and after training. After a first assessment (T1), the entire sample was divided in a training group (group A) and a waiting control group (group B). After 4 weeks of training with group A, a second assessment (T2) was administered with both training groups. Afterwards, group B was trained for 4 weeks, before a last assessment (T3) was carried out in both groups. Overall, the results showed that the word-picture training led to substantial gains on word decoding and attention for both training groups. These effects were preserved six weeks later (group A). There was also a clear tendency of improvement in spelling after training for both groups, although the effect did not reach significance. These findings highlight the fact that an implicit statistical learning training in a playful way by motivating computer programs can not only promote reading development, but also attention in children with intellectual disabilities.

The Career Satisfaction Scale in Context: A Test for Measurement Invariance Across Four Occupational Groups

This study analyzed the influence of the occupational context on the conceptualization of career satisfaction measured by the career satisfaction scale (CSS). In a large sample of N ¼ 729 highly educated professionals, a cross-occupational (i.e., physicians, economists, engineers, and teachers) measurement invariance analysis showed that the CSS was conceptualized according to occupational group membership, that is, 4 of the 5 items of the scale showed measurement noninvariance. More specifically, the relative importance, the response biases, and the reliabilities associated with different career satisfaction content domains measured by the CSS (i.e., achieved success, overall career goals, goals for advancement, goals for income, and goals for development of new skills) varied by occupational context. However, results of a comparison between manifest and latent mean differences between the occupational groups revealed that the observed measurement noninvariance did not affect the estimation of mean differences.

Segmentation and Segregation Patterns of Women-Owned High-Tech Firms in Four Metropolitan Regions in the United States

Mayer H. Segmentation and segregation patterns of women-owned high-tech firms in four metropolitan regions in the United States, Regional Studies. The number of women starting and owning a business has increased dramatically and female entrepreneurs are entering non-traditional sectors such as high technology, construction and manufacturing. This paper investigates the trends in high-tech entrepreneurship by women in four US metropolitan regions (Silicon Valley, California; Boston, Massachusetts; Washington, DC; and Portland, Oregon). The research examines the sectoral and spatial segmentation patterns of women-owned high-tech firms. Although women are entering non-traditional sectors, the research finds that women entrepreneurs tend to own businesses in female-typed high-tech sectors. In established high-tech regions like Silicon Valley and Boston, male-typed and female-typed women-owned high-tech firms differ significantly in terms of sectoral and spatial segmentation regardless of firm age. While differences between male-typed and female-typed firms are not significant at the regional level for Washington, DC, the analysis shows significant intra-metropolitan differences for the female-typed high-tech firms. The paper concludes that sectoral and spatial segmentation are powerful dynamics that shape business ownership by women in high technology.

Identifying observable criteria defining a critical situation involving football fans: an expert focus group study

Critical situations (CSs) involving football fans is a well-researched phenomenon with most studies examining factors leading to an escalation of violence (e.g. Braun & Vliegenthart, 2008). However, research so far has fallen short of analysing CSs that do not escalate (e.g. Hylander & Guvå, 2010) as well as establishing observable criteria that constitute such CSs. Granström et al. (2009), for instance, put forward a definition of a CS describing such situations as characterised by a discrepancy between peace and war-making behaviours between police and demonstrators. Still, this definition remains vague and does not provide concrete, defining criteria that can be identified on site. The present study looks beyond fans’ violent acts per se and focuses on these situations with a potentially – but not necessarily - violent outcome. The aim of this preliminary study is to identify observable criteria defining such a CS involving football fans. This focus group comprised of five experts working with football fans in the German-speaking area of Switzerland who discussed observable characteristics of a CS. Inductive content analysis led to the identification of specific criteria such as, “arrest of a fan”, “insufficient distance (<30m) between fans and police” and “fans mask themselves”. These criteria were then assigned to four phases of a CS highlighting the dynamic aspect of this phenomenon: Antecedents, Causes, Reactions, Consequence. Specifically, Causes, Reactions and Consequences are observable on site, while Antecedents include relevant, background information directly influencing a CS. This study puts forward a working definition of a CS that can facilitate the assessment of actual situations in the football context as well as for further research on fan violence prevention and control. These results also highlight similarities with studies investigating fan violence in other European countries while acknowledging unique characteristics of the Swiss German fan culture.

What supports students' education in the operating room? A focus group study including students' and surgeons' views.

BACKGROUND AND METHODS We conducted a focus group analysis with students and surgeons on factors which influence medical school students' education in the operating room (OR). The interviews were analyzed using grounded theory. RESULTS The analysis resulted in 18 detailed and easily applyable themes, which were grouped into the four categories: "Students' preparation and organizational aspects", "Learning objectives", "Educational strategies for the teacher", and "Social-environmental aspects". CONCLUSION By including students and surgeons, we were able to extend existing knowledge and enable better understanding of factors influencing teaching in the OR.

Acoustic multi-frequency indicator of four major groups on a spatial grid in the Bay of Biscay

The first data set contains the mean and cofficient of variation (standard deviation divided by mean) of a multi-frequency indicator I derived from ER60 acoustic information collected at five frequencies (18, 38, 70, 120, and 200 kHz) in the Bay of Biscay in May of the years 2006, 2008, 2009 and 2010 (Pelgas surveys). The multi-frequency indicator was first calculated per voxel (20 m long × 5 m deep sampling unit) and then averaged on a spatial grid (approx. 20 nm × 20 nm) for five 5-m depth layers in the surface waters (10-15m, 15-20m, 20-25m, 25-30m below sea surface); there are missing values in particular in the shallowest layer. The second data set provides for each grid cell and depth layer the proportion of voxels for which the multi-frequency indicator I was indicative of a certain group of organisms. For this the following interpretation was used: I < 0.39 swim bladder fish or large gas bubbles, I = 0.39-0.58 small resonant bubbles present in gas bearing organisms such as larval fish and phytoplankton, I = 0.7-0.8 fluidlike zooplankton such as copepods and euphausiids, and I > 0.8 mackerel. These proportions can be interpreted as a relative abundance index for each of the four organism groups.

Clay mineralogy of the Cenozoic Pagodroma Group, East Antarctica

The Cenozoic Pagodroma Group in the northern Prince Charles Mountains, East Antarctica, is a glaciomarine succession of fjordal character, comprising four uplifted formations of different ages. The composition of the <2 µm fraction of sediments of the Pagodroma Group was analysed in order to help identify source areas, past weathering conditions and glacial regimes. Both clay and non-clay minerals have been quantified. The assemblage of the upper Oligocene to lower Miocene Mount Johnston Formation is characterised by the dominance of illite and intermediate concentrations of chlorite. Similar to that assemblage is the clay mineral suite of the middle Miocene Fisher Bench Formation, where illite and chlorite together account for 95% of the clay minerals. The middle to upper Miocene Battye Glacier Formation is the only formation with significant and persistent smectite concentrations, although illite is still dominant. The kaolinite concentration is also high and is even higher than that of chlorite. The clay fraction of the upper Pliocene to lower Pleistocene Bardin Bluffs Formation is characterised by maximum kaolinite concentrations and relatively low illite and chlorite concentrations. The bulk of the clay fraction in each formation can be explained by the physical weathering and erosion of a nearby source under glacial conditions. In the case of Mount Johnston Formation and Fisher Bench Formation this source may be situated in the metavolcanic and gneissic rocks of Fisher Massif. The sediments of the Bardin Bluffs Formation indicate a local source within the Amery Oasis, where Proterozoic granitoid rocks and gneisses, and Permo-Triassic fluvial rocks of the Amery Group are exposed. These results suggest a strong local imprint on the glacial sediments as northwards flowing ice eroded the bedrock in these areas. The origin of the clay fraction of the Battye Glacier Formation is a matter of debate. The smectite and kaolinite content most easily can be explained by erosion of sources largely hidden beneath the ice upstream. Less likely, these clay minerals reflect climatic conditions that were much warmer and wetter than today, facilitating chemical weathering.

Physiological response to elevated temperature and pCO2 varies across four Pacific coral species: Understanding the unique host + symbiont response

The physiological response to individual and combined stressors of elevated temperature and pCO2 were measured over a 24-day period in four Pacific corals and their respective symbionts (Acropora millepora/Symbiodinium C21a, Pocillopora damicornis/Symbiodinium C1c-d-t, Montipora monasteriata/Symbiodinium C15, and Turbinaria reniformis/Symbiodinium trenchii). Multivariate analyses indicated that elevated temperature played a greater role in altering physiological response, with the greatest degree of change occurring within M. monasteriata and T. reniformis. Algal cellular volume, protein, and lipid content all increased for M. monasteriata. Likewise, S. trenchii volume and protein content in T. reniformis also increased with temperature. Despite decreases in maximal photochemical efficiency, few changes in biochemical composition (i.e. lipids, proteins, and carbohydrates) or cellular volume occurred at high temperature in the two thermally sensitive symbionts C21a and C1c-d-t. Intracellular carbonic anhydrase transcript abundance increased with temperature in A. millepora but not in P. damicornis, possibly reflecting differences in host mitigated carbon supply during thermal stress. Importantly, our results show that the host and symbiont response to climate change differs considerably across species and that greater physiological plasticity in response to elevated temperature may be an important strategy distinguishing thermally tolerant vs. thermally sensitive species.

Communication peculiarities of early-aged children from speech risk group with close grownups

More children with different versions of speech disorders appear in Russia last decades. This situation reflects general tendency of national health deterioration. Our practical experience shows that close grownups can?t communicate to children with limited health capacity. As a result there arise social disabilities in child development. Speech communication is one of the forms of global communicative interaction process between close grownups and young child in the course of which there is a redistribution of knowledge and ignorance (Nikas Luman,2005). Within a framework of sociocultiral theory of mental growth we consider the appearance of speech communication under any cases of physical illness is possible only under conditions of correctly- organized communication between grownups and young children. (L.S. Vigotski ,2000). The special value in this aspect acquires the study of communication between grownups and young children. For five years we have been conducting the surveys on the problem of communicative contacts between parents and non-verbal children. Analysis of received data gave us the opportunity to systematize peculiar communicative interaction of adults and children who have some lapses in acquiring speech form communication. We have revealed four versions of situational- business communication between close grownups and young children with disabilities in acquiring speech. We have assumed that four versions of situational- business communication negatively affect speech form communication formation.

Novel techniques for automorphism group computation

Graph automorphism (GA) is a classical problem, in which the objective is to compute the automorphism group of an input graph. In this work we propose four novel techniques to speed up algorithms that solve the GA problem by exploring a search tree. They increase the performance of the algorithm by allowing to reduce the depth of the search tree, and by effectively pruning it. We formally prove that a GA algorithm that uses these techniques correctly computes the automorphism group of the input graph. We also describe how the techniques have been incorporated into the GA algorithm conauto, as conauto-2.03, with at most an additive polynomial increase in its asymptotic time complexity. We have experimentally evaluated the impact of each of the above techniques with several graph families. We have observed that each of the techniques by itself significantly reduces the number of processed nodes of the search tree in some subset of graphs, which justifies the use of each of them. Then, when they are applied together, their effect is combined, leading to reductions in the number of processed nodes in most graphs. This is also reflected in a reduction of the running time, which is substantial in some graph families.