Locomotor Training and Muscle Function After Incomplete Spinal Cord Injury: Case Series

Abstract

Background/Objective: To determine whether 9 weeks of locomotor training (LT) results in changes in muscle strength and alterations in muscle size and activation after chronic incomplete spinal cord injury (SCI). Study Design: Longitudinal prospective case series.

Methods: Five individuals with chronic incomplete SCI completed 9 weeks of LT. Peak isometric torque, torque developed within the initial 200 milliseconds of contraction (Torque₂₀₀), average rate of torque development (ARTD), and voluntary activation deficits were determined using isokinetic dynamometry for the knee-extensor (KE) and plantar-flexor (PF) muscle groups before and after LT. Maximum muscle crosssectional area (CSA) was measured prior to and after LT.

Results: Locomotor training resulted in improved peak torque production in all participants, with the largest increases in the more-involved PF (43.9% ± 20.0%), followed by the more-involved KE (21.1% ± 12.3%). Even larger improvements were realized in Torque200 and ARTD (indices of explosive torque), after LT. In particular, the largest improvements were realized in the Torque200 measures of the PF muscle group. Improvements in torque production were associated with enhanced voluntary activation in both the KE and ankle PF muscles and an increase in the maximal CSA of the ankle PF muscles.

Conclusion: Nine weeks of LT resulted in positive alterations in the KE and PF muscle groups that included an increase in muscle size, improved voluntary activation, and an improved ability to generate both peak and explosive torque about the knee and ankle joints.     

From rakhi to romance: negotiating ‘acceptable’ relationships in co-educational secondary schools in New Delhi,India

Based on a multi-method study conducted with middle-class young people (aged 15–17) in three secondary schools in New Delhi, India, this paper focuses on heterosocial dynamics within school peer cultures as an important site of learning about gender and sexuality. Findings indicate that young people negotiate and adapt rakhi (brother-sister) relationships to form less strictly platonic heterosocial friendships, which leave open the possibility of romance. Students’ preferences for certain heterosocial relationships are considered within the context of wider cultural narratives. For example, students often rejected rakhi relationships, tied to traditional, conservative values, in favour of heterosocial friendships associated with more modern and desirable social patterns. Moreover, students’ own definitions of acceptable heterosocial interactions within peer cultures suggest that they are adept at negotiating norms of gender segregation that are enforced in co-educational schools. In contrast to other formal and informal sources of sexual learning available to them, experiences and stories of romances circulating in schools seemed to offer students alternative, more positive ways of understanding teenage intimacy and sexuality.     

Hot exciton transition for organic light-emitting diodes: tailoring excited-state properties and electroluminescence performances of donor–spacer–acceptor molecules

The photophysical, electrochemical and electroluminescent properties of newly synthesized blue emitters with donor–π–acceptor geometry, namely, 4′-(1-(naphthalen-1-yl)-1H-phenanthro[9,10-d]imidazol-2-yl)-N,N-diphenyl-(2-[1,1′-biphenyl]vinyl)-4-amine (NSPI-TPA), 4′-(1-(2-methylnaphthalen-1-yl)-1H-phenanthro[9,10-d]imidazol-2-yl)-N,N-diphenyl-(2-[1,1′-biphenyl]vinyl)-4-amine (MNSPI-TPA), 4-(2-(4′-(diphenylamino)-(2-[1,1′-biphenyl]vinyl)-4-yl)-1H-phenanthro[9,10-d]imidazol-1-yl)-1-naphthalene-1-carbonitrile (SPNCN-TPA) and 4-(2-(4-(9H-carbazol-9-yl)styryl)-1H-phenanthro[9,10-d]imidazol-1-yl)naphthalene-1-carbonitrile (SPNCN-Cz) were analyzed. The conjugation length in the emitters is not conducive to pure emission and hence, a molecular twisting strategy was adopted in NSPI-TPA, MNSPI-TPA, SPNCN-TPA and SPNCN-Cz to enhance pure emission. The emissive state (HLCT) of twisted D–π–A molecules containing both LE and CT (HLCT) states was tuned for high PL (η_PL) (LE) and high exciton utilization (η_s) (CT) efficiencies by replacing triphenylamine (strong donor) with carbazole (weak donor). Among strong donor compounds, namely, NSPI-TPA, MNSPI-TPA and SPNCN-TPA, the SPNCN-TPA-based device exhibited blue emission (451 nm) with CIE coordinates (0.15, 0.08), maximum current efficiency (η_c) of 2.32 cd A⁻¹, power efficiency (η_p) of 2.01 lm W⁻¹ and external quantum efficiency (η_ex) of 3.02%. The device with SPNCN-Cz emitter exhibited higher electroluminescence efficiencies than the SPNCN-TPA-based device, with pure blue emission (443 nm, CIE: 0.15,0.07), η_ex of 3.15%, η_c of 2.56 cd A⁻¹ and η_p of 2.45 lm W⁻¹.

SPNCN-Cz device exhibits η_ex (3.15%), η_c (2.56 cd A⁻¹), η_p (2.45 lm W⁻¹) with CIE (0.15, 0.07).     

Building Economic Security Today: Making the Health–Wealth Connection in Contra Costa County’s Maternal and Child Health Programs

In recent years, maternal and child health professionals have been seeking approaches to integrating the Life Course Perspective and social determinants of health into their work. In this article, we describe how community input, staff feedback, and evidence from the field that the connection between wealth and health should be addressed compelled the Contra Costa Family, Maternal and Child Health (FMCH) Programs Life Course Initiative to launch Building Economic Security Today (BEST). BEST utilizes innovative strategies to reduce inequities in health outcomes for low-income Contra Costa families by improving their financial security and stability. FMCH Programs’ Women, Infants, and Children Program (WIC) conducted BEST financial education classes, and its Medically Vulnerable Infant Program (MVIP) instituted BEST financial assessments during public health nurse home visits. Educational and referral resources were also developed and distributed to all clients. The classes at WIC increased clients’ awareness of financial issues and confidence that they could improve their financial situations. WIC clients and staff also gained knowledge about financial resources in the community. MVIP’s financial assessments offered clients a new and needed perspective on their financial situations, as well as support around the financial and psychological stresses of caring for a child with special health care needs. BEST offered FMCH Programs staff opportunities to engage in non-traditional, cross-sector partnerships, and gain new knowledge and skills to address a pressing social determinant of health. We learned the value of flexible timelines, maintaining a long view for creating change, and challenging the traditional paradigm of maternal and child health.     

Techniques and outcomes of transcatheter closure of complex atrial septal defects – Single center experience

Objective

To prospectively study the techniques and outcomes of transcatheter closure of complex Atrial septal defects (ASD).

Study design and settings

Prospective single center study with experience in catheter closure of ASD. All patients with complex ASD suitable for device closure.

Objective

Analysis of outcomes of transcatheter closure of complex ASD in JIPMER Hospital over the past 5-year period.

Methods

Complex ASD was predefined and patients satisfying inclusion and exclusion criteria are included. All the patients had meticulous Transesophageal echocardiography (TEE) imaging beforehand. Modifications of the conventional techniques were allowed on a case per case basis according to operator preference. Successfully intervened patients were followed up clinically.

Results

Out of the 75 patients enrolled, 69 patients had successful device closure (success rate 92%) despite challenging anatomy. Fifty-six (74%) patients had ASD ≥25 mm. Fifteen patients (20%) had defect size ≥35 mm and 20 patients (26.6%) had devices implanted with ≥35 mm waist size. Fifty percent of patients had complete absence of aortic rim and 25% had deficient posterior rim. Twenty percent of patients had malaligned septum. Mean follow up period was 3.2 years.

Conclusions

Trans catheter closure is feasible in anatomically complex substrates of Secundum ASD. Careful case selection, scrupulous imaging protocol, and expertise in modified techniques are mandatory for successful outcomes.