Publications by authors named "David T Burke"

69 Publications

Medication Adherence and Liquid Level Tracking System for Healthcare Provider Feedback.

Sensors (Basel) 2020 Apr 24;20(8). Epub 2020 Apr 24.

Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA.

A common problem for healthcare providers is accurately tracking patients' adherence to medication and providing real-time feedback on the management of their medication regimen. This is a particular problem for eye drop medications, as the current commercially available monitors focus on measuring adherence to pills, and not to eye drops. This work presents an intelligent bottle sleeve that slides onto a prescription eye drop medication bottle. The intelligent sleeve is capable of detecting eye drop use, measuring fluid level, and sending use information to a healthcare team to facilitate intervention. The electronics embedded into the sleeve measure fluid level, dropper orientation, the state of the dropper top (on/off), and rates of angular motion during an application. The sleeve was tested with ten patients (age ≥65) and successfully identified and timestamped 94% of use events. On-board processing enabled event detection and the measurement of fluid levels at a 0.4 mL resolution. These data were communicated to the healthcare team using Bluetooth and Wi-Fi in real-time, enabling rapid feedback to the subject. The healthcare team can therefore monitor a log of medication use behavior to make informed decisions on treatment or support for the patient.
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http://dx.doi.org/10.3390/s20082435DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7219493PMC
April 2020

Methylphenidate improves executive functions in patients with traumatic brain injuries: a feasibility trial via the idiographic approach.

BMC Neurol 2020 Mar 19;20(1):103. Epub 2020 Mar 19.

Research & Policy Department, World Innovation Summit for Health (WISH), Qatar Foundation, P.O. Box 5825, Doha, Qatar.

Background: Road traffic accidents are known to be the main cause of traumatic brain injury (TBI). TBI is also a leading cause of death and disability. This study, by means of the idiographic approach (single-case experimental designs using multiple-baseline designs), has examined whether methylphenidate (MPH - trade name Ritalin) had a differential effect on cognitive measures among patients with TBI with the sequel of acute and chronic post-concussion syndromes. The effect on gender was also explored.

Methods: In comparison with healthy controls, patients with TBI (acute and chronic) and accompanying mild cognitive impairment (MCI) were screened for their integrity of executive functioning. Twenty-four patients exhibiting executive dysfunction (ED) were then instituted with the pharmacological intervention methylphenidate (MPH). The methylphenidate was administered using an uncontrolled, open label design.

Results: The administration of methylphenidate impacted ED in the TBI group but had no effect on mood. Attenuation of ED was more apparent in the chronic phases of TBI. The effect on gender was not statistically significant with regard to the observed changes.

Conclusions: To our knowledge, this is the first feasibility trial from the Arabian Gulf to report the performance of a TBI population with mild cognitive impairment according to the IQCODE Arabic version. This investigation confirms anecdotal observations of methylphenidate having the potential to attenuate cognitive impairment; particularly those functions that are critically involved in the integrity of executive functioning. The present feasibility trial should be followed by nomothetic studies such as those that adhere to the protocol of the randomized controlled trial. This evidence-based research is the foundation for intervention and future resource allocation by policy- or public health decision-makers.
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http://dx.doi.org/10.1186/s12883-020-01663-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081568PMC
March 2020

The Effect of Body Mass Index on Functional Outcome of Patients With Knee Replacement.

Arch Rehabil Res Clin Transl 2019 Dec 29;1(3-4):100019. Epub 2019 Aug 29.

Research and Statistics, Oman Medical Specialty Board, Muscat, Oman.

Objective: To investigate the effects of body mass index (BMI) on the rehabilitation process in patients with a recent knee replacement.

Design: This retrospective cohort study included all patients admitted to a rehabilitation hospital, with a recent diagnosis of knee replacement and available hospital admission data including height and weight, between 2014 and 2017.

Setting: Rehabilitation hospital.

Participants: Study participants included patients who had undergone knee replacement surgery (N=742), with available BMI data.

Interventions: None.

Main Outcome Measures: FIM scores, including FIM change per day (FIM efficiency) by BMI category.

Results: The chart review identified 742 patients who had undergone knee replacement surgery, with available BMI data. The identified patients ranged in age from 58 to 85 years, with a mean age of 70 years. Of the patients included in the study, 24 were male, 49 were female, 73 were within the normal weight class, 180 in the overweight class, 189 in the obese class I, 143 in the obese class II, and 157 patients were classified as obese class III. The mean FIM efficiency was highest in the obese class II category (3.96). In a multivariate analysis after controlling for age, obese classes II and III had significantly better FIM efficiency.

Conclusion: This study did not demonstrate that obesity adversely affects the rate of recovery during hospitalization after knee replacement surgery.
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http://dx.doi.org/10.1016/j.arrct.2019.100019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853343PMC
December 2019

The Effect of Body Mass Index on Pulmonary Related Debility Rehabilitation.

PM R 2020 04 17;12(4):363-367. Epub 2019 Oct 17.

Department of Biology, Georgia State University, Atlanta, GA.

Background: Obesity is a known factor for the development of abnormal respiratory physiology. However, several studies have found that obesity does not hinder functional recovery in patients hospitalized for postacute care following a stroke or cardiovascular event. This study was designed to determine the effect of overweight and obesity on patients with acute pulmonary disease, hospitalized in an inpatient rehabilitation facility (IRF).

Objective: To investigate the impact of body mass index (BMI) on indices of function, specifically, the functional independence measure (FIM) among patients with pulmonary related debility admitted to a rehabilitation hospital.

Design: Retrospective cohort study.

Setting: Pulmonary unit in an acute freestanding rehabilitation hospital.

Patients: All patients admitted to an IRF with a diagnosis of pulmonary related debility over a 6-year period.

Methods: The data used in the study included the patient height and weight (measured on admission) and FIM (scored on admission and discharge).

Main Outcome Measures: The primary study outcome measure was the change in FIM per day by the patients' BMI category.

Results: For the 381 patients admitted during the observation period, BMI was compared with FIM score changes per day (FIM efficiency). After adjusting for age and sex, the FIM efficiency only slightly differed by BMI, failing to reach statistical significance. However, age did significantly influence the outcome (P = .05).

Conclusion: This study demonstrates that among a large group of patients with a pulmonary related debility, there was no statistically significant correlation between BMI and FIM efficiency. The overweight patients were similar in progression to those who were underweight, normal weight, and obese. However, this study found that increased age adversely affected the outcome of rehabilitation.

Level Of Evidence: III.
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http://dx.doi.org/10.1002/pmrj.12243DOI Listing
April 2020

The Effect of Body Mass Index on the Functional Prognosis of Traumatic Brain Injury Patients.

PM R 2019 10 28;11(10):1045-1049. Epub 2019 Mar 28.

Department of Biology, Georgia State University, Atlanta, GA.

Background: Although many studies have demonstrated that obesity is correlated with an increased risk of chronic disease, some have reported a paradox by which those in the higher weight categories actually recover better during hospitalization. This study was designed to determine whether this obesity paradox is also reflected in the recovery of patients with traumatic brain injury (TBI) undergoing care in a rehabilitation hospital.

Objective: To investigate the association between body mass index (BMI) and the functional progress of patients with TBI, admitted to a rehabilitation hospital.

Design: Retrospective cohort study.

Methods: The study included all patients admitted to the brain injury unit of a rehabilitation hospital over a 6-year period. The data used for this study included patient height and weight (measured on admission) and functional independence measurements (scored on admission and discharge).

Main Outcome Measures: Functional independence measure (FIM) change per day, BMI category.

Results: For the 444 patients admitted, the overall FIM efficiency did not differ significantly by BMI (P = .93). After adjusting for age and gender, overweight and obese patients had the lowest FIM efficiency (1.04 for both groups), followed by the underweight and normal weight groups (1.11 and 1.26, respectively).

Conclusion: This study demonstrated that higher BMI was not significantly correlated with the rate of functional recovery among patients admitted to a rehabilitation hospital for TBI.

Level Of Evidence: III.
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http://dx.doi.org/10.1002/pmrj.12091DOI Listing
October 2019

Human iris three-dimensional imaging at micron resolution by a micro-plenoptic camera.

Biomed Opt Express 2017 Oct 14;8(10):4514-4522. Epub 2017 Sep 14.

Department of Mechanical Engineering, University of Michigan, 1231 Beal Avenue, Ann Arbor, MI 48109, USA.

A micro-plenoptic system was designed to capture the three-dimensional (3D) topography of the anterior iris surface by simple single-shot imaging. Within a depth-of-field of 2.4 mm, depth resolution of 10 µm can be achieved with accuracy (systematic errors) and precision (random errors) below 20%. We demonstrated the application of our micro-plenoptic imaging system on two healthy irides, an iris with naevi, and an iris with melanoma. The ridges and folds, with height differences of 10~80 µm, on the healthy irides can be effectively captured. The front surface on the iris naevi was flat, and the iris melanoma was 50 ± 10 µm higher than the surrounding iris. The micro-plenoptic imaging system has great potential to be utilized for iris disease diagnosis and continuing, simple monitoring.
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http://dx.doi.org/10.1364/BOE.8.004514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654796PMC
October 2017

Asynchronous Magnetic Bead Rotation (AMBR) Microviscometer for Label-Free DNA Analysis.

Biosensors (Basel) 2014 Mar 21;4(1):76-89. Epub 2014 Mar 21.

Department of Chemical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; E-Mail: ; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA.

We have developed a label-free viscosity-based DNA detection system, using paramagnetic beads as an asynchronous magnetic bead rotation (AMBR) microviscometer. We have demonstrated experimentally that the bead rotation period is linearly proportional to the viscosity of a DNA solution surrounding the paramagnetic bead, as expected theoretically. Simple optical measurement of asynchronous microbead motion determines solution viscosity precisely in microscale volumes, thus allowing an estimate of DNA concentration or average fragment length. The response of the AMBR microviscometer yields reproducible measurement of DNA solutions, enzymatic digestion reactions, and PCR systems at template concentrations across a 5000-fold range. The results demonstrate the feasibility of viscosity-based DNA detection using AMBR in microscale aqueous volumes.
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http://dx.doi.org/10.3390/bios4010076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4264372PMC
March 2014

Rate of injury and subjective benefits of gravitational wellness weightlifting.

Open Access J Sports Med 2014 12;5:215-21. Epub 2014 Sep 12.

Georgia College and State University, Milledgeville, GA, USA.

Background: A preliminary study using the "gravitational wellness" weightlifting technique demonstrated this to be a unique technique for loading the musculoskeletal system with extremely high loads over short arcs. This leads to rapid weekly strength gains using 30-minute weekly training sessions. This study was designed to further assess the benefit-risk ratio of the gravitational wellness weightlifting technique.

Purpose: This descriptive/retrospective study examined musculoskeletal and well-being outcomes as well as injuries reported by consecutive participants at one gravitational wellness gym.

Materials And Methods: All adults presenting for training at the Atlanta, Georgia, gravitational wellness system facility over a 6-month period were invited to participate. Data were obtained by telephone interview concerning the presenting complaint/objective of training, subjective outcome, weights lifted, and injuries incurred during training.

Results: Of the 77 participants contacted via telephone, 92% agreed to participate (male, n=40; female, n=31). The participants ranged in age from 18 years to 69 years, with a mean age of 48.6 years. Of these, 42 (59%) presented to the gym with the objective of improving a defined musculoskeletal issue. The modal of these was chronic low-back pain. The subjects realized improvement on a 5-point Likert scale of 4.2/5 for their presenting complaint, and improved by 4.27/5 in their overall subjective health. There were no injuries.

Conclusion: This study of consecutive participants at a gravitational wellness gym found that by lifting large weights over short arcs 3 0 minutes per week, participants significantly increased their strength, reduced their musculoskeletal pain, improve their subjective well-being, and reported a low rate of injury.
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http://dx.doi.org/10.2147/OAJSM.S64078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4168877PMC
September 2014

Lower gastrointestinal bleeding associated with diclofenac topical patch in a patient with colonic mass and on antiplatelet therapy for atrial fibrillation.

Am J Phys Med Rehabil 2014 Nov;93(11):1014-7

From the Emory University School of Medicine, Department of Physical Medicine and Rehabilitation, Atlanta, Georgia.

Topical formulations of diclofenac, a nonsteroidal anti-inflammatory drug commonly prescribed to treat musculoskeletal complaints such as osteoarthritis, low back pain, and myofascial pain, are available in the form of a solution, gel, and patch. The topical application of diclofenac results in substantially lower systemic exposure to diclofenac compared with oral diclofenac, resulting in a more favorable side effect profile. To the authors' knowledge, this is the first case report of a lower gastrointestinal bleed associated with diclofenac topical patch use in a 77 yr-old-woman with a history of colonic mass and atrial fibrillation on antiplatelet therapy.
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http://dx.doi.org/10.1097/PHM.0000000000000172DOI Listing
November 2014

Differential responses to rhinovirus- and influenza-associated pulmonary exacerbations in patients with cystic fibrosis.

Ann Am Thorac Soc 2014 May;11(4):554-61

1 Department of Pediatrics and Communicable Diseases.

Rationale: The mechanism by which viruses cause exacerbations of chronic airway disease and the capacity of patients with cystic fibrosis (CF) to respond to viral infection are not precisely known.

Objectives: To determine the antiviral response to infection in patients with CF.

Methods: Sputum was collected from patients with CF with respiratory exacerbation. Viruses were detected in multiplex polymerase chain reaction (PCR)-based assays. Gene expression of 84 antiviral response genes was measured, using a focused quantitative PCR gene array.

Measurements And Main Results: We examined 36 samples from 23 patients with respiratory exacerbation. Fourteen samples tested virus-positive and 22 virus-negative. When we compared exacerbations associated with rhinovirus (RV, n = 9) and influenza (n = 5) with virus-negative specimens, we found distinct patterns of antiviral gene expression. RV was associated with greater than twofold induction of five genes, including those encoding the monocyte-attracting chemokines CXCL10, CXCL11, and CXCL9. Influenza was associated with overexpression of 20 genes, including those encoding the cytokines tumor necrosis factor and IL-12; the kinases MEK, TBK-1, and STAT-1; the apoptosis proteins caspase-8 and caspase-10; the influenza double-stranded RNA receptor RIG-I and its downstream effector MAVS; and pyrin, an IFN-stimulated protein involved in influenza resistance.

Conclusions: We conclude that virus-induced exacerbations of CF are associated with immune responses tailored to specific infections. Influenza induced a more potent response consisting of inflammation, whereas RV infection had a pronounced effect on chemokine expression. As far as we are aware, this study is the first to compare specific responses to different viruses in live patients with chronic airway disease.
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http://dx.doi.org/10.1513/AnnalsATS.201310-346OCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4225796PMC
May 2014

Effect of body mass index on stroke rehabilitation.

Arch Phys Med Rehabil 2014 Jun 4;95(6):1055-9. Epub 2014 Feb 4.

Georgia College and State University, Milledgeville, GA.

Objective: To investigate the association between body mass index (BMI) and the functional progress of patients with stroke, admitted to a rehabilitation hospital.

Design: A retrospective cohort study.

Setting: A freestanding university rehabilitation hospital stroke unit.

Participants: All patients (N=819) admitted to the stroke unit of a rehabilitation hospital during the study.

Interventions: Not applicable.

Main Outcome Measures: The primary study outcome measure was the FIM efficiency of patients by BMI category.

Results: For the 819 patients admitted during the observation period, BMI was compared with FIM score changes per day (FIM efficiency). After adjusting for age and sex, the FIM efficiency differed by BMI. The underweight group had the lowest FIM efficiency, followed by the obese and normal-weight subgroups. The overweight group had the highest FIM efficiency (P=.05) when compared with the obese subgroup.

Conclusions: Among patients admitted to an acute rehabilitation hospital for stroke rehabilitation, overweight patients had better functional progress than did patients in the other weight categories.
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http://dx.doi.org/10.1016/j.apmr.2014.01.019DOI Listing
June 2014

Significant progression of load on the musculoskeletal system with extremely high loads, with rapid weekly weight gains, using the Anatoly Gravitational System, in a 10-week training period.

Open Access J Sports Med 2013 14;4:211-9. Epub 2013 Oct 14.

Department of Mathematics and Statistics, College of Science, Sultan Qaboos University, Muscat, Oman.

In an age of increasing numbers of lifestyle diseases and plasticity of longevity, exercise and weight training have been increasingly recognized as both preventing and mitigating the severity of many illnesses. This study was designed to determine whether significant weight-lifting gains could be realized through the Anatoly Gravitational System. Specifically, this study sought to determine whether this once-weekly weight-training system could result in significant weekly strength gains during a 10-week training period. A total of 50 participants, ranging in age from 17 to 67 years, completed at least 10 weekly 30-minute training sessions. The results suggest participants could, on average, double their weight-lifting capacity within 10 sessions. This preliminary study, which would require further scrutiny, suggests the Anatoly Gravitational System provides a rather unique opportunity to load the musculoskeletal system with extremely high loads, with rapid weekly weight gains, using only short weekly training sessions. More studies are warranted to scrutinize these findings.
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http://dx.doi.org/10.2147/OAJSM.S48819DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3871029PMC
December 2013

Association of COMT val158met and DRD2 G>T genetic polymorphisms with individual differences in motor learning and performance in female young adults.

J Neurophysiol 2014 Feb 13;111(3):628-40. Epub 2013 Nov 13.

School of Kinesiology, University of Michigan, Ann Arbor, Michigan;

Individuals learn new skills at different rates. Given the involvement of corticostriatal pathways in some types of learning, variations in dopaminergic transmission may contribute to these individual differences. Genetic polymorphisms of the catechol-O-methyltransferase (COMT) enzyme and dopamine receptor D2 (DRD2) genes partially determine cortical and striatal dopamine availability, respectively. Individuals who are homozygous for the COMT methionine (met) allele show reduced cortical COMT enzymatic activity, resulting in increased dopamine levels in the prefrontal cortex as opposed to individuals who are carriers of the valine (val) allele. DRD2 G-allele homozygotes benefit from a higher striatal dopamine level compared with T-allele carriers. We hypothesized that individuals who are homozygous for COMT met and DRD2 G alleles would show higher rates of motor learning. Seventy-two young healthy females (20 ± 1.9 yr) performed a sensorimotor adaptation task and a motor sequence learning task. A nonparametric mixed model ANOVA revealed that the COMT val-val group demonstrated poorer performance in the sequence learning task compared with the met-met group and showed a learning deficit in the visuomotor adaptation task compared with both met-met and val-met groups. The DRD2 TT group showed poorer performance in the sequence learning task compared with the GT group, but there was no difference between DRD2 genotype groups in adaptation rate. Although these results did not entirely come out as one might predict based on the known contribution of corticostriatal pathways to motor sequence learning, they support the role of genetic polymorphisms of COMT val158met (rs4680) and DRD2 G>T (rs 1076560) in explaining individual differences in motor performance and motor learning, dependent on task type.
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http://dx.doi.org/10.1152/jn.00457.2013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921405PMC
February 2014

Types and sociodemographic correlates of complementary and alternative medicine (CAM) use among people with epilepsy in Oman.

Epilepsy Behav 2013 Nov 4;29(2):361-6. Epub 2013 Sep 4.

Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman. Electronic address:

Nonpharmacological treatment strategies that originate from sociocultural teachings and are beyond the scope of allopathic medicine are commonly used among people with epilepsy (PWE) in many parts of the world. The present study explored the types and sociodemographic correlates of complementary and alternative medicine (CAM) use among PWE in Oman among attendees of a neurological unit at a tertiary care center. Data on the types of CAM were gathered from telephone interviews. The relevant demographic and clinical characteristics of the participants were obtained from electronic medical records. Of the total of 101 participants, 73.3% were CAM users. The majority of these participants have not disclosed their CAM use to their allopathic health-care providers. The most common types of CAM reported were those falling under the 'mind-body' type (incantations and fumigation) and biologically based (herbal concoctions) or a combination of them. Compared to non-CAM users, a significant and greater proportion of CAM users attributed the etiology of their illness to nonbiomedical factors such as 'evil eyes' (P=0.04). The multivariate logistic regression model indicated that the use of CAM was highly associated with age of <30years (OR=3.09; 95% CI: 1.10, 5.46), unemployment (OR=2.04; 95% CI: 1.15, 6.39), having basic school education (OR=2.21; 95% CI: 0.83, 5.18), low family income (OR=1.52; 95% CI: 0.91, 2.11), and the presence of hypersalivation (OR=2.20; 95% CI: 1.01, 4.39). Further studies are needed to harmonize these two healing practices. On the whole, this study indicates that among attendees of tertiary care utilization, CAM is common among PWE in Oman. The most utilized type of CAM falls under the umbrella of mind-body practice.
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http://dx.doi.org/10.1016/j.yebeh.2013.07.022DOI Listing
November 2013

Dissection of complex adult traits in a mouse synthetic population.

Genome Res 2012 Aug 15;22(8):1549-57. Epub 2012 May 15.

Department of Human Genetics, University of Michigan, Ann Arbor, Michigan 48109, USA.

Finding the causative genetic variations that underlie complex adult traits is a significant experimental challenge. The unbiased search strategy of genome-wide association (GWAS) has been used extensively in recent human population studies. These efforts, however, typically find only a minor fraction of the genetic loci that are predicted to affect variation. As an experimental model for the analysis of adult polygenic traits, we measured a mouse population for multiple phenotypes and conducted a genome-wide search for effector loci. Complex adult phenotypes, related to body size and bone structure, were measured as component phenotypes, and each subphenotype was associated with a genomic spectrum of candidate effector loci. The strategy successfully detected several loci for the phenotypes, at genome-wide significance, using a single, modest-sized population (N = 505). The effector loci each explain 2%-10% of the measured trait variation and, taken together, the loci can account for over 25% of a trait's total population variation. A replicate population (N = 378) was used to confirm initially observed loci for one trait (femur length), and, when the two groups were merged, the combined population demonstrated increased power to detect loci. In contrast to human population studies, our mouse genome-wide searches find loci that individually explain a larger fraction of the observed variation. Also, the additive effects of our detected mouse loci more closely match the predicted genetic component of variation. The genetic loci discovered are logical candidates for components of the genetic networks having evolutionary conservation with human biology.
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http://dx.doi.org/10.1101/gr.135582.111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3409268PMC
August 2012

Martial arts: time needed for training.

Asian J Sports Med 2011 Mar;2(1):31-6

Department of Physical Medicine & Rehabilitation, Emory University, School of Medicine, Atlanta, Georgia, USA.

Purpose: To measure the time needed to teach a series of martial arts techniques to proficiency.

Methods: Fifteen volunteer subjects without any prior martial arts or self-defense experience were recruited. A panel of martial arts experts selected 21 different techniques including defensive stances, arm blocks, elbow strikes, palm strikes, thumbs to eyes, instep kicks and a carotid neck restraint. The critical elements of each technique were identified by the panel and incorporated into a teaching protocol, and then into a scoring system. Two black belt martial arts instructors directed a total of forty-five 45-minute training sessions. Videotaped proficiency testing was performed weekly. The videotapes were reviewed by the investigators to determine the proficiency levels of each subject for each technique.

Results: The techniques were rated by the average number of training sessions needed for an individual to develop proficiency in that technique. The mean number of sessions necessary to train individuals to proficiency ranged from 27 to 38.3. Using this system, the most difficult techniques seemed to be elbow strikes to the rear, striking with thumbs to the eyes and arm blocking.

Conclusions: In this study 29 hours of training was necessary to train novice students to be proficient in 21 offensive and defensive martial arts techniques. To our knowledge, this is the first study that attempts to measure the learning curves involved when teaching martial arts techniques.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3289195PMC
http://dx.doi.org/10.5812/asjsm.34828DOI Listing
March 2011

Alleles that modulate late life hearing in genetically heterogeneous mice.

Neurobiol Aging 2012 Aug 2;33(8):1842.e15-29. Epub 2012 Feb 2.

Kresge Hearing Research Institute, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, MI, USA.

A genetically heterogeneous population of mice was tested for hearing at 8, 18, and 22 months by auditory brainstem response (ABR), and genotyped at 128 markers to identify loci that modulate late life hearing loss. Half of the test mice were exposed to noise for 2 hours at age 20 months. Polymorphisms affecting hearing at 18 months were noted on chromosomes 2, 3, 7, 10, and 15. Most of these loci had effects only on responses to 48 kHz stimuli, but a subset also influenced the auditory brainstem response at lower frequencies. Loci on chromosomes 4, 10, 12, and 14 had significant effects on hearing at 22 months in noise-exposed mice, and loci on chromosomes 10 and 11 had effects on mice not exposed to noise. Outer hair cell loss was modulated by polymorphisms on chromosomes 10, 11, 12, 17, and 19. Resistance to age-related hearing loss is thus modulated by a set of genetic effects, some age-specific, some frequency specific, some dependent on prior exposure to noise, and some of which compromise survival of cochlear hair cells.
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http://dx.doi.org/10.1016/j.neurobiolaging.2011.12.034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3346888PMC
August 2012

Inadvertent Percutaneous Endoscopic Gastrostomy Tube Placement through the Transverse Colon to the Stomach Causing Intractable Diarrhea: A Case Report.

Diagn Ther Endosc 2011 20;2011:849460. Epub 2011 Dec 20.

Department of Physical Medicine and Rehabilitation, Emory University School of Medicine, Atlanta, GA 30322, USA.

Background. Among patients with chronic disease, percutaneous endoscopic gastrostomy (PEG) tubes are a common mechanism to deliver enteral feedings to patients unable to feed by mouth. While several cases in the literature describe difficulties with and complications of the initial placement of the PEG, few studies have documented the effects of a delayed diagnosis of a misplaced tube. Methods. This case study reviews the hospitalization of an 82 year old male with an inadvertent placement of a PEG tube through the transverse colon. Photos of the placement in the stomach as well as those of the follow up colonoscopy, and a recording of the episodes of diarrhea during the hospitalization were made. Results. The records of this patient reveal complaints of gastrointestinal distress and diarrhea immediately after placement of the tube. Placement in the stomach was verified by endoscopy, with discovery of the tube only after a follow up colonoscopy. The tube remained in place after this discovery, and was removed weeks after the diarrhea was unsuccessfully treated with antibiotics. After tube removal, the patient recovered well and was sent home.
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http://dx.doi.org/10.1155/2011/849460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249601PMC
August 2012

The detection of mood and anxiety in people with epilepsy using two-phase designs: experiences from a tertiary care centre in Oman.

Epilepsy Res 2012 Feb 15;98(2-3):174-81. Epub 2011 Oct 15.

Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.

Background: The detection of mood and anxiety disorders is of great clinical importance in patients with chronic disease but data on the occurrence of affective dysfunction is lacking among people with epilepsy (PWE) in non-western populations. Further compounding such situation, the validity of some of the common assessment measures has not been examined.

Objective: The study aims to investigate the application of the Hospital Anxiety and Depression Scale (HADS) by identifying patients with comorbid affective dysfunctions in an Omani population. The semi structured interview, Composite International Diagnostic Interview (CIDI) will be used to establish the psychometric property of HADS in the Omani population.

Methods: PWE (n=150) were screened with the semi-structured, (CIDI) and the HADS. A receiver operating characteristics (ROC) curve was calculated to discriminate the power of the HADS for every possible threshold score.

Results: The semi-structured interview revealed the prevalence rate of 27% for depressive disorder and 45% for anxiety disorder. The best compromise using, the cut-off score of 7 or 8, gave a sensitivity of 99% for depression and 83-91% for anxiety and a specificity of 87.5-100% for depression and 85-94% for anxiety.

Conclusions: Findings suggest that HADS is a useful screening tool for this particular population. This finding is discussed from the socio-cultural perspective of Omani society.
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http://dx.doi.org/10.1016/j.eplepsyres.2011.09.012DOI Listing
February 2012

Ancestral heterogeneity in a biethnic stroke population.

Ann Hum Genet 2011 Jul;75(4):508-15

Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.

To test for and characterize heterogeneity in ancestral contributions to individuals among a population of Mexican American (MA) and non-Hispanic white (NHW) stroke/transient ischemic attack (TIA) cases, data from a community-based stroke surveillance study in south Texas were used. Strokes/TIA cases were identified (2004-2006) with a random sample asked to provide blood. Race-ethnicity was self-reported. Thirty-three ancestry informative markers were genotyped and individual genetic admixture estimated using maximum likelihood methods. Three hypotheses were tested for each MA using likelihood ratio tests: (1) H(0) : μi = 0 (100% Native American), (2) H(0) : μi = 1.00 (100% European), (3) H(0) : μi = 0.59 (average European). Among 154 self-identified MAs, estimated European ancestry varied from 0.26 to 0.98, with an average of 0.59 (SE = 0.014). We rejected hypothesis 1 for every MA and rejected hypothesis 2 for all but two MAs. We rejected hypothesis 3 for 40 MAs (20 < 59%, 20 > 59%). Among 84 self-identified NHWs, the estimated fraction of European ancestry ranged from 0.83 to 1.0, with an average of 0.97 (SE = 0.014). Self-identified MAs, and to a lesser extent NHWs, from an established bi-ethnic community were heterogeneous with respect to genetic admixture. Researchers should not use simple race-ethnic categories as proxies for homogeneous genetic populations when conducting gene mapping and disease association studies in multi-ethnic populations.
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http://dx.doi.org/10.1111/j.1469-1809.2011.00657.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3133673PMC
July 2011

Effect of amantadine on the sleep-wake cycle of an inpatient with brain injury.

Brain Inj 2009 Jun;23(6):559-65

Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, PO Box 35, Al-Khoudh 123, Muscat, Sultanate of Oman.

Background: A previous study suggested that the routine use of drugs intended to improve attention and arousal, such as methylphenidate, tend to have a variable but not significant effect on sleep-wake cycles. As amantadine is a frequently employed drug in brain injury rehabilitation, with known effects on fatigue and motor processing speed, this study examined the effect of amantadine on the sleep-wake behaviour of patients with brain injury undergoing rehabilitation.

Method: This was a naturalistic observation using an observationally defined sleep-wake distribution for a total of 43 subjects with brain injury. Identified patients were observed for a full 24 hours a day 2 weeks before and 2 weeks after starting amantadine. Some of these patients (n = 12) had been administered amantadine on clinical grounds and, for this paper, served as the experimental group, while the drug naive (n = 31) served as a control. Three outcome measures were operationalized: hours of sleep in 24 hours, hours of sleep during daytime and hours of sleep during night-time.

Result: The average number of hours of sleep during a 24-hour period was not significantly different for the two cohorts. Similarly hours of sleep during daytime and hours of sleep during night-time were on average the same for the two groups. The data suggest that amantadine has no direct bearing on sleep/wake cycles using these parameters.

Conclusion: This study fails to demonstrate that the use of amantadine on an inpatient brain injury population will affect sleep/wake quantity.
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http://dx.doi.org/10.1080/02699050902970745DOI Listing
June 2009

Peritonitis secondary to the migration of a trans-hepatically-placed percutaneous endoscopic gastrostomy tube: a case report.

Arch Phys Med Rehabil 2009 Feb;90(2):354-7

Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA, USA.

Enteral feeding by percutaneous endoscopic gastrostomy (PEG) tube has become a commonly used method of supplying nutrition to patients with impaired neurologic function. In this case study we describe a 33-year-old brain-injured patient whose PEG insertion was complicated by inadvertent malpositioning and subsequent infection. After initially being placed through the liver, the PEG tube migrated out several weeks later, resulting in intra-abdominal feed collection, peri-hepatic abscess formation, and peritonitis. Physicians should be aware of the potential for inadvertent positioning through other viscera, and consider optimal methods of intraprocedural monitoring and post placement verification.
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http://dx.doi.org/10.1016/j.apmr.2008.06.038DOI Listing
February 2009

Association between body mass index and functional independence measure in patients with deconditioning.

Am J Phys Med Rehabil 2008 Jan;87(1):21-5

Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts 02114, USA.

Objective: To assess the association of body mass index (BMI) with functional independence measure (FIM) score in patients with deconditioning. We also examined whether the association was different for motor and cognitive subscales of the FIM instrument.

Design: A retrospective study of 1077 inpatients admitted to the general medicine service for deconditioning at an acute rehabilitation hospital. Patients were classified into underweight (BMI < 18.5), normal range (BMI = 18.5-24.9), overweight (BMI = 25.0-29.9), obese class I (BMI = 30.0-34.9), obese class II (BMI = 35.0-39.9), and obese class III (BMI > or = 40).

Results: Median gain in FIM scores from admission to discharge was highest in obese class I patients (27 points), followed by obese class II patients (26 points). The most gain in FIM scores was accounted for by the motor subscale. Adjusting for age, gender, and length of in-hospital stay, obese class I patients had a 5.8-point (95% confidence limits = 1.2, 7.0) higher gain in FIM score compared with patients with BMI in the normal range.

Conclusions: In an acute rehabilitation setting, obese patients had higher gains in FIM scores as compared with normal-range-BMI patients. Most of the improvements in FIM scores were accounted for by the motor subscale, with little or no improvement on the cognitive scale.
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http://dx.doi.org/10.1097/PHM.0b013e31815e61afDOI Listing
January 2008

Imaging cross-section of DNA electrophoresis in a microfabricated glass device with CLSM.

Conf Proc IEEE Eng Med Biol Soc 2006;2006:4307-9

Dept. of Chem. Eng., Michigan Univ., Ann Arbor, MI 48109, USA.

In this paper, confocal laser scanning microscopy (CLSM) is used to detect and analyze DNA electrophoretic migration in a microchannel filled with in-situ polymerized cross-linked polyacrylamide. DNA distribution at the cross-section of the microchannel is observed to vary only slightly with the tested gel concentrations and the DNA sizes. However, in comparing with DNA electrophoresis using linear polymer solution (LPA), significant differences are observed in the distribution of DNA molecules on the observation plane using a cross-linked matrix (UV-polymerized polyacrylamide). Instead of a uniform signal boost upon the pass of one DNA band in linear polymer matrix, the electrophoretic process with cross-linked polyacrylamide presents a cross-section image with most DNA molecules aggregate near the vertical center of the microchannel during migration. This observation suggests an inhomogeneous nanostructure of in-situ polymerized cross-linked polyacrylamide in a microfabricated glass channel, consistent with SEM results. However, the phenomenon of DNA bands tending to focus in the vertical center along z-axis has not been previously reported. We also conclude from these observations that geometries containing fewer dead corners are desirable to minimize residual DNA in the microchannel.
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http://dx.doi.org/10.1109/IEMBS.2006.260200DOI Listing
April 2008

The role of serum testosterone and TBI in the in-patient rehabilitation setting.

Brain Inj 2007 Jun;21(6):645-9

Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA, USA.

Objectives: To explore the relationship between serum testosterone levels, age, length of stay, admission, discharge and changes in functional capacity over time among patients with traumatic brain injury treated in a rehabilitation hospital.

Design: This study used a nonrandomized chart review of 54 males, consecutively admitted to a brain injury rehabilitation hospital.

Methods: The charts of 54 males consecutively admitted to a brain injury rehabilitation unit between the periods of December 2004 and May 2005 were included in this study. Individuals were included in this study if they were 18 years of age or older, had suffered a traumatic brain injury, undergone admission and discharge, functional independence measure (FIM) testing and had received a serum testosterone level check within one to seven days from admission.

Main Outcome And Results: The main outcome measure of this study was the FIM changes over time, as compared with admission testosterone levels. Low serum testosterone levels on admission to the in-patient rehabilitation unit were associated with longer lengths of stay, lower average admission FIM scores, less improvement in FIM scores, and a lower FIM efficiency. Although not statistically significant, individuals presenting to our unit with low testosterone levels, on average, stayed 26 days longer than did those with normal levels. Age and the presence of multi-trauma did not appear to be factors associated with serum testosterone levels. Changes in discharge cognitive FIM scores between the two groups approached statistical significance (p = 0.06).

Conclusion: This pilot study suggests that testosterone levels may be important in the recovery of patients with traumatic brain injury, treated at an in-patient rehabilitation hospital.
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http://dx.doi.org/10.1080/02699050701210426DOI Listing
June 2007

A comparison of functional outcomes in hypoxia and traumatic brain injury: a pilot study.

J Neurol Sci 2007 Sep 29;260(1-2):95-9. Epub 2007 May 29.

Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, United States.

We present our experience with 30 patients on functional outcomes of patients with anoxic brain injury (ABI, n=15) due to cardiac etiologies from freestanding inpatient rehabilitation hospital. A convenience sample of patient with traumatic brain injury (TBI, n=15) with similar demographic characteristic to ABI was used for comparison on indices of activity of daily living, cognition, mobility as well as other indices of functional prognosis such as hospital length of stay, cost and discharge predisposition. No statistical significant differences were found between the two groups on the presently employed outcome measures. This investigation supports the positive impact of inpatient rehabilitation for individuals with hypoxia of cardiac etiology. Future research comparing outcomes of ABI to TBI with larger, controlled trials is warranted.
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http://dx.doi.org/10.1016/j.jns.2007.04.012DOI Listing
September 2007

The ineffectiveness of the Hospital Anxiety and Depression Scale for diagnosis in an Omani traumatic brain injured population.

Brain Inj 2007 Apr;21(4):385-93

Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman.

Background: The rehabilitation of the traumatic brain injury (TBI) patient is especially challenging in non-western populations as the phenotypic indicators as well as the neurobehavioral assessments for the survivors of brain injury are limited.

Objective: The study screened for the prevalence of anxiety and depressive states among patients with TBI and examined the validity of the Hospital Anxiety and Depression Scale (HADS) to identify TBI patients with comorbid affective dysfunctions, specifically anxiety and depressive disorders, in an Omani population.

Methods: Sixty-eight survivors of TBI were screened with the semi-structured, Composite International Diagnostic Interview (CIDI) and the HADS. A receiver operating characteristics (ROC) curve was calculated to discriminate the power of the HADS for every possible threshold score.

Results: The semi-structured interview revealed the prevalence rate of 57.4% for depressive disorder and 50% for anxiety disorder. The sensitivity (53.8%) and specificity 75.9%, gave the best compromise using the cut-off score of 4, suggesting HADS is not a useful screening tool for this particular population.

Conclusions: Phenotypic indicators as detected by CIDI revealed that prevalence of affective dysfunctionality is common among this TBI population. Although the HADS is the most widely used screening instrument in other clinical populations, it does not appear to be a reliable resource in identifying depression and anxiety in people with traumatic brain injury in Oman.
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http://dx.doi.org/10.1080/02699050701311059DOI Listing
April 2007

Mammalian mRNA splice-isoform selection is tightly controlled.

Genetics 2007 Mar 18;175(3):1079-87. Epub 2006 Dec 18.

Department of Human Genetics, University of Michigan Medical School, Ann Arbor, Michigan 48104-0618, USA.

Post-transcriptional RNA processing is an important regulatory control mechanism for determining the phenotype of eukaryotic cells. The processing of a transcribed RNA species into alternative splice isoforms yields products that can perform different functions. Each type of cell in a multi-cellular organism is presumed to actively control the relative quantities of alternative splice isoforms. In this study, the alternatively spliced isoforms of five mRNA transcription units were examined by quantitative reverse transcription-PCR amplification. We show that interindividual variation in splice-isoform selection is very highly constrained when measured in a large population of genetically diverse mice (i.e., full siblings; N = 150). Remarkably, splice-isoform ratios are among the most invariant phenotypes measured in this population and are confirmed in a second, genetically distinct population. In addition, the patterns of splice-isoform selection show tissue-specific and age-related changes. We propose that splice-isoform selection is exceptionally robust to genetic and environmental variability and may provide a control point for cellular homeostasis. As a consequence, splice-isoform ratios may be useful as a practical quantitative measure of the physiological status of cells and tissues.
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http://dx.doi.org/10.1534/genetics.106.066183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1840070PMC
March 2007

Comparison of gastrostomy tube replacement verification using air insufflation versus gastrograffin.

Arch Phys Med Rehabil 2006 Nov;87(11):1530-3

Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA 02114, USA.

Objective: To compare the safety of air insufflation as a contrast medium for percutaneous endoscopic gastrostomy (PEG) tube replacement verification with that of the more traditional method using positive contrast material (gastrograffin) under fluoroscopic guidance.

Design: Retrospective case series comparing 2 radiographic procedures used for PEG tube verification at a rehabilitation hospital. The first series reviewed studies of patients over 1 year, during which the method of choice for PEG tube replacement verification was with air insufflation. The second series reviewed studies of patients over the subsequent year, during which the method of choice for PEG tube replacement verification was with gastrograffin.

Setting: An inpatient rehabilitation hospital.

Participants: Nineteen patients and 29 PEG tube replacements were identified that used air insufflation and 17 patients and 19 PEG tube replacements were identified that used gastrograffin.

Interventions: Not applicable.

Main Outcome Measures: Medical complications in a 2-week follow-up period as a result of the verification procedures.

Results: There were no cases in either of the replacement procedures in which the PEG tube was found to not be in the gastrointestinal system. There was also no evidence at 2-week follow-up that any of the patients' complications were the result of either procedure.

Conclusions: The air contrast procedure appears to be a relatively safe alternative procedure for PEG tube replacement verification.
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http://dx.doi.org/10.1016/j.apmr.2006.07.266DOI Listing
November 2006