Surbhi Kaura

To improve diagnostic and clinical decision¬making assistance, this study presents MedGen-Trans, a novel generative transformer-based medical system that involves multimodal data. As opposed to using standard discriminative models, MedGen-Trans utilizes generative modeling for enriching small datasets, filling missing values, and providing interpretability. With 92.8% diagnostic accuracy, 89.5% F1-score, and 21% data efficiency improvement, the system has been performing better than CNN and GAN baselines in experiments on the NIH Chest X-ray-14 and BraTS MRI datasets. There was a reduction of 18% in the diagnostic delay as well. There is enormous potential for safe, effective, and clinically relevant AI-based healthcare solutions with the dual generative-predictive pipeline.

Study Design: Prospective pre–post interventional study. Objectives: To evaluate the effects of epidural spinal cord stimulation (ESCS) combined with task-specific rehabilitation on mobility, sitting balance, bladder control, lower limb strength, and postural stability in individuals with spinal cord injury. Methods: Fifteen participants with chronic thoracic SCI received daily ESCS sessions combined with physiotherapy and Tyromotion-based robotic balance training for 8 weeks. Outcome measures included: Timed Up and Go (TUG) test for mobility, Walking Index for Spinal Cord Injury II for ambulatory function, Neurogenic Bladder Symptom Score for bladder control, Manual Muscle Testing for knee extension strength, and anterior–posterior displacement for postural stability and Modified Ashworth Scale (MAS) for spasticity from . Results: All participants successfully completed the study. The Timed Up and Go (TUG) test time significantly improved from 430.25 ± 265.2 seconds to 141.9 ± 92.6 seconds ( P < 0.001). The Walking Index for Spinal Cord Injury II (WISCI II) score increased markedly from 0.07 ± 0.26 to 6.07 ± 1.03 ( P < 0.001). Antero-posterior (AP) displacement during standing balance decreased from 18.2 ± 3.5 mm to 11.4 ± 2.9 mm ( P < 0.001), indicating enhanced static postural control. The Neurogenic Bladder Symptom Score (NBSS) improved significantly, reducing from 24.05 ± 6.91 to 7.4 ± 5.08 ( P < 0.001). Manual Muscle Testing (MMT) of knee extension increased from 0.25 ± 0.44 to 3.85 ± 0.37 ( P < 0.001). Finally, the Modified Ashworth Scale (MAS) scores were significantly reduced from 3.6 ± 0.257 to 1.26 ± 0. ( P < 0.001), reflecting decreased lower limb spasticity. Conclusions: ESCS with Tyromotion significantly improves motor strength, trunk balance, gait function, and bladder control in thoracic SCI. These findings support task-specific therapies in SCI recovery programs.

Background: The pandemic exacerbated burnout experienced by healthcare personnel, whose mental health had long been a public health concern before COVID-19. This study used the Copenhagen burnout inventory (CBI) tool to assess burnout and identify predictors among Indian healthcare workers managing COVID-19. Methods: A cross-sectional study was conducted from June to December 2022, after the third pandemic wave. A web-based, fillable Google form was used to recruit COVID-19 management professionals from multiple Jaipur district hospitals. Healthcare professionals provided socio-demographic, work-related, and CBI scores. Multiple linear regression was used to control for model covariant independent variables. Results: We evaluated the responses of a total of 578 participants with a mean age of 36.59 ± 9.1 years. Based on the CBI cut-off score of 50, 68.1% reported burnout. A total of 67.5%, 56.4%, and 48.6% of healthcare workers reported work-related, personal, and patient-related burnout, respectively. High burnout scores were significantly associated with the nursing profession (β = 7.89, 95% CI; 3.66, 12.11, p < 0.0001). The p-value indicates the probability of observing the data if the null hypothesis is true, and the confidence interval shows the range within which we can be 95% confident that the true effect lies. An independent relationship exists between male gender and higher personal-related burnout scores (β = 4.45, 95% CI 1.9–6.9). Conclusion: This study identified key indicators that need further emphasis and the need for organizational and individual-level burnout monitoring in healthcare delivery sectors. Health workers continue to experience burnout due to a combination of personal, professional, and patient-related factors. This underscores the need for targeted organizational and individual interventions. The findings also suggest that the CBI tool could identify healthcare worker burnout risk groups.

Objective: Cerebrovascular accidents are the second leading cause of death and the third leading cause of disability worldwide. We hypothesized that cerebellar transcranial direct current stimulation (ctDCS) of the dentate nuclei and the lower-limb representations in the cerebellum can improve functional reach during standing balance in chronic (>6 months’ post-stroke) stroke survivors. Materials and Methods: Magnetic resonance imaging (MRI) based subject-specific electric field was computed across a convenience sample of 10 male chronic (>6 months) stroke survivors and one healthy MRI template to find an optimal bipolar bilateral ctDCS montage to target dentate nuclei and lower-limb representations (lobules VII–IX). Then, in a repeated-measure crossover study on a subset of 5 stroke survivors, we compared 15 min of 2 mA ctDCS based on the effects on successful functional reach (%) during standing balance task. Three-way ANOVA investigated the factors of interest– brain regions, montages, stroke participants, and their interactions. Results: “One-size-fits-all” bipolar ctDCS montage for the clinical study was found to be PO9h–PO10h for dentate nuclei and Exx7–Exx8 for lobules VII–IX with the contralesional anode. PO9h–PO10h ctDCS performed significantly (alpha = 0.05) better in facilitating successful functional reach (%) when compared to Exx7–Exx8 ctDCS. Furthermore, a linear relationship between successful functional reach (%) and electric field strength was found where PO9h–PO10h montage resulted in a significantly (alpha = 0.05) higher electric field strength when compared to Exx7–Exx8 montage for the same 2 mA current. Conclusion: We presented a rational neuroimaging based approach to optimize deep ctDCS of the dentate nuclei and lower limb representations in the cerebellum for post-stroke balance rehabilitation. However, this promising pilot study was limited by “one-size-fits-all” bipolar ctDCS montage as well as a small sample size.

Objective: Cerebrovascular accidents are the second leading cause of death and the third leading cause of disability worldwide. We hypothesized that cerebellar transcranial direct current stimulation (ctDCS) of the dentate nuclei and the lower-limb representations in the cerebellum can improve standing balance functional reach in chronic (> 6 months’ post-stroke) stroke survivors. Materials and Methods: Magnetic resonance imaging(MRI) based subject-specific electric field was computed across 10 stroke survivors and one healthy MRI template to find an optimal bipolar bilateral ctDCS montage to target dentate nuclei and lower-limb representations (lobules VII-IX). Then, in a repeated-measure crossover study on 5 stroke survivors, we compared 15minutes of 2mA ctDCS based on the effects on successful functional reach(%) during standing balance task. Three-way ANOVA investigated the factors of interest– brain regions, montages, stroke participants, and their interactions.Results: “One-size-fits-all” ctDCS montage for the clinical study was found to be bipolar PO9h – PO10h for dentate nuclei and bipolar Exx7–Exx8 for lobules VII-IX with contalesional anode. Bipolar PO9h–PO10h ctDCS performed significantly (alpha=0.05) better in facilitating successful functional reach (%) when compared to bipolar Exx7–Exx8 ctDCS. Furthermore, a linear relationship between successful functional reach (%) and electric field strength was found where bipolar PO9h–PO10h montage resulted in a significantly (alpha=0.05) higher electric field strength when compared to bipolar Exx7–Exx8 montage for the same 2mA current. Conclusion: We presented a rational neuroimaging based approach to optimize deep ctDCS of the dentate nuclei and lower limb representations in the cerebellum for post-stroke balance rehabilitation.

BACKGROUND: Constraint induced movement therapy (CIMT) has been found to be an effective intervention for the treatment of upper extremity motor disabilities in people with stroke. There are many concerns around practicality and resource issues with CIMT, consequently there are various modifications in CIMT in terms of duration of constraint and type of constraints used. PURPOSE: The main objective of the study was to compare the effectiveness of voluntary constraint and hand mitt use in modified CIMT (mCIMT) in people with chronic stroke. METHODS: The study was a pre-post experimental design. A total of 20 participants were allocated randomly to two groups, with 10 participants in each group. The outcome measures used were the Wolf Motor Function Test (WMFT, time and functional ability scale, FAS) and a Motor Activity Log (MAL), amount of use (AOU) and quality of movement (QOM). The total duration of the intervention was 4 weeks with frequency of 5 days per week. The participants in group 1 were asked to do voluntary constraint and in group 2 a hand mitt was used to restrain the use of normal hand function during the training. The activities used in hand function training were the same for both the groups. RESULTS: There was no significant difference between groups after the intervention for WMFT time ( t = 0.63, p = 0.5), WMFT FAS ( t = –0.22, p = 0.8), MAL AOU ( t = –0.25, p = 0.8) and MAL QOM ( t = –0.28, p = 0.7). However there was a significant difference between pre-post scores in both groups for WMFT time group 1: t = 31.4, group 2: t = 23.9, p = 0.001 p = 0.001), WMFT FAS ( t = –13.5, p = 0.01, group 2: t = –16.54, p = 0.001), MAL AOU (group 1: t = –10.7, p = 0.001, group 2: t = –9.9, p = 0.001) and MAL AOU QOM (group 1: t = –8.04, p = 0.001, group 2: t = –6.7, p = 0.001). CONCLUSION: Voluntary restraint can be an effective alternative constraint technique used in mCIMT to improve the hand function of the affected arm in people with stroke.