Inpatient rehabilitation of a person with Guillain-Barré syndrome associated with COVID-19 infection: An expert interdisciplinary approach to a case study

BACKGROUND AND PURPOSE

Several cases of Guillain-Barré Syndrome (GBS) associated with a COVID-19 infection have been recently reported. Rehabilitation might be a key player in the recovery of these highly complex patients however, results are yet unknown. This case report aimed to describe the effects of an inpatient rehabilitation program, with an interdisciplinary team approach, in a patient with GBS in the context of a COVID-19 infection.

CASE DESCRIPTION

A 58-year-old man with GBS after COVID-19 started an inpatient rehabilitation program focused on reducing dyspnea and fatigue symptoms; improving muscle strength, balance, aerobic and functional training; practicing activities of daily living and energy conservation techniques; swallowing training; emotional support and patient and family education about daily routines. An expert interdisciplinary team delivered the intervention, approximately 5 h/day, 5 days/week for 6 weeks.

OUTCOMES

Improvements were observed in dyspnea, fatigue, nocturnal ventilation, muscle strength, balance, walking capacity, functional status, and swallowing function.

CONCLUSION

This clinical case report illustrates the impact of a tailored and interdisciplinary rehabilitation program, on promoting recovery in multiple health domains of a patient with GBS associated with COVID-19 infection. Our experience might be useful to guide other inpatient rehabilitation programs to successfully manage these highly complex patients.

Inpatient rehabilitation can improve functional outcomes of post-intensive care unit COVID-19 patients-a prospective study

PURPOSE

To evaluate the impact of an inpatient multimodal and intensive rehabilitation program on neuromuscular, respiratory, and functional impairments of post-ICU COVID-19 patients.

MATERIALS AND METHODS

Prospective study including post-ICU COVID-19 survivors consecutively admitted to a rehabilitation centre. Rehabilitation was conducted by an interdisciplinary team. Medical Research Council (MRC) score, maximum expiratory pressure (MEP), maximum inspiratory pressure (MIP), peak cough flow (PCF), Functional Oral Intake Scale (FOIS), Brief Balance Evaluation Systems Test (Brief-BESTest), Timed Up and Go (TUG) test, 1 min Sit to Stand Test (1' STST), 6 min Walking Test (6MWT), Fatigue Assessment Scale (FAS), Functional Independence Measure (FIM) were assessed at admission (T0) and discharge (T1).

RESULTS

A total of 42 patients were included. After 32.00;26.00 days of inpatient rehabilitation, there was a significant improvement in limb and respiratory muscle strength, cough effectiveness, fatigue, balance, exercise capacity, and in the ability to perform activities of daily living. Advanced age, longer acute care hospitalization, depressive symptoms, and cognitive deficits were associated with poorer functional outcomes.

CONCLUSION

Post-ICU COVID-19 patients present multiple sequelae with detrimental functional impact. An adapted interdisciplinary rehabilitation program is essential for a thorough evaluation of these patients and results in significant functional gains.IMPLICATIONS FOR REHABILITATIONPost-ICU COVID-19 survivors present multiple sequelae and disabilities.An intensive and interdisciplinary inpatient rehabilitation results in significant improvement in limb and respiratory muscle strength, cough effectiveness, fatigue, balance, exercise capacity, and ability to perform activities of daily living.Timely referral from the acute care setting to rehabilitation services is crucial to minimize the functional impact of severe multisystemic disease and prolonged hospitalization.

Post-intensive Care Unit COVID-19 Survivors: Functional Status and Respiratory Function Three Months After an Inpatient Rehabilitation Program

Introduction and objectives Long-term coronavirus disease 2019 (COVID-19) sequelae have become an increasing concern, with persistent dyspnoea and fatigue being the most common and long-lasting symptoms reported. The aim of this study was to evaluate the functional status and respiratory function three months after discharge from an inpatient rehabilitation program. Materials and methods This was a prospective study including post-ICU COVID-19 survivors consecutively admitted to an inpatient and multimodal rehabilitation program in a rehabilitation center. Evaluation of functional status (brief balance evaluation systems test (brief-BESTEST), timed up and go (TUG) test, 1 min sit to stand test (1STST), 6 min walking test (6MWT)); respiratory muscle strength (maximum expiratory pressure (MEP), maximum inspiratory pressure (MIP)); cough effectiveness (peak cough flow (PCF)); and fatigue (fatigue assessment scale (FAS)) were assessed at admission (T0), discharge (T1), and three months after discharge (T2). Results A total of 36 patients were included. Between T1 and T2, there was a significant improvement in MEP (84.47±20.89 vs 97.23±24.63 cmH₂O, p<0.001), PCF (367.83±117.24 vs 441.33±132.90 L/min, p=0.003), functional capacity (1STST (19.90±6.37 vs 23.13±6.07, p=0.004), and 6MWT (459.25±153.70 vs 500.00±163.74 meters, p=0.003)). No differences were seen in MIP, brief-BESTEST, or TUG. Patients presented a higher median final FAS score at T2 compared to T1: 21.50±5 vs 18.60±2.65, p=0.002. Conclusions Post-ICU COVID-19 survivors admitted to an inpatient rehabilitation program maintained a good functional recovery at the three-month follow-up. Despite overall improvement, we found higher scores of FAS, suggesting worse fatigue levels.

Minimal Clinically Important Differences for Measures of Pain, Lung Function, Fatigue, and Functionality in Spinal Cord Injury

OBJECTIVE

The objective of this study was to determine the minimal clinically important differences (MCIDs) for the numerical pain rating scale (NPRS), peak cough flow (PCF), peak expiratory flow (PEF), fatigue severity scale (FSS), and London chest activities of daily living scale (LCADL) in patients with spinal cord injuries (SCIs) after rehabilitation.

METHODS

Inpatients with SCI from 2 rehabilitation centers participating in a daily rehabilitation program were recruited. The NPRS, PCF, PEF, FSS, and LCADL were collected at baseline and discharge. The global rating of change scale was performed at discharge. MCIDs were calculated using anchor (linear regression, mean change, and receiver operating characteristic curves) and distribution-based methods (0.5 times the baseline SD, standard error of measurement, 1.96 times standard error of measurement, and minimal detectable change) and pooled using arithmetic weighted mean.

RESULTS

Sixty inpatients with SCI (36 males; 54.5 [15.9] years) participated. On average their rehabilitation program lasted 7.3 (1.7) weeks. Pooled MCID estimates were 1.6 points for the NPRS, 69.8 L/min for the PCF, 77.4 L/min for the PEF, 1.1 points for the FSS, and 1.4 points for the LCADL.

CONCLUSION

Established MCIDs for NPRS, PCF, PEF, FSS, and LCADL will help health professionals to interpret results and guide rehabilitation interventions in patients with SCI.

IMPACT

Health professionals and researchers may now use -1.6 points for the NPRS, 69.8 L/min for the PCF, 77.4 L/min for the PEF, 1.1 points for the FSS, and 1.4 points for the LCADL to interpret if changes in pain, cough intensity, expiratory flow, fatigue and activities of daily living after rehabilitation of patients with SCI have been clinically relevant.

Boson Sampling with Single-Photon Fock States from a Bright Solid-State Source

A boson-sampling device is a quantum machine expected to perform tasks intractable for a classical computer, yet requiring minimal nonclassical resources as compared to full-scale quantum computers. Photonic implementations to date employed sources based on inefficient processes that only simulate heralded single-photon statistics when strongly reducing emission probabilities. Boson sampling with only single-photon input has thus never been realized. Here, we report on a boson-sampling device operated with a bright solid-state source of single-photon Fock states with high photon-number purity: the emission from an efficient and deterministic quantum dot-micropillar system is demultiplexed into three partially indistinguishable single photons, with a single-photon purity 1-g^{(2)}(0) of 0.990±0.001, interfering in a linear optics network. Our demultiplexed source is between 1 and 2 orders of magnitude more efficient than current heralded multiphoton sources based on spontaneous parametric down-conversion, allowing us to complete the boson-sampling experiment faster than previous equivalent implementations.

Measuring Entanglement in a Photonic Embedding Quantum Simulator

Measuring entanglement is a demanding task that usually requires full tomography of a quantum system, involving a number of observables that grows exponentially with the number of parties. Recently, it was suggested that adding a single ancillary qubit would allow for the efficient measurement of concurrence, and indeed any entanglement monotone associated with antilinear operations. Here, we report on the experimental implementation of such a device-an embedding quantum simulator-in photonics, encoding the entangling dynamics of a bipartite system into a tripartite one. We show that bipartite concurrence can be efficiently extracted from the measurement of merely two observables, instead of 15, without full tomographic information.

Experimental distribution of entanglement with separable carriers

The key requirement for quantum networking is the distribution of entanglement between nodes. Surprisingly, entanglement can be generated across a network without direct transfer-or communication-of entanglement. In contrast to information gain, which cannot exceed the communicated information, the entanglement gain is bounded by the communicated quantum discord, a more general measure of quantum correlation that includes but is not limited to entanglement. Here, we experimentally entangle two communicating parties sharing three initially separable photonic qubits by exchange of a carrier photon that is unentangled with either party at all times. We show that distributing entanglement with separable carriers is resilient to noise and in some cases becomes the only way of distributing entanglement through noisy environments.

Entangling quantum-logic gate operated with an ultrabright semiconductor single-photon source

We demonstrate the unambiguous entangling operation of a photonic quantum-logic gate driven by an ultrabright solid-state single-photon source. Indistinguishable single photons emitted by a single semiconductor quantum dot in a micropillar optical cavity are used as target and control qubits. For a source brightness of 0.56 photons per pulse, the measured truth table has an overlap with the ideal case of 68.4±0.5%, increasing to 73.0±1.6% for a source brightness of 0.17 photons per pulse. The gate is entangling: At a source brightness of 0.48, the Bell-state fidelity is above the entangling threshold of 50% and reaches 71.0±3.6% for a source brightness of 0.15.

Optimisation and validation of a quantitative and confirmatory LC-MS method for multi-residue analyses of β-lactam and tetracycline antibiotics in bovine muscle

A multi-residue method for the determination of the β-lactam antibiotics ampicillin, cefazolin, cloxacillin, dicloxacillin, nafcillin, oxacillin, penicillin G, penicillin V and the tetracyclines chlotetracycline, tetracycline and oxytetracycline was optimised and validated in bovine muscle. The method is based on the extraction of the residues from muscle using water/acetonitrile (2/8, v/v) with subsequent use of dispersive solid-phase C18 and hexane for purification. Extracts were analysed using ultra-performance liquid chromatography (UPLC-MS/MS) coupled with the mass spectrometer in positive electrospray ionisation mode (ESI+) for all analytes. The method was validated according to the requirements of European Commission Decision 2002/657/EC. The validation results were obtained within the MRL range of 0-1.5 of the MRL, with recoveries varying from 90% to 110% and CV < 20% (n = 54), except for cloxacillin, dicloxacillin and nafcillin. However, matrix interference was observed. The decision limit (CCα) ranged from 10% to 15% of the MRL. The uncertainty measurement was estimated based on both bottom-up and top-down strategies and the uncertainty values were found to be lower than 20% of the MRL. The method has a simple extraction procedure whereby analytes are separated with reasonable resolutions in a single 11-min chromatographic run. According to the validation results, this method is suitable for monitoring β-lactams and tetracyclines according to National Program for Residue and Contaminant Control - Brazil (NPRC-Brazil) in bovine muscle.

Reducing multi-photon rates in pulsed down-conversion by temporal multiplexing

We present a simple technique to reduce the emission rate of higher-order photon events from pulsed spontaneous parametric down-conversion. The technique uses extra-cavity control over a mode locked ultrafast laser to simultaneously increase repetition rate and reduce the energy of each pulse from the pump beam. We apply our scheme to a photonic quantum gate, showing improvements in the non-classical interference visibility for 2-photon and 4-photon experiments, and in the quantum-gate fidelity and entangled state production in the 2-photon case.

Efficient measurement of quantum dynamics via compressive sensing

The resources required to characterize the dynamics of engineered quantum systems--such as quantum computers and quantum sensors--grow exponentially with system size. Here we adapt techniques from compressive sensing to exponentially reduce the experimental configurations required for quantum process tomography. Our method is applicable to processes that are nearly sparse in a certain basis and can be implemented using only single-body preparations and measurements. We perform efficient, high-fidelity estimation of process matrices of a photonic two-qubit logic gate. The database is obtained under various decoherence strengths. Our technique is both accurate and noise robust, thus removing a key roadblock to the development and scaling of quantum technologies.

Experimental feedback control of quantum systems using weak measurements

A goal of the emerging field of quantum control is to develop methods for quantum technologies to function robustly in the presence of noise. Central issues are the fundamental limitations on the available information about quantum systems and the disturbance they suffer in the process of measurement. In the context of a simple quantum control scenario-the stabilization of nonorthogonal states of a qubit against dephasing-we experimentally explore the use of weak measurements in feedback control. We find that, despite the intrinsic difficultly of implementing them, weak measurements allow us to control the qubit better in practice than is even theoretically possible without them. Our work shows that these more general quantum measurements can play an important role for feedback control of quantum systems.

Experimental quantum computing without entanglement

Deterministic quantum computation with one pure qubit (DQC1) is an efficient model of computation that uses highly mixed states. Unlike pure-state models, its power is not derived from the generation of a large amount of entanglement. Instead it has been proposed that other nonclassical correlations are responsible for the computational speedup, and that these can be captured by the quantum discord. In this Letter we implement DQC1 in an all-optical architecture, and experimentally observe the generated correlations. We find no entanglement, but large amounts of quantum discord-except in three cases where an efficient classical simulation is always possible. Our results show that even fully separable, highly mixed, states can contain intrinsically quantum mechanical correlations and that these could offer a valuable resource for quantum information technologies.

Evaluation of genetic diversity in a natural rosewood population (Dalbergia nigra Vell. Allemão ex Benth.) using RAPD markers

Dalbergia nigra (rosewood) is a long-lived leguminous species, which is endemic to the Brazilian Atlantic forest. Because of the high economic value of its wood, this species has been over-explored in recent years. Currently, rosewood is included in the IUCN Red List as vulnerable. We examined the genetic diversity of 87 specimens of D. nigra sampled from a continuous forest in the Veracel Reserve and Brazilwood Ecological Station, Porto Seguro, Bahia state, with random amplified polymorphic DNA markers. Grouping analyses were done using unweighted pair group method with arithmetic averages. Using the 16 most informative primers, 112 markers were obtained; 39% (44 bands) were polymorphic. A genetic similarity matrix was made based on the polymorphic bands. The dispersion graph and dendrogram analyses showed three distinct sub-populations. The degree of polymorphism was high, near that of other populations of similar species; however, it was considered low for the conservation of this species.

Environment-Induced Sudden Death of Entanglement

We demonstrate the difference between local, single-particle dynamics and global dynamics of entangled quantum systems coupled to independent environments. Using an all-optical experimental setup, we showed that, even when the environment-induced decay of each system is asymptotic, quantum entanglement may suddenly disappear. This "sudden death" constitutes yet another distinct and counterintuitive trait of entanglement.

Aeolian transport of sand

The airborne transport of particles on a granular surface by the saltation mechanism is studied through numerical simulation of particles dragged by turbulent air flow. We calculate the saturated flux q(s) and show that its dependence on the wind strength u(*) is consistent with several empirical relations obtained from experimental measurements. We propose and explain a new relation for fluxes close to the threshold velocity u(t), namely, q(s)=a(u(*)-u(t))(alpha) with alpha approximately 2. We also obtain the distortion of the velocity profile of the wind due to the drag of the particles and find a novel dynamical scaling relation. We also obtain a new expression for the dependence of the height of the saltation layer as function of the strength of the wind.

Quantum key distribution with higher-order alphabets using spatially encoded qudits

We present a proof of principle demonstration of a quantum key distribution scheme in higher-order -dimensional alphabets using spatial degrees of freedom of photons. Our implementation allows for the transmission of 4.56 bits per sifted photon, while providing improved security: an intercept-resend attack on all photons would induce an average error rate of 0.47. Using our system, it should be possible to send more than a byte of information per sifted photon.

Extended phase-space dynamics for the generalized nonextensive thermostatistics

We apply a variant of the Nosé thermostat to derive the Hamiltonian of a nonextensive system that is compatible with the canonical ensemble of the generalized thermostatistics of Tsallis. This microdynamical approach provides a deterministic connection between the generalized nonextensive entropy and power-law behavior. For the case of a simple one-dimensional harmonic oscillator, we confirm by numerical simulation of the dynamics that the distribution of energy H follows precisely the canonical q statistics for different values of the parameter q. The approach is further tested for classical many-particle systems by means of molecular dynamics simulations. The results indicate that the intrinsic nonlinear features of the nonextensive formalism are capable of generating energy fluctuations that obey anomalous probability laws. For q<1 a broad distribution of energy is observed, while for q>1 the resulting distribution is confined to a compact support.

Observation of image transfer and phase conjugation in stimulated down-conversion

We observe experimentally the transfer of angular spectrum and image formation in the process of stimulated parametric down-conversion. Images and interference patterns can be transferred from either the pump or the auxiliary laser beams to the stimulated down-converted one. The stimulated field propagates as the complex conjugate of the auxiliary laser. The phase conjugation is observed through intensity pattern measurements.

Fluid flow through ramified structures

We investigate the fluid flow through two-dimensional ramified structures by direct simulation of the Navier-Stokes equations. We show that for trees with n generations, the flow distribution strongly depends on the Reynolds number Re. Specifically, for a tree without loops the flow becomes highly heterogeneous at high Re. For a tree with loops, on the other hand, the flow distribution tends to be more uniform at increased Re conditions. We show that these apparently contradictory behaviors have the same origin, namely, the effect of inertia on the momentum transport in the channels of the ramified geometry. In order to simulate the propagation of the flow imbalance throughout the tree without loops, we develop a simple model that incorporates the basic fluid dynamics features of the system. For large trees, the results of the model indicate that the distribution of flow at the outlet branches can be described by a self-affine landscape. Finally, we argue that the nonuniform partitioning of flow found for the structure without loops may contribute to the morphogenesis and functioning of the bronchial tree.

Scaling behavior in a proportional voting process

We perform a statistical analysis on the proportional elections held in Brazil in October 1998. We show that the distribution of votes among candidates for the whole country follows a power law N(v) is proportional to v(-alpha), with alpha=1.00+/-0.02, extending over two orders of magnitude. The voting distributions for several states of the federation also display scale-invariant behavior with alpha approximately equal to 1. We argue that this particular voting system can be modeled as a typical multiplicative process in which the choice of the candidate is governed by a product of probabilities.

Vincristine in steroid-resistant nephrotic syndrome

The therapeutic response to vincristine was examined in seven children (aged 2-15 years) with corticosteroid-resistant (CR) nephrotic syndrome (NS) with focal and segmental glomerulosclerosis (FGS). Five were also resistant to cyclophosphamide. Vincristine was given weekly (1.5 mg/m2 intravenously) for 8 weeks. Simultaneously, prednisone (60 mg/m2 per day, orally) was given for 4 weeks and then gradually tapered. Two of these patients had a complete and stable remission; in five no benefit was observed. It was not possible to identify any characteristics to predict the response to vincristine. Although there is a case for trying vincristine therapy in CR NS with FGS, the results of this study are not encouraging and a better understanding of its action and indications is necessary.