Literature highlights the need for research on changes in lumbar movement patterns, as potential mechanisms underlying the persistence of low-back pain. Variability and local dynamic stability are frequently used to characterize movement patterns. In view of a lack of information on reliability of these measures, we determined their within- and between-session reliability in repeated seated reaching. Thirty-six participants (21 healthy, 15 LBP) executed three trials of repeated seated reaching on two days. An optical motion capture system recorded positions of cluster markers, located on the spinous processes of S1 and T8. Movement patterns were characterized by the spatial variability (meanSD) of the lumbar Euler angles: flexion–extension, lateral bending, axial rotation, temporal variability (CyclSD) and local dynamic stability (LDE). Reliability was evaluated using intraclass correlation coefficients (ICC), coefficients of variation (CV) and Bland-Altman plots. Sufficient reliability was defined as an ICC ≥ 0.5 and a CV < 20%. To determine the effect of number of repetitions on reliability, analyses were performed for the first 10, 20, 30, and 40 repetitions of each time series. MeanSD, CyclSD, and the LDE had moderate within-session reliability; meanSD: ICC = 0.60–0.73 (CV = 14–17%); CyclSD: ICC = 0.68 (CV = 17%); LDE: ICC = 0.62 (CV = 5%). Between-session reliability was somewhat lower; meanSD: ICC = 0.44–0.73 (CV = 17–19%); CyclSD: ICC = 0.45–0.56 (CV = 19–22%); LDE: ICC = 0.25–0.54 (CV = 5–6%). MeanSD, CyclSD and the LDE are sufficiently reliable to assess lumbar movement patterns in single-session experiments, and at best sufficiently reliable in multi-session experiments. Within-session, a plateau in reliability appears to be reached at 40 repetitions for meanSD (flexion–extension), meanSD (axial-rotation) and CyclSD.
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Achtergrond: Ernstige psychische aandoeningen (epa) gaan gepaard met hoge ggz- en andere zorgkosten. Om de discussie hierover tussen verzekeraars, gemeenten en ggz transparanter te voeren zijn in 2012 zorgvignetten ontwikkeld die in een regio een beeld moeten geven over de aanwezige groepen patiënten met epa, ingedeeld naar zorgintensiteit. Doel: Inzicht krijgen in de vraag hoe bruikbaar en valide deze epa-vignetten zijn in relatie tot zorgbehoeften en psychosociaal functioneren. Methode: rom-uitkomsten (zorgbehoeften en psychosociaal functioneren) van 706 patiënten werden per zorgzwaartevignet vergeleken (m.b.v. χ2-toetsen en anova’s). Voor twee complexe zorgzwaartevignetten (zorgwekkende zorgmijders en gevaar afwenden) werden verschillen in zorgbehoeften en functioneren longitudinaal onderzocht (met repeated measures-anova’s en analyses volgens McNemar). Resultaten: De vignetten waren in beperkte mate onderscheidend wat betreft zorgbehoeften en functioneren. Patiënten met vignetten ‘zorgwekkende zorgmijders’ en ‘gevaar afwenden’ hadden de meeste beperkingen in functioneren en de meeste (onvervulde) zorgbehoeften. Deze bevindingen bleken stabiel over tijd. Conclusie: De vignetten zijn onvoldoende onderscheidend. Om regionale zorgplanning te verbeteren is het wenselijk om bestaande informatie van zorgvignetten te verrijken met informatie over zorgbehoeften en functioneren
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INTRODUCTION: After treatment with chemotherapy, many patients with breast cancer experience cognitive problems. While limited interventions are available to improve cognitive functioning, physical exercise showed positive effects in healthy older adults and people with mild cognitive impairment. The Physical Activity and Memory study aims to investigate the effect of physical exercise on cognitive functioning and brain measures in chemotherapy-exposed patients with breast cancer with cognitive problems.METHODS AND ANALYTICS: One hundred and eighty patients with breast cancer with cognitive problems 2-4 years after diagnosis are randomised (1:1) into an exercise intervention or a control group. The 6-month exercise intervention consists of twice a week 1-hour aerobic and strength exercises supervised by a physiotherapist and twice a week 1-hour Nordic or power walking. The control group is asked to maintain their habitual activity pattern during 6 months. The primary outcome (verbal learning) is measured at baseline and 6 months. Further measurements include online neuropsychological tests, self-reported cognitive complaints, a 3-tesla brain MRI, patient-reported outcomes (quality of life, fatigue, depression, anxiety, work performance), blood sampling and physical fitness. The MRI scans and blood sampling will be used to gain insight into underlying mechanisms. At 18 months online neuropsychological tests, self-reported cognitive complaints and patient-reported outcomes will be repeated.ETHICS AND DISSEMINATION: Study results may impact usual care if physical exercise improves cognitive functioning for breast cancer survivors.TRIAL REGISTRATION NUMBER: NTR6104.
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Objective: In myocardial perfusion single-photon emission computed tomography (SPECT), abdominal activity often interferes with the evaluation of perfusion in the inferior wall, especially after pharmacological stress. In this randomized study, we examined the effect of carbonated water intake versus still water intake on the quality of images obtained during myocardial perfusion images (MPI) studies. Methods: A total of 467 MIBI studies were randomized into a carbonated water group and a water group. The presence of intestinal activity adjacent to the inferior wall was evaluated by two observers. Furthermore, a semiquantitative analysis was performed in the adenosine subgroup,using a count ratio of the inferior myocardial wall and adjacent abdominal activity. Results: The need for repeated SPECT in the adenosine studies was 5.3 % in the carbonated water group versus 19.4 % in the still water group (p = 0.019). The inferior wall-to-abdomen count ratio was significantly higher in the carbonated water group compared to the still water group (2.11 ± 1.00 vs. 1.72 ± 0.73, p\0.001). The effect of carbonated water during rest and after exercise was not significant. Conclusions: This randomized study showed that carbonated water significantly reduced the interference of extra-cardiac activity in adenosine SPECT MPI. Keywords: Extra-cardiac radioactivity, Myocardial SPECT, Image quality enhancement, Carbonated water
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Factors affecting repeated sprint ability (RSA) were evaluated in a mixed-longitudinal sample of 48 elite basketball players 14 to 19 years of age (16.1±1.7 years). Players were observed on six occasions during the 2008-2009 and 2009-2010 seasons. Three basketball-specific field tests were administered on each occasion: the Shuttle Sprint Test (SST) for RSA, the Vertical Jump (VJ) for lower body explosive strength (power), and the Interval Shuttle Run Test (ISRT) for interval endurance capacity. Height and weight were measured; body composition was estimated (percent fat, lean body mass). Multilevel modeling of RSA development curve was used with 32 players (16.0±1.7 years) who had two or more observations. The 16 players (16.1±1.8 years) measured on only one occasion were used as a control group to evaluate the appropriateness of the model. Age, lower body explosive strength, and interval endurance capacity significantly contributed to RSA (p < .05). RSA improved with age from 14-17 years (p < .05) and reached a plateau at 17-19 years. Predicted RSA did not significantly differ from measured RSA in the control group (p > .05). The results suggest a potentially important role for the training of lower body explosive strength and interval endurance capacity in the development of RSA among youth basketball players. Age-specific reference values for RSA of youth players may assist basketball coaches in setting appropriate goals for individual players.
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This paper presents the results of a survey which aimed at exploring the perceptions of the employees of a large aviation organization regarding the punitive or preventive character of possible measures that management could take in cases of errors and violations. The analysis of the quantitative and qualitative data collected showed that the viewpoints of the staff were sufficiently aligned only for half of the measures and that all measures inflicting a short- or long-term dissociation of the end-users from their current working place and function were highly unfavourable and linked to castigation. Also, statistically significant differences were observed across groups of specialties and years of service regarding the appropriateness of specific measures especially in the case of errors. The findings of this study in combination with literature references, suggest that the establishment of a just culture structure with agreed lines between the punitive and preventive character of measures and its endorsement by the employees is achievable, but it requires a bottom-up approach and periodical revision. Similar exploratory research, complemented possibly by explanatory studies, is recommended to be carried out by organizations prior or during the development of their just culture policy andrelated measures.
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Background To gain insight into the role of plantar intrinsic foot muscles in fall-related gait parameters in older adults, it is fundamental to assess foot muscles separately. Ultrasonography is considered a promising instrument to quantify the strength capacity of individual muscles by assessing their morphology. The main goal of this study was to investigate the intra-assessor reliability and measurement error for ultrasound measures for the morphology of selected foot muscles and the plantar fascia in older adults using a tablet-based device. The secondary aim was to compare the measurement error between older and younger adults and between two different ultrasound machines. Methods Ultrasound images of selected foot muscles and the plantar fascia were collected in younger and older adults by a single operator, intensively trained in scanning the foot muscles, on two occasions, 1–8 days apart, using a tablet-based and a mainframe system. The intra-assessor reliability and standard error of measurement for the cross-sectional area and/or thickness were assessed by analysis of variance. The error variance was statistically compared across age groups and machines. Results Eighteen physically active older adults (mean age 73.8 (SD: 4.9) years) and ten younger adults (mean age 21.9 (SD: 1.8) years) participated in the study. In older adults, the standard error of measurement ranged from 2.8 to 11.9%. The ICC ranged from 0.57 to 0.97, but was excellent in most cases. The error variance for six morphology measures was statistically smaller in younger adults, but was small in older adults as well. When different error variances were observed across machines, overall, the tablet-based device showed superior repeatability. Conclusions This intra-assessor reliability study showed that a tablet-based ultrasound machine can be reliably used to assess the morphology of selected foot muscles in older adults, with the exception of plantar fascia thickness. Although the measurement errors were sometimes smaller in younger adults, they seem adequate in older adults to detect group mean hypertrophy as a response to training. A tablet-based ultrasound device seems to be a reliable alternative to a mainframe system. This advocates its use when foot muscle morphology in older adults is of interest.
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Nieuwe wetgeving voor jeugdzorg in Nederland heeft geleid tot de implementatie van teams, die geïntegreerde eerstelijns jeugdzorg bieden. Belangrijke doelen van de nieuwe Jeugdwet waren meer geïntegreerde, tijdige zorg en minder gebruik van intensieve vormen van zorg. Het doel van dit onderzoek was het bestuderen van veranderingen in het gebruik van jeugdzorg in de tijd en de rol van nieuw ingevoerde wijkgerichte ondersteuningsteams hierin. Patronen van jeugdzorggebruik veranderden naar meer lokaal geleverde primaire jeugdzorg, iets minder gespecialiseerde en iets meer residentiële jeugdzorg. Bovendien nam het jeugdzorggebruik onder jongere kinderen toe in de tijd. Deze trends komen deels overeen met de trends die de Jeugdwet beoogt. Er is weinig bewijs gevonden voor de rol van specifieke teamkenmerken op veranderingen in jeugdzorggebruik in de tijd.
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Het hanteren van muizen aan de staart wekt bij de dieren een stressrespons op. Deze techniek is echter in de meeste laboratoria nog steeds gebruikelijk. Reden hiervoor ligt grotendeels bij het praktische aspect van het gebruik van deze techniek. Of hanteren met behulp van een buis, dat minder stress veroorzaakt bij de muizen, praktisch toepasbaar is, is de kern van dit onderzoek.
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Abstract Background: Patients with glioma often suffer from cognitive deficits. Physical exercise has been effective in ameliorating cognitive deficits in older adults and neurological patients. This pilot randomized controlled trial (RCT) explored the possible impact of an exercise intervention, designed to improve cognitive functioning in glioma patients, regarding cognitive test performance and patient-reported outcomes (PROs). Methods: Thirty-four clinically stable patients with World Health Organization grades II/III glioma were randomized to a home-based remotely coached exercise group or an active control group. Patients exercised 3 times per week for 20-45 minutes, with moderate to vigorous intensity, during 6 months. At baseline and immediate follow-up, cognitive performance and PROs were assessed with neuropsychological tests and questionnaires, respectively. Linear regression analyses were used to estimate effect sizes of potential between-group differences in cognitive performance and PROs at 6 months. Results: The exercise group (n = 21) had small- to medium-sized better follow-up scores than the control group (n = 11) on several measures of attention and information processing speed, verbal memory, and executive function, whereas the control group showed a slightly better score on a measure of sustained selective attention. The exercise group also demonstrated small- to medium-sized better outcomes on measures of self-reported cognitive symptoms, fatigue, sleep, mood, and mental health-related quality of life. Conclusions: This small exploratory RCT in glioma patients provides a proof of concept with respect to improvement of cognitive functioning and PROs after aerobic exercise, and warrants larger exercise trials in brain tumor patients.
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