Background: Cervical dystonia is characterized by involuntary muscle contractions of the neck and abnormal head positions that affect daily life activities and social life of patients. Patients are usually treated with botulinum toxin injections into affected neck muscles to relief pain and improve control of head postures. In addition, many patients are referred for physical therapy to improve their ability to perform activities of daily living. A recent review on allied health interventions in cervical dystonia showed a lack of randomized controlled intervention studies regarding the effectiveness of physical therapy interventions.Methods/design: The (cost-) effectiveness of a standardized physical therapy program compared to regular physical therapy, both as add-on treatment to botulinum toxin injections will be determined in a multi-centre, single blinded randomized controlled trial with 100 cervical dystonia patients. Primary outcomes are disability in daily functioning assessed with the disability subscale of the Toronto Western Spasmodic Torticollis Rating Scale. Secondary outcomes are pain, severity of dystonia, active range of motion of the head, quality of life, anxiety and depression. Data will be collected at baseline, after six months and one year by an independent blind assessor just prior to botulinum toxin injections. For the cost effectiveness, an additional economic evaluation will be performed with the costs per quality adjusted life-year as primary outcome parameter.Discussion: Our study will provide new evidence regarding the (cost-) effectiveness of a standardized, tailored physical therapy program for patients with cervical dystonia. It is widely felt that allied health interventions, including physical therapy, may offer a valuable supplement to the current therapeutic options. A positive outcome will lead to a greater use of the standardized physical therapy program. For the Dutch situation a positive outcome implies that the standardized physical therapy program forms the basis for a national treatment guideline for cervical dystonia.Trial registration: Number Dutch Trial registration (Nederlands Trial Register): NTR3437.
The six-minute walking test (6MWT) may be a practical test for the evaluation functional exercise capacity in children with end-stage renal disease (ESRD). The aim of this study was to investigate the 6MWT performance in children with ESRD compared to reference values obtained in healthy children and, secondly, to study the relationship between 6MWT performance with anthropometric variables, clinical parameters, aerobic capacity and muscle strength. Twenty patients (13 boys and seven girls; mean age 14.1 ± 3.4 years) on dialysis participated in this study. Anthropometrics were taken in a standardized manner. The 6MWT was performed in a 20-m-long track in a straight hallway. Aerobic fitness was measured using a cycle ergometer test to determine peak oxygen uptake (V⋅O2peak)(V⋅O2peak), peak rate (Wpeak) and ventilatory threshold (VT). Muscle strength was measured using hand-held myometry. Children with ESRD showed a reduced 6MWT performance (83% of predicted, p < 0.0001), irrespective of the reference values used. The strongest predictors of 6MWT performance were haematocrit and height. Regression models explained 59% (haematocrit and height) to 60% (haematocrit) of the variance in 6MWT performance. 6MWT performance was not associated with V⋅O2peakV⋅O2peak, strength, or other anthropometric variables, but it was significantly associated with haematocrit and height. Children with ESRD scored lower on the 6MWT than healthy children. Based on these results, the 6MWT may be a useful instrument for monitoring clinical status in children with ESRD, however it cannot substitute for other fitness tests, such as a progressive exercise test to measure V⋅O2peakV⋅O2peak or muscle strength tests.
Background Testing aerobic fitness in youth is important because of expected relationships with health. Objective The purpose of the study was to estimate the validity and reliability of the Shuttle Ride Test in youth who have spina bifida and use a wheelchair for mobility and sport. Design Ths study is a validity and reliability study. Methods The Shuttle Ride Test, Graded Wheelchair Propulsion Test, and skill-related fitness tests were administered to 33 participants for the validity study (age = 14.5 ± 3.1 y) and to 28 participants for the reliability study (age = 14.7 ± 3.3 y). Results No significant differences were found between the Graded Wheelchair Propulsion Test and the Shuttle Ride Test for most cardiorespiratory responses. Correlations between the Graded Wheelchair Propulsion Test and the Shuttle Ride Test were moderate to high (r = .55–.97). The variance in peak oxygen uptake (VO2peak) could be predicted for 77% of the participants by height, number of shuttles completed, and weight, with large prediction intervals. High correlations were found between number of shuttles completed and skill-related fitness tests (CI = .73 to −.92). Intraclass correlation coefficients were high (.77–.98), with a smallest detectable change of 1.5 for number of shuttles completed and with coefficients of variation of 6.2% and 6.4% for absolute VO2peak and relative VO2peak, respectively. Conclusions When measuring VO2peak directly by using a mobile gas analysis system, the Shuttle Ride Test is highly valid for testing VO2peak in youth who have spina bifida and use a wheelchair for mobility and sport. The outcome measure of number of shuttles represents aerobic fitness and is also highly correlated with both anaerobic performance and agility. It is not possible to predict VO2peak accurately by using the number of shuttles completed. Moreover, the Shuttle Ride Test is highly reliable in youth with spina bifida, with a good smallest detectable change for the number of shuttles completed.
The maximum capacity of the road infrastructure is being reached due to the number of vehicles that are being introduced on Dutch roads each day. One of the plausible solutions to tackle congestion could be efficient and effective use of road infrastructure using modern technologies such as cooperative mobility. Cooperative mobility relies majorly on big data that is generated potentially by millions of vehicles that are travelling on the road. But how can this data be generated? Modern vehicles already contain a host of sensors that are required for its operation. This data is typically circulated within an automobile via the CAN bus and can in-principle be shared with the outside world considering the privacy aspects of data sharing. The main problem is, however, the difficulty in interpreting this data. This is mainly because the configuration of this data varies between manufacturers and vehicle models and have not been standardized by the manufacturers. Signals from the CAN bus could be manually reverse engineered, but this process is extremely labour-intensive and time-consuming. In this project we investigate if an intelligent tool or specific test procedures could be developed to extract CAN messages and their composition efficiently irrespective of vehicle brand and type. This would lay the foundations that are required to generate big data-sets from in-vehicle data efficiently.
In order to stay competitive and respond to the increasing demand for steady and predictable aircraft turnaround times, process optimization has been identified by Maintenance, Repair and Overhaul (MRO) SMEs in the aviation industry as their key element for innovation. Indeed, MRO SMEs have always been looking for options to organize their work as efficient as possible, which often resulted in applying lean business organization solutions. However, their aircraft maintenance processes stay characterized by unpredictable process times and material requirements. Lean business methodologies are unable to change this fact. This problem is often compensated by large buffers in terms of time, personnel and parts, leading to a relatively expensive and inefficient process. To tackle this problem of unpredictability, MRO SMEs want to explore the possibilities of data mining: the exploration and analysis of large quantities of their own historical maintenance data, with the meaning of discovering useful knowledge from seemingly unrelated data. Ideally, it will help predict failures in the maintenance process and thus better anticipate repair times and material requirements. With this, MRO SMEs face two challenges. First, the data they have available is often fragmented and non-transparent, while standardized data availability is a basic requirement for successful data analysis. Second, it is difficult to find meaningful patterns within these data sets because no operative system for data mining exists in the industry. This RAAK MKB project is initiated by the Aviation Academy of the Amsterdam University of Applied Sciences (Hogeschool van Amsterdan, hereinafter: HvA), in direct cooperation with the industry, to help MRO SMEs improve their maintenance process. Its main aim is to develop new knowledge of - and a method for - data mining. To do so, the current state of data presence within MRO SMEs is explored, mapped, categorized, cleaned and prepared. This will result in readable data sets that have predictive value for key elements of the maintenance process. Secondly, analysis principles are developed to interpret this data. These principles are translated into an easy-to-use data mining (IT)tool, helping MRO SMEs to predict their maintenance requirements in terms of costs and time, allowing them to adapt their maintenance process accordingly. In several case studies these products are tested and further improved. This is a resubmission of an earlier proposal dated October 2015 (3rd round) entitled ‘Data mining for MRO process optimization’ (number 2015-03-23M). We believe the merits of the proposal are substantial, and sufficient to be awarded a grant. The text of this submission is essentially unchanged from the previous proposal. Where text has been added – for clarification – this has been marked in yellow. Almost all of these new text parts are taken from our rebuttal (hoor en wederhoor), submitted in January 2016.
In the last decade, the concept on interactions between humans, animals and their environment has drastically changed, endorsed by the One Health approach that recognizes that health of humans and animals are inextricably linked. Consideration of welfare of livestock has increased accordingly and with it, attention into the possibilities to improve livestock health via natural, more balanced nutrition is expanding. Central to effects of healthy nutrition is an optimal gastrointestinal condition which entails a well-balanced functional local immune system leading to a resilient state of well-being. This project proposal, GITools, aims to establish a toolbox of in vitro assays to screen new feed ingredients for beneficial effects on gastrointestinal health and animal well-being. GITools will focus on pig and chicken as important livestock species present in high quantities and living in close proximity to humans. GITools builds on intestinal models (intestinal cell lines and stem cell-derived organoids), biomarker analysis, and in vitro enzymatic and microbial digestion models of feed constituents. The concept of GITools originated from various individual contacts and projects with industry partners that produce animal feed (additives) or veterinary medicines. Within these companies, an urgent need exists for straightforward, well-characterized and standardized in vitro methods that provide results translatable to the in vivo situation. This to replace testing of new feed concepts in live animal. We will examine in vitro methods for their applicability with feed ingredients selected based on the availability of data from (previous) in vivo studies. These model compounds will include long and short chain fatty acids, oligosaccharides and herbal-derived components. GITools will deliver insights on the role of intestinal processes (e.g. dietary hormone production, growth of epithelial cells, barrier function and innate immune responses) in health and well-being of livestock animals and improve the efficiency of testing new feed products.
