The Frail'BESTest: an adaptation of the "balance evaluation system test" for frail older adults; Concurrent validity, responsiveness, validity for fall prediction and detection of slower walkers.

BACKGROUND: The Frail'BESTest was developed in order to include frail older adults when they are using the BESTest. Recently, psychometrics properties (internal coherence, systems usefulness, complementarity and inter-rater reliability) of the Frail'BESTest were tested. To complete these analyses, this study will aim the assessment of its concurrent validity, responsiveness, predictive validity on falls occurrence, and slower walkers detection. METHODS: The correlation between the Frail'BESTest and the Gait Speed Test permitted to assess concurrent validity. The variation between the initial test score and the score obtained after the completion of a rehabilitation program was used to evaluate responsiveness with MANOVA analysis and standard response mean (SRM) calculation. Predictive validity was assessed with receiver-operating characteristic curves and area under the curve (AUC) analysis regarding falls occurrence. Slower walkers detection thresholds were computed by receiver-operating characteristic curves for the Frail'BESTest and the Tinetti test. RESULTS: The concurrent validity of the test was good (r = 0.74; p < 0.001). The Standard Error of measurement was at 2.81 points and the Minimal Detectable Change at 7.79 points for the total score of the Frail'BESTest. The SRM was at 0.41 for the Tinetti test and 0.56 for the Frail'BESTest. The AUC, computed according to fall occurrence, was at 0.71 for the Gait Speed test, 0.673 for the Tinetti test and 0.693 for the Frail'BESTest. Both the Tinetti (AUC = 0.87) and the Frail'BESTest (AUC = 0.88) were found suitable for tracking slower walkers. CONCLUSION: Concurrent validity and responsiveness of the Frail'BESTest were good. As for the Tinetti and the Frail'BESTest, they were unable to predict efficiently falls occurrence in the tested sample. The Frail'BESTest seems enough sensitive to spot the slower walkers efficiently, using a 15/20 threshold method. The Frail'BESTest was found to be a valid and responsive clinical test, therefore it can be recommended as an outcome measure in clinical practice.

The Frail'BESTest. An Adaptation of the "Balance Evaluation System Test" for Frail Older Adults. Description, Internal Consistency and Inter-Rater Reliability.

INTRODUCTION: The Balance Evaluation System Test (BESTest) and the Mini-BESTest were developed to assess the complementary systems that contribute to balance function. These tests include functional tasks involving several high-level exercises to assess the balance function, which may be even more difficult in case of frailty. The Frail'BESTest has been developed to make it possible to include frail older adults in systemic assessment. In this first paper, the objective is to present the Frail'BESTest and to describe the usefulness and complementarity of each system and to test the inter-rater reliability of the score measurements in two health centers. METHODS: In the first center, 192 frail and non-frail older patients were enrolled to test I) the contribution of each system, II) internal consistency, and III) the threshold and ceiling effects. The scores of 32 patients from center 1 and 32 patients recruited in another center (center 2) were used to measure the inter-rater reliability of the measurements by means of Kendall's tau coefficients. RESULTS: The internal consistency was moderate to good for five systems and limited for "biomechanical constraints". The distribution of the Frail'BESTest was more centered than that of the Tinetti and Mini-Motor tests. The Kendall's tau showed strong concordance in center 1 for all systems and only for 4 on 6 systems in center 2. DISCUSSION: Completing a systemic evaluation, the therapist may prioritize the patient's needs identifying the most challenging systems. This paper presents the Frail'BESTest and confirms the psychometric properties at a first step level.

Test-retest reliability and responsiveness of centre of pressure measurements in patients with hip osteoarthritis.

OBJECTIVE: The aim of this study was to determine a set of measures for the evaluation of balance in patients suffering from hip osteoarthritis (OA) that were both reliable and responsive to change. DESIGN: Three groups of subjects; Healthy, hip OA patients without surgery, and hip OA with surgery (pre and post-surgery) were included in this study. Subjects had to perform balance tests in two positions: standard and narrowed stance. CoP-based measures test-retest reliability was assessed in hip OA without surgery group, responsiveness were assessed between all groups and between pre and post-surgery. RESULTS: Intraclass Correlation Coefficient (ICC) values from hip OA without surgery ranged from -0.03 to 0.9 for only five parameters (CoP path length, SD velocity, mean velocity, and antero-posterior Root Mean Square (RMS(AP)) having values over 0.7. SD velocity and RMS(AP) showed significant differences between healthy and surgery group in standard stance whereas narrowed stance revealed most differences between all groups. RMS(AP) showed the best responsiveness (Standardized Response Mean ∼0.5) between pre vs post-surgery in both conditions. RMS(AP) was also capable of discriminating between hip OA with surgery vs without surgery groups with good sensitivity and specificity. CONCLUSIONS: Our results showed there to be reliability and responsiveness of five postural parameters in hip OA patients in two conditions of standing balance. More parameters were significantly different in narrowed stance whereas sensitivity was better in standard stance. SD velocity and RMS(AP) discriminate between degrees of OA severity and highlight potential balance deficits even after arthroplasty. Selected parameters during standing balance could be assessed to complete the set of quantitative measures to quantify hip OA patient deficiencies.

Motor-prediction improvements after virtual rehabilitation in geriatrics: frail patients reveal different learning curves for movement and postural control.

BACKGROUND: Postural control associated with self-paced movement is critical for balance in frail older adults. The present work aimed to investigate the effects of a 2D virtual reality-based program on postural control associated with rapid arm movement in this population. METHODS: Participants in an upright standing position performed rapid arm-raising movements towards a target. Practice-related changes were assessed by pre- and post-test comparisons of hand kinematics and centre-of-pressure (CoP) displacement parameters measured in a training group and a control group. During these pre- and post-test sessions, patients have to reach towards yellow balls appearing on the screen, form a standardized upright position (with 15cm between the two malleoli). Training group patients took part in six sessions of virtual game. In this, patients were asked to reach their arm towards yellow balls appearing on the screen, from an upright position. RESULTS: After training, we observed improvements in arm movements and in the initial phase of CoP displacement, especially in the anticipatory postural adjustments. Learning curves for these two types of motor improvements showed different rates. These were continuous for the control of the arm movement, and discontinuous for the control of the CoP during the anticipatory postural adjustments. CONCLUSION: These results suggest that some level of motor (re)-learning is maintained in frail patients with low functional reserves. They also suggest that re-learning of anticipatory postural control (i.e. motor prediction) is less robust than explicit motor learning involved for the arm reaching. This last point should encourage clinicians to extend the training course duration, even if reaching movement improvements seems acquired, in order to automate these anticipatory postural activities. However, other studies should be done to measure the retention of these two types of learning on a longer-term period.

Transition moment directions and selected spectroscopic properties of Ivabradine.

Based on the Kawski-Gryczynski method the value of angle ß=38° between absorption and fluorescence transition moments of Ivabradine was determined. Such a high value of ß is responsible for low emission anisotropy of Ivabradine in a rigid polyvinyl alcohol matrix and in anhydrous glycerol despite the elongated shape of the fluorophore. Selected steady-state and time-resolved spectroscopic results support the analysis.

Förster resonance energy transfer and trapping in selected systems: analysis by Monte-Carlo simulation.

Monte-Carlo simulation method is described and applied as an efficient tool to analyze experimental data in the presence of energy transfer in selected systems, where the use of analytical approaches is limited or even impossible. Several numerical and physical problems accompanying Monte-Carlo simulation are addressed. It is shown that the Monte-Carlo simulation enables to obtain orientation factor in partly ordered systems and other important energy transfer parameters unavailable directly from experiments. It is shown how Monte-Carlo simulation can predict some important features of energy transport like its directional character in ordered media.

Electronic excitation energy migration in partly ordered polymeric films.

Multistep intermolecular energy migration between elongated fluorophores (carbocyanines) in uniaxially oriented polymer films is studied based on fluorescence depolarization and Monte-Carlo simulations. Contrary to disordered systems it is found experimentally that the concentration depolarization of fluorescence in uniaxially oriented films is extremely weak despite effective energy migration. Based on the concentration depolarization experiment in the ordered matrix it is possible to estimate the angle between absorption and fluorescence transition moments of carbocyanines. The values of that angle are very close to those obtained from other methods.

Protein-dependent reduction of the pyrene excimer formation in membranes.

The presence of proteins in lipid bilayers always decreases the excimer formation rate of pyrene and pyrene lipid analogues in a way that is related to the protein-to-lipid ratio. Energy transfer measurements from intrinsic tryptophans to pyrene have shown (Engelke et al., 1994), that in microsomal membranes, the excimer formation rate of pyrene and pyrene fatty acids is heterogeneous within the membrane plane, because a lipid layer of reduced fluidity surrounds the microsomal proteins. This study investigates whether of not liposomes prepared from egg yolk phosphatidylcholine with incorporated gramicidin A give results comparable to those from microsomal membranes. The results indicate that the influence of proteins on the lipid bilayer cannot be described by one unique mechanism: Small proteins such as gramicidin A obviously reduce the excimer formation rate by occupying neighboring positions of the fluorescent probe and thus decrease the pyrene collision frequency homogeneously in the whole membrane plane, while larger proteins are surrounded by a lipid boundary layer of lower fluidity than the bulk lipid. The analysis of the time-resolved tryptophan fluorescence of gramicidin A incorporated liposomes reveals, that the tryptophan quenching by pyrene is stronger for tryptophans located closely below the phospholipid headgroup region because of the pyrene enrichment in this area of the lipid bilayer.

Differential transcription of plastome-encoded genes in the mesophyll and bundle-sheath chloroplasts of the monocotyledonous NADP-malic enzyme-type C4 plants maize and Sorghum.

The transcription of plastome-encoded genes in mesophyll and bundle-sheath chloroplasts of the monocotyledonous NADP-malic enzyme-type C4 species Zea mays L. (maize) and Sorghum bicolor (L.) Moench. was investigated. RNA accumulation and transcription were assayed starting from isolated mesophyll and bundle-sheath chloroplasts and using quantitative northern and run-on transcription analysis. Determination of the mesophyll to bundle-sheath ratios of transcript abundance in maize and Sorghum chloroplasts showed that the mRNAs of the plastome-encoded photosystem II genes analysed (psbA, psbB, psbD, psbH and psbE/F) varied from 2.5- to 4.0-fold (maize) and 3.1- to 5.2-fold (Sorghum), respectively. The rbcL transcript, in contrast, was more abundant in bundle-sheath chloroplasts of both species, about 3-fold in maize and more than 10-fold in Sorghum. On the other hand, transcripts of genes encoding the 16S ribosomal RNA (r16) and subunits of photosystem I (psaA) and the cytochrome b/f complex (petB, petA) accumulated to similar levels in both types of chloroplasts. Determination of absolute transcript levels for rbcL and psbA in chloroplasts from maize and Sorghum demonstrated that for both genes, the mesophyll to bundle-sheath differences in transcript abundance were more pronounced in Sorghum. Measurements of the transcriptional activities of rbcL and psbA showed that the transcription rate of rbcL is higher in bundle-sheath chloroplasts while psbA is more actively transcribed in mesophyll chloroplasts. The differences in the transcription rates between the two chloroplast types were again more pronounced in Sorghum, thus reflecting the differences between maize and Sorghum in the relative levels of the rbcL and psbA transcripts. However, although transcription rate and mRNA abundance are correlated, they did not exactly match one another. This indicates additional regulation of transcript abundance at the level of RNA stability.

Differences in lipid and lipoprotein levels in white, black and Asian non-insulin dependent (type 2) diabetics with hypertension.

We have examined the prevalence of hyperlipidaemia (defined as representing fasting serum cholesterol greater than 7.1 mmol/L; fasting serum triglyceride greater than 2.1 mmol/L) in 188 hypertensive type 2 diabetics of different ethnic groups. The overall prevalence of hyperlipidaemia was 36.0% with hypertriglyceridaemia at 25% being more frequent than hypercholesterolaemia at 19%. Blacks at 20.5% had strikingly less hyperlipidaemia than whites at 43.3% (p less than 0.01) and Asians, at 53.7% (p less than 0.001). This ethnic difference was noted for each variety of hyperlipidaemia, being most marked for hypertriglyceridaemia. Reflecting these data blacks had lower mean triglyceride levels than whites (p less than 0.001) and Asians (p less than 0.01). In addition, blacks had higher HDL-cholesterol than whites (p less than 0.01) and Asians (p less than 0.001) and HDL2-cholesterol was higher in blacks than Asians (p less than 0.001). In summary we have confirmed that in hypertensive type 2 diabetics similar ethnic differences of lipid and lipoprotein levels exist as that in non-diabetics. In light of the common occurrence of hyperlipidaemia in the white and Asian hypertensive type 2 diabetic, it may be appropriate to screen for this abnormality. However, in black hypertensive type 2 diabetic subjects this would be less rewarding.

High fibre, low sodium and low fat diet in white and black type 2 diabetics with mild hypertension.

White and black mildly hypertensive Type 2 diabetics were given an intended diet high in unrefined carbohydrate (50% daily energy) and fibre (40-45 g/day) while low in fat (25% daily energy) and sodium (60-80 mmol/day) for 3 months. Both white and black diabetic hypertensive patient groups demonstrated a significant reduction of systolic (p less than 0.01 and p less than 0.001 respectively) and diastolic blood pressure (p less than 0.001 and p less than 0.01 respectively). This was accompanied by a significant reduction of daily urine sodium excretion, urine sodium: potassium ratio, weight and glycosylated haemoglobin in both groups. Only whites had a significant reduction of serum triglyceride level (p less than 0.05) although blacks showed similar trends. Compliance to the dietary regimen, assessed by a trends. Compliance to the dietary regimen, assessed by a scoring method appeared comparable in both groups. These data suggest this modified dietary regimen might be considered an attractive alternative to conventional antihypertensive drug therapy in mildly hypertensive Type 2 diabetic black as well as white patients.

Medical conditions underlying recurrence of retinal vein occlusion.

Seventeen patients with recurrent retinal vein occlusion were investigated for underlying medical conditions and compared with 61 patients with single retinal vein occlusion (26 with central, 35 with branch vein occlusion). The two study groups were comparable for age, sex, and weight. Patients with recurrence had a significantly increased prevalence rate of hypertension (88% versus 48%: p less than 0.01), with a trend to increased hyperlipidaemia (47% versus 33%) compared with patients with a single episode. A significantly raised mean systolic (p less than 0.05) but not diastolic blood pressure was found in patients with recurrence. Other cardiovascular risk factors in patients with recurrence were also found and included lower mean levels of high density lipoprotein (HDL)-cholesterol (p less than 0.02) and the HDL2 subfraction (p less than 0.001), and a significantly increased proportion of patients with regular alcohol intake (p less than 0.01). We conclude that hypertension and hyperlipidaemia with an increase in other cardiovascular risk factors are commonly found in patients with recurrent retinal vein occlusion and may therefore be important aetiological factors. The possible benefits of treatment of these underlying conditions to prevent recurrence need to be assessed in well designed prospective studies.

A controlled trial of a high fibre, low fat and low sodium diet for mild hypertension in Type 2 (non-insulin-dependent) diabetic patients.

Fifty hypertensive Type 2 (non-insulin-dependent) diabetic patients were allocated, in a controlled trial, to a treatment diet of high fibre, low fat and low sodium composition, or to a control diet by the hospital dietitian. After 3 months treatment, the modified diet-treated group showed a highly significant reduction in mean systolic (180.5 +/- 19.0 to 165.0 +/- 20.7 mmHg) and diastolic blood pressure (96.6 +/- 9.3 to 88.0 +/- 10.5 mmHg), accompanied by significant reductions in urinary sodium excretion (183.0 +/- 62.1 to 121.7 +/- 65.8 mmol/day) glycosylated haemoglobin (12.4 +/- 3.1 to 10.5 +/- 2.9%), weight (74.6 +/- 13.5 to 71.7 +/- 12.1 kg) and serum triglyceride levels (p less than 0.05). The mean values of diastolic pressure (p less than 0.01), urinary sodium/potassium ratio (p less than 0.001), urinary potassium (p less than 0.01) was significantly reduced at 3 months compared to control. No changes in serum HDL-cholesterol levels were observed. The number of patients with normal blood pressure at 3 months was greater in the modified diet-treated group (ten versus five). Treatment of mild hypertension in diabetic subjects with this form of dietary regimen has a hypotensive response, with improvement in glycaemic control and no side effects. This modified diet may be an attractive alternative to anti-hypertensive drug therapy as a first line treatment.

Comparison of the hypotensive and metabolic effects of metoprolol therapy with a high fibre, low sodium, low fat diet in hypertensive type 2 diabetic subjects.

The clinical and biochemical response over a 3 month trial period of 21 hypertensive diabetics who were given metoprolol, 200 mg twice daily, have been compared to an age, sex, blood pressure, known duration of diabetes and diabetic treatment matched group who were treated with a high cereal fibre, low sodium and low fat diet. Both treatment groups had a significant reduction of systolic (p less than 0.001 on the diet; p less than 0.02 on metoprolol) and diastolic blood pressure (p less than 0.001 respectively). On metoprolol the heart rate significantly decreased throughout the study (p less than 0.001). Only the modified diet was accompanied with a reduction of mean glycosylated haemoglobin (p less than 0.01) and weight (p less than 0.001). By the end of the study mean serum triglyceride level was lower in the diet treated group (p less than 0.05) compared to the metoprolol group. In hyperlipidaemic patients only dietary therapy significantly decreased mean serum triglyceride (p less than 0.02) and glycosylated haemoglobin (p less than 0.001). We conclude that although both treatments had a similar hypotensive response only the modified diet beneficially influenced other cardiovascular risk factors. These data suggest that this diet might be considered an alternative to metoprolol in hypertensive diabetic patients.

Effect of a high fibre, high carbohydrate dietary regimen on serum lipids and lipoproteins in type II hypertensive diabetic patients.

Fifty Type II diabetic patients with mild hypertension were treated by a high cereal fibre, low fat and low sodium diet in a controlled trial for a 3-month period. The modified diet and control diet groups were well matched although the control group had significantly increased levels of HDL2-cholesterol (p less than 0.05). The modified diet group had a significant reduction of mean serum triglyceride (p less than 0.05) and elevation of HDL2 (p less than 0.05) levels. There was also a reduction of systolic (p less than 0.001) and diastolic blood pressure (p less than 0.001), weight (p less than 0.01) and glycosylated haemoglobin (p less than 0.001). No changes were observed in the control group. In those patients with added hyperlipidaemia, dietary therapy resulted in a significant decrease of mean serum cholesterol (p less than 0.02), triglyceride (p less than 0.01) and glycosylated haemoglobin levels (p less than 0.01). The control group had a significant reduction of HDL-cholesterol (p less than 0.02). We conclude that a high cereal fibre, low fat and low sodium dietary regimen is associated with improvement in cardiovascular risk over a 3-month period, especially in those with hyperlipidaemia. Contrary to previous reports, no deleterious effect on serum triglyceride, HDL- and HDL2-cholesterol levels were recorded in this study. These data add further support to the recent dietary recommendations of several Diabetic Associations.

Comparison of the hypotensive and metabolic effects of bendrofluazide therapy and a high fibre, low fat, low sodium diet in diabetic subjects with mild hypertension.

Fifty diabetic patients with mild hypertension were treated by a high fibre, low fat and low sodium diet or bendrofluazide for a three-month period. These two well-matched groups had a similar highly significant decrease in both systolic (P less than 0.001) and diastolic blood pressure (P less than 0.001). Both groups lost weight, the weight loss being greater in those receiving dietary therapy. Only dietary therapy was associated with a significant elevation of HDL2 level (P less than 0.05) and decrease in glycosylated haemoglobin (P less than 0.01). Bendrofluazide therapy resulted in significant elevation of glycosylated haemoglobin level (P less than 0.05) and at the end of the study this group had significantly higher glycosylated haemoglobin level (P less than 0.05) than the diet treated group. In those patients who were also hyperlipidaemic, dietary therapy resulted in a significant decrease of mean serum cholesterol (P less than 0.02), triglyceride (P less than 0.01) and glycosylated haemoglobin (P less than 0.01) while bendrofluazide treatment tended to elevate these levels. We conclude that a high fibre, low fat and low sodium dietary regimen lowers blood pressure, improves several other coronary risk factors and appears free of side-effects. This modified diet may be an attractive alternative to thiazide diuretic therapy in the mildly hypertensive diabetic subject.

Determinants of plasma lipoproteins and coagulation factors in men from Caerphilly, South Wales.

Dietary, social, and constitutional determinants of plasma concentrations of some major risk factors for ischaemic heart disease were investigated in a cross sectional study among 711 men from the general population aged 30-69. For high density lipoprotein cholesterol (HDL-C) six variables were significantly associated with plasma concentrations, and these variables explained 12.6% of the variance. For low density lipoprotein cholesterol (LDL-C), total cholesterol (T-C), and triglyceride 8.4%, 7.5%, and 18.5% of the variance was explained by significantly associated variables. Fibrinogen concentrations determined chemically were significantly associated with age, smoking habit, body mass index, alcohol consumption, and intake of cereal fibre (24.2% variance). These data provide some encouragement for the possibility of dietary intervention to influence plasma concentrations of major risk factors for ischaemic heart disease in men.