Manual and Cognitive Dual Tasks Contribute to Fall-Risk Differentiation in Posturography Measures.

Falls occur in 33% of older adults each year, some leading to moderate to severe injuries. To reduce falls and fall-related injuries, it is important to identify individuals with subtle risk factors elevating their likelihood of falling. The objective of this study was to determine how postural sway measures differed between fallers and nonfallers under standard and dual-task conditions. Quietstanding posturography measures were collected from 150 older adults during standard, cognitive, manual, and cognitive+manual tasks, and analyzed through traditional and nonlinear analyses. Of the traditional measures, M/L sway range and 95% confidence ellipse sway area showed statistically significant differences in all 4 test conditions between fallers and nonfallers. Although the manual dual task showed the most stable balance, effect sizes demonstrated larger differences between fallers and nonfallers. Nonlinear analysis revealed M/L sample entropy and M/L α-scaling exponent differentiating between fallers and nonfallers, with the cognitive task demonstrating larger differences. Based on the results, it is recommended to: (1) apply M/L sway range and 95% confidence ellipse area, (2) use the manual task to differentiate between fallers and nonfallers when using traditional analyses, and (3) use the cognitive task and M/L alpha and M/L sample entropy when using nonlinear analyses.

Subtle Differences During Posturography Testing Can Influence Postural Sway Results: The Effects of Talking, Time Before Data Acquisition, and Visual Fixation.

The goal of this study was to examine the effects of 3 factors and their interactions on posturography: a period of time to become accustomed to the force platform before the initiation of data collection, presence of a visual fixation point, and participant talking during testing. The postural stability of 30 young adults and 30 older adults was evaluated to determine whether any observed effects were confounded with age. Analysis of variance techniques were used to test all possible combinations of the 3 factors. We hypothesized that all 3 factors would significantly affect postural stability. For both participant groups, the results suggest that a period of time to become accustomed to the force platform before the initiation of data collection and a visual fixation point significantly affect postural control measures, while brief participant talking does not. Despite this, no significant interactions existed suggesting that the effects of these factors, which may occur in clinical testing, do not depend on each other. Our results suggest that inconsistencies in posturography testing methods have the potential to significantly affect the results of posturography, underscoring the importance of developing a standardized testing methodology.

Effects of heat stress and sex on pacing in marathon runners.

Recent research suggests that women tend to exhibit less of a precipitous decline in run velocity during the latter stages of a marathon than men when the covariates of age and run time are controlled for. The purpose of this study was to examine this sex effect with the added covariate of heat stress on pacing, defined as the mean velocity of the last 12.2 km divided by the mean velocity of the first 30 km. A secondary purpose of this investigation was to compare the pacing profiles of the elite men and women runners and the pacing profiles of the elite and nonelite runners. Subjects included 22,990 men and 13,233 women runners from the 2007 and 2009 Chicago marathons for which the mean ambient temperatures were 26.67° C and 2.77° C, respectively. Each 5-km split time was measured via an electronic chip worn on the participants' shoe. Multiple regression analysis indicated that age, sex, heat stress, and overall finish time (p < 0.01 for each) were simultaneous independent elements of pacing. Nonelite women were consistently better pacers than nonelite men in both marathons, and this sex difference was magnified from cold to warm race temperatures. No difference (p < 0.05) in pacing was found between elite men and women runners. Elite men and women had enhanced pacing over their nonelite counterparts. In hotter temperatures, coaches of novice runners should advise their athletes to implement a slower initial velocity to maintain or increase running velocity later in the race.

Design of a factorial experiment with randomization restrictions to assess medical device performance on vascular tissue.

BACKGROUND: Energy-based surgical scalpels are designed to efficiently transect and seal blood vessels using thermal energy to promote protein denaturation and coagulation. Assessment and design improvement of ultrasonic scalpel performance relies on both in vivo and ex vivo testing. The objective of this work was to design and implement a robust, experimental test matrix with randomization restrictions and predictive statistical power, which allowed for identification of those experimental variables that may affect the quality of the seal obtained ex vivo. METHODS: The design of the experiment included three factors: temperature (two levels); the type of solution used to perfuse the artery during transection (three types); and artery type (two types) resulting in a total of twelve possible treatment combinations. Burst pressures of porcine carotid and renal arteries sealed ex vivo were assigned as the response variable. RESULTS: The experimental test matrix was designed and carried out as a split-plot experiment in order to assess the contributions of several variables and their interactions while accounting for randomization restrictions present in the experimental setup. The statistical software package SAS was utilized and PROC MIXED was used to account for the randomization restrictions in the split-plot design. The combination of temperature, solution, and vessel type had a statistically significant impact on seal quality. CONCLUSIONS: The design and implementation of a split-plot experimental test-matrix provided a mechanism for addressing the existing technical randomization restrictions of ex vivo ultrasonic scalpel performance testing, while preserving the ability to examine the potential effects of independent factors or variables. This method for generating the experimental design and the statistical analyses of the resulting data are adaptable to a wide variety of experimental problems involving large-scale tissue-based studies of medical or experimental device efficacy and performance.