Effects of individually optimized rocker midsoles and self-adjusting insoles on dynamic stability in persons with diabetes mellitus and neuropathy.

BACKGROUND: Persons with diabetic peripheral neuropathy (DPN) may face challenges such as balance issues due to reduced somatosensory feedback and an increased risk of developing diabetic foot ulcers (DFUs) due to increased plantar pressure. Pressure reducing footwear is thought to further impair balance. We introduced 3D-printed rocker midsoles and self-adjusting insoles that are able to reduce elevated plantar pressure values and aimed to prevent balance deterioration. However, their effect on the balance during walking (dynamic stability) is not analyzed yet. RESEARCH QUESTION: Is dynamic stability of persons with DPN impaired compared to healthy individuals and what is the effect of the 3D-printed rocker midsoles and self-adjusting insoles on the dynamic stability in this population? METHODS: Dynamic stability, specifically the margins of stability (MOS) in the anterior-posterior (AP) and medio-lateral (ML) direction, was measured in ten healthy and nineteen persons with DPN. Independent-samples t-test was applied to analyze the difference in the MOS between groups. One-way repeated measures analyses of variance (ANOVA) was conducted to test the difference between the therapeutic footwear combinations within the DPN group. RESULTS: There is no significant difference between the healthy and DPN group in MOS-AP. MOS-ML is significantly larger in DPN compared to the healthy participants. Using the self-adjusting insole shows a significantly lower (negative) MOS-AP compared to when using a rocker shoe within the DPN group. SIGNIFICANCE: This study provides valuable information on whether DPN and our therapeutic footwear have a negative effect on the dynamic stability. DPN does not have a negative effect on dynamic stability in the AP direction. For the ML direction, DPN seems to cause larger MOS-ML by likely using a compensation strategy (e.g., wider steps) while our experimental footwear does not further impair the MOS-ML.

Effects of individually optimized rocker midsoles and self-adjusting insoles on plantar pressure in persons with diabetes mellitus and loss of protective sensation.

INTRODUCTION: Rocker shoes and insoles reduce peak pressure (PP) in persons with diabetes (DM) and loss of protective sensation (LOPS). However, they are handmade, leading to inconsistent effectiveness. If foot structure changes over time, high PP-locations also change. To address this, individualized algorithm based 3D-printed rockers and self-adjusting pressure-reducing insoles are applied. METHODS: PP across seven foot regions was analyzed in 21 persons with DM and LOPS. Regions with PP < 200 kPa were considered not at risk (RnoR); regions with PP ≥ 200 kPa at risk (RaR). The aim was to offload RaR, while remaining PP < 200 kPa in RnoR. RESULTS: Individualized rockers and self-adjusting insoles combined successfully reduce PP < 200 kPa (on average 24 % - 48 %) in all feet with toes, central and lateral forefoot identified as RaR. Same intervention reduces PP in 68 % of the feet with medial forefoot identified as RaR. With the heel as RaR, no intervention reduces PP successfully in all feet. CONCLUSIONS: Individualized 3D-printed rockers combined with self-adjusting insoles reduce PP (< 200 kPa) in toes, central and lateral forefoot, but not in heels. Alternative insoles with medial arch support, heel cup and compliant midsole materials might enhance success rate across entire foot.

Exploring experiences of people with stroke and health professionals on post-stroke fatigue guidance: getting the right people to the right care at the right time.

PURPOSE: This focus group study aimed to explore experiences and perceptions on post-stroke fatigue guidance in Dutch rehabilitation and follow-up care among people/patients with stroke and health professionals. METHODS: Ten persons with stroke and twelve health professionals with different professions within stroke rehabilitation or follow-up care in the Netherlands were purposively sampled and included. Eight online focus group interviews were conducted. We analysed the data using reflexive thematic analysis. RESULTS: Three themes were identified. Guidance in fatigue management did not always match the needs of people/patients with stroke. Professionals were positive about the provided fatigue guidance (e.g. advice on activity pacing), but found it could be better tailored to the situation of people/patients with stroke. Professionals believe the right time for post-stroke fatigue guidance is when people/patients with stroke are motivated to change physical activity behaviour to manage fatigue - mostly several months after stroke - while people/patients with stroke preferred information on post-stroke fatigue well before discharge. Follow-up care and suggestions for improvement described that follow-up support after rehabilitation by a stroke coach is not implemented nationwide, while people/patients with stroke and professionals expressed a need for it. CONCLUSIONS: The study findings will help guide improvement of fatigue guidance in stroke rehabilitation programmes and stroke follow-up care aiming to improve physical activity, functioning, participation, and health.

We recommend fatigue guidance, including peer support, to be accessible to all people after stroke and for health professionals to pay attention to acceptance of the stroke.To improve fatigue guidance, we suggest providing information on post-stroke fatigue to people after stroke and their relatives well before discharge from stroke rehabilitation.Tailored advice on activity pacing during and after stroke rehabilitation is important to fill the current unmet need of people after stroke to manage fatigue and to gradually improve participation, physical activity behaviour and health.We recommend to health professionals working in stroke rehabilitation to tailor the rehabilitation schedule to their patients' energy level and perception of fatigue levels.

Performance metrics for models designed to predict treatment effect.

BACKGROUND: Measuring the performance of models that predict individualized treatment effect is challenging because the outcomes of two alternative treatments are inherently unobservable in one patient. The C-for-benefit was proposed to measure discriminative ability. However, measures of calibration and overall performance are still lacking. We aimed to propose metrics of calibration and overall performance for models predicting treatment effect in randomized clinical trials (RCTs). METHODS: Similar to the previously proposed C-for-benefit, we defined observed pairwise treatment effect as the difference between outcomes in pairs of matched patients with different treatment assignment. We match each untreated patient with the nearest treated patient based on the Mahalanobis distance between patient characteristics. Then, we define the Eavg-for-benefit, E50-for-benefit, and E90-for-benefit as the average, median, and 90th quantile of the absolute distance between the predicted pairwise treatment effects and local-regression-smoothed observed pairwise treatment effects. Furthermore, we define the cross-entropy-for-benefit and Brier-for-benefit as the logarithmic and average squared distance between predicted and observed pairwise treatment effects. In a simulation study, the metric values of deliberately "perturbed models" were compared to those of the data-generating model, i.e., "optimal model". To illustrate these performance metrics, different modeling approaches for predicting treatment effect are applied to the data of the Diabetes Prevention Program: 1) a risk modelling approach with restricted cubic splines; 2) an effect modelling approach including penalized treatment interactions; and 3) the causal forest. RESULTS: As desired, performance metric values of "perturbed models" were consistently worse than those of the "optimal model" (Eavg-for-benefit ≥ 0.043 versus 0.002, E50-for-benefit ≥ 0.032 versus 0.001, E90-for-benefit ≥ 0.084 versus 0.004, cross-entropy-for-benefit ≥ 0.765 versus 0.750, Brier-for-benefit ≥ 0.220 versus 0.218). Calibration, discriminative ability, and overall performance of three different models were similar in the case study. The proposed metrics were implemented in a publicly available R-package "HTEPredictionMetrics". CONCLUSION: The proposed metrics are useful to assess the calibration and overall performance of models predicting treatment effect in RCTs.

High resolution mass spectrometric suspect screening, wide-scope target analysis of emerging contaminants and determination of legacy pollutants in adult black-tailed godwit Limosa limosa limosa in the Netherlands - A pilot study.

The Dutch breeding population of the black-tailed godwit Limosa limosa limosa has declined substantially over recent decades; the role of contaminants is unknown. We analysed liver samples from 11 adult birds found dead on their breeding grounds in SW Friesland 2016-2020, six from extensive, herb-rich grasslands, five from intensive grasslands. We carried out LC and GC wide-scope target analysis of more than 2400 substances, LC suspect screening for more than 60,000 substances, target analysis for Cd, Hg, Ni and Pb, organo-phosphate flame retardants (OPFRs), dechlorane plus compounds and selected polybrominated diphenyl ether flame retardants (PBDEs), and bioassay for polybrominated dibenzo-p-dioxins and dibenzofurans (PBDDs/PDBFs) and dioxin-like polychlorinated biphenyls (dl-PCBs). Residues of 29 emerging contaminants (ECs) were determined through wide-scope target analysis. Another 20 were tentatively identified through suspect screening. These contaminants include industrial chemicals (personal care products, surfactants, PAHs and others), plant protection products (PPPs) and pharmaceuticals and their transformation products. Total contaminant load detected by wide-scope target analysis ranged from c. 155 to c. 1400 ng g-1 and was generally lower in birds from extensive grasslands. Heatmaps suggest that birds from intensive grasslands have a greater mix and higher residue concentrations of PPPs, while birds from extensive grasslands have a greater mix and higher residue concentrations of per- and polyfluoroalkyl substances (PFAS). All four metals and two OPFRs were detected. All tested PBDEs were below the respective LODs. Bioassay revealed presence of PBDDs, PBDFs and dl-PCBs. Further research is required to elucidate potential health risks to godwits and contaminant sources.

Hybrid-integrated diode laser in the visible spectral range.

Generating visible light with wide tunability and high coherence based on photonic integrated circuits is of high interest for applications in biophotonics, precision metrology, and quantum technology. Here we present, to our knowledge, the first demonstration of a hybrid-integrated diode laser in the visible spectral range. Using an AlGaInP optical amplifier coupled to a low-loss Si3N4 feedback circuit based on microring resonators, we obtain a spectral coverage of 10.8 nm around 684.4 nm wavelength with up to 4.8 mW output power. The measured intrinsic linewidth is 2.3±0.2kHz.

Effects of rocker radii with two longitudinal bending stiffnesses on plantar pressure distribution in the forefoot.

INTRODUCTION: Outsole parameters of the shoe can be adapted to offload regions of pain or region of high pressures. Previous studies already showed reduced plantar pressures in the forefoot due to a proximally placed apex position and higher longitudinal bending stiffness (LBS). The aim of this study was to determine the effect of changes in rocker radii and high LBS on the plantar pressure profile during gait. METHOD: 10 participants walked in seven shoe conditions of which one control shoe and six rocker shoes with small, medium and large rocker radii and low and high longitudinal bending stiffness. Pedar in-shoe plantar pressure measuring system was used to quantify plantar pressures while walking on a treadmill at self-selected walking speed. Peak plantar pressure, maximum mean pressure and force-time integral were analyzed with Generalized Estimated Equation (GEE) and Tukey post hoc correction (α = .05). RESULTS: Significantly lower plantar pressures were found in the first toe, toes 2-5, distal and proximal forefoot in all rocker shoe conditions as compared to the control shoe. Plantar pressures in the first toe and toes 2-5 were significantly lower in the small radius compared to medium and large radii. For the distal forefoot both small and medium radii significantly reduced plantar pressure compared to large radii. Low LBS reduced plantar pressure at the first toe significantly compared to high LBS independent of the rocker radius. Plantar pressures in the distal forefoot and toes 2-5 were lower in high LBS compared to low LBS. CONCLUSION: Manipulation of the rocker radius and LBS can effectively reduce peak plantar pressures in the forefoot region during gait. In line with previous studies, we showed that depending on the exact target location for offloading, different combinations of rocker radius and LBS need to be adopted to maximize treatment effects.

Effects of Longitudinal Bending Stiffness of forefoot rocker profile shoes on ankle kinematics and kinetics.

INTRODUCTION: Rocker profile shoes with a proximally placed apex are currently one of the most prescribed shoe modifications for treatment and prevention of lower leg deficits. Three geometrical rocker design parameters apex position (AP), apex angle (AA) and rocker radius (RR) influence both plantar pressure redistribution and kinetic and kinematic alterations of the lower leg. In addition, longitudinal bending stiffness (LBS) of the outsole influences these parameters as well. This study aims to investigate the effects of the LBS in combination with different forefoot radii of rocker shoes on kinematics and kinetics of the lower limb. METHODS: 10 participants walked in standard shoes and six experimental shoe conditions with high and low LBS and three different forefoot rocker radii with the same (proximal) AP and AA. Lower extremity kinematics and kinetics were collected while walking on an instrumented treadmill at preferred walking speed and analysed with a repeated measures ANOVA and Statistical Parametric Mapping (SPM) (α = .05; post hoc α = .05/6). RESULTS: SPM analyses revealed no significant differences for LBS and interaction LBS*RR for most research variables in terminal stance (ankle angle, ankle moment, ankle power, foot-to-horizontal angle, shank-to-vertical angle, external ankle moment, ground reaction force angle). A significant LBS effect was found for anterior-posterior position of the centre of pressure during pre-swing and peak ankle dorsiflexion angle. No relevant significant differences were found in spatio-temporal parameters and total work at the ankle between low and high LBS. CONCLUSION: This study showed that longitudinal bending stiffness does not affect the biomechanical working mechanism of rocker profile shoes as long as toe plantarflexion is restricted. Providing that the forefoot rocker radius supports at least a normal foot-to-horizontal angle at toe-off, there is no reason to increase sole stiffness to change ankle kinematics and kinetics.

A prospective, observational study of the performance of MEWS, NEWS, SIRS and qSOFA for early risk stratification for adverse outcomes in patients with suspected infections at the emergency department.

BACKGROUND: Many patients with suspected infection are presented to the emergency Department. Several scoring systems have been proposed to identify patients at high risk of adverse outcomes. METHODS: We compared generic early warning scores (MEWS and NEWS) to the (SIRS) criteria and quick Sequential Organ Failure Assessement (qSOFA), for early risk stratification in 1400 patients with suspected infection in the ED. The primary study end point was 30-day mortality. RESULTS: The AUROC of the NEWS score for predicting 30-day mortality was 0.740 (95% Confidence Interval 0.682- 0.798), higher than qSOFA (AUROC of 0.689, 95% CI 0.615- 0.763), MEWS (AUROC 0.643 (95% CI 0.583-0.702) and SIRS (AUROC 0.586, 95%CI 0.521 - 0.651). The sensitivity was also highest for NEWS⋝ 5 (sensitivity 75,8% specificity of 67,4%). CONCLUSION: Among patients presenting to the ED with suspected infection, early risk stratification with NEWS (cut-off of ⋝5) is more sensitive for prediction of mortality than qSOFA, MEWS or SIRS, with adequate specificity.

Effect of different forefoot rocker radii on lower-limb joint biomechanics in healthy individuals.

INTRODUCTION: Previous studies showed that rocker shoes with a stiff forefoot rocker profile significantly reduce peak plantar flexion moment at the ankle (PFM) and peak ankle dorsiflexion (DF). Both parameters are related to Achilles tendon and Plantar Fascia unloading. The shape of an outsole with a forefoot rocker is described with multiple rocker design parameters. The aim of this research is, to determine the relation between different forefoot rocker radii on peak DF and peak PFM at a self-selected walking speed. METHODS: 10 participants walked in standard shoes and three experimental pairs of shoes with different forefoot rocker radii. Lower extremity kinematics and kinetics were collected while walking on an instrumented treadmill at preferred walking speed and analysed with Statistical Parametric Mapping (SPM) (α = .05; post-hoc α = .05/6). RESULTS: Peak value analyses showed significant decreases in peak DF, peak PFM, and peak ankle power generation for the rocker conditions. No relevant significant differences were found in spatio-temporal parameters and total work at the ankle joint. SPM showed a significant decrease (% gait cycle) in DF (40-69 %), PFM (7-15 %; 41-68 %; 69-81 %), ankle power (10-15 %; 32-51 %; 55-64 %; 64-67 %; 72-80 %) and foot-to-horizontal angle (FHA) (0-4 %; 40-62 %; 92-100 %) and an increased shank-to-vertical angle (SVA) (44-84 %) for the rocker conditions. CONCLUSION: The results of this study suggest that rocker shoes with a proximally placed apex significantly reduce DF and PFM during the third rocker compared with control shoes. This effect is mainly explained by a change in the FHA. Smaller radii cause the largest reductions in DF and PFM, so therefore, a uniform standardisation of the forefoot rocker radius is essential.

Trajectories of health-related quality of life among people with a physical disability and/or chronic disease during and after rehabilitation: a longitudinal cohort study.

PURPOSE: To identify Health-related Quality of Life (HR-QoL) trajectories in a large heterogeneous cohort of people with a physical disability and/or chronic disease during and after rehabilitation and to determine which factors before discharge are associated with longitudinal trajectory membership. METHODS: A total of 1100 people with a physical disability and/or chronic disease were included from the longitudinal cohort study Rehabilitation, Sports and Active lifestyle. All participants participated in a physical activity promotion programme in Dutch rehabilitation care. HR-QoL was assessed using the RAND-12 Health Status Inventory questionnaire at baseline (T0: 3-6 weeks before discharge) and at 14 (T1), 33 (T2) and 52 (T3) weeks after discharge from rehabilitation. A data-driven approach using Latent Class Growth Mixture modelling was used to determine HR-QoL trajectories. Multiple binomial multivariable logistic regression analyses were used to determine person-, disease- and lifestyle-related factors associated with trajectory membership. RESULTS: Three HR-QoL trajectories were identified: moderate (N = 635), high (N = 429) and recovery (N = 36). Trajectory membership was associated with person-related factors (age and body mass index), disease-related factors (perceived fatigue, perceived pain and acceptance of the disease) and one lifestyle-related factor (alcohol consumption) before discharge from rehabilitation. CONCLUSIONS: Most of the people who participated in a physical activity promotion programme obtained a relatively stable but moderate HR-QoL. The identified HR-QoL trajectories among our heterogeneous cohort are disease-overarching. Our findings suggest that people in rehabilitation may benefit from person-centred advice on management of fatigue and pain (e.g. activity pacing) and the acceptance of the disability.

Feasibility and short-term effects of Activity Coach+: a physical activity intervention in hard-to-reach people with a physical disability.

PURPOSE: Existing physical activity interventions do not reach a considerable proportion of physically disabled people. This study assessed feasibility and short-term effects of Activity Coach+, a community-based intervention especially targeting this hard-to-reach population. METHODS: Feasibility was determined by reach, dropouts, and compliance with the protocol. Physical activity was measured with the Activ8 accelerometer and the adapted SQUASH questionnaire. Health outcomes were assessed by body composition, blood pressure, hand grip force, 10-metre walk test, 6-minute walk test, and the Berg Balance Scale. The RAND-36, Exercise Self-Efficacy Scale, Fatigue Severity Scale, and IMPACT-S were administered. Measurements were performed at baseline and after 2 and 4 months. Changes over time were analysed by Friedman tests. RESULTS: Twenty-nine participants enrolled during the first 4 months, of whom two dropped out. Intervention components were employed in 86-100% of the participants. Physical activity did not change after the implementation of Activity Coach+. Body mass index (p = 0.006), diastolic blood pressure (p = 0.032), walking ability (p = 0.002), exercise capacity (p = 0.013), balance (p = 0.014), and vitality (p = 0.049) changed over time. CONCLUSIONS: Activity Coach + is feasible in a community setting. Indications for effectivity of Activity Coach + in hard-to-reach people with a physical disability were found.Implications for rehabilitationActivity Coach + was able to reach physically disabled people living in community, a population that is assumed hard-to-reach.Activity Coach + was feasible in a population of persons with a physical disability that was heterogeneous with respect to age and (severity of) disability.The current study provides the first indications for the beneficial health effects of Activity Coach + in hard-to-reach people with a physical disability.

Are consumers satisfied with the use of prosthetic sports feet and the provision process? A mixed-methods study.

BACKGROUND: Special feet connected to a prosthesis, prosthetic sports feet, enable athletes with a lower limb amputation to run. The selection of a prosthetic sports feet is usually based on body weight and preferred sports performance. The selection of a prosthetic sport feet is also based on clinicians who likely have limited experience due to a small number of athletes with a lower limb amputation. HYPOTHESIS: Athletes with a lower limb amputation are not satisfied with the use and service associated with prosthetic sports feet due to a lack of prosthetic sports feet provision guidelines, poorer function of prosthetic sports feet compared to the anatomical foot and ankle, and limited experience of clinicians. EVALUATION OF HYPOTHESIS: A mixed-methods study in 16 athletes with a lower limb amputation using a prosthetic sport foot from Össur or Otto Bock, included semi-structured interviews and quantitative analysis. Three dimensions of prosthetic sports feet were investigated: 1) use, 2) provision process, and 3) cosmetics. Qualitative data were analyzed to identify factors influencing consumer satisfaction. Quantitative data were analyzed to investigate satisfaction and perceived relative importance of the dimensions. RESULTS: Participants were satisfied with the prosthetic sports feet use. However, they were not satisfied with the process prior to provision. The prosthetic sport feet use was perceived as the most important dimension. Sports performance was the critical element in the prosthetic sports feet use and was influenced by stability, confidence and fear, safety, focus, energy return, and comfort. Cosmetics were unimportant. Motivation to purchase the prosthetic sports feet was the key element for the prosthetic sports foot acquisition. Satisfaction about the process prior to provision was negatively influenced by poor support of professionals during rehabilitation, the complexity and duration of the purchase process, and lack of information and accessibility of prosthetic sports feet. CONCLUSION: The most important dimension of the prosthetic sports feet was its use, which was directly influenced by performance. To further increase the satisfaction with prosthetic sports feet, clinicians should establish how to meet the desired sports performance level of athletes with a lower limb amputation. Improving the process prior to the provision process may increase satisfaction. We suggest increasing the support of professionals during rehabilitation and training through cooperation between involved services, organizing prosthetic sports feet try-out sessions, and increase the accessibility of the prosthetic sports feet. In this way, individuals with a lower limb amputation may become and stay more physically active and participate in sports.

Microfabricated tuneable and transferable porous PDMS membranes for Organs-on-Chips.

We present a novel and highly reproducible process to fabricate transferable porous PDMS membranes for PDMS-based Organs-on-Chips (OOCs) using microelectromechanical systems (MEMS) fabrication technologies. Porous PDMS membranes with pore sizes down to 2.0 µm in diameter and a wide porosity range (2-65%) can be fabricated. To overcome issues normally faced when using replica moulding and extend the applicability to most OOCs and improve their scalability and reproducibility, the process includes a sacrificial layer to easily transfer the membranes from a silicon carrier to any PDMS-based OOC. The highly reliable fabrication and transfer method does not need of manual handling to define the pore features (size, distribution), allowing very thin (<10 µm) functional membranes to be transferred at chip level with a high success rate (85%). The viability of cell culturing on the porous membranes was assessed by culturing two different cell types on transferred membranes in two different OOCs. Human umbilical endothelial cells (HUVEC) and MDA-MB-231 (MDA) cells were successfully cultured confirming the viability of cell culturing and the biocompatibility of the membranes. The results demonstrate the potential of controlling the porous membrane features to study cell mechanisms such as transmigrations, monolayer formation, and barrier function. The high control over the membrane characteristics might consequently allow to intentionally trigger or prevent certain cellular responses or mechanisms when studying human physiology and pathology using OOCs.

Chemopreventive effect and lack of genotoxicity and mutagenicity of the exopolysaccharide botryosphaeran on human lymphocytes.

Carbohydrate biopolymers of fungal-origin are an important natural resource in the search for new bioagents with therapeutic and nutraceutical potential. In this study the mutagenic, genotoxic, antigenotoxic and antioxidant properties of the fungal exopolysaccharide botryosphaeran, a (1→3)(1→6)-ß-D-glucan, from Botryosphaeria rhodina MAMB-05, was evaluated. The mutagenicity was assessed at five concentrations in Salmonella typhimurium by the Ames test. Normal and tumor (Jurkat cells) human T lymphocyte cultures were used to evaluate the genotoxicity and antigenotoxicity (Comet assay) of botryosphaeran alone and in combination with the mutagen methyl methanesulfonate (MMS). The ability of botryosphaeran to reduce the production of reactive oxygen and nitrogen species (RONS) generated by hydrogen peroxide was assessed using the CM-H2DCFDA probe in lymphocyte cultures under different treatment times. None of the evaluated botryosphaeran concentrations were mutagenic in bacteria, nor induced genotoxicity in normal and tumor lymphocytes. Botryosphaeran protected lymphocyte DNA against damage caused by MMS under simultaneous treatment and post-treatment conditions. However, botryosphaeran was not able to reduce the RONS generated by H2O2. Besides the absence of genotoxicity, botryosphaeran exerted a protective effect on human lymphocytes against genotoxic damage caused by MMS. These results are important in the validation of botryosphaeran as a therapeutic agent targeting health promotion.

Bilateral periprosthetic joint infection with Ureaplasma urealyticum in an immunocompromised patient.

This case study discusses how we diagnosed and treated a patient with a late haematogenous bilateral periprosthetic joint infection (PJI) after total knee arthroplasties caused by Ureaplasma urealyticum. This has never been reported before. We will discuss how we used a PET-CT, synovial fluid cell count, and synovial fluid analysis by 16S rRNA gene sequencing to diagnose this PJI. We will also discuss how we treated this patient to obtain full recovery.

Running with a minimalist shoe increases plantar pressure in the forefoot region of healthy female runners.

OBJECTIVES: Minimalist running shoes have been proposed as an alternative to barefoot running. However, several studies have reported cases of forefoot stress fractures after switching from standard to minimalist shoes. Therefore, the aim of the current study was to investigate the differences in plantar pressure in the forefoot region between running with a minimalist shoe and running with a standard shoe in healthy female runners during overground running. DESIGN: Randomized crossover design. METHODS: In-shoe plantar pressure measurements were recorded from eighteen healthy female runners. Peak pressure, maximum mean pressure, pressure time integral and instant of peak pressure were assessed for seven foot areas. Force time integral, stride time, stance time, swing time, shoe comfort and landing type were assessed for both shoe types. A linear mixed model was used to analyze the data. RESULTS: Peak pressure and maximum mean pressure were higher in the medial forefoot (respectively 13.5% and 7.46%), central forefoot (respectively 37.5% and 29.2%) and lateral forefoot (respectively 37.9% and 20.4%) for the minimalist shoe condition. Stance time was reduced with 3.81%. No relevant differences in shoe comfort or landing strategy were found. CONCLUSIONS: Running with a minimalist shoe increased plantar pressure without a change in landing pattern. This increased pressure in the forefoot region might play a role in the occurrence of metatarsal stress fractures in runners who switched to minimalist shoes and warrants a cautious approach to transitioning to minimalist shoe use.

Barriers to and facilitators of sports participation for people with physical disabilities: a systematic review.

Most people with physical disabilities do not participate in sports regularly, which could increase the chances of developing secondary health conditions. Therefore, knowledge about barriers to and facilitators of sports participation is needed. Barriers and facilitators for people with physical disabilities other than amputation or spinal cord injuries (SCI) are unknown. The aim of this study was to provide an overview of the literature focusing on barriers to and facilitators of sports participation for all people with various physical disabilities. Four databases were searched using MeSH terms and free texts up to April 2012. The inclusion criteria were articles focusing on people with physical disabilities, sports and barriers and/or facilitators. The exclusion criteria were articles solely focusing on people with cognitive disabilities, sensory impairments or disabilities related to a recent organ transplant or similar condition. Fifty-two articles were included in this review, with 27 focusing on people with SCI. Personal barriers were disability and health; environmental barriers were lack of facilities, transport and difficulties with accessibility. Personal facilitators were fun and health, and the environmental facilitator was social contacts. Experiencing barriers to and facilitators of sports participation depends on age and type of disability and should be considered when advising people about sports. The extent of sports participation for people with physical disabilities also increases with the selection of the most appropriate sport.

Adaptation of Ti(III)-NTA colorimetric assay for use in detecting microbial demethylation of lignin and lignin derived compounds in aerobic conditions.

An anaerobic colorimetric assay for quantifying microbial demethylation activity was adapted for aerobic use in studying lignin and lignin-derived compounds. Standard curves of 0-500µM pyrocatechol with and without 0.3% lignin demonstrated the use in either case. This method detects demethylation products up to 500µM without using additional dilutions.

Barriers and facilitators of sports in Dutch Paralympic athletes: An explorative study.

The purpose of this study was to gain insight in barriers and facilitators of sports in paralympic athletes. An online questionnaire was distributed through the Netherlands Olympic Committee and National Sports Confederation to determine personal and environmental barriers and facilitators of sports participation. The International Classification of Functioning, Disability and Health model and theory of planned behavior were used to respectively categorize the results in environmental and personal factors, and attitude, subjective norm and perceived behavioral control. Seventy-six Dutch Paralympic athletes completed the questionnaire (51% response rate). Barriers and facilitators experienced by ambulant and wheelchair athletes were compared. Most frequently mentioned personal barrier was dependency of others (22%), while most frequently mentioned environmental barrier was lack of sports facilities (30%). Wheelchair athletes mentioned more barriers (median = 3, interquartile range: 0.5-6), than ambulant athletes (median = 1.0,interquartile range:0.0-3.0, P = 0.023). One-third of the athletes did not experience any barriers. Most frequently mentioned personal facilitators to initiate sports participation were fun (78%), health (61%), and competition (53%). Most frequently mentioned environmental facilitator was social support (40%). This study indicated that barriers of sport were mostly environmental, while facilitators were usually personal factors. Attitude and subjective norm were considered the most important components for intention to participation in sports. The facilitators outweighed the barriers and kept the athletes being active in sports.