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1.
Nutrients ; 12(5)2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-32365848

RESUMO

We investigated the impact of nutrient intake on hydration biomarkers in cyclists before and after a 161 km ride, including one hour after a 650 mL water bolus consumed post-ride. To control for multicollinearity, we chose a clustering-based, machine learning statistical approach. Five hydration biomarkers (urine color, urine specific gravity, plasma osmolality, plasma copeptin, and body mass change) were configured as raw- and percent change. Linear regressions were used to test for associations between hydration markers and eight predictor terms derived from 19 nutrients merged into a reduced-dimensionality dataset through serial k-means clustering. Most predictor groups showed significant association with at least one hydration biomarker: 1) Glycemic Load + Carbohydrates + Sodium, 2) Protein + Fat + Zinc, 3) Magnesium + Calcium, 4) Pinitol, 5) Caffeine, 6) Fiber + Betaine, and 7) Water; potassium + three polyols, and mannitol + sorbitol showed no significant associations with any hydration biomarker. All five hydration biomarkers were associated with at least one nutrient predictor in at least one configuration. We conclude that in a real-life scenario, some nutrients may serve as mediators of body water, and urine-specific hydration biomarkers may be more responsive to nutrient intake than measures derived from plasma or body mass.

2.
Public Health Nutr ; 23(6): 971-973, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31852551

RESUMO

OBJECTIVE: To recognize the causality of environmental factors (i.e. temperature, humidity and sun exposure) on nutritional variables, specifically body water balance and water-seeking behaviour. DESIGN: Author perspective. SETTING: Global. PARTICIPANTS: Not applicable. RESULTS: A free-standing code supplement is provided to facilitate investigators in accessing meteorological data for incorporation into analyses related to nutrition and hydration. CONCLUSIONS: Analytical models related to human hydration should account for the environment de rigueur.

3.
Nutrients ; 11(8)2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31394869

RESUMO

With the collection of water-intake data, the National Health and Nutrition Examination Survey (NHANES) is becoming an increasingly popular resource for large-scale inquiry into human hydration. However, are we leveraging this resource properly? We sought to identify the opportunities and limitations inherent in hydration-related inquiry within a commonly studied database of hydration and nutrition. We also sought to critically review models published from this dataset. We reproduced two models published from the NHANES dataset, assessing the goodness of fit through conventional means (proportion of variance, R2). We also assessed model sensitivity to parameter configuration. Models published from the NHANES dataset typically yielded a very low goodness of fit R2 < 0.15. A reconfiguration of variables did not substantially improve model fit, and the goodness of fit of models published from the NHANES dataset may be low. Database-driven inquiry into human hydration requires the complete reporting of model diagnostics in order to fully contextualize findings. There are several emergent opportunities to potentially increase the proportion of explained variance in the NHANES dataset, including novel biomarkers, capturing situational variables (meteorology, for example), and consensus practices for adjustment of co-variates.


Assuntos
Água Corporal/fisiologia , Ingestão de Líquidos , Inquéritos Nutricionais , Índice de Massa Corporal , Bases de Dados Factuais , Humanos , Modelos Teóricos , Estado Nutricional , Estado de Hidratação do Organismo , Concentração Osmolar , Reprodutibilidade dos Testes , Urina
7.
Prosthet Orthot Int ; 42(5): 490-497, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29775130

RESUMO

BACKGROUND: The incidence and etiology of prosthetic services utilization is poorly understood during the first 90 days post-delivery of the initial lower limb prosthesis. This period is of critical importance, as prevailing policy dictates limits on the reimbursement for certain services provided during this time period. The first step in understanding the financial ramifications of such policy is to examine the taxonomy behind clinical encounters during this tenuous time period. OBJECTIVES: Quantify and categorize clinical encounters by incidence and etiology. STUDY DESIGN: Retrospective chart review. METHODS: A central database containing data on prosthetic services was examined. Incidence and etiology were extracted through independent review of each patient chart. RESULTS: A total of 537 unique patients were identified, with 109 meeting the inclusion criteria. Chi-square testing showed that comfort ( p < 0.05), cosmesis ( p < 0.01), and mechanical failure ( p < 0.001) yielded statistical significance in scheduled versus unscheduled visits. Stepwise regression analysis demonstrated that both sex and K-level were important predictors of unscheduled visits. CONCLUSION: Taxonomization of clinical encounters experienced during the first 90 days provides a framework for future studies to be conducted. The data provided can serve as a basis for informing reimbursement policy, workforce planning, and advocacy. Clinical relevance Comfort is the most frequent reason for a clinical encounter during the first 90 days after delivering a lower limb prosthesis. The data on the taxonomy behind the clinical encounters can be used to guide workforce planning and advocate for just reimbursement policy that better reflect patient's needs.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Membros Artificiais , Utilização de Instalações e Serviços/estatística & dados numéricos , Extremidade Inferior , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
8.
Exp Brain Res ; 236(3): 645-654, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29285555

RESUMO

Although trunk muscles extend across multiple vertebral joints, recent motor control studies have shown that a top-down progression of trunk control in typical infants occurs incrementally, one segment at a time, until independent sitting. The current study merges this surprising developmental pattern with parent behavior by exploring the relationship between how parents hold their infant and the segmental level for which the infant exhibits postural control. We measured trunk control of 60 infants (1-8 months) via the segmental assessment of trunk control. Spontaneous parental hold and variability was recorded during repeated sitting and standing conditions. Parent hold correlated with infant level of control in both sitting and standing, providing evidence for a positive interaction between parent behavior and segmental trunk development.


Assuntos
Desenvolvimento Infantil/fisiologia , Educação Infantil , Atividade Motora/fisiologia , Músculo Esquelético/fisiologia , Equilíbrio Postural/fisiologia , Postura/fisiologia , Tronco/fisiologia , Feminino , Humanos , Lactente , Masculino , Pais
10.
Pediatr Phys Ther ; 29(4): 356-359, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28953183

RESUMO

The Academy of Pediatric Physical Therapy Research Summit IV issued a Call to Action for community-wide intensification of a research enterprise in inquiries related to pediatric brain injury and motor disability by way of technological integration. But the barriers can seem high, and the pathways to integrative clinical research can seem poorly marked. Here, we answer the Call by providing framework to 3 objectives: (1) instrumentation, (2) biometrics and study design, and (3) data analytics. We identify emergent cases where this Call has been answered and advocate for others to echo the Call both in highly visible physical therapy venues and in forums where the audience is diverse.


Assuntos
Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/terapia , Transtornos Motores/fisiopatologia , Transtornos Motores/terapia , Modalidades de Fisioterapia/organização & administração , Adolescente , Pesquisa Biomédica , Criança , Pré-Escolar , Feminino , Humanos , Invenções , Masculino
11.
Physiol Meas ; 37(12): 2231-2244, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27883345

RESUMO

Wearable activity monitors are increasingly prevalent in health research, but there is as yet no data-driven study of artefact removal in datasets collected from typically developing children across childhood. Here, stride count data were collected via a commercially available activity monitor (StepWatch), which employs an internal filter for sub-threshold accelerations, but does not post-process supra-threshold activity data. We observed 428 typically-developing children, ages 2-15, wearing the StepWatch for 5 consecutive days. We developed a minimum per-minute stride-count below which the data outputted from the StepWatch could be considered 'idle' and not 'productive'. We found that a threshold stride count of 10 steps per minute captured 90% of samples in a weighted average among isolated non-zero stride-count samples offset by inactivity. This threshold did not vary by age, gender, or by an age-gender interaction. Filtering the activity data according to this threshold reduced overall stride count by 8-10% by age group, from 8177 ± 2659 to 7432 ± 2641 strides per day. The impact on number of bouts per day decreased from an overall average of 79.3 ± 17.2 to 72.7 ± 12.1; this effect varied by age group. This study delivers the first data-driven estimate of a minimum activity threshold in step- or stride units that may extend to other studies. We conclude that the impact of production-idle filtering on activity data is substantial and suggests a possible impetus for re-contextualizing extant studies and guidelines reported without such filtering.


Assuntos
Caminhada/fisiologia , Dispositivos Eletrônicos Vestíveis , Acelerometria/instrumentação , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino
12.
J Funct Biomater ; 7(2)2016 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-27213460

RESUMO

In this issue, Naylor et al. [1] report on the surface topography of prosthetic phalanges, important research that is increasingly vital to researchers and clinicians alike.[...].

13.
Arch Phys Med Rehabil ; 97(11): 1872-1879, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27132160

RESUMO

OBJECTIVE: To assess the efficacy of an off-loading wheelchair seat cushion in removing pressure from high-risk ischial tuberosities and the coccyx/sacrum in wheelchair sitting. DESIGN: Repeated-measures design. SETTING: Private research laboratory. PARTICIPANTS: Manual wheelchair users with chronic spinal cord injuries (N=10). INTERVENTIONS: Three configurations of an off-loading wheelchair seat cushion compared with a flotation style (10-cm air inflation) wheelchair seat cushion. MAIN OUTCOME MEASURES: Outcome measures included peak pressure index (PPI), ischial tuberosity peak pressures, and the dispersion index or ratio of pressures under the ischial and sacral regions to the total of all pressures recorded. RESULTS: PPI and ischial tuberosities peak pressure ranged from a low of 39±18 and 68±46mmHg in the fully off-loaded cushion to a high of 97±30 and 106±34mmHg, respectively, for the flotation style cushion (2-way analysis of variance main effect across 4 conditions, P<.001). Dispersion index ranged from a low of 8%±3% in the fully off-loaded cushion to a high of 16%±3% in the flotation style cushion. Pairwise comparisons yielded significance in all cushion-pair analyses (P<.05 after multiple corrections). CONCLUSIONS: The force-removal approach of this orthotic off-loading cushion design effectively reduces a known extrinsic risk factor for pressure ulcers-interface pressure-in the high-risk ischial tuberosity and sacral/coccygeal regions of the buttocks.


Assuntos
Ísquio , Equipamentos Ortopédicos , Lesão por Pressão/prevenção & controle , Região Sacrococcígea , Traumatismos da Medula Espinal/reabilitação , Cadeiras de Rodas , Desenho de Equipamento , Feminino , Humanos , Masculino , Pressão/efeitos adversos , Adulto Jovem
14.
Med Eng Phys ; 38(5): 427-32, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27021374

RESUMO

Measurement of contact pressures at the wheelchair-seating interface is a critically important approach for laboratory research and clinical application in monitoring risk for pressure ulceration. As yet, measures obtained from pressure mapping are static in nature: there is no accounting for changes in pressure distribution over time, despite the well-known interaction between time and pressure in risk estimation. Here, we introduce the first dynamic analysis for distribution of pressure data, based on the Kaplan-Meier (KM) Product Limit Estimator (PLE) a ubiquitous tool encountered in clinical trials and survival analysis. In this approach, the pressure array-over-time data set is sub-sampled two frames at a time (random pairing), and their similarity of pressure distribution is quantified via a correlation coefficient. A large number (here: 100) of these frame pairs is then sorted into descending order of correlation value, and visualized as a KM curve; we build confidence limits via a bootstrap computed over 1000 replications. PLEs and the KM have robust statistical support and extensive development: the opportunities for extended application are substantial. We propose that the KM-PLE in particular, and dynamic analysis in general, may provide key leverage on future development of seating technology, and valuable new insight into extant datasets.


Assuntos
Pressão , Estatística como Assunto/métodos
15.
Front Neurorobot ; 10: 21, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28066228

RESUMO

Embodiment is the process by which patients with limb loss come to accept their peripheral device as a natural extension of self. However, there is little guidance as to how exacting the prosthesis must be in order for embodiment to take place: is it necessary for the prosthetic hand to look just like the absent hand? Here, we describe a protocol for testing whether an individual would select a hand that looks like their own from among a selection of five hands, and whether the hand selection (regardless of homology) is consistent across multiple exposures to the same (but reordered) set of candidate hands. Pilot results using healthy volunteers reveals that hand selection is only modestly consistent, and that selection of the prosthetic homologue is atypical (61 of 192 total exposures). Our protocol can be executed in minutes, and makes use of readily available equipment and softwares. We present both a face-to-face and a virtual protocol, for maximum flexibility of implementation.

16.
Neurorehabil Neural Repair ; 30(6): 583-90, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26450442

RESUMO

Background While recent clinical trials involving robot-assisted therapy have failed to show clinically significant improvement versus conventional therapy, it is possible that a broader strategy of intensive therapy-to include robot-assisted rehabilitation-may yield clinically meaningful outcomes. Objective To test the immediate and sustained effects of intensive therapy (robot-assisted therapy plus intensive conventional therapy) on outcomes in a chronic stroke population. Methods A multivariate mixed-effects model adjusted for important covariates was established to measure the effect of intensive therapy versus usual care. A total of 127 chronic stroke patients from 4 Veterans Affairs medical centers were randomized to either robot-assisted therapy (n = 49), intensive comparison therapy (n = 50), or usual care (n = 28), in the VA-ROBOTICS randomized clinical trial. Patients were at least 6 months poststroke, of moderate-to-severe upper limb impairment. The primary outcome measure was the Fugl-Meyer Assessment at 12 and 36 weeks. Results There was significant benefit of intensive therapy over usual care on the Fugl-Meyer Assessment at 12 weeks with a mean difference of 4.0 points (95% CI = 1.3-6.7); P = .005; however, by 36 weeks, the benefit was attenuated (mean difference 3.4; 95% CI = -0.02 to 6.9; P = .05). Subgroup analyses showed significant interactions between treatment and age, treatment and time since stroke. Conclusions Motor benefits from intensive therapy compared with usual care were observed at 12 and 36 weeks posttherapy; however, this difference was attenuated at 36 weeks. Subgroups analysis showed that younger age, and a shorter time since stroke were associated with greater immediate and long-term improvement of motor function.


Assuntos
Terapia por Exercício/métodos , Recuperação de Função Fisiológica/fisiologia , Robótica/métodos , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Doença Crônica , Feminino , Hospitais de Veteranos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Estados Unidos
17.
J Clin Monit Comput ; 30(6): 821-831, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26446002

RESUMO

Our goal is to use automatic data monitoring for reliable prediction of episodes of intracranial hypertension in patients with traumatic brain injury. Here we test the validity of our method on retrospective patient data. We developed the Continuous Hemodynamic Autoregulatory Monitor (CHARM), that siphons and stores signals from existing monitors in the surgical intensive care unit (SICU), efficiently compresses them, and standardizes the search for statistical relationships between any proposed index and adverse events. CHARM uses an automated event detector to reliably locate episodes of elevated intracranial pressure (ICP), while eliminating artifacts within retrospective patient data. A graphical user interface allowed data scanning, selection of criteria for events, and calculating indices. The pressure reactivity index (PRx), defined as the least square linear regression slope of intracranial pressure versus arterial BP, was calculated for a single case that spanned 259 h. CHARM collected continuous records of ABP, ICP, ECG, SpO2, and ventilation from 29 patients with TBI over an 18-month period. Analysis of a single patient showed that PRx data distribution in the single hours immediately prior to all 16 intracranial hypertensive events, significantly differed from that in the 243 h that did not precede such events (p < 0.0001). The PRx index, however, lacked sufficient resolution as a real-time predictor of IH in this patient. CHARM streamlines the search for reliable predictors of intracranial hypertension. We report statistical evidence supporting the predictive potential of the pressure reactivity index.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico , Processamento Eletrônico de Dados , Hipertensão Intracraniana/diagnóstico , Artefatos , Automação , Lesões Encefálicas Traumáticas/fisiopatologia , Lesões Encefálicas Traumáticas/terapia , Circulação Cerebrovascular , Gráficos por Computador , Hemodinâmica , Humanos , Unidades de Terapia Intensiva , Pressão Intracraniana , Análise dos Mínimos Quadrados , Modelos Lineares , Informática Médica , Monitorização Fisiológica/métodos , Estudos Retrospectivos , Processamento de Sinais Assistido por Computador
18.
Disabil Rehabil Assist Technol ; 11(4): 295-300, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-25203501

RESUMO

PURPOSE: The common responses to pressure sensor saturation are extreme: either discarding of data, or wholesale alteration of experimental protocol. Here, we test four simplistic strategies for restoring missing data due to sensor saturation, avoiding such drastic measures. METHODS: We tested these algorithms on 62 pressure maps collected from 42 individuals (20 M/22 F, 54.1 ± 26.2 years, 1.7 ± 0.1 m, 71.9 ± 17.8 kg) under a variety of seating conditions. These strategies were tested via a cross-validation design, censoring the maximum pressure value in the datasets and measuring prediction error. RESULTS: The four strategies showed various prediction error rates: ? = 0.43 ± 0.14 (simple substitution), ? = 0.16 ± 0.21 (scaled substitution), ? = 0.19 ± 0.21 (feature extraction), and ? = 0.24 ± 0.32 (extrapolation by non-linear modeling). CONCLUSION: For single-sensor saturation, it may be possible to restore missing data using simple techniques. Implications for Rehabilitation We present a method for imputing missing data from pressure sensor arrays. The implications for rehabilitation are as follows. Improved flexibility in design of protocols concerning interfacial pressure measurement. Restoration of missing data from existing datasets. Reduction in recruitment burden for future studies. Reduction in exposure risk to study participants.


Assuntos
Algoritmos , Monitorização Ambulatorial/métodos , Pressão , Projetos de Pesquisa , Cadeiras de Rodas , Adulto , Idoso , Idoso de 80 Anos ou mais , Interpretação Estatística de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Lesão por Pressão/prevenção & controle , Reprodutibilidade dos Testes
19.
Cleft Palate Craniofac J ; 53(4): 394-403, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26247705

RESUMO

OBJECTIVE: To establish consensus on definitive, actionable standards for the management of deformational plagiocephaly. DESIGN: Three-stage Delphi Survey process based on best practice statements obtained through literature review. SETTING: Electronic survey delivery. PARTICIPANTS: Review panel of 10 multidisciplinary subject matter experts (SMEs); survey panel of 30 cranial orthotists. RESULTS: Fifty-four best practice statements were accepted in four categories: diagnosis, presentation and severity, initiating treatment, and management principles. CONCLUSIONS: Clinical practice can be guided en route to robust evidence as to the efficacy of various plagiocephaly management strategies, in pursuit of definitive standards.


Assuntos
Aparelhos Ortopédicos , Plagiocefalia não Sinostótica/terapia , Padrão de Cuidado , Consenso , Técnica Delfos , Humanos , Lactente , Crânio
20.
Ther Adv Neurol Disord ; 8(5): 203-11, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26668586

RESUMO

OBJECTIVES: New metrics for clinical spasticity are needed to assess motor performance, since scales such as the Ashworth and Tardieu are unreliable. Here, we assessed outcomes of baclofen treatment in patients with multiple sclerosis (MS) using biomechanical analysis of voluntary movements. METHODS: Patients with MS and symptomatic limb spasticity were recruited for a pre-post baclofen titration study, along with age-matched healthy controls. Oral baclofen was titrated to optimize spasticity symptoms in all MS cases over 4 weeks. Clinical assessments included the Modified Ashworth Scale (MAS), Tardieu Scale (TS); elbow kinematics were measured via the Transient Acceleration Measurement Interface (TAMI); performance was measured as the score at 4 weeks minus the baseline score in all measures. Movement proficiency within TAMI was quantified through a scale-free smoothness measure, according to the regional excursion deviation (RED) from a constant-velocity approximant. RESULTS: Twelve patients with MS [age: 47.8 ± 9.8 years; women: 4; disease duration: 20 ± 10 years; disease-modifying therapy use: 7; Expanded Disability Status Scale (EDSS): 6.8 ± 1.4] and eight age-matched healthy controls were evaluated concurrently (mean age: 49.5 ± 13.1 years; women = 3). In MS cases, no significant improvement in arm spasticity was observed with main effects: MAS: -41.6 ± 72.6 (p = 0.09); EDSS: -1.6 ± 10.4% (p = 0.49); and TS: -8.3 ± 2.1% (p = 0.32), -24.9 ± 63.6% (p = 0.42), and -30.7 ± 79.9% (p = 0.06), at slow, moderate, and fast speeds, respectively. However, voluntary motion smoothness, as measured by TAMI: RED, decreased significantly: 0.62 ± 0.08 versus 0.54 ± 0.09, p < 0.001, indicating significant increase in movement smoothness post treatment. CONCLUSION: A simple biomechanical analysis of voluntary movements revealed a significant reduction of spasticity after 30 days of baclofen therapy in patients with MS that was not detected by clinical assessments.

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