Genotyping of European Toxoplasma gondii strains by a new high-resolution next-generation sequencing-based method.

PURPOSE: A new high-resolution next-generation sequencing (NGS)-based method was established to type closely related European type II Toxoplasma gondii strains. METHODS: T. gondii field isolates were collected from different parts of Europe and assessed by whole genome sequencing (WGS). In comparison to ME49 (a type II reference strain), highly polymorphic regions (HPRs) were identified, showing a considerable number of single nucleotide polymorphisms (SNPs). After confirmation by Sanger sequencing, 18 HPRs were used to design a primer panel for multiplex PCR to establish a multilocus Ion AmpliSeq typing method. Toxoplasma gondii isolates and T. gondii present in clinical samples were typed with the new method. The sensitivity of the method was tested with serially diluted reference DNA samples. RESULTS: Among type II specimens, the method could differentiate the same number of haplotypes as the reference standard, microsatellite (MS) typing. Passages of the same isolates and specimens originating from abortion outbreaks were identified as identical. In addition, seven different genotypes, two atypical and two recombinant specimens were clearly distinguished from each other by the method. Furthermore, almost all SNPs detected by the Ion AmpliSeq method corresponded to those expected based on WGS. By testing serially diluted DNA samples, the method exhibited a similar analytical sensitivity as MS typing. CONCLUSION: The new method can distinguish different T. gondii genotypes and detect intra-genotype variability among European type II T. gondii strains. Furthermore, with WGS data additional target regions can be added to the method to potentially increase typing resolution.

Early ctDNA dynamics as a surrogate for progression-free survival in advanced breast cancer in the BEECH trial.

BACKGROUND: Dynamic changes in circulating tumour DNA (ctDNA) levels may predict long-term outcome. We utilised samples from a phase I/II randomised trial (BEECH) to assess ctDNA dynamics as a surrogate for progression-free survival (PFS) and early predictor of drug efficacy. PATIENTS AND METHODS: Patients with estrogen receptor-positive advanced metastatic breast cancer (ER+ mBC) in the BEECH study, paclitaxel plus placebo versus paclitaxel plus AKT inhibitor capivasertib, had plasma samples collected for ctDNA analysis at baseline and at multiple time points in the development cohort (safety run-in, part A) and validation cohort (randomised, part B). Baseline sample ctDNA sequencing identified mutations for longitudinal analysis and mutation-specific digital droplet PCR (ddPCR) assays were utilised to assess change in ctDNA abundance (allele fraction) between baseline and 872 on-treatment samples. Primary objective was to assess whether early suppression of ctDNA, based on pre-defined criteria from the development cohort, independently predicted outcome in the validation cohort. RESULTS: In the development cohort, suppression of ctDNA was apparent after 8 days of treatment (P = 0.014), with cycle 2 day 1 (4 weeks) identified as the optimal time point to predict PFS from early ctDNA dynamics. In the validation cohort, median PFS was 11.1 months in patients with suppressed ctDNA at 4 weeks and 6.4 months in patients with high ctDNA (hazard ratio = 0.20, 95% confidence interval 0.083-0.50, P < 0.0001). There was no difference in the level of ctDNA suppression between patients randomised to capivasertib or placebo overall (P = 0.904) nor in the PIK3CA mutant subpopulation (P = 0.071). Clonal haematopoiesis of indeterminate potential (CHIP) was evident in 30% (18/59) baseline samples, although CHIP had no effect on tolerance of chemotherapy nor on PFS. CONCLUSION: Early on-treatment ctDNA dynamics are a surrogate for PFS. Dynamic ctDNA assessment has the potential to substantially enhance early drug development. CLINICAL REGISTRATION NUMBER: NCT01625286.

BEECH: a dose-finding run-in followed by a randomised phase II study assessing the efficacy of AKT inhibitor capivasertib (AZD5363) combined with paclitaxel in patients with estrogen receptor-positive advanced or metastatic breast cancer, and in a PIK3CA mutant sub-population.

BACKGROUND: BEECH investigated the efficacy of capivasertib (AZD5363), an oral inhibitor of AKT isoforms 1-3, in combination with the first-line weekly paclitaxel for advanced or metastatic estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-) breast cancer, and in a phosphoinositide 3-kinase, catalytic, alpha polypeptide mutation sub-population (PIK3CA+). PATIENTS AND METHODS: BEECH consisted of an open-label, phase Ib safety run-in (part A) in 38 patients with advanced breast cancer, and a randomised, placebo-controlled, double-blind, phase II expansion (part B) in 110 women with ER+/HER2- metastatic breast cancer. In part A, patients received paclitaxel 90 mg/m2 (days 1, 8 and 15 of a 28-day cycle) with capivasertib taken twice daily (b.i.d.) at two intermittent ascending dosing schedules. In part B, patients were randomly assigned, stratified by PIK3CA mutation status, to receive paclitaxel with either capivasertib or placebo. The primary end point for part A was safety to recommend a dose and schedule for part B; primary end points for part B were progression-free survival (PFS) in the overall and PIK3CA+ sub-population. RESULTS: Capivasertib was well tolerated, with a 400 mg b.i.d. 4 days on/3 days off treatment schedule selected in part A. In part B, median PFS in the overall population was 10.9 months with capivasertib versus 8.4 months with placebo [hazard ratio (HR) 0.80; P = 0.308]. In the PIK3CA+ sub-population, median PFS was 10.9 months with capivasertib versus 10.8 months with placebo (HR 1.11; P = 0.760). Based on the Common Terminology Criteria for Adverse Event v4.0, the most common grade ≥3 adverse events in the capivasertib group were diarrhoea, hyperglycaemia, neutropoenia and maculopapular rash. Dose intensity of paclitaxel was similar in both groups. CONCLUSIONS: Capivasertib had no apparent impact on the tolerability and dose intensity of paclitaxel. Adding capivasertib to weekly paclitaxel did not prolong PFS in the overall population or PIK3CA+ sub-population of ER+/HER2- advanced/metastatic breast cancer patients.ClinicalTrials.gov: NCT01625286.

Unilateral lower limb strength assessed using the Nintendo Wii Balance Board: a simple and reliable method.

BACKGROUND: Lower limb weakness is an important risk factor for fall accidents and a predictor for all-cause mortality among older adults. Unilateral whole-lower limb strength may be a better measure of fall risk than the bilateral measure. In addition, a number of clinical conditions affect only one leg, and thus this type of assessment is relevant in clinical settings. AIM: To explore the intra-rater reproducibility of the Nintendo Wii Balance Board (WBB) to measure unilateral whole-lower limb strength and to compare the method with stationary isometric muscle apparatus (SID). METHOD: Intra-rater test-retest design with 1 week between sessions. Thirty community-dwelling older adults (69 ± 4.2 years) were enrolled and examined for maximum lower limb strength in their dominant and non-dominant leg. Intraclass correlation coefficient (ICC) was calculated to describe relative reproducibility, while standard error of measurement (SEM), limits of agreement (LOA) and smallest real difference (SRD) were calculated to describe absolute reproducibility between test sessions. Concurrent validity with the SID was explored using the Pearson product-moment correlation coefficient (PCC). RESULTS: No systematic difference was observed between test sessions. ICC was 0.919-0.950 and SEM, LOA and SRD was 2.9-4.1 kg, 24.1-28.3 kg and 7.6-11.3 kg, respectively. Further, the PCC was 0.755 and 0.730 for the dominant limb and the non-dominant limb, respectively. CONCLUSION: A high relative and an acceptable absolute reproducibility was seen when using the Nintendo Wii Balance Board for testing unilateral lower limb strength in community-dwelling older adults. The WBB correlated strongly with the SID.

Isometric hand grip strength measured by the Nintendo Wii Balance Board - a reliable new method.

BACKGROUND: Low hand grip strength is a strong predictor for both long-term and short-term disability and mortality. The Nintendo Wii Balance Board (WBB) is an inexpensive, portable, wide-spread instrument with the potential for multiple purposes in assessing clinically relevant measures including muscle strength. The purpose of the study was to explore intrarater reliability and concurrent validity of the WBB by comparing it to the Jamar hand dynamometer. METHOD: Intra-rater test-retest cohort design with randomized validity testing on the first session. Using custom WBB software, thirty old adults (69.0 ± 4.2 years of age) were studied for reproducibility and concurrent validity compared to the Jamar hand dynamometer. Reproducibility was tested for dominant and non-dominant hands during the same time-of-day, one week apart. Intraclass correlation coefficient (ICC) and standard error of measurement (SEM) and limits of agreement (LOA) were calculated to describe relative and absolute reproducibility respectively. To describe concurrent validity, Pearson's product-moment correlation and ICC was calculated. RESULTS: Reproducibility was high with ICC values of >0.948 across all measures. Both SEM and LOA were low (0.2-0.5 kg and 2.7-4.2 kg, respectively) in both the dominant and non-dominant hand. For validity, Pearson correlations were high (0.80-0.88) and ICC values were fair to good (0.763-0.803). CONCLUSION: Reproducibility for WBB was high for relative measures and acceptable for absolute measures. In addition, concurrent validity between the Jamar hand dynamometer and the WBB was acceptable. Thus, the WBB may be a valid instrument to assess hand grip strength in older adults.

Influenza at the animal-human interface: a review of the literature for virological evidence of human infection with swine or avian influenza viruses other than A(H5N1).

Factors that trigger human infection with animal influenza virus progressing into a pandemic are poorly understood. Within a project developing an evidence-based risk assessment framework for influenza viruses in animals, we conducted a review of the literature for evidence of human infection with animal influenza viruses by diagnostic methods used. The review covering Medline, Embase, SciSearch and CabAbstracts yielded 6,955 articles, of which we retained 89; for influenza A(H5N1) and A(H7N9), the official case counts of t he World Health Organization were used. An additional 30 studies were included by scanning the reference lists. Here, we present the findings for confirmed infections with virological evidence. We found reports of 1,419 naturally infected human cases, of which 648 were associated with avian influenza virus (AIV) A(H5N1), 375 with other AIV subtypes, and 396 with swine influenza virus (SIV). Human cases naturally infected with AIV spanned haemagglutinin subtypes H5, H6, H7, H9 and H10. SIV cases were associated with endemic SIV of H1 and H3 subtype descending from North American and Eurasian SIV lineages and various reassortants thereof. Direct exposure to birds or swine was the most likely source of infection for the cases with available information on exposure.

PEMOCS: Evaluating the effects of a concept-guided, PErsonalised, MOtor-Cognitive exergame training on cognitive functions and gait in chronic Stroke-study protocol for a randomised controlled trial.

BACKGROUND: Many stroke survivors remain with residual cognitive and motor impairments despite receiving timely acute and sub-acute rehabilitation. This indicates that rehabilitation following stroke should be continuous to meet the needs of individual stroke patients. Both cognitive and motor functions are essential for mastering daily life and, therefore, should be aimed at with rehabilitation. Exergames, motor-cognitive exercises performed using video games, are an auspicious method to train both motor and cognitive functions and at the same time may foster the long-term motivation for training. This study aims to assess the effect of concept-guided, personalised, motor-cognitive exergame training on cognitive and motor functions in chronic stroke survivors. METHODS: This study is a single-blinded, randomised controlled trial. Assessments are performed at baseline, after a 12-week intervention, and at a 24-weeks follow-up. Chronic stroke patients (≥ 18 years old, ≥ 6 months post-stroke) able to stand for 3 min, independently walk 10 m, follow a two-stage command, and without other neurological diseases apart from cognitive deficits or dementia are included. Participants in the intervention group perform the exergame training twice per week for 30 (beginning) up to 40 (end) minutes additionally to their usual care programme. Participants in the control group receive usual care without additional intervention(s). Global cognitive functioning (total Montreal Cognitive Assessment (MoCA) score) is the primary outcome. Secondary outcomes include health-related quality of life, specific cognitive functions, single- and dual-task mobility, and spatiotemporal gait parameters. The target sample size for this trial is 38 participants. Linear mixed models with the post-outcome scores as dependent variables and group and time as fixed effects will be performed for analysis. DISCUSSION: Superior improvements in global cognitive functioning and in the abovementioned secondary outcomes in the intervention group compared to the control group are hypothesised. The results of this study may guide future design of long-term rehabilitation interventions after stroke. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05524727). Registered on September 1, 2022.

Combining one-session treatment with a homework program including app-based technology to enhance the treatment of childhood specific phobias: A study protocol of a multicenter pragmatic randomized controlled trial.

Introduction: Childhood specific phobias are among the most common and earliest onset mental disorders with a lifetime prevalence of more than ten percent. Brief intensive cognitive behavioral therapy (CBT) programs such as the One-Session Treatment (OST) are found to be effective in the remission of the specific phobias following treatment, but there is still room for improvement. The goal of the current study is to examine whether the long-term efficacy of OST increases by using a homework program supported by an app specifically designed for children; the Kids Beat Anxiety (KibA) homework program. Methods: Children aged between 7 and 14 years with a specific phobia receive OST preceded by a three-week baseline phase to control for time-effects. Directly following OST, children are randomized to either a four-week homework period supported by an app (OST + app), or standard One-Session Treatment with a four-week homework period that is only supported by therapist instructions (OST-only). Primary outcome variables are diagnosis and severity of the specific phobia. Secondary outcomes include behavioral avoidance, self-reported fear, and functional impairment. Data will be analyzed based on intention-to-treat and per protocol samples using mixed-effects multilevel linear models. Ethics and dissemination: The current study was approved by the METC of the Academic Medical Center, Amsterdam, The Netherlands (number: NL72697.018.20) and the Ethical Committee of the Ruhr University, Bochum, Germany (number: 663). Results of this trial will be published in peer-reviewed journals. Trial registration: The study was pre-registered at the Dutch Trial Register, number: NL 9216.

Mindfulness-based childbirth and parenting for pregnant women with high fear of childbirth and their partners: outcomes of a randomized controlled trial assessing short- and longer-term effects on psychological well-being, birth and pregnancy experience.

OBJECTIVES: Mindfulness-Based Childbirth and Parenting (MBCP) reduces mothers' anticipated fear of childbirth (FOC), nonurgent obstetric interventions during childbirth and may improve childbirth outcomes in women with high FOC (Veringa-Skiba et al, 2022). The aim of this study was to examine the short- and longer-term outcomes of MBCP on psychological well-being, pregnancy and birth experience, as compared to enhanced care-as-usual (ECAU), in pregnant women with high FOC and their partners. DESIGN: Participants were randomly assigned to MBCP or ECAU and completed questionnaires preintervention (T1), immediately after intervention (T2), two to four weeks after childbirth (T3) and 16-20 weeks after childbirth (T4). Both intention-to-treat and per-protocol analyses were conducted. SETTING: The courses were provided by trained midwives. PARTICIPANTS: Participants included 141 pregnant women and 120 partners. INTERVENTION: MBCP comprised a nine-weekly three-hour session mindfulness group course for pregnant couples; ECAU consisted of two 90-minute individual couple consultation sessions. MEASUREMENTS: Measures of psychological well-being included measures like stress, depression, anxiety and fatigue. Measures of pregnancy and birth experience concerned experiencing uplifts during pregnancy, experienced fear of childbirth, labour pain and satisfaction with childbirth. FINDINGS: No differences between MBCP and ECAU in the total group of birthing women were found. However, women with (at least an onset of) labour that participated in MBCP reported a better birth experience compared to ECAU at T3. Concerning the total partner group only one difference between MBCP and ECAU was found at T4; MBCP partners reported an increase in fatigue. However, in the partner risk group (i.e., partners with lower psychological well-being before intervention) partners experienced better psychological well-being at T2 and T3 after MBCP than ECAU. KEY CONCLUSIONS: MBCP and ECAU demonstrate similar effects on psychological well-being, birth and pregnancy experience. However, MBCP appears superior to ECAU for labouring women in having a better childbirth experience and for partners at risk for psychological complaints in increasing their psychological well-being. IMPLICATIONS FOR PRACTICE: MBCP only positively affects the childbirth experience of those who experience (onset of) natural birth. It might be advisable to include partners at risk for psychological complaints in the MBCP.

Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? A systematic review.

INTRODUCTION: The effect size for exercise therapy in the treatment of chronic non-specific low back pain (cLBP) is only modest. This review aims to analyse the specificity of the effect by examining the relationship between the changes in clinical outcome (pain, disability) and the changes in the targeted aspects of physical function (muscle strength, mobility, muscular endurance) after exercise therapy. METHODS: We searched for exercise therapy trials for cLBP published up to 15 April 2010 in Medline, Embase, Cochrane Library, Cinahl, and PEDro. Two independent reviewers selected studies according to the inclusion criteria. DATA EXTRACTION: one author extracted the data of the articles. DATA SYNTHESIS: 16 studies with a total of 1,476 participants met the inclusion criteria. There was little evidence supporting a relationship between the changes in pain or physical function and the changes in performance for the following measures: mobility (no correlation in 9 studies, weak correlation in 1 study), trunk extension strength (7 and 2, respectively), trunk flexion strength (4 and 1, respectively) and back muscle endurance (7 and 0, respectively). Changes in disability showed no correlation with changes in mobility in three studies and a weak correlation in two; for strength, the numbers were four (no correlation) and two (weak correlation), respectively. CONCLUSIONS: The findings do not support the notion that the treatment effects of exercise therapy in cLBP are directly attributable to changes in the musculoskeletal system. Future research aimed at increasing the effectiveness of exercise therapy in cLBP should explore the coincidental factors influencing symptom improvement.

Black tea improves attention and self-reported alertness.

Tea has previously been demonstrated to better help sustain alertness throughout the day in open-label studies. We investigated whether tea improves attention and self-reported alertness in two double-blind, randomised, placebo-controlled, crossover studies. Participants received black tea (made from commercially available tea bags) in one condition and placebo tea (hot water with food colours and flavours) similar in taste and appearance to real tea in the other condition. Attention was measured objectively with attention tests (the switch task and the intersensory-attention test) and subjectively with a self-report questionnaire (Bond-Lader visual analogue scales). In both studies, black tea significantly enhanced accuracy on the switch task (study 1 p<.002, study 2 p=.007) and self-reported alertness on the Bond-Lader questionnaire (study 1 p<.001, study 2 p=.021). The first study also demonstrated better auditory (p<.001) and visual (p=.030) intersensory attention after black tea compared to placebo. Simulation of theanine and caffeine plasma time-concentration curves indicated higher levels in the first study compared to the second, which supports the finding that tea effects on attention were strongest in the first study. Being the second most widely consumed beverage in the world after water, tea is a relevant contributor to our daily cognitive functioning.

Pre-surgical sensorimotor training for patients undergoing total hip replacement: a randomised controlled trial.

The aim of this study was to investigate whether pre-operative, sensorimotor training results in improved physical function, quality of life, sensorimotor function and reduced disability in total hip replacement patients. 80 subjects awaiting total hip replacement at a Swiss hospital were recruited for this randomised controlled trial. The intervention group participated in a pre-operative home exercise sensorimotor training programme; the control group received no therapy. Primary outcome measure was physical function, secondary outcome measures were quality of life, disability and sensorimotor function. Outcomes were measured using generic and disease-specific questionnaires as well as objectively assessed balance ability. Measurements were taken one day before surgery and 10 days, 4 and 12 months after surgery. The intervention showed improved quality of life and sensorimotor function before surgery. These effects were lost following surgery. The intervention group experienced more disability at 4 months than the control group. At one year follow-up group-membership influenced quality of life scores depending on the measurement-time-point. It can be concluded that no useful effect was identified for a pre-operative sensory-motor training-programme. The psychological aspects following total hip replacement need to be considered in order to facilitate coping-strategies, reduce unrealistic expectations and increase satisfaction.

[Recommendation of an assessment protocol to describe geriatric inpatient rehabilitation of lower limb mobility based on ICF: an interdisciplinary consensus process]. / Empfehlungen für die Durchführung des motorischen Assessments der unteren Extremität zur ICF-basierten Verlaufsbeurteilung der Mobilität in der stationären geriatrischen Rehabilitation: Bericht eines interdisziplinären Konsensusprozesses.

Because of the growing demand of geriatric rehabilitation, objective and clear indication decisions are needed with respect to limited financial resources. The aim of an interdisciplinary consensus group was to critically evaluate the most commonly used tests of functional performance of the lower limbs and to recommend useful tests to document progress of inpatient rehabilitation. Assessment of standing, walking, walking with a dual-task, sit-to-stand transfer, lying-to-sit-to-stand transfer, and stair climbing were recommended to document functional performance of the lower limbs and to describe rehabilitation targets. Future research is needed, because reasonably validated assessment tools do not exist for all of these domains. In addition to a standardized assessment of physical capacity, physical activity and participation with regard to the International Classification of Functioning, Disability, and Health (ICF) context have to be assessed. Body fixed sensors seem to be a promising assessment tool to objectively document progress in rehabilitation.

The gait and balance of patients with diabetes can be improved: a randomised controlled trial.

AIMS/HYPOTHESIS: Gait characteristics and balance are altered in diabetic patients. Little is known about possible treatment strategies. This study evaluates the effect of a specific training programme on gait and balance of diabetic patients. METHODS: This was a randomised controlled trial (n=71) with an intervention (n=35) and control group (n=36). The intervention consisted of physiotherapeutic group training including gait and balance exercises with function-orientated strengthening (twice weekly over 12 weeks). Controls received no treatment. Individuals were allocated to the groups in a central office. Gait, balance, fear of falls, muscle strength and joint mobility were measured at baseline, after intervention and at 6-month follow-up. RESULTS: The trial is closed to recruitment and follow-up. After training, the intervention group increased habitual walking speed by 0.149 m/s (p<0.001) compared with the control group. Patients in the intervention group also significantly improved their balance (time to walk over a beam, balance index recorded on Biodex balance system), their performance-oriented mobility, their degree of concern about falling, their hip and ankle plantar flexor strength, and their hip flexion mobility compared with the control group. After 6 months, all these variables remained significant except for the Biodex sway index and ankle plantar flexor strength. Two patients developed pain in their Achilles tendon: the progression for two related exercises was slowed down. CONCLUSIONS/INTERPRETATION: Specific training can improve gait speed, balance, muscle strength and joint mobility in diabetic patients. Further studies are needed to explore the influence of these improvements on the number of reported falls, patients' physical activity levels and quality of life. TRIAL REGISTRATION: ClinicalTrials.gov NCT00637546 FUNDING: This work was supported by the Swiss National Foundation (SNF): PBSKP-123446/1/

The combination of L-theanine and caffeine improves cognitive performance and increases subjective alertness.

The non-proteinic amino acid L-theanine and caffeine, a methylxanthine derivative, are naturally occurring ingredients in tea. The present study investigated the effect of a combination of 97 mg L-theanine and 40 mg caffeine as compared to placebo treatment on cognitive performance, alertness, blood pressure, and heart rate in a sample of young adults (n = 44). Cognitive performance, self-reported mood, blood pressure, and heart rate were measured before L-theanine and caffeine administration (i.e. at baseline) and 20 min and 70 min thereafter. The combination of moderate levels of L-theanine and caffeine significantly improved accuracy during task switching and self-reported alertness (both P < 0.01) and reduced self-reported tiredness (P < 0.05). There were no significant effects on other cognitive tasks, such as visual search, choice reaction times, or mental rotation. The present results suggest that 97 mg of L-theanine in combination with 40 mg of caffeine helps to focus attention during a demanding cognitive task.

Use of virtual reality technique for the training of motor control in the elderly. Some theoretical considerations.

Virtual augmented exercise, an emerging technology that can help to promote physical activity and combine the strengths of indoor and outdoor exercise, has recently been proposed as having the potential to increase exercise behavior in older adults. By creating a strong presence in a virtual, interactive environment, distraction can be taken to greater levels while maintaining the benefits of indoor exercises which may result in a shift from negative to positive thoughts about exercise. Recent findings on young participants show that virtual reality training enhances mood, thus, increasing enjoyment and energy. For older adults virtual, interactive environments can influence postural control and fall events by stimulating the sensory cues that are responsible in maintaining balance and orientation. However, the potential of virtual reality training has yet to be explored for older adults. This manuscript describes the potential of dance pad training protocols in the elderly and reports on the theoretical rationale of combining physical game-like exercises with sensory and cognitive challenges in a virtual environment.

Clinical factors associated with gait alterations in diabetic patients.

AIM: To identify clinical factors associated with gait alterations in patients with Type 2 diabetes. METHODS: A sample of 76 diabetic patients underwent clinical examination and an outdoor gait assessment on tarred and cobblestoned terrains. We calculated respective differences in gait speed (performance measure) and gait variability (fall risk index) on changing terrains. Associations with clinical factors were investigated using correlation coefficients and linear regression analysis. RESULTS: The mean walking speed on the tarred pathway was 4.5 +/- 0.6 km/h and 3.9 +/- 0.8 km/h on the cobblestone pathway (P < 0.001). The CVGCT increased from 2.6 +/- 0.9% on the tarred pathway to 5.1 +/- 2.8% on the cobblestone pathway (P < 0.001). Regression analysis showed that 36% of the decrease in gait speed was explained proportionally by the mean of maximal isometric lower limb strength (22.2%; P < or = 0.01), fear of falls (7.4%; P < or = 0.01) and participants' perceived vibration threshold (6.4%; P < or = 0.01). Moreover, mean maximal isometric strength explained 11.8% (P < or = 0.01) of the increase of the coefficient of variation of the gait cycle time when participants changed from tarred terrain to cobblestones. CONCLUSION: This study indicated that both physiological (strength and proprioception) and cognitive-behavioural factors (fear of falls) should be considered when treating diabetic patients with gait alterations. Therapists should apply these findings when developing specific fall prevention and treatment programmes.

Reliability of diabetic patients' gait parameters in a challenging environment.

UNLABELLED: Activities of daily life require us to move about in challenging environments and to walk on varied surfaces. Irregular terrain has been shown to influence gait parameters, especially in a population at risk for falling. A precise portable measurement system would permit objective gait analysis under such conditions. The aims of this study are to (a) investigate the reliability of gait parameters measured with the Physilog in diabetic patients walking on different surfaces (tar, grass, and stones); (b) identify the measurement error (precision); (c) identify the minimal clinical detectable change. METHODS: 16 patients with Type 2 diabetes were measured twice within 8 days. After clinical examination patients walked, equipped with a Physilog, on the three aforementioned surfaces. RESULTS: ICC for each surface was excellent for within-visit analyses (>0.938). Inter-visit ICC's (0.753) were excellent except for the knee range parameter (>0.503). The coefficient of variation (CV) was lower than 5% for most of the parameters. Bland and Altman Plots, SEM and SDC showed precise values, distributed around zero for all surfaces. DISCUSSION: Good reliability of Physilog measurements on different surfaces suggests that Physilog could facilitate the study of diabetic patients' gait in conditions close to real-life situations. Gait parameters during complex locomotor activities (e.g. stair-climbing, curbs, slopes) have not yet been extensively investigated. CONCLUSION: Good reliability, small measurement error and values of minimal clinical detectable change recommend the utilization of Physilog for the evaluation of gait parameters in diabetic patients.

Making More of IT: Enabling Intensive Motor Cognitive Rehabilitation Exercises in Geriatrics Using Information Technology Solutions.

Although the health benefits of physical activity and exercise for older people are well established, a largely sedentary lifestyle still prevails in ageing western societies. Finding new ways to make exercise more accessible and acceptable for older adults must be developed to fully unleash its potential in preventing and weakening age-related physical and cognitive decline. Existing barriers to implement effective exercise-based treatment plans include motivational reservations on both the clinician's and patient's side, but also physical limitations caused by disease or deconditioning. Particularly in the more senior population, debilitating conditions do not allow adherence to currently recommended exercise regimes. A major rethinking of age- and user-adapted exercise is overdue. The high intensities required for physical and mental adaptations must be modifiable and personalized according to the functional status of each patient. Emerging information and communication technologies (ICT) have brought forward a plethora of attractive solutions for smart and adapted exercise, but there remains a vast gap between technological advancement and clinical relevance. Where in the beginning ICT for active ageing mainly focussed on aspects of usability and user experience, the current status of IT as applied in ageing populations noticeably shifted toward new services, applications, and devices that can be offered with the aim to prevent, compensate, care, and/or enhance daily life functioning of senior citizens. In this perspective paper, we aim to summarize the current state of the art in ICT-based interventions aimed at improved motor-cognitive control and make suggestions about how these could be combined with high-intensive interval exercise regimes to make rehabilitation for the impaired older adults more effective, and more fun.

Serological evidence for exposure to avian influenza viruses within poultry workers in southern China.

The risk of infection with avian influenza viruses for poultry workers is relatively unknown in China, and study results are often biased by the notification of only the severe human cases. Protein microarray was used to detect binding antibodies to 13 different haemagglutinin (HA1-part) antigens of avian influenza A(H5N1), A(H7N7), A(H7N9) and A(H9N2) viruses, in serum samples from poultry workers and healthy blood donors collected in the course of 3 years in Guangdong Province, China. Significantly higher antibody titre levels were detected in poultry workers when compared to blood donors for the most recent H5 and H9 strains tested. These differences were most pronounced in younger age groups for antigens from older strains, but were observed in all age groups for the recent H5 and H9 antigens. For the H7 strains tested, only poultry workers from two retail live poultry markets had significantly higher antibody titres compared to blood donors.