Real time noninvasive estimation of work of breathing using facemask leak-corrected tidal volume during noninvasive pressure support: validation study

We describe a real time, noninvasive method of estimating work of breathing (esophageal balloon not required) during noninvasive pressure support (PS) that uses an artificial neural network (ANN) combined with a leak correction (LC) algorithm, programmed to ignore asynchronous breaths, that corrects for differences in inhaled and exhaled tidal volume (V_T) from facemask leaks (WOB_ANN,LC/min). Validation studies of WOB_ANN,LC/min were performed. Using a dedicated and popular noninvasive ventilation ventilator (V60, Philips), in vitro studies using PS (5 and 10 cm H₂O) at various inspiratory flow rate demands were simulated with a lung model. WOB_ANN,LC/min was compared with the actual work of breathing, determined under conditions of no facemask leaks and estimated using an ANN (WOB_ANN/min). Using the same ventilator, an in vivo study of healthy adults (n = 8) receiving combinations of PS (3–10 cm H₂O) and expiratory positive airway pressure was done. WOB_ANN,LC/min was compared with physiologic work of breathing/min (WOB_PHYS/min), determined from changes in esophageal pressure and V_T applied to a Campbell diagram. For the in vitro studies, WOB_ANN,LC/min and WOB_ANN/min ranged from 2.4 to 11.9 J/min and there was an excellent relationship between WOB_ANN,LC/breath and WOB_ANN/breath, r = 0.99, r² = 0.98 (p < 0.01). There were essentially no differences between WOB_ANN,LC/min and WOB_ANN/min. For the in vivo study, WOB_ANN,LC/min and WOB_PHYS/min ranged from 3 to 12 J/min and there was an excellent relationship between WOB_ANN,LC/breath and WOB_PHYS/breath, r = 0.93, r² = 0.86 (p < 0.01). An ANN combined with a facemask LC algorithm provides noninvasive and valid estimates of work of breathing during noninvasive PS. WOB_ANN,LC/min, automatically and continuously estimated, may be useful for assessing inspiratory muscle loads and guiding noninvasive PS settings as in a decision support system to appropriately unload inspiratory muscles.     

Longitudinal study of bone mineral content in the lumbar spine, the forearm and the lower extremities after spinal cord injury

Bone mineral content (BMC) of the lumbar spine, femoral neck and shaft, and proximal tibia was measured by dual photon absorptiometry in six men and two women after traumatic spinal cord injuries. In six of these patients, BMC of the distal forearm was measured as well. The patients were 18-49 years old at injury and had complete motor lesions from C7 to L1. All but one had some spasticity, and they all used a wheelchair. The initial BMC measurements were carried out from 9-167 days (median 43) post-injury and followed up by 5-13 (median 8) measurements up to 31-53 months (median 41) after the injury. BMC of the lumbar spine and distal forearm remained nearly unchanged in the whole period, and the measurements were within the normal range, except for the lumbar spine when Harrington rods in the scanned area induced high BMC values. In the lower extremities the BMC decreased after injury. New steady-state levels for BMC were reached at 2 years post-injury for the proximal tibia and the femoral neck at 40-50% and 60-70% respectively of normal values. For the femoral shaft the decrease in BMC was more slow and it seems that a steady-state was not reached within our observation period for several of the patients. This longitudinal study indicates, in agreement with a previous cross-sectional study, that normal muscle function and load bearing is necessary to prevent bone loss.     

Effect of In situ Recycling of Sugarcane Crop Residues on Soil Enzyme Activities Under Soybean–Maize System

An investigation was carried out by conducting a field experiment at the farm of the Mahatma Phule Krishi Vidyapeeth (MPKV), Rahuri. The significant grain yield of soybean (37.5 q ha^?1) and maize (49 q ha^?1) were observed in the treatment receiving 100 % recommended doses of Nitrogen, Phosphorus and Potassium (NPK) + in situ compost of crop residues, pressmud compost (T₆). After harvest of maize dehydrogenase activity, acid phosphatase, β-glucosidase and urease were significantly improved in T₇ treatment as compared to other treatments. However, fluorescein diacetate activity and alkaline phosphatase were significantly greater in T₆ treatment in post-harvest soil samples of maize. In the post-harvest soil of maize the bacterial and actinomycetes population were greater in the treatment receiving in situ decomposition of sugarcane crop residues + 100 % recommended dose of NPK (T₃). The fungal population after harvest of maize was found maximum in treatment T₇. The total organic carbon was significantly correlated with dehydrogenase (r = 0.65, P < 0.01), fluorescein diacetate (r = 0.71, P < 0.01), acid phosphatase (r = 0.66, P < 0.01), β-glucosidase (r = 0.65, P < 0.01), and urease (r = 0.57, P < 0.01). There was a significant correlation (r = 0.77, P < 0.01) between TOC and soybean yield, and between total organic carbon and maize yield (r = 0.98, P < 0.01). The result suggest that in situ recycling of sugarcane crop residues and the industrial wastes with suitable interventions like use of bioinoculum, phosphatic fertilizer and urea may help for improving better crop productivity and soil biological activities.     

Contribution of the trabecular component to mechanical strength and bone mineral content of the femoral neck. An experimental study on cadaver bones

Both proximal femora from 10 females were acquired at autopsy. The trabecular component of the femoral neck of one specimen from each pair was evacuated, while the contralateral specimen was left intact as a reference. Bone mineral content (BMC) of the femoral neck, demonstrated only a slight (mean 4.8%) individual side to side variation. After evacuation of the trabecular component, BMC was reduced with mean 23.5%. Mechanical strength of the specimens, determined by applying a force to the femoral head perpendicularly to the axis of the femoral shaft, was reduced by mean 39.5%. Correlation between BMC and fracture strength was poor. There was no correlation between reduction in BMC and reduction in mechanical strength after evacuation, indicating that bone fracture strength is influenced by factors other than the mineral content.     

The roles of adulthood behavioural factors and familial influences in bone density among men

BACKGROUND. A primary strategy in osteoporosis prevention is advice on exercise, smoking, and calcium intake, although its practical value is unclear. AIM. To investigate the roles of such factors on bone density (BMD) after considering the influences of familial aggregation (combined effects of genetics and familial influences) in Finnish men 35-69 years old. METHODS. We selected 105 male monozygotic twin pairs, with discordance in suspected determinants. RESULTS. Dietary calcium was associated with BMD of the femoral neck; and body weight and lifetime frequency of endurance and ball game sport activities were associated with both femoral neck and lumbar BMD. Occupational loading and smoking were associated with neither. However, age and familial aggregation explained 73% of the variance of BMD in both the femoral neck and lumbar spine; calcium intake explained 1% in femoral neck and lifetime exercise 1% in lumbar spine. CONCLUSIONS. The effects of dietary calcium and physical activity that are not 'embedded' in the familial influences had very modest effects on the variance of BMD. Thus our chances of influencing BMD in later adulthood by targeting behavioural habits are likely to be limited. Interventions focused on childhood and the family unit may achieve more beneficial long-term results.     

Non-invasive measurement of cardiac output in obese children and adolescents: comparison of electrical cardiometry and transthoracic Doppler echocardiography

The objective of this study was to evaluate the reliability and accuracy of electrical cardiometry (EC) for the noninvasive determination of cardiac output (CO) in obese children and adolescents. We compared these results with those obtained by transthoracic echocardiography. Sixty-four participants underwent simultaneous measurement of CO. Cardiac output was measured by EC using the ICON^® device. Simultaneously CO was determined by using transthoracic Doppler echocardiography from parasternal long-axis and apical view. The median age was 12.52 years (range 7.9–17.6 years) and 36 (56 %) were female. A strongly significant correlation was found between the CO_EC and CO_Echo measurements (p < 0.0001, r = 0.91). Significant correlations were also found between CO and age (r = 0.37, p = 0.002), weight (r = 0.57, p < 0.0001), height (0.60, p < 0.0001) and BMI (r = 0.42, p = 0.001). The mean difference between the two methods (CO_EC ? CO_Echo) was 0.015 l min^?1. According to the Bland and Altman method, the upper and lower limits of agreement, defined as mean difference ±2 SD, were +1.21 and ?0.91 l min^?1, respectively. Compared to the transthoracic Doppler echocardiography, Electrical Cardiometry provides accurate and reliable CO measurements in obese children and adolescents.     

Double photon absorptiometry in renal osteodystrophy

Bone mineral content (BMC) of the lumbar spine (L2-L4), femoral neck, Ward's triangle and the trochanteric region was measured in 52 consecutive patients on maintenance haemodialysis. In the whole group the median BMC value as percentage of sex- and age-matched normal means was significantly decreased only in Ward's triangle (91.7%; p less than 0.02). In patients with chronic interstitial nephritis there was a significant decrease in bone density in Ward's triangle and the trochanteric region (p less than 0.02). There was no correlation between BMC and time on dialysis or intact parathormone. BMC value did not predict the type of renal osteodystrophy, according to Delling. 17 patients underwent a second investigation after one year. There was a slight fall in mean BMC of the lumbar spine (-0.9%) and Ward's triangle (-1.1%). The fall in mean BMC of the trochanteric region was pronounced (-3.2%). We believe that the observed low demineralisation, which was more pronounced in patients with interstitial nephritis, may be attributable to early and carefully monitored therapy with vitamin D metabolites.     

Computed tomography calcium score scan for attenuation correction of N-13 ammonia cardiac positron emission tomography: effect of respiratory phase and registration method

The use of coronary calcium scoring (CaScCT) for attenuation correction (AC) of ¹³N-ammonia PET/CT studies (NH₃) is still being debated. We compare standard ACCT to CaScCT using various respiratory phases and co-registration methods for AC. Forty-one patients underwent a stress/rest NH₃. Standard ACCT scans and CaScCT acquired during inspiration (CaScCTinsp, 26 patients) or expiration (CaScCTexp, 15 patients) were used to correct PET data for photon attenuation. Resulting images were compared using Pearson’s correlation and Bland–Altman (BA) limits of agreement (LA) on segmental relative and absolute coronary blood flow (CBF) using both manual and automatic co-registration methods (rigid-body and deformable). For relative perfusion, CaScCTexp correlates better than CaScCTinsp with ACCT when using manual co-registration (r = 0.870; P < 0.001 and r = 0.732; P < 0.001, respectively). Automatic co-registration provides the best correlation between CaScCTexp and ACCT for relative perfusion (r = 0.956; P < 0.001). Both CaScCTinsp and CaScCTexp yielded excellent correlations with ACCT for CBF when using manual co-registration (r = 0.918; P < 0.001; BA mean bias 0.05 ml/min/g; LA: ?0.42 to +0.3 ml/min/g and r = 0.97; P < 0.001; BA mean bias 0.1 ml/min/g; LA: ?0.65 to +0.5 ml/min/g, respectively). The use of CaScCTexp and deformable co-registration is best suited for AC to quantify relative perfusion and CBF enabling substantial radiation dose reduction.     

Influence of age and gender on autonomic regulation of heart

Heart rate variability (HRV) is a non-invasive method to measure cardiac autonomic function. Impairments in HRV have been proposed as independent risk factor for increased cardiac mortality and morbidity. Cardio protective phenomenon in females has been hypothesized to be due to differential autonomic tone. Age related loss of vagal control has been reported as predisposing factor for the development of cardiovascular disease. In this study we assessed effect of age and gender on autonomic regulation of heart in healthy volunteers. HRV data of 189 subjects (114 males and 75 females) were analyzed in time and frequency domains using customized program. Artifact free 5 min electrocardiogram segment was used for analysis. It was ensured that none of the subject had medical illness such as diabetes, hypertension, thyroid disorders, cardiac disorders, diseases potentially related with autonomic neuropathy and major psychiatric illness by careful history and clinical examination. HRV recordings were done under standard laboratory condition. On correlation analysis SDNN, RMSSD, total power negatively correlated with age suggesting reduced autonomic regulation of heart with increase in age (SDNN: r = ?0.444, p < 0.01; RMSSD: r = ?0.552, p < 0.01; total power: r = ?0.474, p < 0.01); similarly High frequency power (HF.nu) negatively correlated with age (r = ?0.167, p = 0.02), denoting loss of vagal tone with aging. LF/HF ratio correlated positively with age (r = 0.19, p < 0.01) suggesting a relative increase of sympathetic activity with increase in age. On multiple regression analysis to control for effect of age and heart rate while comparing males and females, LF.nu showed significant reduction suggesting lower sympathetic tone in females (β = ?6.64; p < 0.01) and HF.nu showed increase at trend level (β = 4.47; p = 0.053). In conclusion, there is overall reduction in autonomic control of heart with increase in the age. Sympathetic tone predominates and vagal tone diminishes with aging process. Females showed greater vagal tone than male. This differential autonomic tone indicate age, gender related predisposition to cardiovascular disease.     

The roles of adulthood behavioural factors and familial influences in bone density among men

BACKGROUND: A primary strategy in osteoporosis prevention is advice on exercise, smoking, and calcium intake, although its practical value is unclear. AIM: To investigate the roles of such factors on bone density (BMD) after considering the influences of familial aggregation (combined effects of genetics and familial influences) in Finnish men 35-69 years old. METHODS: We selected 105 male monozygotic twin pairs, with discordance in suspected determinants. RESULTS: Dietary calcium was associated with BMD of the femoral neck; and body weight and lifetime frequency of endurance and ball game sport activities were associated with both femoral neck and lumbar BMD. Occupational loading and smoking were associated with neither. However, age and familial aggregation explained 73% of the variance of BMD in both the femoral neck and lumbar spine; calcium intake explained 1% in femoral neck and lifetime exercise 1% in lumbar spine. CONCLUSIONS: The effects of dietary calcium and physical activity that are not 'embedded' in the familial influences had very modest effects on the variance of BMD. Thus our chances of influencing BMD in later adulthood by targeting behavioural habits are likely to be limited. Interventions focused on childhood and the family unit may achieve more beneficial long-term results.     

Lumbar kinematic variability during gait in chronic low back pain and associations with pain,disability and isolated lumbar extension strength

BackgroundChronic low back pain is a multifactorial condition with many dysfunctions including gait variability. The lumbar spine and its musculature are involved during gait and in chronic low back pain the lumbar extensors are often deconditioned. It was therefore of interest to examine relationships between lumbar kinematic variability during gait, with pain, disability and isolated lumbar extension strength in participants with chronic low back pain.MethodsTwenty four participants with chronic low back pain were assessed for lumbar kinematics during gait, isolated lumbar extension strength, pain, and disability. Angular displacement and kinematic waveform pattern and offset variability were examined.FindingsAngular displacement and kinematic waveform pattern and offset variability differed across movement planes; displacement was highest and similar in frontal and transverse planes, and pattern variability and offset variability higher in the sagittal plane compared to frontal and transverse planes which were similar. Spearman's correlations showed significant correlations between transverse plane pattern variability and isolated lumbar extension strength (r = − .411) and disability (r = .401). However, pain was not correlated with pattern variability in any plane. The r² values suggested 80.5% to 86.3% of variance was accounted for by other variables.InterpretationConsidering the lumbar extensors role in gait, the relationship between both isolated lumbar extension strength and disability with transverse plane pattern variability suggests that gait variability may result in consequence of lumbar extensor deconditioning or disability accompanying chronic low back pain. However, further study should examine the temporality of these relationships and other variables might account for the unexplained variance.     

Respiratory dysfunction in patients with chronic neck pain – Influence of thoracic spine and chest mobility

Patients with chronic neck pain exhibit various musculoskeletal deficits and respiratory dysfunction. As there is a link between thoracic and cervical spine motion, the aim of this study was to investigate the relationship between thoracic spine and chest mobility with respiratory function and neck disability. Nineteen patients with chronic neck pain (7 male, 46.6 ± 10.5 years) and 19 healthy subjects (7 male, 46.5 ± 9.9 years) participated. Spirometry was conducted to determine maximal voluntary ventilation (MVV), maximal inspiratory (Pi_max) and maximal expiratory pressure (Pe_max). Thoracic spine mobility was measured using the Spinal Mouse^®. Chest expansion was assessed by subtracting chest circumference during maximal inspiration and expiration. Neck function was investigated by examining range of motion, forward head posture, neck flexor muscle synergy endurance and self-assessment (Neck disability index (NDI)). Correlation analyses and multiple linear regression analyses were conducted using MVV, Pi_max and Pe_max as independent variables. Thoracic spine mobility during flexion and chest expansion correlated significantly to MVV (r = 0.45 and 0.42), all neck motions (r between 0.39 and 0.59) and neck muscle endurance (r_S = 0.36). Pe_max and Pi_max were related to NDI (r = −0.58 and −0.46). In the regression models, chest expansion was the only significant predictor for MVV, and Pe_max was determined by neck muscle endurance. These results suggest that chronic neck pain patients should improve the endurance of the neck flexor muscles and thoracic spine and chest mobility. Additionally, these patients might benefit from respiratory muscle endurance training, possibly by increasing chest mobility and Pe_max.     

Beweglichkeit der Wirbelsäulensegmente

The aim of the study was to establish reference values for estimation of the mobility of individual moveable segments in all sections of the spinal column. A total of 143 young healthy men were investigated by means of defined mechanical impulses at points over each mobile segment of the spine. The test impulse was evoked at an initial pressure of 2.7 kg on skin. The duration of the impulse was <1 ms with a force of 421.84 g/cm². The response of the tissue (including part of spine) following the impulse was registered by means of a piezoelectric sensor. The mean value and the mean deviation of parameters characterizing the response were calculated for all 26 test points. Considering physical principles and anatomical relationships of the cervical and lumbar spine the following parameters characterize a higher level of mobility of the spine or segment::

lower amplitude (peak)

smaller area under the response curve (area_topeak: area_total)

longer duration of answer = lower frequency (time_topeak: time_total)

higher attenuation (time_total – time_topeak).

The parameters appear to characterize functionally the important parts of the spine: C3, C5, C7/Th1, Th3, Th12, L3. Reliability and pathological considerations need further investigation.     

Near-infrared spectroscopy determined cerebral oxygenation with eliminated skin blood flow in young males

We estimated cerebral oxygenation during handgrip exercise and a cognitive task using an algorithm that eliminates the influence of skin blood flow (SkBF) on the near-infrared spectroscopy (NIRS) signal. The algorithm involves a subtraction method to develop a correction factor for each subject. For twelve male volunteers (age 21 ± 1 yrs) +80 mmHg pressure was applied over the left temporal artery for 30 s by a custom-made headband cuff to calculate an individual correction factor. From the NIRS-determined ipsilateral cerebral oxyhemoglobin concentration (O₂Hb) at two source-detector distances (15 and 30 mm) with the algorithm using the individual correction factor, we expressed cerebral oxygenation without influence from scalp and scull blood flow. Validity of the estimated cerebral oxygenation was verified during cerebral neural activation (handgrip exercise and cognitive task). With the use of both source-detector distances, handgrip exercise and a cognitive task increased O₂Hb (P < 0.01) but O₂Hb was reduced when SkBF became eliminated by pressure on the temporal artery for 5 s. However, when the estimation of cerebral oxygenation was based on the algorithm developed when pressure was applied to the temporal artery, estimated O₂Hb was not affected by elimination of SkBF during handgrip exercise (P = 0.666) or the cognitive task (P = 0.105). These findings suggest that the algorithm with the individual correction factor allows for evaluation of changes in an accurate cerebral oxygenation without influence of extracranial blood flow by NIRS applied to the forehead.     

Coupling of vessel wall morphology and function in the aorta and the carotid artery: an evaluation with MRI

To evaluate the regional association between vessel wall morphology [i.e. cross-sectional vessel wall area (VWA)] and function [i.e. wall stiffness expressed in the pulse wave velocity (PWV)] in both the aortic arch and the left carotid artery. Thirty-two healthy volunteers (mean age 41 ± 16 years) underwent 3T MRI examination to assess PWV and VWA of the aorta and the left carotid artery. PWV was determined by the transit-time method with velocity-encoded MRI recordings of the systolic blood flow propagation. VWA was assessed for both the aorta and the carotid artery, by detecting lumen and outer vessel wall contours in cross-sectional black blood images. Linear regression analyses were used to test associations between aortic and carotid vessel wall area and stiffness. Within the same vascular territory, correlation between PWV and VWA was stronger than across vascular territories. For the aorta, the correlation between PWV_AO and VWA_AO (r = 0.71, p < 0.0001) was stronger than between PWV_AO and VWA_CA (r = 0.53, p = 0.002). For the carotid artery, the correlation between PWV_CA and VWA_CA (r = 0.61, p < 0.0001) was stronger than between PWV_CA and VWA_AO (r = 0.46, p = 0.008). Morphologic and functional vessel wall properties assessed in the aortic arch and the left carotid artery are significantly stronger associated within the same vascular territory rather than across different vascular territories.     

Relationship between trunk muscle torque and bone mineral content of the lumbar spine and hip in healthy postmenopausal women

The purpose of the study was to determine the relationship between trunk muscle strength and bone mineral density (BMD). Fifty-six postmenopausal women, aged 38 to 73 years, were examined. The BMD of lumbar vertebrae L2-4, the femoral neck, the Ward's triangle, and the greater trochanter was measured with dual-photon absorptiometry. Isometric and isokinetic torque and work measurements obtained on a trunk testing unit were used to assess trunk flexor and extensor strength. Correlation analysis demonstrated a statistically significant relationship between most trunk torque and work measurements and BMD. The trunk extensors generally provided higher correlations with BMD than did the trunk flexors, and the isokinetic extension torque values demonstrated higher correlations than the isometric extension values in every case. Linear backward-regression models, based on the subjects' weight and trunk flexor and extensor torque and work measurements, demonstrated multiple-correlation coefficients of .67, .58, .43, and .65 in predicting the BMD of the L2-4 region, femoral neck, Ward's triangle, and greater trochanter region, respectively. Estrogen therapy status did not affect the linear regression models. These data suggest a positive relationship in postmenopausal women between flexor and extensor torque values and BMD at the lower lumbar spine and proximal femur.     

Estimation of particulate zinc using MERIS data of the Pearl River Estuary

Marine heavy metals in the particulate phase are considered to be undetectable from remote sensing since their minor spectral signal is masked by marine optical constitutes. However, over 80% of heavy metals adsorb to and complex with the suspended sediment and the quantity of adsorbed heavy metals strongly depends on suspended sediment load and size. Thus, the suspended sediment load and size could be useful information to estimate heavy metal levels through remote-sensing techniques. We investigate the potential to derive heavy metal concentration, using zinc as an example. Eight cruises in the Pearl River Estuary were carried out to measure zinc concentrations in the particulate phase (C _zn) and remote-sensing reflectance (R _rs) data from 2009 to 2010. The relationship of R _rs ratio in the near infrared bands and the scattering spectral slope (which indicates particle size distribution (PSD)) is first proposed. According to a previously established suspended sediment algorithm for the study area and the newly proposed relationship of remote-sensing reflectance and suspended sediment size, a piecewise algorithm is developed to retrieve C _zn. The accuracies of the algorithm developed here (correlation coefficient (r) = 0.88, mean relative error (MRE) = 24.7% and root mean square error (RMSE) = 5.51) are higher than those algorithms only considering suspended sediment load (r = 0.79, MRE = 35.3% and RMSE = 8.93) or size (r = 0.78, MRE = 30.0% and RMSE = 7.19). The algorithm is applied to Medium Resolution Imaging Spectrometer (MERIS) full resolution data to obtain C _zn distribution in the Pearl River Estuary. The C _zn from image is mainly in the range from 10 to 63 μg l^?1, which is consistent with the in situ data ranges (5.67–86.62 μg l^?1).     

Bone mineral status in immigrant Indo-Asian women

BACKGROUND: Indo-Asian immigrants are known to be at high risk of metabolic bone disease, but the prevalence of osteoporosis in this population is unknown. AIM: To compare the bone mineral at the lumbar spine and femoral neck of Indo-Asian immigrant women with that of age-matched Caucasian women. DESIGN: Retrospective analysis. METHODS: Women of Indo-Asian origin referred for bone density scans in the last five years were identified. The skeletal status of each was compared with an age-matched Caucasian control for bone mineral content (BMC), bone mineral density (BMD) and bone mineral apparent density (BMAD) at the lumbar spine and femoral neck, and hip axis length was measured. RESULTS: At the lumbar spine, Indo-Asians had a significantly lower BMD than Caucasians (0.834 vs. 0.913, p = 0.008), but there was no significant difference when BMAD values were calculated (0.123 vs. 0.122). At the femoral neck, there was no difference in BMD (0.728 vs. 0.712, p = 0.5), and BMAD values were significantly higher among Indo-Asians than Caucasians (0.393 vs. 0.319, p = 0.022). Hip axis length was significantly shorter among Indo-Asian women (10.3 vs. 10.7, p = 0.009). DISCUSSION: Although Indo-Asian women appear to have lower spinal BMD than Caucasians, these differences disappear when BMAD values are calculated. While BMD is an areal density, not taking into account the 'depth' of the bone, BMAD is an estimation of volumetric density. Hence lower BMD values in Asians may be a size-related artefact. Longitudinal studies may be required to evaluate the use of BMD as a marker for fracture risk in this population.     

Reliability,validity and minimal detectable change of the Mini-BESTest in Greek participants with chronic stroke

Objectives: This study aimed to investigate the psychometric characteristics of reliability, validity and ability to detect change of a newly developed balance assessment tool, the Mini-BESTest, in Greek patients with stroke. Design: A prospective, observational design study with test-retest measures was conducted. Methods: A convenience sample of 21 Greek patients with chronic stroke (14 male, 7 female; age of 63 ± 16 years) was recruited. Two independent examiners administered the scale, for the inter-rater reliability, twice within 10 days for the test-retest reliability. Bland Altman Analysis for repeated measures assessed the absolute reliability and the Standard Error of Measurement (SEM) and the Minimum Detectable Change at 95% confidence interval (MDC_95%) were established. The Greek Mini-BESTest (Mini-BESTest_GR) was correlated with the Greek Berg Balance Scale (BBS_GR) for assessing the concurrent validity and with the Timed Up and Go (TUG), the Functional Reach Test (FRT) and the Greek Falls Efficacy Scale-International (FES-I_GR) for the convergent validity. Results: The Mini-BESTestGR demonstrated excellent inter-rater reliability (ICC (95%CI) = 0.997 (0.995–0.999, SEM = 0.46) with the scores of two raters within the limits of agreement (mean_dif = ?0.143 ± 0.727, p > 0.05) and test-retest reliability (ICC (95%CI) = 0.966 (0.926–0.988), SEM = 1.53). Additionally, the Mini-BESTest_GR yielded very strong to moderate correlations with BBS_GR (r = 0.924, p < 0.001), TUG (r = ?0.823, p < 0.001), FES-I_GR (r = ?0.734, p < 0.001) and FRT (r = 0.689, p < 0.001). MDC₉₅ was 4.25 points. Conclusion: The exceptionally high reliability and the equally good validity of the Mini-BESTest_GR, strongly support its utility in Greek people with chronic stroke. Its ability to identify clinically meaningful changes and falls risk need further investigation.     

Type effect of inhibitory KT tape on measured vs. perceived maximal grip strength

This study examined the effects of KT tape (KT) applied in an inhibitory manner on muscle activity, measured maximal grip strength, and perceived maximal grip strength in regular KT-users and non-users. This study was a single-blinded crossover study with sixty participants including 27 kT-users and 33 non-users. Participants underwent maximal grip strength tests with and without inhibitory KT applied across the wrist extensors. Muscle activity and maximal grip strength were measured, while perceived maximal grip strength was rated using a visual analogue scale. No significant interaction effect was found between taping conditions and participant KT-experience for muscle activity (F = 0.825, p = 0.367), measured grip strength (F = 1.018, p = 0.317) or perceived grip strength (F = 0.122, p = 0.728). No significant differences were observed in the EMG activity between taping conditions for either KT-users (p = 0.367) or non-users (p = 0.215). A similar trend was found in the measured grip strength (KT-users: p = 0.317; non-users: p = 0.294) and perceived grip strength (KT-users: p = 0.728; non-users: p = 0.063). KT applied in an inhibitory manner does not impede EMG activity, measured maximal grip strength, or perceived maximal grip strength in adults, regardless of their preconceived notions of KT.