Παρασκευή, 15 Ιουνίου 2018

Detecting de Novo Homoeologous Recombination Events in Cultivated Brassica napus Using a Genome-Wide SNP Array

The heavy selection pressure due to intensive breeding of Brassica napus has created a narrow gene pool, limiting the ability to produce improved varieties through crosses between B. napus cultivars. One mechanism that has contributed to the adaptation of important agronomic traits in the allotetraploid B. napus has been chromosomal rearrangements resulting from homoeologous recombination between the constituent A and C diploid genomes. Determining the rate and distribution of such events in natural B. napus will assist efforts to understand and potentially manipulate this phenomenon. The Brassica high-density 60K SNP array, which provides genome-wide coverage for assessment of recombination events, was used to assay 254 individuals derived from 11 diverse cultivated spring type B. napus. These analyses identified reciprocal allele gain and loss between the A and C genomes and allowed visualization of de novo homoeologous recombination events across the B. napus genome. The events ranged from loss/gain of 0.09 Mb to entire chromosomes, with almost 5% aneuploidy observed across all gametes. There was a bias towards sub-telomeric exchanges leading to genome homogenisation at chromosome termini. The A genome replaced the C genome in 66% of events, and also featured more dominantly in gain of whole chromosomes. These analyses indicate de novo homoeologous recombination is a continuous source of variation in established Brassica napus and the rate of observed events appears to vary with genetic background. The Brassica 60K SNP array will be a useful tool in further study and manipulation of this phenomenon.



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Editorial Board



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Spinal manipulation for chronic low back pain: is it all it is cracked up to be?

The systematic review by Coulter et al. [1] suggests that manipulation reduces pain and improves function in chronic low back pain (CLBP). This contrasts sharply with the most recent Cochrane systematic review [2]. As physiotherapists who remain open to the use of manipulation in CLBP, we have several concerns about the review:

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Table of Contents



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Table of Contents



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Response to Letter to the Editor entitled “Spinal manipulation for chronic low back pain: is it all it is cracked up to be?” concerning “Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis” by Coulter et al. Spine J; doi: 10.1016/j.spinee.2018.01.013

The authors state that "Coulter et al suggests that manipulation reduces pain and improves function in chronic low back pain, which contrasts sharply with the most recent Cochrane systematic review" [1]. This Cochrane review is entitled, "Spinal manipulative therapy for acute low back pain." Our review focused on chronic low back pain. Our review was not confined to spinal manipulation therapy alone but was inclusive of manipulation and mobilization in chiropractic settings and other non-invasive therapy settings.

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Meetings Calendar



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Table of Contents



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Table of Contents



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Decreased alpha2 connectivity in EEG is correlated with the cognitive and psychiatric manifestations of Parkinson’s disease

Parkinson's disease (PD) was traditionally thought of as a motor disorder induced by selective apoptosis of unknown cause affecting dopaminergic neurons in the pars compacta of the substantia nigra (SNpc), leading, in turn, to basal ganglionic dysfunction that manifests itself as bradykinesia, rigidity, and rest tremor. These features remain important elements of the current diagnostic criteria for PD, which, however, also give a prominent role to non-motor manifestations of the disease (Postuma et al.

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Quantitative EEG and functional outcome following acute ischemic stroke

Stroke is a leading cause of disability and mortality worldwide, and despite advances in disease prevention, acute treatment and rehabilitation, global stroke burden is expected to rise in the future (Feigin et al. 2017). Early post-stroke prognostication is essential both in the short-term (f. ex. in guiding treatment strategies) and in the long-term (to aid in rehabilitation management, in order to improve recovery and minimize disability). Predictors of stroke disability and associate death consistently include age and clinical / imaging related stroke severity (Adams et al.

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Impaired Consciousness through a Focal Lesion under the left Posteromedial Cortex

Consciousness is made up of arousal (i.e. wakefulness) and awareness (i.e. awareness of the environment and self) (Laurey et al., 1999; Laurey et al., 2004). A series of imaging studies have potently suggested that awareness processing is associated with the posteromedial cortex (PMC, Laurey et al., 1999; Laurey et al., 2004; Cavanna et al., 2006), an area composed of multiple association cortices in the interhemispheric fissure, including the precuneus (BA 7), posterior cingulate area (BA 23), and retrosplenial area (BA 29 and 30) (Cavanna et al., 2006).

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Treatment of ulnar neuropathy at the elbow – an ongoing conundrum

Ulnar neuropathy at the elbow (UNE) is the second most common mechanical mononeuropathy after carpal tunnel syndrome (CTS). Despite the frequency with which it is seen in the neurophysiology clinic, UNE still poses clinical and diagnostic challenges. The clinical diagnosis of ulnar neuropathy is generally easy to determine, but UNE may be difficult to localize on nerve conduction studies. Diagnostic localization is improved when the ulnar nerve is examined by ultrasound (Simon et al., 2015) and best with magnetic resonance neurography (Keen et al., 2012).

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Hepatic vein stenting in a 7 week/old infant with Budd–Chiari syndrome using an anterograde approach from the inferior accessory hepatic vein



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Regional Anesthesia: What We Need to Know in the Era of Enhanced Recovery After Surgery Protocols and the Opioid Epidemic

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Publication date: Available online 15 June 2018
Source:Anesthesiology Clinics
Author(s): Lee A. Fleisher




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Adding to the Rainbow of Diversity: Caring for Children of Polyamorous Families

Indirect evidence suggests that interest in and practice of polyamory is increasing in the United States. Pediatric nurse practitioners (PNPs) may come into contact with polyamorous families. This case study describes polyamory, addresses the known research on the child's experience by developmental stage, and responds to potential queries about mental health issues and outcomes.

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Excitability tests using high-density surface-EMG: A novel approach to studying single motor units

Publication date: August 2018
Source:Clinical Neurophysiology, Volume 129, Issue 8
Author(s): Boudewijn T.H.M. Sleutjes, Judith Drenthen, Ernest Boskovic, Leonard J. van Schelven, Maria O. Kovalchuk, Paul G.E. Lumens, Leonard H. van den Berg, Hessel Franssen
ObjectiveTo study excitability of single motor units (MUs) using high-density surface-EMG.MethodsMotor unit action potentials (MUAPs) were evoked by submaximal stimulation of the median nerve at the wrist and recorded with a 9 × 14 electrode grid on the skin overlying the thenar muscles. For excitability tests of single MUs, the most optimal specific single-channel surface-EMG signal was selected based on the spatiotemporal profile of single MUs.ResultsAxonal excitability measures were successfully obtained from 14 single MUs derived from ten healthy subjects. Selecting the optimal single-channel surface-EMG signals minimized interference from other single MUs and improved signal-to-noise ratio. The muscle fiber conduction velocity (MFCV) could also be derived from the unique spatiotemporal profile of single MUs.ConclusionHigh-density surface-EMG helps to isolate single MUAP responses, making it a suitable technique for assessing excitability in multiple single motor axons per nerve.SignificanceOur method enables the reliable study of ion-channel dysfunction in single motor axons of nerves without any requirement for specific conditions, such as prominent MU loss or enlarged MUAPs due to collateral sprouting.



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Relationships Between English Language Proficiency, Health Literacy, and Health Outcomes in Somali Refugees

Abstract

Little is known about the impacts of health literacy and English proficiency on the health status of Somali refugees. Data came from interviews in 2009–2011 of 411 adult Somali refugees recently resettled in Massachusetts. English proficiency, health literacy, and physical and mental health were measured using the Basic English Skills Test Plus, the Short Test of Health Literacy in Adults, and the Physical and Mental Component Summaries of the Short Form-12. Associations were analyzed using multiple linear regression. In adjusted analyses, higher English proficiency was associated with worse mental health in males. English proficiency was not associated with physical health. Health literacy was associated with neither physical nor mental health. Language proficiency may adversely affect the mental health of male Somali refugees, contrary to findings in other immigrant groups. Research on underlying mechanisms and opportunities to understand this relationship are needed.



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Associations of HSP90AA2 gene polymorphisms with disease susceptibility, glucocorticoids efficacy and health-related quality of life in Chinese systemic lupus erythematosus patients

Abstract

Although the current glucocorticoids (GCs) treatment for systemic lupus erythematosus (SLE) is effective to a certain extent, the difference in therapeutic effect between patients is still a widespread problem. Some patients can have repeated attacks that greatly diminish their quality of life. This study was conducted to investigate the relationship between HSP90AA2 polymorphisms and disease susceptibility, GCs efficacy and health-related quality of life (HRQoL) in Chinese SLE patients. A case–control study was performed in 470 SLE patients and 470 normal controls. Then, 444 patients in the case group were followed up for 12 weeks to observe efficacy of GCs and improvement of HRQoL. Two single nucleotide polymorphisms (SNPs) of HSP90AA2 were selected for genotyping: rs1826330 and rs6484340. HRQoL was assessed using the SF-36 questionnaire. The minor T allele of rs1826330 and the TT haplotype formed by rs1826330 and rs6484340 showed associations with decreased SLE risk (T allele: PBH  = 0.022; TT haplotype: PBH  = 0.033). A significant association between rs6484340 and improvement of HRQoL was revealed in the follow-up study. Five subscales of SF-36 were appeared to be influenced by rs6484340: total score of SF-36 (additive model: PBH  = 0.026), physical function (additive model: PBH  = 0.026), role-physical (recessive model: PBH  = 0.041), mental health (dominant model: PBH  = 0.047), and physical component summary (additive model: PBH  = 0.026). No statistical significance was found between HSP90AA2 gene polymorphisms and GCs efficacy. These results revealed a genetic association between HSP90AA2 and SLE. Remarkably, HSP90AA2 has an impact on the improvement of HRQoL in Chinese population with SLE.



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All eyes on rapid adaptive evolution

All eyes on rapid adaptive evolution

All eyes on rapid adaptive evolution, Published online: 15 June 2018; doi:10.1038/s41576-018-0027-9

A new study reveals that DNA methylation-mediated repression of gene expression regulates early eye development in blind cave morphs of Astyanax mexicanus.

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Do medical complications impact long-term outcomes in prolonged disorders of consciousness?

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Publication date: Available online 26 May 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Anna Estraneo, Vincenzo Loreto, Orsola Masotta Psy, Angelo Pascarella, Luigi Trojano
Objectiveto investigate medical complications (MC) occuring within 6 months post-injury in brain-injured patients with prolonged disorders of consciousness (DoC) and to evaluate impact of MC on mortality and long-term clinical outcomes.Design: prospective observational cohort study.Setting: rehabilitation unit for acquired DoC.Partecipants194 patients with DoC (142 in vegetative state, 52 in minimally conscious state; traumatic etiology: 43, anoxic: 69, vascular: 82) consecutively admitted to a neurorehabilitation unit within 1-3 months after onset.Interventionsnot applicable.Main Outcome Measuresmortality and improvements in clinical diagnosis and functional disability level (assessed by Coma Recovery Scale-Revised and Disability Rating Scale) at 12, 24 and 36 months post-onset.Resultswithin 6 months post-injury, more than 95% of patients (188/194) developed at least 1 MC and 73% of them (142) showed at least 1 severe MC. Respiratory and musculoskeletal-cutaneous MC were the most frequent, followed by endocrino-metabolic abnormalities. Follow-up, complete in 189/194 patients, showed that male sex and endocrine-metabolic MC were associated to higher risk for mortality at all timepoints. Older age, anoxic etiology, lower CRS-R total scores and diagnosis of vegetative state at study entry predicted no clinical and functional improvements at most timepoints, whereas epilepsy predicted no improvement in diagnosis at 24 months post-onset only.ConclusionsMC are very frequent in patients with DoC within at least 6 months after brain injury, regardless of clinical diagnosis, etiology and age. Endocrino-metabolic MC are independent predictors of mortality at all timepoints, whereas epilepsy predicted poor long-term outcome. Occurrence and severity of MC in patients with DoC call for long-term appropriate levels of care after the post-acute phase.



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Invited Commentary on “The Report to Congress on the Management of Traumatic Brain Injury in Children”

Publication date: Available online 12 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Stacy J. Suskauer, Amy J. Houtrow
The Centers for Disease Control and Prevention published the "Report to Congress on the Management of Traumatic Brain Injury in Children" in the spring of 2018. The report is a call to action for professionals providing care for children with traumatic brain injury in the health, social and educational sectors and for researchers, administrators and agencies to develop strategies to improve outcomes. For pediatric rehabilitation providers there are clear opportunities to improve service delivery for individual patients and for the population of children after traumatic brain injury more generally. Notably there is a workforce shortage, and fragmentation exists among the various systems that serve children with traumatic brain injuries and their families.



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Archives of Physical Medicine and Rehabilitation Supplements

Publication date: June 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 6





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Effectiveness of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease with different degrees of static lung hyperinflation

Publication date: Available online 12 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Michiel J.E.G.W. Vanfleteren, Maud Koopman, Martijn A. Spruit, Herman-Jan Pennings, Frank Smeenk, Willem Pieters, Jan J.A.M. van den Bergh, Arent-Jan Michels, Emiel F.M. Wouters, Miriam T.J. Groenen, Frits M.E. Franssen, Lowie E.G.W. Vanfleteren
ObjectiveTo evaluate the effect of pulmonary rehabilitation (PR) on exercise performance and quality of life in patients with chronic obstructive pulmonary disease (COPD) with different degrees of static lung hyperinflation (LH).DesignRetrospective cohort study.SettingPulmonary Rehabilitation Network.ParticipantsA cohort of 1981 patients with COPD (55% males; age: 66.8 ± 9.3y; FEV1%: 50.7 ± 19.5; RV%: 163.0 ± 49.7).InterventionAn interdisciplinary PR program for patients with COPD consisting of 40 sessions.Main outcome measuresParticipants were stratified into five quintiles according to baseline RV and were evaluated on the basis of pre and post PR 6 minute walk distance (6MWD), constant work rate test (CWRT) and Saint George's Respiratory Questionnaire (SGRQ), among other clinical parameters.ResultsWith increasing RV quintile, patients were younger, more frequently female, had lower FEV1%, lower body mass index and fat-free mass index, shorter 6MWD, shorter CWRT and worse SGRQ scores (p<0.01). All RV strata improved following PR in all three outcomes (p<0.001). Nevertheless, higher, compared to lower RV categories, had lower ΔCWRT (p<0.01) but similar Δ6MWD (p=0.948) and ΔSGRQ (p=0.086) after PR.ConclusionsLH in COPD is related to younger age, female gender, lower body weight, worse exercise capacity and health status, but did not prevent patients from benefitting from PR. LH however influences walking and cycling response following PR differently.



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Key Characteristics of Rehabilitation Quality Improvement Publications: Scoping Review From 2010 to 2016

Publication date: June 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 6
Author(s): Tiago S. Jesus, Christina Papadimitriou, Cátia S. Pinho, Helen Hoenig
ObjectiveTo characterize the peer-reviewed quality improvement (QI) literature in rehabilitation.Data SourcesFive electronic databases were searched for English-language articles from 2010 to 2016. Keywords for QI and safety management were searched for in combination with keywords for rehabilitation content and journals. Secondary searches (eg, references-list scanning) were also performed.Study SelectionTwo reviewers independently selected articles using working definitions of rehabilitation and QI study types; of 1016 references, 112 full texts were assessed for eligibility.Data ExtractionReported study characteristics including study focus, study setting, use of inferential statistics, stated limitations, and use of improvement cycles and theoretical models were extracted by 1 reviewer, with a second reviewer consulted whenever inferences or interpretation were involved.Data SynthesisFifty-nine empirical rehabilitation QI studies were found: 43 reporting on local QI activities, 7 reporting on QI effectiveness research, 8 reporting on QI facilitators or barriers, and 1 systematic review of a specific topic. The number of publications had significant yearly growth between 2010 and 2016 (P=.03). Among the 43 reports on local QI activities, 23.3% did not explicitly report any study limitations; 39.5% did not used inferential statistics to measure the QI impact; 95.3% did not cite/mention the appropriate reporting guidelines; only 18.6% reported multiple QI cycles; just over 50% reported using a model to guide the QI activity; and only 7% reported the use of a particular theoretical model. Study sites and focuses were diverse; however, nearly a third (30.2%) examined early mobilization in intensive care units.ConclusionsThe number of empirical, peer-reviewed rehabilitation QI publications is growing but remains a tiny fraction of rehabilitation research publications. Rehabilitation QI studies could be strengthened by greater use of extant models and theory to guide the QI work, consistent reporting of study limitations, and use of inferential statistics.



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Measurement Characteristics and Clinical Utility of the ABILHAND Among People With Rheumatoid Arthritis

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Publication date: Available online 12 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Ann Van de Winckel, Majd Jarrar, Namrata Grampurohit, Linda Ehrlich-Jones




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Addressing the Evidence Gap in Stroke Rehabilitation for Complex Patients: A Preliminary Research Agenda

Publication date: June 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 6
Author(s): Michelle L. Nelson, Kaileah A. McKellar, Sarah Munce, Linda Kelloway, Parminder Kaur Hans, Martin Fortin, Renee Lyons, Mark Bayley
Evidence suggests that a stroke occurs in isolation (no comorbid conditions) in less than 6% of patients. Multimorbidity, compounded by psychosocial issues, makes treatment and recovery for stroke increasingly complex. Recent research and health policy documents called for a better understanding of the needs of this patient population, and for the development and testing of models of care that meet their needs. A research agenda specific to complexity is required. The primary objective of the think tank was to identify and prioritize research questions that meet the information needs of stakeholders, and to develop a research agenda specific to stroke rehabilitation and patient complexity. A modified Delphi and World Café approach underpinned the think tank meeting, approaches well recognized to foster interaction, dialogue, and collaboration between stakeholders. Forty-three researchers, clinicians, and policymakers attended a 2-day meeting. Initial question-generating activities resulted in 120 potential research questions. Sixteen high-priority research questions were identified, focusing on predetermined complexity characteristics—multimorbidity, social determinants, patient characteristics, social supports, and system factors. The final questions are presented as a prioritized research framework. An emergent result of this activity is the development of a complexity and stroke rehabilitation research network. The research agenda reflects topics of importance to stakeholders working with stroke patients with increasingly complex care needs. This robust process resulted in a preliminary research agenda that could provide policymakers with the evidence needed to make improvements toward better-organized services, better coordination between settings, improved patient outcomes, and lower system costs.



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Home-based exercise enhances health-related quality of life in persons with spinal cord injury: A randomized controlled trial

Publication date: Available online 11 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Tom E. Nightingale, Peter C. Rouse, Jean-Philippe Walhin, Dylan Thompson, James L.J. Bilzon
ObjectiveTo assess the influence of a home-based exercise intervention on indices of health-related quality of life (HRQOL) in persons with spinal cord injury (SCI).DesignThis was a randomized controlled trial (HOMEX-SCI; ISRCTN57096451). After baseline laboratory testing and a week of free-living physical activity monitoring, eligible participants were randomly assigned (2:1 allocation ratio) to a home-based moderate-intensity upper-body exercise intervention (INT, n = 13), or a lifestyle maintenance control group (CON, n = 8), for 6 weeks.SettingHome-based with short laboratory visits immediately before and after the intervention/control period.ParticipantsTwenty-one inactive participants with chronic (> 1 year) SCI (injury level range, T4 – L5).InterventionParticipants assigned to the exercise intervention group (INT) completed 4 x 45 min moderate-intensity (60-65% peak oxygen uptake [V̇O2 peak]) arm-crank exercise per week for 6 weeks. Participants assigned to the control group (CON) were asked to maintain their habitual physical activity behaviour.Main Outcome MeasuresSecondary outcome measures were assessed, including physical and emotional component scores (PCS and MCS) of health-related quality of life (SF-36), fatigue, global fatigue (FSS) and shoulder pain index (WUSPI). Cardiorespiratory fitness (CRF), objectively measured habitual moderate-to-vigorous physical activity (MVPA) and exercise self-efficacy (ESE) were also assessed at baseline and follow-up.ResultsChanges in the PCS (P = 0.017) of the SF-36, ESE (P = 0.011) and FSS (P = 0.036) were significantly different between the two groups, with moderate to large effect sizes (d = 0.75 – 1.37). Various HRQOL outcomes demonstrated 'likely' to 'very likely' positive inferences in favour of the INT group following the 6-week exercise intervention. Changes in ESE were significantly (P < 0.01) associated with changes in PCS (r = 0.62) and MCS (r = 0.71), FSS (r = -0.71) and global fatigue (r = 0.57).ConclusionsA 6-week upper-body exercise intervention improved indices of HRQOL in persons with SCI. Improvements were associated with increases in ESE. While this intervention demonstrated a positive impact on perceived physical functioning, future interventions should aim to support social and mental functioning and exercise maintenance.



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Feasibility of ballistic strength training in sub-acute stroke: A randomized, controlled, assessor-blinded pilot study

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Publication date: Available online 30 May 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Genevieve Hendrey, Ross A. Clark, Anne E. Holland, Benjamin F. Mentiplay, Carly Davis, Cristie Windfeld-Lund, Melissa J. Raymond, Gavin Williams.
ObjectiveTo establish the feasibility and effectiveness of a six week ballistic strength training protocol in people with stroke.DesignRandomized, controlled, assessor-blinded study.SettingSub-acute inpatient rehabilitation.ParticipantsConsecutively admitted inpatients with a primary diagnosis of first ever stroke with lower limb weakness, functional ambulation category score of ≥3, and ability to walk ≥14m were screened for eligibility to recruit 30 participants for randomization.InterventionsParticipants were randomized to standard therapy or ballistic strength training three times per week for six weeks.Main outcome measuresThe primary aim was to evaluate feasibility and outcomes included recruitment rate, participant retention and attrition, feasibility of the exercise protocol, therapist burden and participant safety. Secondary outcomes included measures of mobility, lower limb muscle strength, muscle power and quality of life.ResultsThirty participants (11% of those screened) with mean age of 50 (SD 18) years were randomized. The median number of sessions attended was 15/18 and 17/18 for the ballistic and control groups respectively. Earlier than expected discharge home (n=4) and illness (n=7) were the most common reasons for non-attendance. Participants performed the exercises safely, with no study-related adverse events. There were significant (p<0.05) between-group changes favoring the ballistic group for comfortable gait velocity (mean difference (MD) 0.31m/s, 95% confidence interval CI: 0.08 to 0.52), muscle power, as measured by peak jump height (MD 8cm, 95% CI: 3 to 13) and peak propulsive velocity (MD 64cm/s, 95% CI: 17 to 112).ConclusionsBallistic training was safe and feasible in select ambulant people with stroke. Similar rates of retention and attrition suggest that ballistic training was acceptable to patients. Secondary outcomes provide promising results that warrant further investigation in a larger trial.



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Effects of post-acute multidisciplinary rehabilitation including exercise in out-of-hospital settings in the aged: systematic review and meta-analysis

Publication date: Available online 11 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Lotte Verweij, Eva van de Korput, Joost G. Daams, Gerben ter Riet, Ron J.G. Peters, Raoul H.H. Engelbert, Wilma J.M. Scholte op Reimer, Bianca M. Buurman
ObjectiveMany older individuals receive rehabilitation in an out-of-hospital setting (OOHS) after acute hospitalization; however, its effect on mobility and unplanned hospital readmission is unclear. Therefore a systematic review and meta-analysis were conducted on this topic.Data sourcesMedline OVID, Embase OVID, and Cinahl were searched from their inception until February 22, 2018.Study selectionOOHS (i.e., skilled nursing facilities, outpatient clinics, or community-based at home) randomized trials studying the effect of multidisciplinary rehabilitation were selected, including those assessing exercise in older patients (mean age ≥ 65 years) after discharge from hospital following an acute illness.Data extractionTwo reviewers independently selected the studies, performed independent data extraction, and assessed the risk of bias. Outcomes were pooled using fixed- or random-effect models as appropriate. The main outcomes were mobility at and unplanned hospital readmission within 3 months of discharge.Data synthesisFifteen studies (1255 patients) were included in the systematic review and twelve were included in the meta-analysis (seven assessing mobility using the 6-minute walk distance (6MWD) test and seven assessing unplanned hospital readmission). Based on the 6MWD, patients receiving rehabilitation walked an average of 23 m more than controls (95% CI: −1.34–48.32; I2: 51%). Rehabilitation did not lower the 3-month risk of unplanned hospital readmission (RR: 0.93; 95% CI: 0.73–1.19; I2: 34%). The risk of bias was present, mainly due to the nonblinded outcome assessment in three studies, and seven studies scored this unclearly.ConclusionOOHS-based multidisciplinary rehabilitation leads to improved mobility in older patients 3 months after they are discharged from hospital following an acute illness and is not associated with a lower risk of unplanned hospital readmission within 3 months of discharge. However, the wide 95% confidence intervals indicate that the evidence is not robust.Prospero registration numberCRD42017058592.



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Personality, High-risk Behaviors, and Elevated Risk of Unintentional Deaths Related to Drug Poisoning among Individuals with Spinal Cord Injury

Publication date: Available online 13 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): James S. Krause, Yue Cao, Nicole D. DiPiro, Emma Cuddy
ObjectiveTo identify risk and protective factors for unintentional death related to drug poisoning from prescription medications, including opioid-related deaths, and death due to all other causes among participants with spinal cord injury (SCI).DesignProspective cohort study.SettingLarge specialty hospital in the Southeastern United States.ParticipantsTwo cohorts of SCI participants, totaling 3070 adults (>18 years old) with chronic (>1 year) traumatic SCI. Cohort 1 was enrolled in 1997-1998 (n = 1386) and cohort 2 was enrolled in 2007-2009 (n = 1684).InterventionsN/AMain Outcome Measure(s)Participants completed self-report assessments including multiple behavioral variables (alcohol, smoking, and prescription medication), as well as the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). The primary outcome is unintentional death related to drug poisoning. Mortality status was determined as of December 31, 2014, using the National Death Index. Centers for Disease Control guidelines were used for classifying participants into 3 groups: (1) unintentional death related to drug poisoning, (2) other death, and (3) alive.ResultsThere were 690 deaths (23%), including 24 unintentional deaths related to drug poisoning (11 from opioids). Binge drinking, medication usage total score, and impulsive-sensation seeking were risk factors for unintentional death related to drug poisoning, whereas the ZKPQ activity scale was protective. Risk factors for other causes of death included older age, greater injury severity, being non-ambulatory, regular smoker, medication use total score, and greater neuroticism-anxiety scale scores.ConclusionsUnintentional deaths related to prescription drug overdose are associated with a set of risk factors that differs in meaningful ways from risk of death due to other causes after SCI, and these differences hold the key to prevention strategies.



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Acceptance of tele-rehabilitation by stroke patients: perceived barriers and facilitators

Publication date: Available online 11 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Shilpa Tyagi, Daniel SY. Lim, Wilbert HH. Ho, Yun Qing Koh, Vincent Cai, Gerald CH. Koh, Helena Legido-Quigley
ObjectiveTo explore the perceived barriers and facilitators of tele-rehabilitation by stroke patients, caregivers and rehabilitation therapists in an Asian setting.DesignQualitative study involving semi-structured in-depth interviews and focus group discussions.SettingGeneral communityParticipants37 participants including stroke patients, their caregivers and tele-therapists selected by purposive sampling.InterventionsSTARS trial.Main outcome Measure(s)Perceived barriers and facilitators for tele-rehabilitation uptake, as reported by patients, their caregivers and tele-therapists.ResultsThematic analysis was used to inductively identify following themes: facilitators identified by patients were affordability and accessibility; by tele-therapists, was filling a service gap and common to both was unexpected benefits such as detection of uncontrolled hypertension. Barriers identified by patients were equipment set-up related difficulties and limited scope of exercises, by tele-therapists were patient assessments, interface problems and limited scope of exercises and common to both was connectivity barriers. Patient characteristics like age, stroke severity, caregiver support and cultural influence modified patient perceptions and choice of rehabilitation.ConclusionsPatient attributes and context are significant determinants in adoption and compliance of stroke patients to technology driven interventions like tele-rehabilitation. Policy recommendations from our work are inclusion of introductory videos in tele-rehabilitation program, provision of technical support to older patients, longer facetime sessions as re-enforcement for severely disabled stroke patients and training of tele-therapists in assessments methods suitable for virtual platform.



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Automated Mechanical Peripheral Stimulation Effects on Gait Variability in Individuals With Parkison’s Disease and Freezing of Gait: A Double-Blind, Randomized Controlled Trial (Ms. Ref. No.: ARCHIVES-PMR-D-18-00162)

Publication date: Available online 11 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Ana Francisca Rozin Kleiner, Aline de Souza Pagnussat, Camila Pinto, Ritchele Rovido, Ana Paula Salazar, Manuela Galli
Objectiveto assess the effects of Automated Peripheral Stimulation (AMPS) in reducing gait variability of subjects with Parkinson's Disease (PD) and freezing of gait (FOG) treated with AMPS and to explore the effects of this treatment on gait during a single task (walking) and a dual task (walking while attending the word-color Stroop test).Designinterventional, double-blinded, placebo-controlled, randomized trial.SettingClinical rehabilitation.ParticipantsThirty subjects were randomized into two groups: AMPS (n=15) and AMPS SHAM (n=15).InterventionsBoth groups received two treatment sessions a week for 4 consecutive weeks (totaling 8 treatment sessions). AMPS was applied by using a medical device (Gondola™) and consisted in mechanical pressure stimulations delivered by metallic actuators on four areas of the feet. Treatment parameters and device configuration were modified for AMPS SHAM group.Main Outcome MeasuresGait analyses were measured at baseline and after the 1st, 4th, and 8th treatment sessions.ResultsInteractions among groups and sessions were found for both conditions while off anti-parkinsonian medications. AMPS decreased gait variability in subjects with PD and FOG for both single and dual task conditions.ConclusionsAMPS is an effective add-on therapy for treating gait variability in patients with PD and FOG.



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Effectiveness of supervised home-based exercise therapy compared to a control intervention on functions, activities and participation in older patients after hip fracture: a systematic review and meta-analysis

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Publication date: Available online 7 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Isolde A.R. Kuijlaars, Lieke Sweerts, Maria W.G. Nijhuis-van der Sanden, Romke van Balen, J. Bart Staal, Nico L.U. van Meeteren, Thomas J. Hoogeboom
ObjectiveThe aim of this review was to investigate whether supervised home-based exercise therapy after hospitalization is more effective on improving functions, activities and participation in older patients after hip fracture as compared with a control intervention (including usual care). Furthermore, we aimed to account the body of evidence for therapeutic validity.Data sourcesSystematic searches of Medline, Embase and CINAHL databases up to 30 June 2016.Study selectionRandomized controlled trials studying supervised home-based exercise therapy after hospitalization in older patients (≥65 years) after hip fracture.Data extractionTwo reviewers assessed methodological quality (PEDro) and therapeutic validity (CONTENT). Data were primary analysed using a best evidence synthesis on methodological quality and meta-analyses.Data synthesisNine articles were included (six trials; 602 patients). Methodological quality was high in 4/6 studies. One study had high therapeutic validity. We found limited evidence in favour of home-based exercise therapy for short- (≤four months) and long-term (>four months) performance-based activities of daily living and effects at long-term for gait (fast) and endurance. Evidence of no effectiveness was found for short- and long-term effects on gait and self-reported (instrumental) activities of daily living and short-term effects on balance, endurance and mobility. Conflicting evidence was found for strength, long-term balance, short-term gait (comfortable), long-term self-reported activities of daily living and long-term mobility.ConclusionsResearch findings show no evidence in favour of home-based exercise therapy after hip fracture for most outcomes of functions, activities and participation. However, trials in this field have low therapeutic validity (absence of rationale for content and intensity and reporting of adherence) which results in interventions which do not fit patients limitations and goals.



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Archives Manuscript Reviewers

Publication date: June 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 6





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A High-Intensity Multi-Component Agility Intervention Improves Parkinson’s Patients’ Clinical and Motor Symptoms

Publication date: Available online 7 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): József Tollár, Ferenc Nagy, Norbert Kovács, Tibor Hortobágyi
ObjectiveTo determine the effects of a high-intensity exercise therapy using sensorimotor and visual stimuli on non-demented Parkinson's disease (PD) patients' clinical symptoms, mobility, and standing balanceDesignRandomized clinical intervention, using a before-after trial design.SettingUniversity hospital setting.Participants72 PD patients with Hoehn-Yahr stage of 2 to 3, of whom 64 were randomized, and 55 completed the study.InterventionPD patients were randomly assigned to a no physical intervention control (n = 20 of 29 completed, 9 withdrew before baseline testing) or to a high-intensity agility program (15 sessions, 3 weeks, n = 35 completed).Main outcomesPrimary outcome was the MDS-UPDRS M-EDL. Secondary outcomes were: Beck depression score, PDQ-39, EQ5D VAS, Schwab & England Activities of daily living scale, timed up and go test, and 12 measures of static posturographyResultsThe agility program improved MDS-UPDRS M-EDL by 38% compared with the 2% change in control (Group by Time interaction, p = 0.001). Only the intervention group improved in PDQ-39 (6.6 points), depression (18%), EQ5D VAS score (15%), the Schwab and England ADL score (15%), the TUG (39%), and in 8 of 12 posturography measures by 42 to 55% (all p < 0.001). The levodopa equivalent dosage did not change.ConclusionA high-intensity agility program improved non-demented, stage 2-3 PD patients' clinical symptoms, mobility, and standing balance by functionally meaningful margins at short-term follow-up.



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Behavioral and Health Outcomes Associated with Deployment and Non-Deployment Acquisition of Traumatic Brain Injury in Iraq and Afghanistan Veterans

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Publication date: Available online 30 May 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Sarah L. Martindale, Erica L. Epstein, Katherine H. Taber, Jared A. Rowland
ObjectiveCharacterize behavioral and health outcomes in veterans with TBI acquired in non-deployment and deployment settings.DesignCross-sectional assessment evaluating TBI acquired during and outside of deployment, mental and behavioral health symptoms, and diagnoses.SettingVeterans Affairs Medical Centers.ParticipantsIraq and Afghanistan Veterans who deployed to a warzone (N = 1399).InterventionsNot applicable.Main Outcome MeasuresComprehensive lifetime TBI interview; Structured Clinical Interview for DSM-IV Disorders; Combat Exposure Scale; behavioral and health measures.ResultsThere was a main effect of deployment TBI on depressive symptoms, posttraumatic stress symptoms, poor sleep quality, substance use, and pain. Veterans with deployment TBI were also more likely to have a diagnosis of bipolar, major depressive, alcohol use, and posttraumatic stress disorders than those who did not have a deployment TBI.ConclusionsTBIs acquired during deployment are associated with different behavioral and health outcomes than TBI acquired in non-deployment environments. The presence of TBI during deployment is associated with poorer behavioral outcomes, as well as a greater lifetime prevalence of behavioral and health problems in contrast to veterans without deployment TBI. These results indicate that problems may persist chronically following a deployment TBI and should be considered when providing care for veterans. Veterans with deployment TBI may require treatment alterations to improve engagement and outcomes.



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Masthead

Publication date: June 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 6





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Development Of A Multivariate Prognostic Model For Pain And Activity Limitation In People With Low Back Disorders Receiving Physiotherapy

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Publication date: Available online 28 May 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Jon J. Ford, Matt C. Richards BPhysio, Luke D. Surkitt BPhysio, Alexander YP. Chan BPhysio, Sarah L. Slater, Nicholas F. Taylor, Andrew J. Hahne
ObjectiveTo identify predictors for back pain, leg pain and activity limitation in patients with early persistent low back disorders.DesignProspective inception cohort study; Setting: primary care private physiotherapy clinics in Melbourne, Australia.Participants300 adults aged 18-65 years with low back and/or referred leg pain of ≥6-weeks and ≤6-months duration.InterventionsNot applicable.Main Outcome MeasuresNumerical rating scales for back pain and leg pain as well as the Oswestry Disability Scale.ResultsPrognostic factors included sociodemographics, treatment related factors, subjective/physical examination, subgrouping factors and standardized questionnaires. Univariate analysis followed by generalized estimating equations were used to develop a multivariate prognostic model for back pain, leg pain and activity limitation. Fifty-eight prognostic factors progressed to the multivariate stage where 15 showed significant (p<0.05) associations with at least one of the three outcomes. There were five indicators of positive outcome (two types of low back disorder subgroups, paresthesia below waist, walking as an easing factor and low transversus abdominis tone) and 10 indicators of negative outcome (both parents born overseas, deep leg symptoms, longer sick leave duration, high multifidus tone, clinically determined inflammation, higher back and leg pain severity, lower lifting capacity, lower work capacity and higher pain drawing percentage coverage). The preliminary model identifying predictors of low back disorders explained up to 37% of the variance in outcome.ConclusionThis study evaluated a comprehensive range of prognostic factors reflective of both the biomedical and psychosocial domains of low back disorders. The preliminary multivariate model requires further validation before being considered for clinical use.



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Editorial Board

Publication date: June 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 6





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Meta-analysis of depleted uranium levels in the Middle East region

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Publication date: December 2018
Source:Journal of Environmental Radioactivity, Volume 192
Author(s): Larisa Bešić, Imer Muhović, Fatima Mrkulić, Lemana Spahić, Ammar Omanović, Amina Kurtovic-Kozaric
Since the first widespread use of depleted uranium in military in the 1991 Gulf War, the so-called "Gulf War Syndrome" has been a topic of ongoing debate. However, a low number of reliable scientific papers demonstrating the extent of possible contamination as well as its connection to the health status of residents and deployed veterans has been published. The authors of this study have therefore aimed to make a selection of data based on strict inclusion and exclusion criteria. With the goal of clarifying the extent of DU contamination after the Gulf Wars, previously published data regarding the levels of DU in the Middle East region were analyzed and presented in the form of a meta-analysis. In addition, the authors attempted to make a correlation between the DU levels and their possible effects on afflicted populations.According to results observed by comparing 234U/238U and 235U/238U isotopic activity ratios, as well as 235U/238U mass ratios in air, water, soil and food samples among the countries in the Middle East region, areas indicating contamination with DU were Al Doha, Manageesh and Um Al Kwaty in Kuwait, Al-Salman, Al-Nukhaib and Karbala in Iraq, Beirut in Lebanon and Sinai in Egypt. According to these data, no DU contamination was observed in Algeria, Israel, Afghanistan, Oman, Qatar, Iran, and Yemen.Due to the limited number of reliable data on the health status of afflicted populations, it was not possible to make a correlation between DU levels and health effects in the Middle East region.



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Investigation of sedimentation rates and sediment dynamics in Danube Delta lake system (Romania) by 210Pb dating method

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Publication date: December 2018
Source:Journal of Environmental Radioactivity, Volume 192
Author(s): R.-Cs Begy, H. Simon, Sz Kelemen, L. Preoteasa
Being a dynamic environment associated with complex costal, fluvial and marine processes, only a few studies regarding the evolution of the Danube Delta and the human impacts on its ecosystem have been carried out. Being a sensible to all processes occurring in its catchment area, information is stored in the deposited sediments, which can be used as tracers for natural and anthropogenic processes. The aim of this study is to determine a detailed reconstruction of the sedimentation rates in the last century by applying the 210Pb dating method validated by 137Cs profiles. Additionally, the impacts of the construction of river-regulating structures (mainly the Iron Gates Hydro-Energetic Power Plants) are investigated, along with the assessment of natural phenomena (floods, storms etc.). To achieve this, 26 sediment cores from seven lakes were collected. 210Pbsup and 137Cs were determined using gamma spectrometry, while 210Pbtot was measured via alpha spectrometry (210Po), using the CRS model for age determination. From the assessed lakes, the most affected was the Matița Lake with a maximum sedimentation rate of 10.93 g cm−2 yr−1 and the least affected was the Isac Lake. Average sedimentation rates are: 0.95 g cm−2 yr−1 for Cruhlig Lake, 0.70 g cm−2 yr−1 for Uzlina Lake, 0.44 g cm−2 yr−1 for Isac Lake, 0.47 g cm−2 yr−1 for Cuibida Lake, 0.51 g cm−2 yr−1 for Iacob Lake, 1.00 g cm−2 yr−1 for Matița Lake and 0.76 g cm−2 yr−1 for Merhei Lake. Physical parameters (water content, porosity and bulk density) and LOI (organic matter and inorganic carbon content) were determined for each core to differentiate organic and non-organic sedimentation. Beside the natural influences, it is difficult to track the effects of the Iron Gates and not all analysed lakes were suitable for this task. The 1940–1970 period and the following ten years were compared in means of sedimentation: a decrease in sedimentation can be observed in four of the lakes: 59% in Cruhlig Lake, 16% in Uzlina Lake, 10% in Iacob Lake and 42% in Isac Lake, leading to an average 32% for the four lakes. The other three lakes show increasing tendencies of 39% in this period: 87% in Matița Lake, 6% in Merhei Lake and 24% in Cuibida Lake. Sedimentation rates show growths of 3 times after 1989, the most affected being the two northern lakes (3 times increase in both Matița Lake and Merhei Lake) and the four central lakes (2 times in case of Cuibida Lake, 3 times in Iacob Lake, 3 times in Isac Lake and 4 times in Uzlina Lake) with an average increase of 3 times, while the southern one (Cruhlig Lake) 2 times.



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Investigating the potentialities of Monte Carlo simulation for assessing soil water content via proximal gamma-ray spectroscopy

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Publication date: December 2018
Source:Journal of Environmental Radioactivity, Volume 192
Author(s): Marica Baldoncini, Matteo Albéri, Carlo Bottardi, Enrico Chiarelli, Kassandra Giulia Cristina Raptis, Virginia Strati, Fabio Mantovani
Proximal gamma-ray spectroscopy recently emerged as a promising technique for non-stop monitoring of soil water content with possible applications in the field of precision farming. The potentialities of the method are investigated by means of Monte Carlo simulations applied to the reconstruction of gamma-ray spectra collected by a NaI scintillation detector permanently installed at an agricultural experimental site. A two steps simulation strategy based on a geometrical translational invariance is developed. The strengths of this approach are the reduction of computational time with respect to a direct source-detector simulation, the reconstruction of 40K, 232Th and 238U fundamental spectra, the customization in relation to different experimental scenarios and the investigation of effects due to individual variables for sensitivity studies. The reliability of the simulation is effectively validated against an experimental measurement with known soil water content and radionuclides abundances. The relation between soil water content and gamma signal is theoretically derived and applied to a Monte Carlo synthetic calibration performed with the specific soil composition of the experimental site. Ready to use general formulae and simulated coefficients for the estimation of soil water content are also provided adopting standard soil compositions. Linear regressions between input and output soil water contents, inferred from simulated 40K and 208Tl gamma signals, provide excellent results demonstrating the capability of the proposed method in estimating soil water content with an average uncertainty <1%.



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Acute Serum Cartilage Biomarker Response after Walking and Drop Landing

imageIntroduction An in-depth understanding of the healthy cartilage response to activities of daily living is needed to better understand the complex relationship between cartilage health and loading. The purpose was to assess the role of loading on the acute serum cartilage oligomeric matrix protein (COMP) response in recreationally active individuals. Methods Forty individuals without previous lower extremity injury participated in this repeated-measures study in which each participant completed all conditions during independent data collection sessions separated by at least 1 wk. An antecubital blood draw was performed before and after walking, drop-landing, and control (i.e., sitting) conditions. Commercially available enzyme-linked immunosorbent assays measured COMP concentration. The acute COMP response was quantified as the percent change of COMP concentration from before to after each condition. A one-way, repeated-measures ANOVA compared the acute COMP response between conditions. Post hoc Pearson product–moment correlation and chi-square analysis determined the relationship between the walking and drop-landing acute COMP response within individuals. Results Acute COMP response was greater after walking (+4.2, P = 0.008) and drop landing (+4.6%, P = 0.002) compared with control (−2.3%), but did not differ between the walking and drop-landing conditions (P = 0.596). The magnitudes of the acute COMP response during walking and drop landing were correlated (r = 0.56, P

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Yerba Maté and Exercise Performance

No abstract available

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Exercise Training in “At-Risk” Black and White Women: A Comparative Cohort Analyses

imagePurpose Few data on the effect of exercise interventions in black women at risk for cardiovascular disease are available. Methods Women ≥18 yr of age without known cardiovascular disease with ≥1 coronary risk factor were enrolled in a community-based exercise program ≥3 d·wk−1 for ≥30 min per session for 6 months. Exercise training intensity ~50% to 80% of functional capacity, using heart rate (HR) and/or rating of perceived exertion (RPE) as the primary intensity modulators. Preconditioning versus postconditioning quality of life assessments (depression and level of daytime sleepiness), dietary fat intake, Duke Activity Status Index score, changes in cardiovascular efficiency (systolic/diastolic blood pressure (SBP/DBP), HR, RPE during a standardized submaximal workload), and anthropometric measures, including body weight, body mass index, and waist circumference, were evaluated. Results Of 556 volunteers, 143 were excluded, leaving 413 women (222 white, 191 black; mean ± SD age, 61 ± 9 yr) who met compliance criteria. Both groups demonstrated significant (P

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Abdominal Muscle Density Is Inversely Related to Adiposity Inflammatory Mediators

imagePurpose Skeletal muscle is the largest regulator of glucose metabolism, but few population-based studies have examined the associations between muscle and inflammation. We studied the relationships between abdominal muscle area and density with selected adiposity-associated inflammatory mediators. Methods Nearly 2000 subjects underwent computed tomography of the abdomen and had venous fasting blood drawn concomitantly. The computed tomography scans were interrogated for visceral and subcutaneous fat, as well as abdominal lean muscle areas and densities. We then categorized the muscle into locomotion (psoas) and stabilization (rectus, obliques, and paraspinal) groups. Blood samples were assayed for interleukin-6 (IL-6), resistin, C-reactive protein, and TNF-α. Results The mean age was 64.7 yr, and 49% were female. Forty percent were white, 26% Hispanic/Latino American, 21% African American, and 13% Chinese American. The mean body mass index was 28.0 kg·m−2, and 30% were obese (body mass index, >30 kg·m−2). Using multivariable linear regression models that included adjustment for abdominal muscle area, a 1-SD increment in the mean densities for total, stabilization, and locomotive abdominal muscle were each significantly associated with lower levels of IL-6 (β = −15%, −15%, and −9%, P

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Aerobic Training Improves Quality of Life in Women with Polycystic Ovary Syndrome

imagePurpose To investigate the effects of a supervised aerobic exercise training intervention on health-related quality of life (HRQL), cardiorespiratory fitness, cardiometabolic profile, and affective response in overweight/obese women with polycystic ovary syndrome (PCOS). Methods Twenty-seven overweight/obese inactive women with PCOS (body mass index, ≥ 25 kg·m−2; age 18 to 34 yr) were allocated into an exercise group (n = 14) and a control group (n = 13). Progressive aerobic exercise training was performed three times per week (~150 min·wk−1) over 16 wk. Cardiorespiratory fitness, HRQL, and cardiometabolic profile were evaluated before and after the intervention. Affective response (i.e., feeling of pleasure/displeasure) was evaluated during the exercise sessions. Results The exercise group improved 21% ± 12% of cardiorespiratory fitness (P

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Blood Pressure Response during Cardiopulmonary Exercise Testing in Heart Failure

imageIntroduction The prognostic value of peak V˙O2 and V˙E/V˙CO2 slope measured during cardiopulmonary exercise (CPX) testing has been well established in patients with advanced heart failure, but blood pressure response to exercise is less well characterized. Methods We retrospectively studied 151 outpatients who underwent CPX testing as part of an advanced heart failure evaluation. The outcome of interest was failure of medical management, defined by death, cardiac transplantation, or left ventricular assist device placement. Patients were stratified into tertiles by change in systolic blood pressure (SBP) (20 mm Hg were associated with an increased hazard (hazard ratio = 1.046, 95% CI = 1.018–1.075). Conclusion In conclusion, changes in SBP during CPX testing provide additional prognostic information above standard clinical variables. The peculiar increase in risk noted in those with a rise in SBP >20 mm Hg is less clear and needs to be investigated further.

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Exercise Improves Physical Activity and Comorbidities in Obese Adults with Asthma

imageIntroduction Obese adults with asthma have an increased number of comorbidities and reduced daily life physical activity (DLPA), which may worsen asthma symptoms. Exercise is recommended to improve asthma outcomes; however, the benefits of exercise for psychosocial comorbidities and physical activity levels in obese adults with asthma have been poorly investigated. Objective This study aimed to assess the effects of exercise on DLPA, asthma symptoms, and psychosocial comorbidities in obese adults with asthma. Methods Fifty-five grade II obese adults with asthma were randomly assigned to either a weight loss program + exercise program (WL + E group, n = 28) or a weight loss program + sham (WL + S group, n = 27). The WL + E group incorporated aerobic and resistance muscle training into the weight loss program (nutrition and psychological therapies), whereas the WL + S group performed breathing and stretching exercises. DLPA, asthma symptoms, sleep quality, and anxiety and depression symptoms were quantified before and after treatment. Results After 3 months, the WL + E group presented a significant increase in daily step counts (3068 ± 2325 vs 729 ± 1118 steps per day) and the number of asthma symptom–free days (14.5 ± 9.6 vs 8.6 ± 11.4 d·month−1) compared with the WL + S group. The proportion of participants with improvements in depression symptoms (76.4% vs 16.6%) and a lower risk of developing obstructive sleep apnea (56.5% vs 16.3%) was greater in the WL + E group than that in the WL + S group (P

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Plasma Metabolite Profiles in Response to Chronic Exercise

imagePurpose High-throughput profiling of metabolic status (metabolomics) allows for the assessment of small-molecule metabolites that may participate in exercise-induced biochemical pathways and corresponding cardiometabolic risk modification. We sought to describe the changes in a diverse set of plasma metabolite profiles in patients undergoing chronic exercise training and assess the relationship between metabolites and cardiometabolic response to exercise. Methods A secondary analysis was performed in 216 middle-age abdominally obese men and women (mean ± SD, 52.4 ± 8.0 yr) randomized into one of four groups varying in exercise amount and intensity for 6-month duration: high amount high intensity, high amount low intensity, low amount low intensity, and control. One hundred forty-seven metabolites were profiled by liquid chromatography-tandem mass spectrometry. Results No significant differences in metabolite changes between specific exercise groups were observed; therefore, subsequent analyses were collapsed across exercise groups. There were no significant differences in metabolite changes between the exercise and control groups after 24 wk at a Bonferroni-adjusted statistical significance (P

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Valid but Invalid: Suboptimal ImPACT Baseline Performance in University Athletes

imagePurpose This study aimed to investigate the frequency of valid yet suboptimal Immediate Postconcussion Assessment and Cognitive Test (ImPACT) performance in university athletes and to explore the benefit of subsequent ImPACT administrations. Methods This descriptive laboratory study involved baseline administration of ImPACT to 769 university athletes per the institution's concussion management protocol. Testing was proctored in groups of ≤2 participants. Participants who scored below the 16th percentile according to ImPACT normative data were readministered the ImPACT test up to two additional times because these scores were thought to be potentially indicative of suboptimal effort or poor understanding of instructions. Descriptive analyses were used to examine validity indicators and individual Verbal and Visual Memory, Visual Motor Speed, and Reaction Time ImPACT composite scores in initial and subsequent administrations. Results On the basis of ImPACT's validity criteria, 1% (9/769) of administrations were invalid and 14.6% (112/769) had one or more composite score of 16th percentile. Clinicians must be aware of suboptimal ImPACT performance as it limits the clinical utility of the baseline assessment. Further research is needed to address factors leading to "valid" but invalid baseline performance.

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Compliance of Adolescent Girls to Repeated Deployments of Wrist-Worn Accelerometers

imagePurpose This study aimed to determine the cross-sectional and cumulative compliance of adolescent girls to accelerometer wear at three deployment points and to identify variables associated with compliance. Methods Girls from 20 secondary schools were recruited: 10 schools were participating in the "Girls Active" intervention and 10 were control schools. Physical activity was measured using the GENEActiv accelerometer worn on the nondominant wrist 24 h·d−1 for up to 7 d at baseline, 7 months, and 14 months. Demographic and anthropometric characteristics were recorded. Results Seven valid days (≥16 h) of accelerometer wear was obtained from 83%, 77%, and 68% of girls at baseline (n = 1734), 7 months (n = 1381), and 14 months (n = 1326), respectively. Sixty-eight percent provided 7 valid days for both baseline and 7 months, 59% for baseline and 14 months, and 52% for all three deployment points. Estimates of physical activity level from 3 d of measurement could be considered equivalent to a 7-d measure (i.e., they fell within a ±5% equivalence zone). Cross sectionally, 3 valid days was obtained from at least 91% of girls; cumulatively, this was obtained from ≥88% of girls across any two deployment points and 84% of girls across all three deployment points. When controlling for clustering at school level and other potential predictors, physical activity level, being South Asian, being in the intervention group, and prior compliance were positively associated with monitor wear. Conclusions Compliance reduced across deployment points, with the reduction increasing as the deployment points got further apart. High prior compliance and high physical activity level were associated with the most additional wear time.

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Muscle Fiber Hypertrophy and Myonuclei Addition: A Systematic Review and Meta-analysis

imageIntroduction The myonuclear domain theory postulates that myonuclei are added to muscle fibers when increases in fiber cross-sectional area (i.e., hypertrophy) are ≥26%. However, recent studies have reported increased myonuclear content with lower levels (e.g., 12%) of muscle fiber hypertrophy. Purpose This study aimed to determine whether a muscle fiber hypertrophy "threshold" is required to drive the addition of new myonuclei to existing muscle fibers. Methods Studies of resistance training endurance training with or without nutrient (i.e., protein) supplementation and steroid administration with measures of muscle fiber hypertrophy and myonuclei number as primary or secondary outcomes were considered. Twenty-seven studies incorporating 62 treatment groups and 903 subjects fulfilled the inclusion criteria and were included in the analyses. Results Muscle fiber hypertrophy of ≤10% induces increases in myonuclear content, although a significantly higher number of myonuclei are observed when muscle hypertrophy is ~22%. Additional analyses showed that age, sex, and muscle fiber type do not influence muscle fiber hypertrophy or myonuclei addition. Conclusions Although a more consistent myonuclei addition occurs when muscle fiber hypertrophy is >22%, our results challenge the concept of a muscle hypertrophy threshold as significant myonuclei addition occurs with lower muscle hypertrophy (i.e.,

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Applied Demography and Public Health in the 21st Century

No abstract available

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Changes in Motor Coordination Induced by Local Fatigue during a Sprint Cycling Task

imagePurpose This study investigated how muscle coordination is adjusted in response to a decrease in the force-generating capacity of one muscle group during a sprint cycling task. Methods Fifteen participants were tested during a sprint before and after a fatigue electromyostimulation protocol was conducted on the quadriceps of one leg. Motor coordination was assessed by measuring myoelectrical activity, pedal force, and joint power. Results The decrease in force-generating capacity of the quadriceps (−28.0% ± 6.8%) resulted in a decrease in positive knee extension power during the pedaling task (−34.4 ± 30.6 W; P = 0.001). The activity of the main nonfatigued synergist and antagonist muscles (triceps surae, gluteus maximus and hamstrings) of the ipsilateral leg decreased, leading to a decrease in joint power at the hip (−30.1 ± 37.8 W; P = 0.008) and ankle (−20.8 ± 18.7 W; P = 0.001). However, both the net power around the knee and the ability to effectively orientate the pedal force were maintained during the extension by reducing the coactivation and the associated negative power produced by the hamstrings. Adaptations also occurred in flexion phases in both legs, exhibiting an increased power (+17.9 ± 28.3 [P = 0.004] and +19.5 ± 21.9 W [P = 0.026]), associated with an improvement in mechanical effectiveness. Conclusion These results demonstrate that the nervous system readily adapts coordination in response to peripheral fatigue by (i) decreasing the activation of adjacent nonfatigued muscles to maintain an effective pedal force orientation (despite reducing pedal power) and (ii) increasing the neural drive to muscles involved in the flexion phases such that the decrease in total pedal power is limited.

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Objectively Differentiating Movement Patterns between Elite and Novice Athletes

imageIntroduction Movement screens are frequently used to identify abnormal movement patterns that may increase risk of injury or hinder performance. Abnormal patterns are often detected visually based on the observations of a coach or clinician. Quantitative or data-driven methods can increase objectivity, remove issues related to interrater reliability and offer the potential to detect new and important features that may not be observable by the human eye. Applying principal component analysis (PCA) to whole-body motion data may provide an objective data-driven method to identify unique and statistically important movement patterns, an important first step to objectively characterize optimal patterns or identify abnormalities. Therefore, the primary purpose of this study was to determine if PCA could detect meaningful differences in athletes' movement patterns when performing a non-sport-specific movement screen. As a proof of concept, athlete skill level was selected a priori as a factor likely to affect movement performance. Methods Motion capture data from 542 athletes performing seven dynamic screening movements (i.e., bird-dog, drop-jump, T-balance, step-down, L-hop, hop-down, and lunge) were analyzed. A PCA-based pattern recognition technique and a linear discriminant analysis with cross-validation were used to determine if skill level could be predicted objectively using whole-body motion data. Results Depending on the movement, the validated linear discriminant analysis models accurately classified 70.66% to 82.91% of athletes as either elite or novice. Conclusions We have provided proof that an objective data-driven method can detect meaningful movement pattern differences during a movement screening battery based on a binary classifier (i.e., skill level in this case). Improving this method can enhance screening, assessment, and rehabilitation in sport, ergonomics, and medicine.

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Vascular Nitric Oxide–Superoxide Balance and Thrombus Formation after Acute Exercise

imageIntroduction An acute bout of strenuous exercise in humans results in transient impairment of nitric oxide (NO)–dependent function, but it remains unknown whether this phenomenon is associated with increased risk of thrombotic events after exercise. This study aimed to evaluate effects of a single bout of exhaustive running in mice on the balance of vascular NO/reactive oxygen species production, and on thrombogenicity. Methods At different time points (0, 2, and 4 h) after exercise and in sedentary C57BL/6 mice, the production of NO and superoxide (•O2−) in aorta was measured by electron paramagnetic resonance spin trapping and by dihydroethidium/high-performance liquid chromatography–based method, respectively, whereas collagen-induced thrombus formation was analyzed in a microchip-based flow-chamber system (total thrombus-formation analysis system). We also measured pre- and postexercise plasma concentration of nitrite/nitrate and 6-keto-PGF1α. Results An acute bout of exhaustive running in mice resulted in decreased production of NO and increased production of •O2− in aorta, with maximum changes 2 h after completion of exercise when compared with sedentary mice. However, platelet thrombus formation was not changed by exercise as evidenced by unaltered time to start of thrombus formation, capillary occlusion time, and total thrombogenicity (area under the flow pressure curve) as measured in a flow-chamber system. Strenuous exercise increased the plasma concentration of nitrite but did not affect nitrate and 6-keto-PGF1α concentrations. Conclusion An acute bout of strenuous exercise in mice reduced NO and in parallel increased •O2− production in aorta. This response was most pronounced 2 h after exercise. Surprisingly, the reduced NO and increased •O2− production in mice after exercise did not result in increased platelet-dependent thrombogenicity. These results show that transient reduction in NO bioavailability does not modify thromboresistance in healthy mice after exercise.

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Let the Pleasure Guide Your Resistance Training Intensity

imagePurpose The purpose of this study was to evaluate the feasibility and reliability of the Feeling Scale (FS) to self-regulate resistance training (RT) intensity. Methods Sixteen sedentary men (39.7 ± 7.5 yr) performed 3 familiarization sessions, 2 one-repetition maximum (1RM) testing, and 16 RT sessions (four sessions for each FS descriptor; randomized). The FS descriptors were "very good" (FS + 5), "good" (FS + 3), "fairly good" (FS + 1), and "fairly bad" (FS − 1). Resistance exercises were leg press, chest press, knee extension, and seated biceps curl. Participants were instructed to select a load associated with the verbal/numerical descriptor of the FS to perform three sets of 10 repetitions. Results Participants lifted a significantly greater %1RM as the FS level decreased from FS + 5 to FS − 1 (P

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Changes in Cycling and Incidence of Overweight and Obesity among Danish Men and Women

imagePurpose Overweight and obesity are associated with increased risk of several noncommunicable diseases and are a growing public health issue. The primary purpose of the current study was to investigate incidence of overweight and obesity according to 5-yr cycling habits. The secondary purpose was to investigate incidence of remission from overweight and obesity according to 5-yr cycling habits. Methods We analyzed 9014 men and 8661 women without chronic disease who between 1993 and 2003 completed two assessments approximately 5 yr apart. At both assessments, participants reported habitual cycling habits. Also, body weight and waist circumference were measured by a laboratory technician at baseline and self-assessed at second examination. We computed multivariable adjusted odds ratios (OR) with 95% confidence intervals (CI) for development of and remission from abdominal and general overweight and obesity, according to 5-yr cycling habits. Results Continued cycling was associated with lower odds for incidence of abdominal (men, >102 cm; women, >88 cm) and incidence of general (body mass index ≥30 kg·m−2) obesity; compared with no cycling, OR (95% CI) values were 0.82 (0.74–0.91) and 0.74 (0.60–0.92) for abdominal and general obesity, respectively. Also, those who initiated cycling had lower odds for incidence of abdominal obesity; OR (95% CI) was 0.85 (0.73–1.00) relative to no cycling. Although we found no evidence of remission from abdominal and general overweight and obesity according to 5-yr cycling habits, those who continued cycling had significantly larger decreases in waist circumference relative to noncyclists (β coefficient (95% CI), −0.95 cm (−1.56 to −0.33 cm)). Conclusions Continued cycling compared with no cycling was associated with lower odds for abdominal and general obesity. Also, late-in-life initiation of cycling was associated with lower odds for abdominal obesity relative to no cycling.

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Classification of Intensity in Team Sport Activity

imagePurpose This study aimed to assess the efficacy of critical metabolic power derived from variable-speed movement for classifying intensity in team sport activity. Methods Elite male hockey players (n = 12) completed a series of time trials (100 yards, 400 yards, 1500 yards) and a 3-min all-out test to derive both critical speed (CS) and critical power (CP). Heart rate (HR), blood lactate, and rating of perceived exertion were measured during each protocol. Participants (n = 10) then played two competitive hockey matches. Time spent greater than 85% of maximum HR was compared with time spent above CS (from the time trials) and CP (from the 3-min test). Results Between protocols, there was a moderate and nonsignificant association for CS (r = 0.359, P = 0.252) and a very large association for CP (r = 0.754, P = 0.005); the association was very large for peak HR (r = 0.866, P

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Power-to-Strength Ratio Influences Performance Enhancement with Contrast Training

imagePurpose The effectiveness of contrast training (CST) for improving explosive exercise performance is modulated by various individual characteristics; however, further work is required to define these factors. Methods Subelite male Australian Football players (n = 22; age, 19 ± 2 yr; body mass, 80.4 ± 9.4 kg; one-repetition maximum [1-RM] half squat, 172 ± 18 kg; mean ± SD) completed two experimental trials involving two sets of squat jumps (six repetitions at 30% 1-RM) performed either alone (CTL condition) or after half squats (six repetitions at 85% 1-RM; CST condition). Results Squat jump peak power was similar between CTL and CST during set 1 (mean change: ±90% confidence interval, 2.8% ± 2.0%; effect size [ES]: ±90% confidence interval, 0.13 ± 0.09; P = 0.079) and set 2 (0.3% ± 1.7%; ES, 0.01 ± 0.08; P = 0.781). Peak power enhancement with CST was not related to maximal (1-RM half squat) strength (r2 = 0.001, P = 0.884), but was negatively correlated with both baseline peak power (r2 = 0.44, P

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Physical Activity Alters Inflammation in Older Adults by Different Intensity Levels

imagePurpose To examine the influence of reallocating time spent at different objectively measured physical activity (PA) behaviors on markers of systemic inflammation in older women with different levels of metabolic risk. Methods Accelerometer-based monitoring of PA was conducted in a population of community-dwelling older women (n = 111; age, 65–70 yr) for determination of daily sedentary time, time in light PA (LPA) and moderate-to-vigorous PA (MVPA). Blood samples were collected for the assessment of the systemic inflammatory markers C-reactive protein (CRP), fibrinogen, and adiponectin. Metabolic risk was assessed by standardized procedures based on definitions for the metabolic syndrome. Data were analyzed by linear regression models based on isotemporal substitution analysis. Results Reallocating 30 min of sedentary time with either time in LPA (β = −0.47; P

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Mental practice for upper limb rehabilitation after stroke: a systematic review and meta-analysis

Mental practice (MP) is usually provided in combination with other therapies, and new developments for neurofeedback to support MP have been made recently. The objectives of this study were to evaluate the effectiveness of MP and to investigate the intervention characteristics including neurofeedback that may affect treatment outcome. The Cochrane Central Register of Controlled Trials, PubMed, Embase, KoreaMed, Scopus, Web of Science, PEDro, and CIRRIE were searched from inception to March 2017 for randomized controlled trials to assess the effect of MP for upper limb rehabilitation after stroke. Fugl-Meyer Assessment (FMA) was used as the outcome measure for meta-analysis. Twenty-five trials met the inclusion criteria, and 15 trials were eligible for meta-analysis. Among the trials selected for meta-analysis, MP was added to conventional therapy in eight trials or to modified constraint-induced movement therapy in one trial. The other trials provided neurofeedback to support MP: MP-guided neuromuscular electrical stimulation (NMES) in four trials and MP-guided robot-assisted therapy (RAT) in two trials. MP added to conventional therapy resulted in significantly higher FMA gain than conventional therapy alone. MP-guided NMES showed superior result than conventional NMES as well. However, the FMA gain of MP-guided RAT was not significantly higher than RAT alone. We suggest that MP is an effective complementary therapy either given with neurofeedback or not. Neurofeedback applied to MP showed different results depending on the therapy provided. This study has limitations because of heterogeneity and inadequate quality of trials. Further research is requested. Correspondence to Si-Woon Park, MD, MSCR, Department of Rehabilitation Medicine, Catholic Kwandong University International St. Mary's Hospital, 25 Simgok-ro-100beon-gil, Seo-Gu, Incheon 22711, South Korea Tel: +82 322 903 114; fax: +82 322 903 120; e-mail: seanpark05@gmail.com Received April 15, 2018 Accepted May 25, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Squamate reptiles from Kanapoi: Faunal evidence for hominin paleoenvironments

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Publication date: Available online 14 June 2018
Source:Journal of Human Evolution
Author(s): Jason J. Head, Johannes Müller
The squamate fossil record from Kanapoi reveals generic to higher-order similarities with modern East African herpetofaunas. The record is derived from surface collection and screen washing, and consists primarily of isolated vertebrae with a few maxillary and mandibular elements. The most abundant remains are vertebrae of large-bodied Python that are morphologically similar to extant Python sebae, and vertebrae of Varanus cf. (Varanus niloticus + Varanus exanthematicus). Additional cranial and vertebral remains indicate the presence of lygosomine skinks, indeterminate Varanus, Viperidae, cf. Atractaspididae, and multiple colubrine morphotypes in the Kanapoi ecosystem. Despite similarities with modern herpetofaunas, the Kanapoi record lacks taxa common to other East African records, including agamids, chamaeleonids, amphisbaenians, the elapid Naja, and typhlopids. The overall composition of the Kanapoi squamate record is consistent with paleoenvironments similar to modern shrub savanna habitats. There are no indicators of canopied forest environments in squamate faunal composition. The fossil record of Kanapoi suggests that assembly of squamate faunas of modern East Africa was well underway by the late Neogene.



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All eyes on rapid adaptive evolution



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Response to the letter to the editor on “Effects of Myofascial Release on Pressure Pain Thresholds in Patients with Neck Pain. A Single-Blind Randomized Controlled Trial”

No abstract available

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Measuring effect size – to standardize on not to standardize? (Comment on “Effects of myofascial release on pressure pain thresholds in patients with neck pain” by Rodríguez-Huguet et al.1)

No abstract available

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