Feasibility of social cognitive theory-based fall prevention intervention for people with intellectual disabilities living in group-home

BACKGROUND

Adults with intellectual disability (ID) have a higher rate of fall events than the general population. Consequently, interventions for reducing fall events and improving health are highly required for individuals with ID. One essential step towards effectively delivering fall prevention interventions among adults with ID involves evaluating their feasibility. This study examined the feasibility of a home-based exercise intervention, supplemented with behavioural change strategies, among individuals with ID living in residential settings.

METHOD

This study provided an 8-week intervention, consisting of a workshop for support workers and sessions for participants with ID, focusing on behavioural reward/s, education regarding fall prevention/exercise and exercise training. One week prior to and 1 week following such an intervention, such participants underwent measurements for (1) physical performance, (2) fall efficacy, (3) self-efficacy for activity and (4) social support.

RESULTS

Participants having ID (n = 33), support workers (n = 11) and one administrator participated in this study. There were no adverse events during the intervention, and the mean adherence rate was 70.8 ± 19.5%. Two participants with ID dropped out of the programme due to a lack of interest. The participants with ID significantly improved individual physical performance, self-efficacy for activity, fall efficacy and support from friends and support workers.

CONCLUSIONS

Fall prevention interventions for adults with ID living in group-homes were highly promising for eventual large-scale implementation within such communities.

Predicting the rate of oxygen uptake from step counts using ActiGraph waist-worn accelerometers in adults with Down syndrome

BACKGROUND

Step rate predicts ambulatory intensity as reflected in the rate of oxygen uptake (VO₂ ) - a measure of energy expenditure. Whether step rate as measured by an accelerometer predicts VO₂ in adults with Down syndrome (DS) is unknown. We examined whether step rate predicts VO₂ in adults with and without DS. We also developed an equation for predicting VO₂ and examined its accuracy.

METHOD

Sixteen adults with DS (6 women and 10 men; age 31 ± 15 years) and 19 adults without DS (9 women and 10 men; age 25 ± 6 years) performed standing and walking at their preferred speed, 0.8 and 1.4 m·s^-1 . We measured VO₂ with a portable spirometer and step rate with a triaxial accelerometer (wGT3X-BT; ActiGraph) on the non-dominant hip, using the low-frequency extension filter. We ran multilevel regression for predicting VO₂ from linear and quadratic terms for step rate, group (1 = DS; 0 = non-DS), body mass, height, body mass index (BMI), leg length and sex. We estimated VO₂ with the resultant equation and calculated the equation's absolute per cent error, which we compared between groups.

RESULTS

VO₂ was higher in persons with than without DS only at the fast walking speed (P = 0.018). DS did not predict VO₂ . Step rate, step rate squared and BMI were significant predictors of VO₂ (P < 0.001; R²  = 0.80). Absolute error across walking speeds was 13.5-18.8% and 11.7-13.4% for adults with and without DS, respectively, and did not differ between groups or speeds.

CONCLUSIONS

Step rate, step rate squared and BMI predict VO₂ in adults with and without DS. Prediction error does not differ between groups.

Torsion of an Accessory Spleen in a Child With Biliary Atresia Splenic Malformation Syndrome

Torsion of an accessory spleen is an exceedingly rare cause of abdominal pain in pediatric patients. The diagnosis is frequently challenging as presentation is variable and diagnostic imaging can be aspecific. The current case describes an unusual presentation of a torted accessory spleen in a 5-year-old girl with biliary atresia splenic malformation syndrome who initially presented with non-specific abdominal symptoms and fever. The diagnosis was made following fine-needle aspiration of a suspected intraabdominal abscess. The case highlights the diagnostic challenge of accessory splenic torsion and stresses the importance of its inclusion on the differential diagnosis of pediatric patients, especially those with known splenic or laterality abnormalities, presenting with both acute and sub-acute abdominal symptoms.

Effects of meal composition on postprandial incretin, glucose and insulin responses after surgical and medical weight loss

Background

Meal tolerance tests are frequently used to study dynamic incretin and insulin responses in the postprandial state; however, the optimal meal that is best tolerated and suited for hormonal response following surgical and medical weight loss has yet to be determined.

Objective

To evaluate the tolerability and effectiveness of different test meals in inducing detectable changes in markers of glucose metabolism in individuals who have undergone a weight loss intervention.

Methods

Six individuals who underwent surgical or medical weight loss (two Roux‐en‐Y gastric bypass, two sleeve gastrectomy and two medical weight loss) each completed three meal tolerance tests using liquid‐mixed, solid‐mixed and high‐fat test meals. The tolerability of each test meal, as determined by the total amount consumed and palatability, as well as fasting and meal‐stimulated glucagon‐like peptide, glucose‐dependent insulinotropic polypeptide, insulin and glucose were measured.

Results

Among the six individuals, the liquid‐mixed meal was better and more uniformly tolerated with a median meal completion rate of 99%. Among the four bariatric surgical patients, liquid‐mixed meal stimulated on average a higher glucagon‐like peptide (percent difference: 83.7, 89), insulin secretion (percent difference: 155.1, 158.7) and glucose‐dependent insulinotropic polypeptide (percent difference: 113.5, 34.3) compared with solid‐mixed and high‐fat meals.

Conclusions

The liquid‐mixed meal was better tolerated with higher incretin and insulin response compared with the high‐fat and solid‐mixed meals and is best suited for the evaluation of stimulated glucose homeostasis.

Atomic scale investigation of non-equilibrium segregation of boron in a quenched Mo-free martensitic steel

B-added low carbon steels exhibit excellent hardenability. The reason has been frequently attributed to B segregation at prior austenite grain boundaries, which prevents the austenite to ferrite transformation and favors the formation of martensite. The segregation behavior of B at prior austenite grain boundaries is strongly influenced by processing conditions such as austenitization temperatures and cooling rates and by alloying elements such as Mo, Cr, and Nb. Here an local electrode atom probe was employed to investigate the segregation behavior of B and other alloying elements (C, Mn, Si, and Cr) in a Cr-added Mo-free martensitic steel. Similar to our previous results on a Mo-added steel, we found that in both steels B is segregated at prior austenite grain boundaries with similar excess values, whereas B is neither detected in the martensitic matrix nor at martensite-martensite boundaries at the given cooling rate of 30K/s. These results are in agreement with the literature reporting that Cr has the same effect on hardenability of steels as Mo in the case of high cooling rates. The absence of B at martensite-martensite boundaries suggests that B segregates to prior austenite grain boundaries via a non-equilibrium mechanism. Segregation of C at all boundaries such as prior austenite grain boundaries and martensite-martensite boundaries may occur by an equilibrium mechanism.

Combining structural and chemical information at the nanometer scale by correlative transmission electron microscopy and atom probe tomography

In many cases, the three-dimensional reconstructions from atom probe tomography (APT) are not sufficiently accurate to resolve crystallographic features such as lattice planes, shear bands, stacking faults, dislocations or grain boundaries. Hence, correlative crystallographic characterization is required in addition to APT at the exact same location of the specimen. Also, for the site-specific preparation of APT tips containing regions of interest (e.g. grain boundaries) correlative electron microscopy is often inevitable. Here we present a versatile experimental setup that enables performing correlative focused ion beam milling, transmission electron microscopy (TEM), and APT under optimized characterization conditions. The setup was designed for high throughput, robustness and practicability. We demonstrate that atom probe tips can be characterized by TEM in the same way as a standard TEM sample. In particular, the use of scanning nanobeam diffraction provides valuable complementary crystallographic information when being performed on atom probe tips. This technique enables the measurement of orientation and phase maps as known from electron backscattering diffraction with a spatial resolution down to one nanometer.

Atomic-scale quantification of grain boundary segregation in nanocrystalline material

Grain boundary segregation leads to nanoscale chemical variations that can alter a material's performance by orders of magnitude (e.g., embrittlement). To understand this phenomenon, a large number of grain boundaries must be characterized in terms of both their five crystallographic interface parameters and their atomic-scale chemical composition. We demonstrate how this can be achieved using an approach that combines the accuracy of structural characterization in transmission electron microscopy with the 3D chemical sensitivity of atom probe tomography. We find a linear trend between carbon segregation and the misorientation angle ω for low-angle grain boundaries in ferrite, which indicates that ω is the most influential crystallographic parameter in this regime. However, there are significant deviations from this linear trend indicating an additional strong influence of other crystallographic parameters (grain boundary plane, rotation axis). For high-angle grain boundaries, no general trend between carbon excess and ω is observed; i.e., the grain boundary plane and rotation axis have an even higher influence on the segregation behavior in this regime. Slight deviations from special grain boundary configurations are shown to lead to unexpectedly high levels of segregation.