Lower body reaction testing using ultrasonic motion capture

This paper presents a lower body reaction test that utilizes a new portable ultra-sound based motion capture system (MobiFit) combined with a synchronized visual stimulus. This novel system was tested first for criterion validity and agreement against a gold standard laboratory based optical motion capture system (CODA). It was subsequently tested in the field during Gaelic football (GAA) team gym sessions with 35 subjects to demonstrate its utility and versatility. The lower body reaction test itself is novel in that it can be applied to a gross motor task. During testing, participants had sensors attached to their lower limbs and trunk. The speed of movement for each sensor was monitored at 500Hz using the Mobifit motion capture system, and reaction time was measured as the elapsed time from the appearance of a green indicator on the screen to a sensor reaching a set threshold velocity as the participant raised the corresponding leg. Pearson's correlation coefficient tested criterion validity against the CODA system and Intra class correlation coefficients and Bland-Altman plots assessed agreement of velocity measures obtained from the MobiFit and CODA systems. Results indicate that the MobiFit system is an accurate device to assess lower body reaction time and has advantage over standard laboratory measures in terms of portability and ease of set-up.

The role of clinical specialist physiotherapists in the management of low back pain in a spinal triage clinic

BACKGROUND

Traditional care pathways for patients with low back pain (LBP) where general practitioners (GPs) refer to consultant specialists can lead to excessive waiting times for patients and questionable use of health care resources. The evaluation of more cost effective pathways is a priority.

AIMS

The study aims to determine if clinical specialist physiotherapists can allocate patients into the three distinct diagnostic triage categories in line with international guidelines. A secondary aim is to examine the utility of baseline domains to inform clinical decision making.

METHODS

A review of LBP patients (n = 1,532) consecutively referred between 2008 and 2010 to a physiotherapy led spinal triage clinic was undertaken. Baseline demographics, pain severity (Visual Analogue Scale), disability (Roland Morris Disability Questionnaire), distress (Distress and Risk Assessment Method), mobility and function were assessed. Relationships between these factors were analysed.

RESULTS

Eighty-five percent of the population were deemed suitable for conservative management and were referred for either group exercise intervention (n = 1,125, 73 %) or individual treatment (n = 178, 12 %), in line with clinical guidelines. Fourteen percent were discharged and only 1 % required a specialist opinion. Patients allocated to the three management streams could be clearly discriminated by baseline measures of pain, distress, disability and function (p < 0.01).

CONCLUSION

Clinical Specialist physiotherapists are effective in assessing and selecting appropriate care pathways for LBP patients in line with international LBP clinical guidelines. The utility of the physical and psychological measures to differentiate between groups of varying clinical severity has important implications for treatment selection and management.

An evaluation of low back pain among farmers in Ireland

BACKGROUND

Low back pain (LBP) is the most commonly reported musculoskeletal disorder among farmers. There is limited research regarding LBP among farmers in Ireland.

AIMS

To explore attributed causes of LBP, investigate the relationship between LBP and personal and work-related factors and measure the impact of LBP.

METHODS

A questionnaire survey of Irish farmers was conducted on farmers from each of the main farm enterprise systems in Ireland. Data were analysed using chi-square tests, t-tests, Mann-Whitney tests and logistic regression models.

RESULTS

There were 600 farmers included in the survey with 100 from each of the six main farm systems. Lifting/pulling/pushing was identified as the most commonly attributed cause of LBP. In the multiple regression analysis the variables found to be associated with LBP included farm size and self-rated health. The odds ratios (OR) of LBP were greater among operators of medium and large farms [(OR = 1.52; 95% confidence interval (CI): 1.04-2.22 and OR = 1.86; 95% CI: 1.16-3.98, respectively] compared with smaller farms (P < 0.05). Those who perceived health as 'good' (OR = 1.63; 95% CI: 1.14-2.33) by comparison with a rating of 'very good' had greater odds of LBP (P < 0.01). Some farmers changed work habits, sought help and needed time off work due to LBP.

CONCLUSIONS

Lifting was identified as the main attributed cause for LBP. LBP leads to work disability that necessitated farmers changing work habits, getting help and needing time off work. In order to reduce LBP-related disability among farmers in the future, work practices involving lifting need to be further investigated.

Lipid organization and the morphology of solid-like domains in phase-separating binary lipid membranes

In multi-component lipid membranes, phase separation can lead to the formation of domains. The morphology of fluid-like domains has been rationalized in terms of membrane elasticity and line tension. We show that the morphology of solid-like domains is governed by different physics, and instead reflects the molecular ordering of the lipids. An understanding of this link opens new possibilities for the rational design of patterned membranes.

Low back pain and occupation among Irish health service workers

BACKGROUND

The health services sector has been identified as a high-risk work sector for low back pain (LBP) and related absenteeism.

AIMS

To establish levels and predictors of LBP prevalence and associated sick leave among health service workers. To identify if levels of LBP or related absenteeism differ between occupational groups.

METHODS

A postal survey using a standardized questionnaire and disproportionate random sampling of occupational groups was conducted at a single Dublin hospital. Overall hospital LBP prevalence and sickness absence were calculated using weighted analysis methods. Univariate analysis included the use of Chi-square, Fisher's exact and Mann-Whitney tests. Multivariate logistic regression techniques were used to explore for independent predictors of lifetime LBP prevalence and LBP-related sickness absence.

RESULTS

An overall response rate of 62% (n = 246) was achieved. Lifetime, annual and point prevalence rates for the hospital employees were calculated at 46, 30 and 15.5%, respectively. No significant difference in prevalence was found between occupational groups but sick leave did differ with the highest level among general support and nursing staff. Multivariate analysis confirmed that occupation was an independent predictor for LBP-related sick leave (P < 0.05).

CONCLUSIONS

LBP prevalence rates did not differ significantly between occupational groups but occupation was found to be an independent predictor of LBP-related sick leave. Involvement in manual handling did not predict either LBP or related sick leave.

A NOMOGRAM TO CLASSIFY MEN WITH LOWER URINARY TRACT SYMPTOMS USING URINE FLOW AND NONINVASIVE MEASUREMENT OF BLADDER PRESSURE

PURPOSE

Bladder pressure during voiding can be estimated by a noninvasive technique using controlled inflation of a penile cuff. This test provides a valid and reliable estimate of isovolumetric bladder pressure but to our knowledge the role of the test for the routine clinical treatment of patients with lower urinary tract symptoms (LUTS) has yet to be demonstrated. As a first step, we evaluated a proposed nomogram for the diagnosis of bladder outlet obstruction in men with LUTS using noninvasive measurements of pressure and flow.

MATERIALS AND METHODS

Using a combination of theoretical calculation and experimental data the existing International Continence Society pressure flow nomogram was modified to allow noninvasive measurement of isovolumetric bladder pressure in place of detrusor pressure at maximum urine flow. Accuracy of the nomogram for classifying obstruction was then tested in a group of 144 men with LUTS who underwent an invasive and a noninvasive pressure flow study.

RESULTS

The modified nomogram identified men with obstruction with 68% positive predictive value and 78% negative predictive value. Predictive accuracy could be improved by adding an additional criterion of obstruction, that is maximum urine flow less than 10 ml second, whereby an identifiable 69% of all cases could be classified as obstructed (88% positive predictive value) or not obstructed (86% negative predictive value). In the remaining 31% of patients invasive pressure flow studies would provide additional information, although some results would remain equivocal.

CONCLUSIONS

The proposed nomogram combined with the additional flow rate criterion can classify more than two-thirds of cases without recourse to invasive pressure flow studies. We must now evaluate the usefulness of this classification for the treatment of men with LUTS.

Concentrations and bioavailability of cadmium and lead in cocoa powder and related products

Concentrations and bioavailability of cadmium (Cd) and lead (Pb) were determined in cocoa powders and related products (beans, liquor, butter) of different geographical origins. Particular attention was paid to the fractionation of these metals, which was investigated by determining the metal fraction soluble in extractant solutions acting selectively with regard to the different classes of ligands. The targeted classes of Cd and Pb species included: water-soluble compounds, polypeptide and polysaccharide complexes, and compounds soluble in simulated gastrointestinal conditions. The bioavailability of Cd and Pb from cocoa powder, liquor and butter was evaluated using a sequential enzymolysis approach. The data obtained as a function of the geographical origin of the samples indicated strong differences not only in terms of the total Cd and Pb concentrations, but also with regard to the bioavailability of these metals. The Cd concentrations in the cocoa powders varied from 94 to 1833 microg kg(-1), of which 10-50% was potentially bioavailable. The bioavailability of Pb was generally below 10% and the concentrations measured in the cocoa powders were in the 11-769 microg kg(-1) range. Virtually all the Cd and most of Pb were found in the cocoa powder after the pressing of the liquor.

Development of a sequential enzymolysis approach for the evaluation of the bioaccessibility of Cd and Pb from cocoa

An in vitro model simulating enzymatic activity in the gastrointestinal tract was developed for the assessment of the potential bioaccessibility of Cd and Pb in cocoa powder and liquor. The model was based on the sequential extraction with simulated gastric and intestinal juices; the residue after the latter extraction was further investigated by using, in parallel, solutions of phytase and cellulase. The solubility of Cd and Pb in the corresponding enzymatic extracts was measured by ICP MS. The bioaccessibility of Cd in cocoa varied from 10 to 50% in gastrointestinal conditions. An additional 20 or 30% of Cd could be recovered by phytase and cellulase, respectively. The bioaccessibility of Pb in gastrointestinal conditions did not exceed 5-10%. Only a few percent more of this metal could be recovered by extraction with phytase and cellulase.