A standardised template for reporting lower limb kinematic waveform movement compensations from a sensor-based portable clinical movement analysis toolkit

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Standardised terminology for the interpretation of movement analysis waveforms is provided, to describe the amount, nature and timing of a compensation strategy.

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A stand-alone application have been created for users to generate a movement analysis report for lower limb joint kinematics.

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A digital, interactive version of the movement analysis report is now being created in the next iteration of the sensor based portable movement analysis toolkit.

Objectives

To develop a standardised template to support physiotherapist reporting of lower limb kinematic waveform data

Design

Within and between user agreement identification of movement compensation strategies.

Setting

University Health Board Physiotherapy Department

Participants

Fourteen individuals with anterior cruciate ligament reconstruction performed overground gait, double-leg squat, and stair ascent wearing body-worn sensors. Six users viewed 252 kinematic waveforms of hip, knee and ankle joint angles in the sagittal and frontal planes.

Main outcome measures

Between and within-user observed agreement and themes from movement analysis reports

Results

Between-user observed agreement for presence of a movement compensation was 0.6–0.9 for the sagittal plane and 0.75–1.0 for the frontal place. Within-user observed agreement was 0.57–1.00 for the sagittal plane and 0.71–1.00 for the frontal plane. Three themes and seven categories were identified from the waveform interpretations: Amount (qualitative and quantitative description), timing (phase, discrete time point, cycle), and nature (peak, range of motion, timing) of the compensation.

Conclusion

There was good agreement between users at identifying the presence of movement compensation from the kinematic waveforms, but there was variation in how movement compensations were described. An interactive report, a standardised template for interpretation of kinematic waveforms, and training to support the clinical application of a movement analysis toolkit are proposed.

Abundance and Distribution of Malaria Vectors in Various Aquatic Habitats and Land Use Types in Kakamega County, Highlands of Western Kenya

Background

Management of malaria transmission relies heavily on vector control. Implementation and sustenance of effective control measures require regular monitoring of malaria vector occurrences, species abundance and distribution. The study assessed mosquito larval species composition, distribution and productivity in Kakamega County, western Kenya.

Methods

A cross-sectional survey of Anopheline larvae was conducted in various aquatic habitats and land use types in Kakamega County, highlands of western Kenya between the month of March and June 2019.

Results

One thousand, five hundred and seventy six aquatic habitats were sampled in various land use types. The mean densities of An. gambiae s.l (46.2), An. funestus (5.3), An. coustani (1.7), An. implexus (0.13) and An. squamosus (2.0) were observed in fish ponds, burrow pits, drainage ditches, and tire tracks, respectively. High mean densities of An. gambiae s.l was reported in farmland (20.4) while high mean abundance of An. funestus s.l (8.2) and An. coustani s.l (4.0) were observed in artificial forests.

Conclusion

The study revealed that the productivity of anopheles larvae varied across various habitat types and land use types. Therefore, treatment of potential breeding sites should be considered as an additional strategy for malaria vector control in Kakamega County, western Kenya.

A quantitative study of the morphological development and bacterial colonisation of the gut of the tammar wallaby Macropus eugenii eugenii and brushtail possum Trichosurus vulpecula during in-pouch development

We compared the rates of change of various morphological parameters of the stomach, small intestine, caecum and colon of tammar wallabies and brushtail possums with body mass during in-pouch development. These were correlated with changes in the numbers of bacterial species in the various gut segments. In the pouch-young of both species, the wet tissue masses of all gut segments increased with body mass in a positively allometric manner (i.e. with a body mass exponent > 1), suggesting that the mass of each component was disproportionately low at birth, but increased disproportionately rapidly postnatally. However, the lengths of the wallaby stomach and small intestine scaled isometrically with respect to body mass (i.e. with a body mass exponent around 0.33), which may indicate that the shape of these components changes to the adult form during early neonatal development. Conversely, the length of the caecum and colon of both wallabies and possums scaled in a positively allometric manner with respect to body mass, showing area to volume compensation. This may indicate a more general pattern of disproportionately rapid postnatal enlargement in areas that are distal to the principal sites of neonatal digestion (i.e. the stomach). The numbers of bacterial species present in the various gastrointestinal segments of both species were low in animals aged 100 days or less but there was a significant increase in microbial diversity in the caecum of brushtail possums aged over 100 days. The possum caecum also showed the greatest rate of increase in wet tissue mass relative to body mass. It is postulated that caecal development may act as a nidus for establishment of communities of commensal microflora in the developing marsupial.

Low grade gliomas treated with adjuvant radiation therapy in the modern imaging era

The purpose of this study is to evaluate tumor control and failure patterns in patients with low grade gliomas treated with surgery and conventional adjuvant radiation therapy. Twenty-eight patients with low grade gliomas (7 grade I, 21 grade II) were retrospectively evaluated. Extent of resection was gross total (3), subtotal (17), and biopsy alone (8). All grade I tumors underwent subtotal resection. Median radiation therapy dose was 54 Gy delivered to localized fields. Tumor control and patterns of failure were determined from follow-up computed tomography and/or magnetic resonance scans. Median follow-up was 86 months (range, 2.4-177 months). Thirteen patients (46%) (four grade I, nine grade II) developed tumor progression. The 5-year actuarial progression-free survival rates for grade I and grade II patients were 86% and 51%, respectively. Corresponding 5-year actuarial survival rates were 100% and 70%. All recurrences were within the treated volume. Our results reveal that conventional adjuvant radiation therapy is associated with high rates of local tumor progression in both grade II and incompletely resected grade I low grade gliomas. Alternative strategies need to be explored in these patients in an effort to improve tumor control and outcome.

Developmentally-regulated expression of a putative protease inhibitor gene in the lactating mammary gland of the tammar wallaby, Macropus eugenii

A novel milk protein, which is secreted only in the early stage of lactation, has been identified in the whey fraction of milk from the tammar wallaby (Macropus eugenii). The amino acid sequence currently available suggests the protein comprises 71 amino acids. The protein migrates at 18 kDa when analysed by SDS polyacrylamide gel electrophoresis but has a calculated molecular weight of 8 kDa. A partial cDNA clone of 153 bp has been isolated by reverse transcriptase PCR. Northern analysis of mammary gland RNA extracted from various stages throughout the entire lactation period showed a messenger RNA transcript of approximately 500 bp present only in the first third of lactation. The protein shares 74.5% similarity at the amino acid level with early lactation protein (ELP) from the brush-tailed possum (Trichosurus vulpecula) and 37% with bovine colostrum trypsin inhibitor, a member of the Kunitz family of protease inhibitors. We hypothesise that the expression of this gene may be controlled by changes in the sucking patterns of the dependent pouch young.

Molecular characterisation and hormone-dependent expression of the porcine whey acidic protein gene

A 17.5 kDa protein was isolated from porcine whey by reverse phase HPLC and identified as a putative whey acidic protein (WAP) homologue by sequencing 35 and 40 amino acid residues of the amino- and carboxy-terminus respectively. Degenerate oligonucleotides to both of these amino acid sequences were designed and used in reverse transcriptase PCR with RNA from lactating porcine mammary gland as a template. A 162 bp PCR fragment was detected and sequenced. Compilation of the deduced and determined amino acid sequence revealed a protein of 111 amino acids, which had approximately 75, 50, 40 and 35% similarity at amino acid level to camel, rabbit, rat and mouse WAP respectively. It also included the four-disulphide core characteristic of all WAP proteins and most Kunitz-type protease inhibitors. This provides the first unequivocal evidence for WAP secretion in the pig. SDS PAGE analysis of the whey fraction showed that WAP is secreted as a major protein in sow's milk from farrowing to weaning. The molecular mass of WAP in SDS PAGE was significantly greater than the 11.7 kDa determined from amino acid sequence, indicating that porcine WAP is possibly glycosylated. Northern analysis detected a single mRNA transcript of approximately 600 bp in porcine RNA from the mammary gland of lactating sows. To examine the hormone-regulated expression of the WAP gene the mammary glands of sows at day 90 of pregnancy were biopsied and explants cultured for 3 days in the presence of various combinations of porcine insulin (I), cortisol (F) and porcine prolactin (P). Northern analysis of RNA extracted from the tissue indicated that WAP gene expression was barely detectable in the mammary gland prior to culture and there was no increment in explants cultured in the presence of I and F. However, a significant increase in the accumulation of WAP mRNA was observed in explants cultured in I, F and P. A similar result was observed for beta-casein and alpha-lactalbumin gene expression.

The tammar wallaby: a model to study putative autocrine-induced changes in milk composition

The marsupial newborn is immature and the mother has the capacity to alter milk composition significantly during lactation, presumably to meet the nutritional requirements of the developing young. Furthermore, macropodid marsupials may practice asynchronous concurrent lactation (ACL)7 whereby the mother provides milk which differs in all the major components from adjacent mammary glands for two young of different ages. This phenomenon suggests that local regulation of mammary function, in addition to endocrine stimuli, is likely to be important for controlling milk composition. This paper explores the possibility that changes in sucking patterns of the young represent the first step in a mechanism to signal the mammary gland for putative autocrine-induced changes in milk composition.

Prolactin-independent induction of alpha-lactalbumin gene expression in mammary gland explants from pregnant Balb/c mice

A four-fold increment of alpha-lactalbumin mRNA was induced in mammary gland explants from mid-pregnant Balb/c mice cultured for 24h in media containing insulin, cortisol and T3, and this response was enhanced by 40% with the addition of prolactin. In contrast, elevated beta-casein gene expression was evident only in explants cultured in media with insulin, cortisol, T3 and prolactin. These results suggest that the induction of the alpha-lactalbumin gene was prolactin-independent and did not result from retention of endogenous prolactin, or its effects, by the mammary explants.

Manual verification of computer analysis of 24-hour esophageal motility

The application of solid-state technology to intraesophageal pressure monitoring over an entire circadian cycle has resulted in large amounts of data that require computer analysis. Recently available commercial software has yet to be validated. The aim of this study was to compare the analysis of ambulatory esophageal manometry by an automated computer program with manual analysis and make the software modifications necessary to validate the automated system for clinical use. Computer-aided analysis of a large number of esophageal contractions recorded during ambulatory esophageal manometry was compared with manual analysis by four experienced physicians. Good correlations were found between manual and computerized measurements of contraction amplitude and duration (r = 0.99 and r = 0.73, respectively). Software modifications resulted in correct identification of 94% of contractions and correct classification of 93.3% of these waves as peristaltic or simultaneous. These results demonstrate that the evaluated program for automated analysis of ambulatory esophageal manometry is accurate and reliable for research and clinical applications.

Molecular characterization and in-vitro hormonal requirements for expression of two casein genes from a marsupial

Two marsupial casein genes have been isolated from a tammar wallaby (Macropus eugenii) mammary gland cDNA library. Comparisons of the tammar alpha- and beta-casein genes with their eutherian homologous reveal extensive divergence at the levels of nucleotide and amino acid sequences. Regions of similarity between the tammar and eutherian Ca(2+)-sensitive caseins are restricted to the major phosphorylation sites and the signal peptides. Quantification of casein mRNA levels in hormone-stimulated mammary gland explants from tammars in late pregnancy suggests that maximal induction of the beta-casein gene is dependent upon prolactin and insulin, while maximal induction of the alpha-casein gene is dependent upon prolactin, insulin and cortisol. These results are in contrast to earlier studies which show that the maximal induction of a putative 19 kDa casein, alpha-lactalbumin and beta-lactoglobulin in the tammar mammary gland is dependent upon prolactin alone. The expression of the latter three genes is not modulated by other hormones known to play a role in the in-vitro initiation of lactation in eutherians.

Detection of Norwalk-like virus and specific antibody by immune-electron microscopy with colloidal gold immune complexes

Direct electron-microscopy (DEM), immune electron microscopy (IEM) and four different procedures of immune electron microscopy with colloidal gold immune complexes were evaluated for the detection of Norwalk-like virus and specific antibody. A solid-phase immune electron microscopy with colloidal gold immune complexes-triple layer method (SPIEMGIC-TLM) is developed for screening patients' specimens for the detection of Norwalk-like virus and its specific antibody. The method demonstrates low non-specific background labelling and is simple, sensitive and easy to perform. A quadruple layer method (SPIEMGIC-QLM), which is a modification of the triple layer method, has been established by adding a cross-linking anti-IgG layer to amplify the reaction and to provide a more sensitive test which is suitable for screening monoclonal antibodies prepared against 32-34-nm Norwalk-like virus isolated in our laboratory.

A marsupial beta-lactoglobulin gene: characterization and prolactin-dependent expression

Analysis of the tammar wallaby beta-lactoglobulin cDNA and inferred amino acid sequences reveal extensive sequence divergence from the eutherian beta-lactoglobulins. Conserved residues include the cysteines and a number of individual amino acids involved in structure and ligand-binding. The only region of extended similarity is a heptapeptide sequence which may impart specificity to its interaction with a receptor protein. Northern analysis of total mammary RNA revealed two transcripts which result from differential utilization of polyadenylation signals. The concentration of beta-lactoglobulin mRNA increased in late lactation and correlates with increases in milk production and levels of milk fat. Quantification of beta-lactoglobulin mRNA levels in hormone-stimulated mammary gland explants from tammars in late pregnancy suggests that maximal induction of the gene is dependent on prolactin alone and that expression is not modulated by other hormones known to play a role in the initiation of lactation in eutherians.

A questionnaire survey of the prevalence of scrapie in sheep in Britain

An anonymous, self-administered questionnaire has been used in two independent surveys to try to determine the prevalence of scrapie in the national sheep flock. The disease was recorded in 35 counties in England and Wales. About a third (26.5 and 37.3 percent) of respondents owning 100 or more sheep indicated that they had seen sheep with scrapie in their flocks. The incidences of clinical cases recorded in affected flocks in the two surveys were 0.5 and 1.1 cases/100 ewes/year. At present there is no control over the disposal of these animals. If as has been suggested, an increase in the prevalence of scrapie was a contributory factor in the emergence of bovine spongiform encephalopathy, it would seem logical that measures should be introduced to monitor the prevalence and incidence of scrapie and to control the disposal of clinical cases.

Cloning, cDNA analysis and prolactin-dependent expression of a marsupial alpha-lactalbumin

The gene for alpha-lactalbumin has been cloned from a tammar wallaby (Macropus eugenii) mammary gland cDNA library. Tammar alpha-lactalbumin has approximately 50 and 30% homology to the alpha-lactalbumins of eutherians at the levels of nucleotide and protein sequence respectively. Comparison of the inferred tammar polypeptide sequence with the sequence of the eutherian proteins reveals extensive divergence at almost all of the non-essential amino acid residues. However, the hydropathy plots of the tammar protein are almost identical to those of eutherian alpha-lactalbumins, suggesting that protein conformation is conserved. The tammar gene encodes a transcript of approximately 975 bases. Northern blot analysis of hormone-stimulated mammary gland explants shows that maximal induction of alpha-lactalbumin mRNA is dependent on prolactin and that expression is not modulated by other hormones that play a role in the initiation of lactation in eutherians.

Molecular cloning and characterization of a novel marsupial milk protein gene

The tammar wallaby (Macropus eugenii) produces two different types of milk; "early" milk for the first 180 days and "late" milk for the remaining 150 days of lactation. We report the cloning of the cDNA of a novel whey protein, Late-Lactation Protein (LLP), which is produced during the late phase of lactation. The cDNA was cloned using an oligonucleotide probe deduced from the published partial protein sequence. The cDNA encodes an open-reading frame of 176 amino acids of which the first 18 residues represent a signal peptide. Northern blot analysis revealed a 1kb transcript in late phase lactation but not in the early phase.

Isolation, partial sequence and asynchronous appearance during lactation of lysozyme and alpha-lactalbumin in the milk of a marsupial, the common ringtail possum (Pseudocheirus peregrinus)

1. Lysozyme and alpha-lactalbumin from the milk of the common ringtail possum have been purified and partially sequenced. 2. The lysozyme had similar enzymic activity to the c-type lysozyme of the domestic hen and 43% homology over the N-terminal 49 residues. 3. alpha-Lactalbumin was present in the milk in two biologically active forms; the more acidic form had 66% sequence homology with the N-terminal 35 residues of red-necked wallaby, 54% with human and 43% with bovine alpha-lactalbumin. 4. SDS polyacrylamide-gel electrophoresis of milk samples showed that alpha-lactalbumin was present in the milk throughout lactation but that lysozyme first appeared only in mid-lactation. The implications of this functional adaptation are discussed.