Measurement of Knee Extensor Torque During Repetitive Peripheral Magnetic Stimulation: Comparison of the Forces Induced by Different Stimulators

Objective

To investigate the factors that induce strong contractions during repetitive peripheral magnetic stimulation (rPMS) and compare the muscle torque induced by two stimulators (Stim A and Stim B) with different coil properties.

Methods

rPMS was applied to the right vastus lateralis of 30 healthy young adults. Stim A contained a 10.1 cm2 rectangular iron core coil, while Stim B contained a 191 cm2 round coil. The knee extensor torque (KET) induced by rPMS at 30 Hz was measured isometrically and divided by the maximum voluntary contraction (MVC) to obtain a relative value of MVC (%MVC). KET at 100% intensity of Stim A (A100%, 1.08 T) was compared to those at 100% or 70% intensity of Stim B (B100%, 1.47 T vs. B70%, 1.07 T). Additionally, we conducted a comprehensive literature search for studies that measured the KET during rPMS.

Results

Both the mean values of %MVC using B100% and B70% were significantly greater than that using A100%. Furthermore, the KET induced by Stim B was found to be larger than that described in previous reports, unless booster units were used to directly stimulate the main trunk of the femoral nerve.

Conclusion

Stim B induced a stronger muscle contraction force than Stim A did. This may be because the larger the coil area, the wider the area that can be stimulated. Additionally, a circular coil allows for deeper stimulation.

The influence of exercise on pain, disability and quality of life in office workers with chronic neck pain: A systematic review and meta-analysis

BACKGROUND

Exercise is recommended for office workers with neck pain. However, recent reviews evaluated the effectiveness of workplace interventions only.

OBJECTIVES

To evaluate the effect of exercise on pain, disability, and quality of life (QoL) in office workers with chronic neck pain.

DESIGN

Systematic review with meta-analysis.

METHODS

Electronic databases were searched from inception to April 30, 2022, to identify studies in which participants were adults aged ≥18 years undergoing any form of neck exercises (e.g., strengthening, motor control) or physical activity (e.g., aerobic exercise) performed for a minimum of two-weeks without any other additional treatment besides advice or education. Two reviewers independently screened papers and determined the certainty of the evidence.

RESULTS

Eight randomised controlled trials met the eligibility criteria. Seven studies reported a significant decrease in Visual Analogue Scale (VAS) scores for neck pain intensity and five studies reported a significant decrease in Neck Disability Index (NDI) scores following strengthening exercises. Only one study assessed the effect of strengthening exercises on QoL and reported no significant effect. All eight included studies had a high risk of bias and the overall certainty of evidence was low. Meta-analyses demonstrated a significant decrease of neck pain intensity and disability for strengthening exercises compared to a control (p < 0.01).

CONCLUSION

There is low certainty of evidence that strengthening of the neck, shoulder and scapular musculature is effective at reducing neck pain and disability in office workers. Further research evaluating the effect of exercise on QoL is required.

Phase transformation and strengthening of the gas-atomized FeCoCrNiMo0.5Al1.3 high-entropy alloy powder during annealing

Phase evolution and strengthening of the FeNiCoCrMo0.5Al1.3 powder alloy produced via inert gas atomization and annealed in the temperature interval of 300-800 °C have been studied by X-ray diffraction, scanning electron microscopy, energy dispersive X-ray spectroscopy, and microhardness testing. It was found that annealing at 300-600 °C leads to an increase of the element segregations between the several solid solutions with a rise of the lattice misfit (ε) to 1.5 % and microhardness growth to 1070 HV. It was assumed that elastic stress caused by the element partitioning is the main strengthening mechanism: microhardness rises linearly with misfit rise with dHV/dε = 43400 MPa. Sigma arises after the maximum elastic deformation (in 1.5 %) was reached. Formation of the dispersed coherent sigma phase in the annealing interval 600-800 °C results in the microhardness rise. Oxidation that began at 800 °C in 27 h is accompanied with FCC formation due to a depletion of the B2 in Al caused by Al2O3 formation. Estimation of the activation energy of the initial stage of the solid solution decomposition gives a very low value in 0.65eV, apparently caused by the high concentration of quenched vacancies. The activation energy of sigma formation approximately coincides with the activation energy of self-diffusion in BCC metals (about 2.60 eV).

Effects of high frequency strengthening on pain sensitivity and function in female runners with chronic patellofemoral pain

OBJECTIVE

To investigate the effects of a high frequency strengthening program on function, pain, and pain sensitization in female runners with chronic patellofemoral pain (PFP).

DESIGN

Cross-sectional study.

SETTING

University laboratory.

PARTICIPANTS

Thirty female runners (mean age 32 ± 8.1 years) with chronic PFP completed an 8-week home strengthening program.

MAIN OUTCOME MEASURES

Variables assessed at baseline, 8-weeks, and 12 weeks included single leg step down test (SLSD), pain, Anterior Knee Pain Scale (AKPS), University of Wisconsin Running Injury and Recovery Index (UWRI), and quantitative sensory testing.

RESULTS

There was large and statistically significant improvement at 8 and 12 weeks for average knee pain (ηp2 = 0.334, p < 0.001), worst knee pain (ηp2 = 0.351, p < 0.001), SLSD (ηp2 = 0.161, p = 0.001), AKPS (ηp2 = 0.463, p < 0.001), and UWRI (ηp2 = 0.366, p < 0.001). A medium to large effect and statistically significant improvement in pressure pain threshold testing was found for all local and remote structures (ηp2 range, 0.110 to 0.293, range p < 0.001 to p = 0.009) at 8 and 12 weeks.

CONCLUSIONS

There was a significant decrease in local and remote hyperalgesia via mechanical and thermal pain sensitivity testing in female runners with chronic PFP. There was a large effect and significant improvement in self-reported pain and function.

Optimizing primary health care in Burkina Faso: an approach informed by EQUIST

Introduction

Burkina Faso has made access to primary health care a national priority by including it in the 2021-2030 national health development plan.

Purpose of research

Our study aimed to analyze the causes of inequalities in access to primary health care, priority interventions and strategies for strengthening primary health care, and their potential impact on reducing maternal and infant mortality.

Results

Diarrheal diseases, malaria, and pneumonia are the main causes of inequalities in infant and child deaths in rural areas. As for maternal deaths, abortion and its complications are the main causes of inequalities in deaths associated with hypertensive disorders. The Sahel, Boucle du Mouhoun, Center-North, East, and Cascades regions are the geographical areas where interventions are essential to reduce inequalities in maternal, neonatal, infant and child deaths and malnutrition.

Conclusions

The national priorities have included all the high-impact interventions for strengthening primary health care identified in our study. Interventions must prioritize the populations in rural areas, the most affected and high-impact geographical regions. This requires the involvement and empowerment of beneficiary communities and the consideration of the fragile safety context.

Effectiveness of the "Evidence-Based Scientific Exercise Guidelines" in Increasing Cardiorespiratory Fitness, Cardiometabolic Health, and Muscle Strength in Acute Spinal Cord Injury Rehabilitation: A Systematic Review

Objective

To determine the effect of exercise and physical activity interventions that meet current guideline recommendations on cardiorespiratory fitness, cardiometabolic health, and muscle strength in adults in the acute stage (<1 year post onset) of spinal cord injury (SCI) rehabilitation.

Data Sources

Six electronic databases (PubMed, CINAHL, SPORTDiscus, Google Scholar, National Institute Clinical Excellence, World Health Organization) were searched (January 2016-March 2022) to extend a previously published review.

Study Selection

Included studies implemented exercise interventions in the acute stage of SCI rehabilitation participants which met the exercise guidelines and measured cardiorespiratory fitness, cardiometabolic health, and strength outcomes.

Data Extraction

Titles and abstracts were screened against eligibility criteria and duplicates removed using EndNote X8. Full texts were independently assessed and results presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart. Data extraction was completed on included studies by 2 reviewers (L.R. and V.B.) using a modified Cochrane Group form.

Data Synthesis

Data were synthesized, appraised using the Modified Downs & Black checklist and presented in narrative and tabular format. This review was registered on PROSPERO (Register ID:CRD42021249441). Of the 1255 studies, 4 were included, featuring 108 total participants <1-year post-SCI. Functional electrical stimulation cycle ergometry reduced muscle atrophy after 3 months training and increased lean body mass after 6 months. Resistance training increased muscle peak torque, perceived muscle strength and function. Aerobic exercise interventions did not increase cardiorespiratory fitness.

Conclusions

Interventions meeting the exercise guidelines did not increase cardiorespiratory fitness but were shown to improve cardiometabolic health and perceived muscle strength and function in adults in the acute stage of SCI rehabilitation. Further empirical research using standardized outcome measures are required to explore the effectiveness of aerobic exercise and strengthening interventions in acute stage of SCI rehabilitation to support the development of exercise guidelines.

Strategies for maintaining and strengthening the health care workers during epidemics: a scoping review

INTRODUCTION

During epidemics such as COVID-19, healthcare workers (HCWs) face several challenges, leading to a shortage and weakening of human resources. To address this issue, employing effective strategies is essential in maintaining and strengthening human resources during outbreaks. This study aimed to gather and classify strategies that could retain and strengthen human health resources during epidemics.

METHODS

In this scoping review, all studies published about strategies for maintaining and strengthening HCWs in epidemics were collected from 4 international databases, including PubMed, Embase, Scopus, and Web of Science. The English language articles published after 2000 up until June 2022 recommended specific strategies regarding the research question. Then, they were analyzed and classified according to thematic analysis based on Braun and Clarke 6 phases protocols.

RESULTS

In total, 9405 records were screened, of which 59 articles were included, and their full texts were reviewed. Fifty factors were identified and classified into five themes: Instruction, Protection, Supporting, Caring, and Communication. Most of the suggestions were conducted in high-income countries and related to the Supporting theme.

DISCUSSION

The majority of strategies discussed in the literature addressed only one or two aspects of human resources. This study provides a holistic perspective on these issues by providing a thematic map of different strategies for strengthening and maintaining HCWs during epidemics. Considering the multidimensionality of human nature, it is suggested that policymakers and managers of health systems provide facilities that simultaneously address a wide range of needs.

Effect of case hardening on the wear and hardness properties of medium carbon steel for bone crushing application

The majority of wear-related problems are connected to crushing machines because hammer failure frequently causes machine failure which eventually leads to machine downtime. Therefore, improving the reliability of crushing materials is necessary for effective production. This research investigation focused on the development of crushing material with appropriate strength properties that can function in critical, impact-prone, corrosive, and abrasive conditions. The current study used palm kernel shell, coconut shell, and sawdust powder as the media for medium carbon steel in order to valorize the agro waste. Carburising media PKS-composition, CS-composition, and SD-composition were changed to 40%: 30%: 30%, PKS-composition 100%, CS-composition 100%, and SD-composition 100%. The process was carried out in 1 h (60 mims), 1 h:30 min (90 min), 2 h (120 min), 2 h:30 (150 min), and 3 h (180 min) soak period with varied carburising temperatures of 900, 950, 1000, and 1050 °C. However, several characterisation and mechanical tests were carried out using an optical microscope, a spark spectrometer, a scanning electron microscope coupled with an energy dispersive spectrometer, wear tester to explore their microstructural features. Vicker's hardness tester, sliding wear tester, and a thermal gravimetric analysis testing machine were also employed. In order to establish reasons for failure other than the cyclic loading on the materials, the results were compared with the properties of as-received un-failed, and carburised medium carbon steel. The results of carburisation show that PKS penetrates carbon at a rate that is noticeably higher than that of other materials at various temperatures and times, indicating that carbon diffuses deeply into the material. Hence, this enhances the wear resistance, and sample's hardness number but decreased its impact toughness respectively.

Disinsertion-distal myectomy and tucking of inferior oblique combined with superior oblique full tendon advancement in superior oblique palsy

PURPOSE

To assess the preliminary outcomes of inferior oblique (IO) disinsertion-distal myectomy and tucking combined with superior oblique (SO) full tendon advancement in patients with Knapp II or III superior oblique palsy.

METHODS

This single-centered retrospective study included 16 eyes from 13 patients with Knapp Class II or III SO palsy. All patients underwent IO disinsertion-distal myectomy and tucking combined with SO full tendon advancement while under general anesthesia. Pre- and post-operative levels of vertical deviation in the primary position, abnormal head position, IO hyperfunction and SO hypofunction, torsion, as well as the presence of diplopia, were all measured, and the differences were statistically compared.

RESULTS

Pre-operatively, 12 patients had abnormal head positions, and two had diplopia. The pre-and post-operative levels of IO hyperfunction and SO hypofunction, as well as a vertical deviation in the primary position and torsion, all differed statistically significantly (p < 0.01).

CONCLUSIONS

Inferior oblique disinsertion distal myectomy and tucking combined with SO full tendon advancement surgery appears to be an effective procedure in patients with congenital and acquired Knapp Class II or III SO palsy.

Brazilian Portuguese version and content validity of the Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH)

INTRODUCTION

The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) program is a personalized, progressive 12-week exercise program for people with hand problems due to rheumatoid arthritis (RA). Patients are provided with two guidance documents, the 'Patient Exercise Booklet' and the 'Personal Exercise Guide', to continue the exercises independently at home.

OBJECTIVE

This study aimed to translate and culturally adapt the SARAH protocol into Brazilian Portuguese and validate its content.

METHODS

The guidance documents 'Patient Exercise Booklet' and 'Personal Exercise Guide' of the SARAH program were translated and culturally adapted to Brazilian Portuguese. The content validity was obtained by calculating the content validity index (CVI).

RESULTS

The Brazilian version of the SARAH protocol reached semantic, idiomatic, conceptual, and cultural equivalences. The CVI was greater than 0.8, corresponding to a satisfactory index. The verbal comprehension was 4.9, showing good verbal comprehension of the target population.

CONCLUSION

The Brazilian Portuguese version of the SARAH protocol is available to Brazilian people with compromised hands due to RA with satisfactory content validity.

Biomass-derived polyphosphazene toward simultaneously enhancing the flame retardancy and mechanical properties of epoxy resins

As one of the most widely used polymers, the intrinsic brittleness and high flammability bring about a stringent requirement for the practical application of epoxy resins (EPs). It is difficult to toughen EP without compromising its mechanical and thermal properties for many conventional toughening agents. Here, a novel furan-derived bio-based polyphosphazene (PFMP) with a flexible backbone and rigid side groups was prepared by the nucleophilic substitution reaction between polydichlorophosphazene (PDCP) and furfuralcohol. The resultant PFMP was incorporated into EP to realize exceptional toughening, strengthening, and flame retardant function. By adding 15% of PFMP, the limit oxygen index value is from 25% (EP) to 33% (EP/PFMP-15) and reaches the UL-94 V-0 rating. According to the cone calorimeter results, EP/PFMP-15 exhibits exceedingly reduced peak heat release rate (pHRR) (50.2%) and total heat release (THR) (49.6%). The significantly increased fire performance index (FPI) and decreased fire growth rate index (FIGRA) of EP/PFMP-15 demonstrate an improvement in its flame retardancy. The catalytic carbonization effect (condensed phase) and radical quenching effect (gas phase) of PFMP account for the greatly improved flame retardancy. Moreover, the impact and tensile tests indicate that PFMP can ameliorate the mechanical performance of EP with a maximum increase of impact strength (111.8%) and elongation at break (35.2%) for EP/PFMP-5. With 15% PFMP added, the tensile strength of EP/PFMP-15 increases by 40.4%. This work demonstrates that PFMP is expected to overcome shortcomings (flammability, toughness, and strength) of EP and spread its applied fields.

Effects of the Counseling Program on Strengthening Mental-Crisis Management to Strengthen Adolescent Life Crisis Awareness

Background

A mental crisis is a dangerous state with many subsequent harmful effects on the adolescent. It is a state in which the adolescent needs help and must get that help immediately. If they do not receive the assistance they require, they may end up isolating themselves from social interaction and become completely preoccupied with themselves. The counseling program is therefore being put into effect to strengthen the mental crisis management capacity of adolescents and to offer counseling and assistance to students who find themselves beset with a mental crisis so that they will be fully able to manage their mental crises, restore a sense of balance to their psyches, and carry on with their lives effectively.

Objective

The aim of the study was to compare the life crisis awareness scores of adolescent students enrolled in a program of study at Thammasat University.

Methods

This research was quasi-experimental and consisted of a two-group pretest-post test design. They were subdivided into two groups of 30 students each by simple random sampling, of which one group was the experimental group and the other was control group. The experimental group underwent a counseling program of bolstering mental crisis management capacity once a week for a period of six weeks. Results were assessed using a crisis awareness evaluation form. Results were assessed twice, before testing and after testing. The data were analyzed by the statistics of percentage, mean, dependent t-test, and independent t-test.

Results

1. The average life crisis awareness scores of the adolescents in the experimental group following acceptance into the counseling program by fortifying their mental crisis management capacity (M=132.77, SD=11.03) were higher than they were prior to program entry (M=113.73, SD=14.40), with a statistical significance (t=6.81, p<0.001).2. The average life crisis awareness scores of the experimental group that had been accepted into the above-mentioned counseling program were higher after undergoing testing (M=132.77, SD=11.03) than the scores for the control group (M=118.83, SD=10.73), with a statistical significance (t=4.95, p<0.001).

Conclusion

This program thus helps the adolescent restore a sense of mental balance and live a normal happy life.

Effect of ultrasonic vibration on adhesive enhancement of plasma-modified nickel surface

Poor adhesion of nickel surface limits its further application in the aerospace field. In this study, plasma modification was conducted on the surface of the nickel plate pretreated by sandblasting, and then ultrasonic vibration was applied during the adhesively bonding process of the CFRP(Carbon fibre-reinforced polymer)/Ni joints. The bonding strength of the joints was increased by 65%. The adherend surface and the bonding interface were analyzed from microstructure, element distribution and chemical bonding to study the strengthening mechanism. By the sandblasting, irregular pits were formed on the nickel surface, effectively increasing the surface roughness. The plasma modification could introduce active functional groups including hydroxyl, amino and carbonyl on the nickel surface, which improved the surface wettability macroscopically. However, at a microscopic level, the adhesive with high viscosity and poor fluidity did not form a compact interface with the nickel. The ultrasonic application could promote the filling of the adhesive in irregular micro-scale pits on the surface, thereby strengthening the mechanical anchoring effect. Furthermore, the ultrasonic application produced dynamic impingement at the interface, enhancing the contact between the adhesive and the nickel plate. The adhesive molecules could fully collide and react with the active functional groups introduced on the nickel surface to form more chemical bonds, thus effectively improving the bonding strength of the CFRP/Ni joints.

Gelatin from leather waste to tough biodegradable packaging film: One valuable recycling solution for waste gelatin from leather industry

Large amount of gelatin can be extracted from the solid waste in leather industry. The advanced application of such gelatin is always desired by the leather industry, but remains challenging. Considering the urgent requirement of biodegradable plastic film, in this study, the gelatin extracted from waste skin scrap in the leather industry was used to fabricate a waste gelatin-based film with a high gelatin content, excellent mechanical performance, and autonomous biodegradability in natural soil. The film was prepared by introducing covalent bonds and metal-ligand bonds to the gelatin matrix. These covalent bonds, metal-ligand bonds, and inherent hydrogen bonds in the gelatin matrix serve as multiple sacrificial bonds for effective energy dissipation giving the waste gelatin-based film excellent mechanical parameters with the highest fracture stress of ≈ 32 MPa, maximum fracture strain of ≈1.25 mm/mm, and a high Young's modulus of ≈ 471 MPa, which are significantly higher than those of the original gelatin film (fracture stress ≈ 4 MPa, fracture strain ≈ 0.70 mm/mm, and Young's modulus ≈ 22 MPa). Owing to the water resistance of covalent bonds and metal-ligand bonds existed in gelatin matrix, the gelatin film possesses good water resistance. Additionally, after use, the fabricated film can completely biodegrade in natural soil in approximately 7 weeks. This strategy not only provides a valuable recycling solution for the gelatin from the unwelcome solid waste of the leather industry, but it also broadens the range of ecofriendly and cost effective biodegradable films available.

Intensive physiotherapy versus home-based exercise and custom-made orthotic insoles in patients with plantar fasciitis: Pilot study

BACKGROUND

This prospective pilot study assessed the feasibility of comparing intensive physiotherapy group (IPG), home-based exercise (HBEG) group, and insole group (IG) to find the most effective treatment program for plantar fasciitis.

METHODS

Thirty-nine individuals with plantar fasciitis were selected to participate in this pilot study. The patients were randomly divided into 3 groups, as IPG (manual interventions, exercise, insoles), HBEG (exercise, insoles), and IG (insoles). The feasibility details including percentage of the enrollment and adherence to the groups were recorded. Pain was measured with a visual analog scale, and dorsiflexion range of motion (DROM), foot function, and health-related quality of life were evaluated at the baseline and week 6. One-way ANOVA analysis and Kruskal Wallis test were used to determine the differences of the percentage change of the parameters.

RESULTS

Pain and functional evaluation results showed improvements clinically in all of groups and quality of life results were similar for all groups. There was no difference between the groups after 6 weeks of treatment (P > 0.05).

CONCLUSIONS

The 3 treatment programs were found clinically applicable with high patient adherence. According to the data all intervention types were found moderately effective for pain and function. Insoles could be an option applied alone or with other treatments, and manual techniques gave better results in patients with limited ankle dorsiflexion. Although the results should be interpreted with caution because of the small sample size, these results were found promising and feasible to conduct a future RCT.

CLINICAL TRIAL REGISTRATION NUMBER

RCT 06144834.

Effects of adding aerobic physical activity to strengthening exercise on hip osteoarthritis symptoms: protocol for the PHOENIX randomised controlled trial

BACKGROUND

Hip osteoarthritis (OA) is a leading cause of musculoskeletal pain. Exercise is a core recommended treatment. Most evidence is based on muscle-strengthening exercise, but aerobic physical activity has potential to enhance clinical benefits. The primary aim of this study is to test the hypothesis that adding aerobic physical activity to a muscle strengthening exercise leads to significantly greater reduction in hip pain and improvements in physical function, compared to a lower-limb muscle strengthening exercise program alone at 3 months.

METHODS

This is a superiority, 2-group, parallel randomised controlled trial including 196 people with symptomatic hip OA from the community. Following baseline assessment, participants are randomly allocated to receive either i) aerobic physical activity and muscle strengthening exercise or; ii) muscle strengthening exercise only. Participants in both groups receive 9 consultations with a physiotherapist over 3 months. Both groups receive a progressive muscle strengthening exercise program in addition to advice about OA management. The aerobic physical activity plan includes a prescription of moderate intensity aerobic physical activity with a goal of attaining 150 min per week. Primary outcomes are self-reported hip pain assessed on an 11-point numeric rating scale (0 = 'no pain' and 10 = 'worst pain possible') and self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index physical function subscale) at 3 months. Secondary outcomes include other measures of self-reported pain (assessed at 0, 3, 9 months), self-reported physical function (assessed at 0, 3, 9 months), performance-based physical function (assessed at 0, 3 months), joint stiffness (assessed at 0, 3, 9 months), quality of life (assessed at 0, 3, 9 months), muscle strength (assessed at 0, 3 months), and cardiorespiratory fitness (assessed at 0, 3 months). Other measures include adverse events, co-interventions, and adherence. Measures of body composition, serum inflammatory biomarkers, quantitative sensory measures, anxiety, depression, fear of movement and self-efficacy are included to explore causal mechanisms.

DISCUSSION

Findings will assist to provide an evidence-based recommendation regarding the additional effect of aerobic physical activity to lower-limb muscle strengthening on hip OA pain and physical function.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry reference: ACTRN 12619001297112. Registered 20th September 2019.

The supralaryngeal articulation of stress and accent in Greek

It is well reported that articulatory movements comprising prominence units are longer, larger and faster than their non-prominent counterparts. However, it is unclear whether these effects arise at the level of lexical stress or accent or both, reflecting a hierarchy of prominence, i.e., being stronger when induced by accent as opposed to stress. It is also uncertain whether prominence-induced kinematic effects are invariant across positions of stress within the word, types of focus the accent denotes, and positions of words in the phrase. We conduct an electromagnetic articulography (EMA) study to assess the supralaryngeal kinematic correlates of prominence in Greek across three stress positions (antepenultimate, penultimate, ultimate; i.e., all possible stress positions in Greek), two accentual conditions (accented and de-accented) and two phrasal positions (phrase-medial and phrase-final). Focus type is also considered, with the accentual conditions coming from two types of focus (broad and narrow), while the de-accented conditions are by default unfocused. Our results indicate that stressed syllables involve longer, larger and faster gestures than their unstressed counterparts, regardless of the position of stress within the word. Notably, variation in velocity is accounted for by variation in displacement. Presence of accent does not further expand the stressed gestures, although it is related to minimal kinematic changes across the whole word, the exact profile of which depends on stress position. With the exception of final vowel duration, focus type is not systematically encoded in these kinematic effects. Finally, interactions are detected between the kinematic profile of prominence and that of boundaries. Implications of our findings for the hierarchy of prominence and cross-linguistic differences are discussed, and a gestural account of prominence and boundaries is put forward.

Muscle strength gains after strengthening exercise explained by reductions in serum inflammation in women with knee osteoarthritis

Background Individuals with knee osteoarthritis have elevated circulating inflammatory markers and altered cartilage properties but it is unclear if these features adapt to exercise. We aimed to determine (1) whether inflammatory markers, cartilage transverse relaxation time and thickness mediate the effect of body mass index (BMI) on quadriceps strength at baseline; and (2) whether these changes explain variance in quadriceps strength improvements after 12 weeks of exercise in women with knee osteoarthritis. Methods This secondary analysis (17 women with clinical knee osteoarthritis) of a randomized control trial compared supervised group interventions, 3 times/week for 12 weeks (36 sessions): (a) weight-bearing progressive resistive quadriceps exercise or (b) attention control. (1) From baseline, separate linear regressions were conducted with strength (Nm/kg) as the dependent, BMI as the predictor, and c-reactive protein, tumor necrosis factor, interleukin-6, cartilage transverse relaxation time or thickness as potential mediators. (2) Multiple linear regression analyses were completed with 12-week strength change (post-pre) as the dependent, change in serum inflammatory markers and cartilage measurements as predictors, and age, BMI and adherence as covariates. Findings (1) At baseline, there was no mediation. (2) A decrease in each of interleukin-6 (β = -0.104 (95% confidence intervals: -0.172, -0.036), R² = 0.51, P < 0.007) and tumor necrosis factor (β = -0.024 (-0.038, -0.009), R² = 0.54, P < 0.005) was associated with strength gains. Interpretation At baseline, inflammatory markers and cartilage measurements do not act as mediators of BMI on quadriceps strength. After 12 weeks of exercise, reduced interleukin-6 and tumor necrosis factor were associated with increased quadriceps strength in women with knee osteoarthritis.

Effects of bi-axial ankle strengthening on muscle co-contraction during gait in chronic stroke patients: A randomized controlled pilot study

INTRODUCTION

Ankle dysfunction in patients with stroke is a common but serious cause of balance and gait impairments. However, comprehensive paretic ankle training seldom exists. Thus, we investigated the effects of a bi-axial ankle muscle training program using visual feedback as a means to improve ankle strength and performance of functional activities in patients with stroke.

METHODS

This study was a randomized controlled pilot trial with concealed allocation and assessor blinding and intention-to-treat analysis. Twenty-five patients with stroke and difficulty in walking (e.g., foot drop) or ankle muscle weakness receiving inpatient rehabilitation were included. The experimental group underwent ankle muscle training consisting of passive stretching, control of ankle muscles, and active-resistive strengthening using visual feedback for 40 min per day, 5 times per week for 4 weeks. The control group underwent ankle-related physical therapy, including ankle range-of-motion exercises. The amount of time for training was equal between the two groups. The outcome measurements were isometric ankle contraction force to assess the strength of ankle muscles, ankle proprioception, Fugl-Meyer lower extremity score, Berg balance scale score, walking speed, and ankle co-contraction index to assess muscle efficiency during gait.

RESULTS

The analysis revealed significant between-group differences in the ankle muscle strength in each direction (P < 0.05), Fugl-Meyer score (P < 0.01), and stance-phase co-contraction index (P < 0.05). After training, the experimental group displayed significant within-group differences in the strength of the ankle muscles in each direction (P < 0.01), ankle proprioception (P < 0.05), and walking speed (P < 0.05).

CONCLUSIONS

Our findings demonstrate the significant short-term effects of ankle muscle training on strength, walking speed, and muscle efficiency in patients with chronic stroke.

A review on alloy design, biological response, and strengthening of β-titanium alloys as biomaterials

From the past few years, developments of β-Ti alloys have been the subject of active research in the medical domain. The current paper highlights significant findings in the area of β-Ti alloy design, biological responses, strengthening mechanisms, and developing low-cost implants with a high degree of biocompatibility. It is evident that an astonishing demand for developing the low modulus-high strength implants can be fulfilled by synchronizing β stabilizer content and incorporating tailored thermo-mechanical techniques. Furthermore, the biological response of the implants is as important as the physical properties that regulate healing response; hence, the optimum selection of alloying elements plays a curial role for clinical success. The paper also presents the evolution of patents in this field from the year 2010 to 2020 showing the relevant innovations that may benefit a wide range of researchers.

Glucaric acid additives for the antiplasticization of fibers wet spun from cellulose acetate/acetic acid/water

Cellulose acetate (CA) receives notable attention as an environmentally friendly, biodegradable polymer from renewable, low-cost resources. CA polymers are believed to have a critical role in shaping a greener and more circular textile economy. However, the mechanical properties of CA fibers are among the lowest in terms of its tensile strength, poor wet strength, and low flexural strength. This study investigates the effect of biobased additives for antiplasticizing the mechanical performance and structure of CA fibers. At up to 5 % of CA, glucaric acid (GA) and its monoammonium salt were added to CA fibers. With 1.5 % GA additive, tensile modulus improved by 155%, tensile strength by 55 %, and CA flexibility according to knot to straight fiber tenacity ratios improved by 107 % when compared to neat CA fibers. Based on the results, green small molecule antiplasticizers do exist, but their performance improvements are observed at low percentages of loading.

Chromium carbide micro-whiskers dataset: Morphologies with scanning and transmission electronic microscopy

Chromium carbide exhibits a superior set of mechanical properties and chemical stabilities and is widely used in various engineering applications. Here, micro-whiskers of the Cr₂O₃ were successfully prepared using a carbothermal reduction method with high energy milling and liquid phase catalysis. The whiskers growth was observed with scanning electron microscopy and field emission gun transmission electron microscopy. This dataset shows all kinds of morphologies of the Cr₂O₃ whiskers during the growth stage, including agglomerated, pointed, and non-whiskered shapes, which are products of the mixture of Cr₂O₃:C = 1:5 or 1:8 or 1:10 under different temperatures and duration time. These data provide important additional information different from the source article but complement it with some negative but indicative and instructive data. Experimental scientists who want to investigate the growth and strengthening of whiskers of Cr₂O₃ or others can refer to and benefit from these data, such as possible combinations of the experimental conditions which may lead to certain outcomes and guide the predictive design of future relevant research with similar materials system.

Constructing a robust chrome-free leather tanned by biomass-derived polyaldehyde via crosslinking with chitosan derivatives

Tanning leather using green biomass-derived polyaldehyde (BPA) is a promising approach to eliminate the widespread Cr pollution in leather industry, but unsatisfactory thermal stability and mechanical strength of the correlated resultant leather limited its industrial application. Herein, we report a green methodology to strengthen BPA tanned leather via introducing chitosan derivatives to crosslink with free aldehyde groups on dialdehyde carboxymethylcellulose (DCMC) tanned leather. H₂O₂ was employed for purposely modifying chitosan to prepare low-molecular chitosan (LMC) with lower positive charge. The interactions between chitosan/LMC and DCMC were investigated to elucidate the strengthening mechanism. Owing to the weakened hydrogen bonding network and higher accessibility of amino groups on LMC, LMC could react much easier with aldehyde groups on DCMC. Moreover, LMC could efficiently penetrate into the internal fiber networks of leather for further interlocking, which enhanced the thermal stability and the lubricating degree of crust leather and, as a result, the tensile and tear strengths were significantly improved by 79.3% and 25.3%, respectively. Therefore, the use of LMC can promote the widespread application of BPA tanned leather, benefiting to the complete elimination of hazardous Cr pollution.

Russian current versus high voltage current with isokinetic training on the quadriceps muscle strength and endurance

Electrotherapy modalities are one of the increasing ways of muscle strength and endurance. However, it is not clear which electrotherapy modalities are more effective. The purpose of this study is to compare the effect of Russian current (RC) and high voltage pulsed current (HVPC) on the strength and endurance of the quadriceps muscle. The study was performed on 10 volleyball athletes. The participants' extremities were divided into two groups as RC and HVPC. Muscle strength and endurance levels were assessed by an isokinetic device. Isokinetic training and 20-min electrotherapy were given in each treatment session. This training program consisted of a total of 12 sessions, scheduled twice a week for 6 weeks. After training, knee extensor peak torque values and endurance ratios have increased in both groups, but it was determined that this increase was only significant in terms of the endurance ratio (P<0.05). There was no significant difference between the muscle strength and the endurance ratio of the RC and HVPC groups (P>0.05). RC or HVPC have no advantages over each other, and therefore it has been determined that both currents can be used in order to strengthen muscles and increase muscular endurance. Additional studies whose longer-term effects will investigate are needed.

What type of exercise is most effective for people with knee osteoarthritis and co-morbid obesity?: The TARGET randomized controlled trial

OBJECTIVE

Different exercise types may yield different outcomes in osteoarthritis (OA) subgroups. The objective was to directly compare effectiveness of two exercise programs for people with medial knee OA and co-morbid obesity.

DESIGN

We performed a participant- and assessor-blinded randomized controlled trial. 128 people ≥50 years with medial knee OA and body mass index ≥30 kg/m² were recruited from the community. Interventions were home-based non-weight bearing (NWB) quadriceps strengthening or weight bearing (WB) functional exercise for 12 weeks. Primary outcomes were change in overall knee pain (numeric rating scale, range 0-10) and difficulty with physical function (Western Ontario and McMaster Universities Osteoarthritis Index, 0-68) over 12 weeks. Secondary outcomes included other pain measures, physical function, quality-of-life, global changes, physical performance, and lower-limb muscle strength.

RESULTS

123 (96%) participants were retained. There was no evidence of a between-group difference in change in pain (mean difference 0.73 units (95% confidence intervals (0.05,1.50)) or function (2.80 units (-1.17,6.76)), with both groups reporting improvements. For secondary outcomes, the WB group had greater improvement in quality-of-life (-0.043 units (-0.085,-0.001)) and more participants reporting global improvement (overall: relative risk 1.40 (0.98,2.01); pain 1.47 (0.97,2.24); function 1.43 (1.04,1.98). Although adverse events were minor, more NWB group participants reported ≥1 adverse event (26/66 (39%) vs 14/62 (23%), p = 0.04).

CONCLUSIONS

Both exercise types similarly improved primary outcomes of pain and function and can be recommended for people with knee OA and obesity. WB exercise may be preferred given fewer adverse events and potential additional benefits on some secondary outcomes.

REGISTRATION

Prospectively registered (Australian New Zealand Clinical Trials Registry #12617001013358, 14/7/2017).

Efficacy and Safety of Abdominal Trunk Muscle Strengthening Using an Innovative Device in Elderly Patients With Chronic Low Back Pain: A Pilot Study

Objective

To examine the efficacy and safety of an innovative, device-driven abdominal trunk muscle strengthening program, with the ability to measure muscle strength, to treat chronic low back pain (LBP) in elderly participants.

Methods

Seven women with non-specific chronic LBP, lasting at least 3 months, were enrolled and treated with the prescribed exercise regimen. Patients participated in a 12-week device-driven exercise program which included abdominal trunk muscle strengthening and 4 types of stretches for the trunk and lower extremities. Primary outcomes were adverse events associated with the exercise program, improvement in abdominal trunk muscle strength, as measured by the device, and improvement in the numerical rating scale (NRS) scores of LBP with the exercise. Secondary outcomes were improvement in the Roland-Morris Disability Questionnaire (RDQ) score and the results of the locomotive syndrome risk test, including the stand-up and two-step tests.

Results

There were no reports of increased back pain or new-onset abdominal pain or discomfort during or after the device-driven exercise program. The mean abdominal trunk muscle strength, NRS, RDQ scores, and the stand-up and two-step test scores were significantly improved at the end of the trial compared to baseline.

Conclusion

No participants experienced adverse events during the 12-week strengthening program, which involved the use of our device and stretching, indicating the program was safe. Further, the program significantly improved various measures of LBP and physical function in elderly participants.

Grafted nanocellulose and alkaline nanoparticles for the strengthening and deacidification of cellulosic artworks

HYPOTHESIS

Strongly degraded cellulosic artworks usually need deacidification and consolidation. Alkaline nanoparticles are known to be effective in neutralizing the acidity, while cellulose nanocrystals have the potential to be used as compatible and effective strengthening agents.

EXPERIMENTS

We have grafted cellulose nanocrystals with oleic acid using a 1'1-carbonyldiimidazole-mediated procedure, to increase their dispersibility in organic solvents, and synthesized Ca(OH)₂ or CaCO₃ nanoparticles via a solvothermal process. Grafted nanocellulose and alkaline nanoparticles were used to prepare ethanol-based "hybrids". Prior to the application, the physico-chemical properties of nanocellulose dispersions and "hybrids" were studied by rheology and small-angle X-ray scattering.

FINDINGS

Cellulose nanocrystals were effectively grafted and stably dispersed in ethanol. It was shown that the use of ethanol as a dispersing medium, and the addition of alkaline nanoparticles act in a synergistic way, increasing the interactions between grafted cellulose nanocrystals, leading to the formation of clusters. These dispersions are thixotropic, a behavior particularly appealing to conservation purposes, since they can be applied in the liquid state, or, when a more confined application is required, they can be applied in a gel-like state. As a result of the application, an improvement in the mechanical properties of paper and an increase of pH were obtained.

Experimental data from strengthening bamboo reinforcement using adhesives and hose-clamps

The bamboo treatment process starts with cutting, soaking in water, draining in free air, reinforcing in the fireplace, first-stage adhesive coating, hose-clamp installation, second-stage adhesive coating, and sand resurfacing. Data was taken from experimental testing of bamboo materials and bond strength tests of bamboo reinforcement in the laboratory of the Faculty of Engineering, University of Brawijaya Malang. The aim of treating and strengthening bamboo reinforcement is to overcome low-load capacity and prevent collapse due to slippage in bamboo reinforced concrete elements. Adhesive coating is employed to increase durability and prevent water absorption, while installing hose-clamps increases bamboo reinforcement slip resistance. The process outlined here represents the way to approach bamboo reinforcement, and laboratory data is processed into graphic images and tables of bond strength of bamboo reinforcement providing the basis for further research. This article comprises a standard operating procedure for treatment of bamboo reinforcement, graphic images, documentation photos, and data tables. The data is related to “Enhancing bamboo reinforcement using a hose-clamp to increase bond-stress and slip resistance” [1].

Self-dosed and pre-determined progressive heavy-slow resistance training have similar effects in people with plantar fasciopathy: a randomised trial

QUESTION

For people with plantar fasciopathy, is a 12-week self-dosed heavy-slow resistance training program more beneficial than a 12-week pre-determined heavy-slow resistance training program?

DESIGN

A randomised trial with concealed allocation, partial blinding, and intention-to-treat analysis.

PARTICIPANTS

Seventy people with plantar fasciopathy confirmed on ultrasonography.

INTERVENTION

Both groups performed a repeated heel raise exercise in standing for 12 weeks. Participants in the experimental group were self-dosed (ie, they performed as many sets as possible with as heavy a load as possible, but no heavier than 8 repetition maximum). The exercise regimen for the control group was pre-determined (ie, it followed a standardised progressive protocol).

OUTCOME MEASURES

The primary outcome was the Foot Health Status Questionnaire pain domain. Secondary outcomes included: a 7-point Likert scale of Global Rating of Change dichotomised to 'improved' or 'not improved'; Patient Acceptable Symptom State defined as when participants felt no further need for treatment; and number of training sessions performed.

RESULTS

There was no significant between-group difference in the improvement of Foot Health Status Questionnaire pain after 12 weeks (adjusted MD -6.9 points, 95% CI -15.5 to 1.7). According to the Global Rating of Change, 24 of 33 in the experimental group and 20 of 32 in the control group were improved (RR = 1.16, 95% CI 0.83 to 1.64). Only four participants achieved Patient Acceptable Symptom State: three of 35 in the experimental group and one of 35 in the control group. No significant between-group difference was found in the number of training sessions that were performed (MD -2 sessions, 95% CI -8 to 3).

CONCLUSION

Self-dosed and pre-determined heavy-slow resistance exercise programs are associated with similar effects on plantar fasciopathy pain and other outcomes over 12 weeks. Advising people with plantar fasciopathy to self-dose their slow-heavy resistance training regimen did not substantially increase the achieved dose compared with a pre-determined regimen. These regimens are not sufficient to achieve acceptable symptom state in the majority of people with plantar fasciopathy.

REGISTRATION

ClinicalTrials.govNCT03304353.

Determining the most effective exercise for gluteal muscle activation in children with cerebral palsy using surface electromyography

BACKGROUND

Reduced lumbo-pelvic postural control is a common feature of gait in children with Cerebral Palsy (CP). These features are commonly attributed to insufficiency of the hip musculature as well as underlying bony geometry. Exercises aimed at strengthening the hip muscles are frequently prescribed in children with Cerebral Palsy (CP). There is a lack of evidence indicating the most effective exercises in targeting gluteal muscle activation in this population.

RESEARCH QUESTION

To determine the most effective exercise for gluteal muscle activation in children with CP.

METHODS

This was a cross-sectional study of children with CP. Surface EMG data from the gluteus medius (GMed) and maximus (GMax) on the more involved limb were recorded as participants completed 6 commonly prescribed gluteal strengthening exercises. EMG was assessed for peak activation, normalised to functional reference values.

RESULTS

Data from ten children (5 males, 5 females; mean +- SD age, 13+-3 years) were included for final analysis. The single leg bridge and step up were the most effective exercises for gluteal muscle activation. Differences in activation were found to be statistically significant using Friedman's rank test (GMax p = 0.0001, GMed p = 0.0023).

SIGNIFICANCE

This study is the first to show clear differences in activation across gluteal strengthening exercises in a CP population. Exercises which involve weight bearing through a single limb appear most effective in activating the target muscles i.e the single leg bridge and the step up. Exercises involving double limb support or open-chain movements were less effective. The results of this study indicate that careful exercise selection is required to achieve targeted muscle activation in a paediatric CP population. The results of this study will provide guidance for exercise prescription for gluteal strengthening in this population and will inform future research studies on the effectiveness hip muscle strengthening programmes in CP.

Health Professional Training and Capacity Strengthening Through International Academic Partnerships: The First Five Years of the Human Resources for Health Program in Rwanda

BACKGROUND

The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strengthening the capacity of academic institutions in Rwanda.

METHODS

The data for this organizational case study was collected through official reports from the Rwanda Ministry of Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors.

RESULTS

In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99 visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019. The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the establishment of additional partnerships and collaborations with the US academic institutions.

CONCLUSION

The milestones achieved by the HRH Program have been substantial although some challenges persist. These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning); ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected by a severe shortage of health professionals.

Energy dissipation in mammalian collagen fibrils: Cyclic strain-induced damping, toughening, and strengthening

As the fundamental structural protein in mammals, collagen transmits cyclic forces that are necessary for the mechanical function of tissues, such as bone and tendon. Although the tissue-level mechanical behavior of collagenous tissues is well understood, the response of collagen at the nanometer length scales to cyclical loading remains elusive. To address this major gap, we cyclically stretched individual reconstituted collagen fibrils, with average diameter of 145 ± 42 nm, to small and large strains in the partially hydrated conditions of 60% relative humidity. It is shown that cyclical loading results in large steady-state hysteresis that is reached immediately after the first loading cycle, followed thereafter by limited accumulation of inelastic strain and constant initial elastic modulus. Cyclic loading above 20% strain resulted in 70% increase in tensile strength, from 638 ± 98 MPa to 1091 ± 110 MPa, and 70% increase in toughness, while maintaining the ultimate tensile strain of collagen fibrils not subjected to cyclic loading. Throughout cyclic stretching, the fibrils maintained a steady-state hysteresis, yielding loss coefficients that are 5-10 times larger than those of known homogeneous materials in their modulus range, thus establishing damping of nanoscale collagen fibrils as a major component of damping in tissues. STATEMENT OF SIGNIFICANCE: It is shown that steady-state energy dissipation occurs in individual collagen fibrils that are the building blocks of hard and soft tissues. To date, it has been assumed that energy dissipation in tissues takes place mainly at the higher length scales of the tissue hierarchy due to interactions between collagen fibrils and fibers, and in limited extent inside collagen fibrils. It is shown that individual collagen fibrils need only a single loading cycle to assume a highly dissipative, steady-state, cyclic mechanical response. Mechanical cycling at large strains leads to 70% increase in mechanical strength and values exceeding those of engineering steels. The same cyclic loading conditions also lead to 70% increase in toughness and loss properties that are 5-10 times higher than those of engineering materials with comparable stiffness.

Comparison of the different retention appliances produced using CAD/CAM and conventional methods and different surface roughening methods

The purposes of this study are to conduct an in vitro comparison of the shear bond strength, breakage mode, and wire deformation of three different types of retainers and to compare the subsequent enamel surface changes. Two hundred seventy intact lower incisor teeth were embedded in acrylic blocks in pairs. Dead wire and CAD/CAM-fabricated and fiber-reinforced wires were applied to the teeth roughened with acid and Er:YAG or Er,Cr:YSGG laser. The surface roughness was observed by scanning electron and atomic force microscopy. The samples were analyzed for shear bonds. The dead wire and acid group were found to have the highest bonding strength and the strengths for all groups in which acid was used as an agent were found to be higher than others. Deformation of retainers was most noted in the dead wire-acid group. Among all the groups, the CAD/CAM-fabricated wire group showed the least deformation, with no deformation observed. In this study, it was determined that there is a significant correlation between ARI scores and agents. Consequently, acid etching was found to create more enamel surface roughness than laser groups. It was also seen that the combined use of the acid method and dead soft wire had the highest bond strength, even though it was not statistically significant. It was concluded that CAD/CAM-fabricated wire provides the opportunity for reuse in clinical applications due to its lack of deformation, being more conservative for the patient, and being more advantageous for the clinician in terms of session time, considering the residual adhesive amount left on the enamel surface.

Clinical and MRI changes of puborectalis and iliococcygeus after a short period of intensive pelvic floor muscles training with or without instrumentation : A prospective randomized controlled trial

PURPOSE

This study evaluates the impact of a 3-week period of intensive pelvic floor muscles training (PFMT), with or without instrumentation, on clinical and static magnetic resonance imaging (MRI) changes of puborectalis (PR) and iliococcygeus (IL) muscles.

METHODS

24 healthy young women were enrolled in the study and 17 achieved the 9 sessions of 30 min training exercises and conducted all assessments. Participants were randomly assigned in two training groups: voluntary contractions combined with hypopressive exercises (HYPO) or biofeedback exercises combined with transvaginal electrical stimulations (ELEC). Clinical and T2-weighted MRI assessments were realized before and after training.

RESULTS

Modified Oxford Grading System (MOGS) scores for left PR and perineal body significantly increased in the two groups (p = 0.039, p = 0.008), but MOGS score for right PR significantly increased only in HYPO (p = 0.020). Muscle volumes of right and left IL significantly decreased (p = 0.040, p = 0.045) after training as well as signal intensities of right and left PR (p = 0.040, p = 0.021) and thickness of right and left IL at mid-vagina location (p = 0.012, p = 0.011).

CONCLUSIONS

A short period of intensive PFMT induces clinical and morphological changes in PFMs at rest suggesting a decrease in IL volume and adipose content of PR. Although the results suggested that an intensive non-instrumented PFMT is as effective as an instrumented training, future controlled studies with greater sample sizes are needed to establish the relative and absolute effectiveness of each of the two interventions.

Enhancing anaerobic digestion and methane production of tetracycline wastewater in EGSB reactor with GAC/NZVI mediator

Packing nano mediators into anaerobic system is an attractive technology to strengthen refractory pollutant removal and methane production from wastewater, but is limited by the drawbacks such as easy loss and poor mass transfer. In this study, GAC/NZVI mediator was added into EGSB reactor to investigate the enhancement effects and mechanism for anaerobic digestion of tetracycline wastewater and its impacts on microbial community structure. The results indicated that GAC/NZVI could enhance COD and TOC removal by 12.1% and 10.3%, while have no evident influence on tetracycline removal and sulfide production. The biogas production and methane content were increased by 21.2% and 26.9%, respectively. GAC/NZVI addition resulted in formation of densely packed aggregates, and evidently increased the electrical conductivity and EPS content in sludge. Fe content in sludge was 20.43% with the loss of only 5.4% during 34 d operation. Microbial community analysis revealed that GAC/NZVI addition could both increase the Chao 1 richness index and Shannon diversity index of bacteria and archaea. It was notable that total methanogens contents increased from 74.7% to 81.74% at genera level, resulting in higher methane production, while Treponema increase might promote the degradation of tetracycline and its metabolite, leading to higher COD removal.

Quadriceps combined with hip abductor strengthening versus quadriceps strengthening in treating knee osteoarthritis: a study protocol for a randomized controlled trial

Background

Lower limb strengthening, especially the quadriceps training, is of much necessity for patients with knee osteoarthritis (KOA). Previous studies suggest that strengthening of the hip muscles, especially the hip abductor, can potentially relieve the KOA-associated symptoms. Nevertheless, the effects of quadriceps combined with hip abductor strengthening remain unclear. Therefore, the current randomized controlled trial is designed aiming to observe whether quadriceps in combination with hip abductor strengthening can better improve the function and reduce pain in KOA patients than quadriceps training alone.

Methods

A total of 80 subjects with symptomatic KOA will be recruited from the communities and hospital outpatient, and will be randomly assigned to the experiment group (Quadriceps-plus-hip-abductor-strengthening) or the control group (Quadriceps-strengthening). Specifically, participants in the experiment group will complete 4 exercises to train the quadriceps and hip abductor twice a day for 6 weeks at home, while those in the control group will only perform 2 exercises to strengthen the quadriceps. Besides, all patients will also receive usual care management, including health education and physical agent therapy when necessary. Knee pain will be measured using the Visual Analogue Scale (VAS) at baseline, in every week during the course of treatment, as well as 8 and 12 weeks after randomization. Furthermore, knee function will be measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale, and the quality of life will be measured using the MOS Item Short-form Health Survey (SF-36). In this study, several simple tests will be applied to assess the objective function. All the assessments except for VAS will be carried out at baseline, and in the 6th, 8th and 12th weeks respectively.

Discussion

Our findings will provide more evidence for the effects of hip abductor strengthening on relieving pain and improving function in KOA patients. Hip abductor strengthening can be added into the muscle training program for KOA patients as a supplementary content if it is proved to be effective.

Trial registration

The current study has been registered with the Chinese Clinical Trials Registry (the registration number is ChiCTR-IOC-15007590, 3rd December, 2015).

A service evaluation and improvement project: a three year systematic audit cycle of the physiotherapy treatment for Lateral Epicondylalgia

OBJECTIVES

To improve outcomes of physiotherapy treatment for patients with Lateral Epicondylalgia.

DESIGN

A systematic audit and quality improvement project over three phases, each of one year duration.

SETTING

Salford Royal NHS Foundation Trust Teaching Hospital Musculoskeletal Physiotherapy out-patients department.

PARTICIPANTS

n=182.

INTERVENTIONS

Phase one - individual discretion; Phase two - strengthening as a core treatment however individual discretion regarding prescription and implementation; Phase three - standardised protocol using high load isometric exercise, progressing on to slow combined concentric & eccentric strengthening.

MAIN OUTCOME MEASURES

Global Rating of Change Scale, Pain-free grip strength, Patient Rated Tennis Elbow Evaluation, Tampa Scale of Kinesophobia-11.

RESULTS

Phase three demonstrated a reduction in the average number of treatments by 42% whilst improving the number of responders to treatment by 8% compared to phase one. Complete cessation of non-evidence based treatments was also observed by phase three.

CONCLUSIONS

Strengthening should be a core treatment for LE. Load setting needs to be sufficient. In phase three of the audit a standardised tendon loading programme using patient specific high load isometric exercises into discomfort/pain demonstrated a higher percentage of responders compared to previous phases.

Strengthening mechanisms, deformation behavior, and anisotropic mechanical properties of Al-Li alloys: A review

Al-Li alloys are attractive for military and aerospace applications because their properties are superior to those of conventional Al alloys. Their exceptional properties are attributed to the addition of Li into the Al matrix, and the technical reasons for adding Li to the Al matrix are presented. The developmental history and applications of Al-Li alloys over the last few years are reviewed. The main issue of Al-Li alloys is anisotropic behavior, and the main reasons for the anisotropic tensile properties and practical methods to reduce it are also introduced. Additionally, the strengthening mechanisms and deformation behavior of Al-Li alloys are surveyed with reference to the composition, processing, and microstructure interactions. Additionally, the methods for improving the formability, strength, and fracture toughness of Al-Li alloys are investigated. These practical methods have significantly reduced the anisotropic tensile properties and improved the formability, strength, and fracture toughness of Al-Li alloys. However, additional endeavours are required to further enhance the crystallographic texture, control the anisotropic behavior, and improve the formability and damage tolerance of Al-Li alloys.

Effects of hip and trunk muscle strengthening on hip function and lower limb kinematics during step-down task

BACKGROUND

Strengthening of the hip and trunk muscles has the potential to change lower limb kinematic patterns, such as excessive hip medial rotation and adduction during weight-bearing tasks. This study aimed to investigate the effect of hip and trunk muscles strengthening on hip muscle performance, hip passive properties, and lower limb kinematics during step-down task in women.

METHODS

Thirty-four young women who demonstrated dynamic knee valgus during step-down were divided into two groups. The experimental group underwent three weekly sessions of strengthening exercises for eight weeks, and the control group continued their usual activities. The following evaluations were carried out: (a) isokinetic maximum concentric and eccentric work of hip lateral rotators, (b) isokinetic hip passive torque of lateral rotation and resting transverse plane position, and (c) three-dimensional kinematics of the lower limb during step-down.

FINDINGS

The strengthening program increased concentric (P<0.001) and eccentric (P<0.001) work of hip lateral rotators, and changed hip resting position toward lateral rotation (P<0.001). The intervention did not significantly change hip passive torque (P=0.089, main effect). The program reduced hip (P=0.002), thigh (P=0.024) and shank (P=0.005) adduction during step-down task. Hip, thigh and knee kinematics in transverse plane and foot kinematics in frontal plane did not significantly modify after intervention (P≥0.069, main effect).

INTERPRETATION

Hip and trunk strengthening reduced lower limb adduction during step-down. The changes in hip maximum work and resting position may have contributed to the observed kinematic effects.

Effect of rotator cuff strengthening as an adjunct to standard care in subjects with adhesive capsulitis: A randomized controlled trial

STUDY DESIGN

Randomized controlled trial.

PURPOSE OF THE STUDY

To study the effect of adding rotator cuff (RC) muscles strengthening to joint mobilization and transcutaneous electrical nerve stimulation (TENS) in patients with adhesive capsulitis.

METHODS

A prospective, parallel-group, randomised clinical trial was conducted on 42 patients. One group received TENS and joint mobilization and in the other group RC muscles strengthening was added. Treatment was given for 12 sessions within 4 weeks.

RESULTS

When compared between the groups statistically significant changes were seen in all the outcome measures in the group that received RC muscle strengthening exercises vs TENS and mobilization. VAS 12.76 ± 1.04 vs 4.05 ± 1.32; SPADI 34.66 ± 6.69 vs 54.29 ± 12.17; PFPS 3.06 ± 0.80 vs 4.70 ± 0.81; and ROM (elevation >125 vs >110 degrees and rotations >70 vs >48 degrees).

CONCLUSIONS

Addition of a structured RC strengthening program to TENS and joint mobilization in the treatment of adhesive capsulitis resulted in improvement in pain, ROM and function.

LEVEL OF EVIDENCE

1b.

The contribution of the polio eradication initiative to narrowing the gaps in the health workforce in the African Region

INTRODUCTION

The Global Polio Eradication Initiative (GPEI) massively invested to overcome the crippling disease in countries of the WHO African Region. In the context of economic crisis, almost all countries in the Region lack an adequate health workforce. Large amounts were invested by GPEI in human resources. This paper shows how the human resources funded by polio contributed to narrowing the gaps in health workforce and helped strengthening and supporting other priority health programmes in Angola, Chad, DRC, Nigeria, Tanzania, and Togo.

METHODS

The health workforce strengthening methods used in the five different countries included the following: policy development and strategic planning, microplanning, capacity building of public health and community workers, implementation and services, monitoring and evaluation, advocacy and social mobilization, and programme review.

RESULTS

Staff funded by polio helped with achieving good coverage in vitamin A and insecticide-treated mosquito nets (Angola, Chad); improvement of EPI and integrated disease surveillance indicators, improved quality of data (all five countries), administrative support, smooth introduction of new vaccines, increased case detection, and early isolation of patients suffering from the Guinea worm (Chad); reduction of cholera, extension of directly observed TB short course treatment (Democratic Republic of Congo); significant staff performance improvement (Nigeria).

DISCUSSION

GPEI investment achieved far beyond its primary goal, and contributed to narrowing the gaps in the health workforce in countries of the African Region, as demonstrated by the best practice documentation exercise. We recommend that expertise and experience of polio funded staff should be leveraged to strengthen, expand and support other public health programmes.

Large strengthening effect of a hip-flexor training programme: a randomized controlled trial

PURPOSE

To investigate the effect on hip-flexion strength of a 6-week hip-flexor training programme using elastic bands as resistance. We hypothesized that the training group, compared to a control group, would increase their hip-flexion strength more.

METHODS

Thirty-three healthy subjects (45 % females), 24(5) years of age, were included in a randomized controlled trial and allocated to heavy strength training of the hip-flexor muscles or to control (no strength training). Strength training of the hip-flexors (dominant leg) was performed three times 10 min per week for 6 weeks. The strength training group progressed from 15 repetition maximum (RM) (week 1) to 8 RM (week 6). Isometric hip-flexion strength (primary outcome) was measured by a blinded assessor using a reliable test procedure.

RESULTS

In the strength training group, the isometric hip-flexion strength of the trained leg increased by 17 %, (p < 0.001). The between-group difference in hip-flexion strength change in the trained leg (dominant leg, training group) versus the non-trained leg (dominant leg, control group) was significantly different from baseline to follow-up, corresponding to a mean change of 0.34 (95 % CI 0.17-0.52) Nm/kg, in favour of the strength training group (p < 0.001).

CONCLUSION

Simple hip-flexor strength training using elastic bands as external loading, for only 6 weeks, substantially improves hip-flexor muscle strength. This simple exercise programme seems promising for future prevention and treatment of acute and longstanding hip-flexor injuries, such as acute rectus femoris injuries and longstanding iliopsoas-related pain and impingement.

LEVEL OF EVIDENCE

I.

Effectiveness of pelvic floor muscle training in treating urinary incontinence in women: A current review

OBJECTIVE

To analyse the content of various published studies related to physical exercise and its effects on urinary incontinence and to determine the effectiveness of pelvic floor training programmes.

METHOD

We conducted a search in the databases of PubMed, CINAHL, the Cochrane Plus Library, The Cochrane Library, WOS and SPORTDiscus and a manual search in the Google Scholar metasearcher using the search descriptors for documents published in the last 10 years in Spanish or English. The documents needed to have an abstract or complete text on the treatment of urinary incontinence in female athletes and in women in general.

RESULTS

We selected 3 full-text articles on treating urinary incontinence in female athletes and 6 full-text articles and 1 abstract on treating urinary incontinence in women in general. The 9 studies included in the review achieved positive results, i.e., there was improvement in the disease in all of the studies.

CONCLUSIONS

Physical exercise, specifically pelvic floor muscle training programmes, has positive effects on urinary incontinence. This type of training has been shown to be an effective programme for treating urinary incontinence, especially stress urinary incontinence.

Randomized pilot trial of yoga versus strengthening exercises in breast cancer survivors with cancer-related fatigue

PURPOSE

Fatigue is one of the most common and bothersome refractory symptoms experienced by cancer survivors. Mindful exercise interventions such as yoga improve cancer-related fatigue; however, studies of yoga have included heterogeneous survivorship populations, and the effect of yoga on fatigued survivors remains unclear.

METHODS

We randomly assigned 34 early-stage breast cancer survivors with cancer-related fatigue (≥4 on a Likert scale from 1-10) within 1 year from diagnosis to a 12-week intervention of home-based yoga versus strengthening exercises, both presented on a DVD. The primary endpoints were feasibility and changes in fatigue, as measured by the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF). Secondary endpoint was quality of life, assessed by the Functional Assessment of Cancer Therapies-Breast (FACT-B).

RESULTS

We invited 401 women to participate in the study; 78 responded, and we enrolled 34. Both groups had significant within-group improvement in multiple domains of the fatigue and quality of life scores from baseline to post-intervention, and these benefits were maintained at 3 months post-intervention. However, there was no significant difference between groups in fatigue or quality of life at any assessment time. Similarly, there was no difference between groups in adherence to the exercise intervention.

CONCLUSIONS

Both DVD-based yoga and strengthening exercises designed for cancer survivors may be good options to address fatigue in breast cancer survivors. Both have reasonable uptake, are convenient and reproducible, and may be helpful in decreasing fatigue and improving quality of life in the first year post-diagnosis in breast cancer patients with cancer-related fatigue.

The dynamic nature of the reconsolidation process and its boundary conditions: Evidence based on human tests

The reconsolidation process is the mechanism by which the strength and/or content of consolidated memories are updated. This process is triggered by the presentation of a reminder (training cues). It is not always possible to trigger the reconsolidation process. For example, memory age and strength are boundary conditions for the reconsolidation process. Here, we investigated the dynamic changes in these conditions. We propose that the boundary conditions of the reconsolidation process are not fixed and vary as a consequence of the interaction between memory features and reminder characteristics. To modify memory properties, participants received a threatening social protocol that improves memory acquisition or a control condition (fake, without social interaction) prior to learning pairs of meaningless syllables. To determine whether a strong young or old declarative memory undergoes the reconsolidation process, we used an interference task (a second list of pairs of meaningless syllables) to disrupt memory re-stabilization. To assess whether the older memory could be strengthened, we repeated the triggering of reconsolidation. Strong young or old memories modulated by a threatening experience could be interfered during reconsolidation and updated (strengthened) by reconsolidation. Rather than being fixed, boundary conditions vary according to the memory features (strong memory), which indicates the dynamic nature of the reconsolidation process. Our findings demonstrate that it is possible to modify these limits by recruiting the reconsolidation process and making it functionally operative again. This novel scenario opens the possibility to new therapeutically approaches that take into account the reconsolidation process.

Wild plants, pregnancy, and the food-medicine continuum in the southern regions of Ghana and Benin

ETHNOPHARMACOLOGICAL RELEVANCE

In West Africa, women utilize wild plant species to maintain and enhance their health throughout the duration of pregnancy. These plants are a culturally resilient and financially accessible form of nourishment for pregnant women in the region, many of whom are malnourished, yet studies that identify both the nutritional and medicinal properties of these plants are limited.

AIM OF THE STUDY

The objective of this study was to analyze women's knowledge of plants consumed in pregnancy in the southern regions of Ghana and Benin from a food-medicine continuum perspective.

MATERIALS AND METHODS

We gathered data in two fieldwork periods in West Africa (Ghana 2010 and Benin 2011) through herbal market surveys and 56 questionnaires with women and then conducted a literature review on known properties of the plants.

RESULTS

Ghanaian women reported consuming wild greens such as iron-rich Nephrolepis biserrata and tree barks such as protein-rich Ricinodendron heudelotii in a soup based on the African oil palm fruit (Elaeis guineensis), a source of fatty acids. In Benin, participants frequently reported ingesting plants during pregnancy in the form of herbal teas. Commonly cited species included Securidaca longipedunculata, Dichapetalum madagascariense, and Schwenckia americana. Several of the plants demonstrated antioxidant, anti-malarial and anti-inflammatory activity in pharmacological studies, yet the majority has incomplete nutritional and pharmacological profiles. In total, informants cited 105 species that were consumed during pregnancy. Although Ghanaian and Beninese women mentioned different species and different forms of consumption, in both countries women cited "strengthening" as the most common motivation to consume wild plants during pregnancy. Strengthening is a concept that resonates within the food-medicine continuum, bridging the local diet and herbal pharmacopoeia of women's plant use during pregnancy.

CONCLUSIONS

Ethnobotanical studies of this nature highlight the multidimensional use of plants and can improve health and nutritional programs in the region.

The effects of ankle joint muscle strengthening and proprioceptive exercise programs accompanied by functional electrical stimulation on stroke patients' balance

[Purpose] The purpose of the present study was to examine the effects of ankle joint muscle strengthening and proprioceptive exercises accompanied by functional electrical stimulation on stroke patients’ balance ability. [Methods] For six weeks beginning in April 2015, 22 stroke patients receiving physical therapy at K Hospital located in Gyeonggi-do were divided into a functional electrical stimulation (FES), ankle proprioceptive exercise and ankle joint muscle strengthening exercise group (FPS group) of 11 patients and an FES and stretching exercise group (FS group) of 11 patients. The stimulation and exercises were conducted for 30 min per day, five days per week for six weeks. Balance ability was measured using a BioRescue and the Berg balance scale, functional reach test, and the timed up-and-go test were also used as clinical evaluation indices. Repeated measures ANOVA was conducted to examine differences between before the exercises and at three and six weeks after beginning the exercises within each group, and the amounts of change between the two groups were compared. [Results] In the comparison within each group, both groups showed significant differences between before and after the experiment in all the tests and comparison between the groups showed that greater improvement was seen in all values in the FPS group. [Conclusion] In the present study, implementing FES and stretching exercises plus ankle joint muscle strengthening and proprioceptive exercises was more effective at improving stroke patients balance ability than implementing only FES and stretching exercises.

Analysis of muscle activations in lower extremities muscles at various angles of ankle flexion using wedges during static squat exercise

[Purpose] This study aimed to investigate changes in activation of the rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius muscles during one-legged squats performed at various angles of ankle flexion. With the use of wedges, the muscles were activated at different angles of ankle flexion angles to establish the appropriate posture necessary for muscle strengthening and rehabilitation. [Subjects and Methods] Healthy adults aged 20–40 years were recruited from Good Morning Hospital in Ulsan City. Of the 22 participants, two dropped out during the tests, leaving a final sample of 20 participants. The wedges were 100 mm wide and 200 mm long and had inclinations of 10°, 30°, and 50°. EMG Analyzer software was used to measure muscle activation. [Results] A significant difference in the activation of the rectus femoris muscle at various angles of ankle flexion was seen. The gastrocnemius muscle exhibited significant differences in activation among the 0°–30°, 0°–50°, and 10°–50° inclinations. [Conclusion] Wedge-assisted muscle activation under different ankle flexion angles can be introduced as an effective exercise option under clinical conditions.

Principles and applications of therapeutic exercises for small animals

Therapeutic exercises are the cornerstone of the rehabilitation programs of companion animals. Therapeutic exercises are used to improve active joint range of motion, to improve weight bearing and limb use, to build strength and muscle mass, and to increase conditioning (eg, endurance, speed). Each case is unique as chronicity, type of injury, patient signalment and temperament, owner compliance, and level of required functional recovery vary widely. Therapeutic exercises are also essential for partial return to work or performance and to learn to perform activities of daily living after injury or surgery.