The effectiveness of an upper extremity neuromuscular training program on the shoulder function of military members with a rotator cuff tendinopathy : a pilot randomized controlled trial

INTRODUCTION: La tendinopathie de la coiffe des rotateurs (TCR) entraine au quotidien des douleurs et faiblesses musculaires et une diminution du contrôle moteur à l'épaule. OBJECTIFS: Les objectifs de cette étude étaient i) d'effectuer une revue de littérature pour identifier les méthodes de quantification de la proprioception de l'épaule utilisées en laboratoire et en clinique et d’en présenter les qualités métrologiques, ii) d'évaluer l'efficacité d’un programme d’entrainement neuro-musculaire en comparant son efficacité à réduire la douleur à l’épaule et en améliorer la fonction à celle obtenue par des soins usuels de physiothérapie. MÉTHODES: i) Une revue de 5 bases de données a été conduite d’octobre 2015 à juillet 2016 pour documenter les propriétés métrologiques de protocoles d’évaluation de la proprioception à l'épaule. Les études incluses ont été évaluées à l'aide de l’outil de contrôle QualSyst et de l'échelle COSMIN à 4 points. ii) Trente-trois soldats en service actif au sein des Forces armées canadiennes ont été assignés au hasard à 1) programme standardisé supervisé d’entrainement neuromusculaire et contrôle moteur (Exp) ou à 2) soins usuels de physiothérapie (Ctl). Les variables principales étaient les symptômes, la capacité fonctionnelle et les limitations physiques évalués avec le questionnaire Disabilities of the Arm, Shoulder and Hand (DASH) et la variable secondaire était l'indice Western Ontario Rotator Cuff (WORC). Toutes les variables ont été mesurées au départ (T0) et à 6 (T6) et 12 (T12) semaines après l'intervention. La comparaison des effets des interventions a été évaluée à l'aide d’une analyse per protocole (APP), analyse intention-traitement (AIT) et avec une analyse de variance à mesures répétées à 2 voies. RÉSULTATS: i) Vingt et une études (n = 407 participants, 553 épaules) ont été retenues. Les études analysées confirment d'excellents scores méthodologiques avec l’outil QualSyst (88,1 ± 9,9%) et de bons scores avec le COSMIN pour la fidélité (71,1%) et un score de qualité modérée à faible (50%) pour la validité de critère. Les coefficients de corrélation intraclasse (CCI) pondérés pour la fidélité intraévaluateur étaient les plus élevés pour le sens du positionnement articulaire passif et la kinesthésie soit 0,92 ± 0,07 (n = 214) et 0,92 ± 0,04 (n = 74), respectivement. Le mouvement et l'outil les plus fidèles sont la rotation interne à 90 ° d'abduction (CCI = 0,88 ± 0,01 (n = 53)) et le dynamomètre (CCI = 0,92 ± 0,88 (n = 225)). Aucune étude n’a rapporté d’indices de sensibilité au changement. ii) Aucune interaction significative (p ≥ 0,101) de groupe × temps (p ≥ 0,101) n'a été démontrée. Par contre, nous avons observé un effet de temps significatif (p <0,001) pour le questionnaire DASH et l'indice WORC. CONCLUSION: Ces données préliminaires suggèrent que les deux approches proposées conduisent à des améliorations comparables. L'utilisation d'une intervention de groupe axée sur l'exercice a le potentiel d'être aussi efficace qu'une approche un à un plus exigeante en terme de temps de traitement. Ces résultats permettront de fournir aux cliniciens des lignes directrices pour la mesure de la proprioception à l'épaule et l’utilisation d’une approche novatrice de traitement en groupe pour la TCR. Mots clés : Épaule, tendinopathie, contrôle moteur, proprioception, programme d'exercices, soins en physiothérapieINTRODUCTION: The shoulder is the most mobile joint of the body which means that it heavily relies of an important level of neuromuscular control at all times. A rotator cuff (RC) complex provides stability to the shoulder and often times falls victim to injury, which can produce functional limitations during activities of daily living and work tasks. Individuals affected by an RC tendinopathy often have neuromuscular and proprioceptive deficits. OBJECTIVES: The objectives of this study are to (i) conduct a systematic review to identify methods of quantifying shoulder proprioception in a laboratory and clinical setting and to present the associated psychometric properties. (ii) To evaluate the effectiveness of a novel neuromuscular training program for the upper extremities versus one-on-one physiotherapy care (manual therapy, range of motion exercises, strengthening) for the reduction of shoulder pain and improvement in function with soldiers affected by an RC tendinopathy. METHODS: (i) A review of five databases was conducted from conception to July 2016 to identify studies that reported at least one psychometric property of a shoulder proprioception protocol. The included studies were evaluated using the QualSyst checklist and the 4-point COSMIN scale. (ii) Thirty-three military personnel with the Canadian Armed Forces were randomly assigned to one of the following interventions: 1) Upper Extremity Neuromuscular Training Program; (2) usual physiotherapy care. The main outcomes included symptoms and functional capacity assessed using the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. A secondary outcome included the Western Ontario Rotator Cuff (WORC) Index. Outcome measures were evaluated at baseline (T0) and 6 (T6) and 12 (T12) weeks post-intervention. The effects of the interventions were evaluated using repeated 2-way variance measures (ANOVAs) for a per-protocol analysis and intention-to-treat. RESULTS: i) Twenty-one studies were included, resulting in 407 participants and 553 evaluated shoulders (n). The weighed intraclass correlation coefficients (ICC) for intra-rater reliability were highest for passive joint position sense and kinesthesia, ICC = 0.92 ± 0.07 (n = 214) and ICC = 0.92 ± 0.04 (n = 74), respectively. The most reliable direction of movement and equipment used were internal rotation at 90° abduction, ICC = 0.88 ± 0.01 (n = 53), and the dynamometer, ICC = 0.92 ± 0.88 (N = 225). ii) No significant group (p ≥ 0.1) or group × time interactions (p ≥ 0.1) were found; though a statistically significant time effect (p < 0.001) was established for the DASH questionnaire and WORC Index. Our preliminary data suggests a marginally better improvement with the control group with all outcomes over 12 weeks. CONCLUSION: The evaluation of shoulder proprioception is most reliable when using a passive protocol with an isokinetic dynamometer for internal rotation at 90° shoulder abduction. The preliminary results of our pilot RCT suggest that both groups statistically improved with a time effect, but that the usual care group further demonstrated clinically significant gains. The results of this study will provide clinicians with potential guidelines for measuring shoulder proprioception in a clinical setting, as well as an innovative approach to group therapy that is potentially less costly and equally as effective as conventional one-on-one physiotherapy. Key words (4-6) : Shoulder, tendinopathy, motor control, proprioception, exercise program, physiotherapy car

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Euthanasia

No one really wants to die, or do they? From classical times to our post-modern era of medical high tech, societies have struggled with the thorny issue of euthanasia, and what it entails. Who shall be entitled to a "good death" and in what form shall it arrive? This book provides the reader with insight and enlightenment on the medical, philosophical, social, cultural and existential aspects of "good death" amid our digitized, individualized and ageing society, hampered by rising health care costs but unchained from one standardized level of care

A computer aided diagnosis system for lung nodules detection in postero anterior chest radiographs

This thesis describes a Computer Aided System aimed at lung nodules detection. The fully automatized method developed to search for nodules is composed by four steps. They are the segmentation of the lung field, the enhancement of the image, the extraction of the candidate regions, and the selection between them of the regions with the highest chance to be True Positives. The steps of segmentation, enhancement and candidates extraction are based on multi-scale analysis. The common assumption underlying their development is that the signal representing the details to be detected by each of them (lung borders or nodule regions) is composed by a mixture of more simple signals belonging to different scales and level of details. The last step of candidate region classification is the most complicate; its 8 task is to discern among a high number of candidate regions, the few True Positives. To this aim several features and different classifiers have been investigated. In Chapter 1 the segmentation algorithm is described; the algorithm has been tested on the images of two different databases, the JSRT and the Niguarda database, both described in the next section, for a total of 409 images. We compared the results obtained with another method presented in the literature and described by Ginneken, in [85], as the one obtaining the best performance at the state of the art; it has been tested on the same images of the JSRT database. No errors have been detected in the results obtained by our method, meanwhile the one previously mentioned produced an overall number of error equal to 50. Also the results obtained on the images of the Niguarda database confirmed the efficacy of the system realized, allowing us to say that this is the best method presented so far in the literature. This sentence is based also on the fact that this is the only system tested on such an amount of images, and they are belonging to two different databases. Chapter 2 is aimed at the description of the multi-scale enhancement and the extraction methods. The enhancement allows to produce an image where the \u201cconspicuity\u201d of nodules is increased, so that nodules of different sizes and located in parts of the lungs characterized by completely different anatomic noise are more visible. Based on the same assumption the candidates extraction procedure, described in the same chapter, employs a multi-scale method to detect all the nodules of different sizes. Also this step has been compared with two methods ([8] and [1]) described in the literature and tested on the same images. Our implementation of the first one of them ([8]) produced really poor results; the second one obtained a sensitivity ratio (See Appendix C for its definition) equal to 86%. The considerably better performance of our method is proved by the fact that the sensitivity ratio we obtained is much higher (it is equal to 97%) and also the number of False positives detected is much less. The experiments aimed at the classification of the candidates are described in chapter 3; both a rule based technique and 2 learning systems, the Multi Layer Perceptron (MLP) and the Support Vector Machine (SVM), have been investigated. Their input is a set of 16 features. The rule based system obtained the best performance: the cardinality of the set of candidates left is highly reduced without lowering the sensitivity of the system, since no True Positive region is lost. It can be added that this performance is much better than the one of the system used by Ginneken and Schilam in [1], since its sensitivity is lower (equal to 77%) and the number of False Positive left is comparable. The drawback of a rule based system is the need of setting the 9 thresholds used by the rules; since they are experimentally set the system is dependent on the images used to develop it. Therefore it may happen that, on different databases, the performance could not be so good. The result of the MLPs and of the SVMs are described in detail and the ROC analysis is also reported, regarding the experiments performed with the SVMs. Furthermore, the attempt to improve the performance of the classification leaded to other experiments employing SVMs trained with more complicate feature sets. The results obtained, since not better than the previous, showed the need of a proper selection of the features. Future works will then be focused at testing other sets of features, and their combination obtained by means of proper feature selection techniques

The role of nutritional information in human energy intake regulation

Previous research has shown that over time, humans can develop learnt associations between the sensory profile of a food and the energy it contains. These associations are then used to guide appetite for the same food in future situations. However, whether more acute, explicit information relating to the nutritional content of food can also shape eating behaviours in non-dieting individuals remains undecided. Following a review of previous literature, several methodological questions were raised relating to the effectiveness and validity of experimental manipulations used in some previous studies. The main aim of this thesis is to re-assess whether nutritional information could influence eating behaviours when these factors have been taken into consideration. In two initial experiments designed to address these issues, an interesting association was observed between participants' initial expectations of a preload and their ability to compensate for covert manipulations of its energy content. In order to further investigate this association, measures were developed based upon psychophysical analysis to provide an alternative method of measuring expectancies of the satiating efficacy of a food. The use of this measure allowed a quantifiable measurement of a participant's expectancies towards a food, while lessening the risk that demand effects were contaminating results. The final experiments of this thesis then re-examined the earlier observation that expectations of foods could mediate the regulatory responses that ingesting the food creates. The observed results did not support the proposal that expectancies of a preload were mediating compensatory ability by prompting attention towards visceral cues. Instead, results suggested that enhanced compensation was observed when participants were provided with an unexpected deficit in energy intake, rather than an unexpected surplus. This introduces the concept that an individual's short-term compensatory ability may be partly determined by pre-existing expectations about the food they are eating. The implications of this finding with regard to dietary preloading paradigms are discussed, and the possibility that this mechanism could explain the poor compensatory ability often associated with liquid loads is explored.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Proceedings of the II International Congress on Interdisciplinarity in Social and Human Sciences

Interdisciplinarity is the main topic and the main goal of this conference. Since the sixteen century with the creation of the first Academy of Sciences, in Napoles (Italy) (1568), and before that with the creation of the Fine Arts Academies, the world of science and arts began to work independently, on the contrary of the Academy of Plato, in Classical Antiquity, where science, art and sport went interconnected. Over time, specific sciences began to be independent, and the specificity of sciences caused an increased difficulty in mutual understanding. The same trend has affected the Human and Social Sciences. Each of the specific sciences gave rise to a wide range of particular fields. This has the advantage of allowing the deepening of specialised knowledge, but it means that there is often only a piecemeal approach of the research object, not taking into account its overall complexity. So, it is important to work for a better understanding of the scientific phenomena with the complementarity of the different sciences, in an interdisciplinary perspective. With this growing specialisation of sciences, Interdisciplinarity acquired more relevance for scientists to find more encompassing and useful answers for their research questions. CIEO (Research Centre for Spatial and Organizational Dynamics) organises this conference, being Interdisciplinarity an important issue.info:eu-repo/semantics/acceptedVersio