Increasing physical activity levels among individuals with spinal cord injury

Three mixed methods studies were completed within the Spinal Cord Injury and Physical Activity in the Community (SCIPA Com) program: 1) identification barriers and facilitators to physical activity among individuals with spinal cord injury (SCI); 2) implementation of physical activity programs in community fitness centres; and 3) measures of personality attributes related to active behaviour. Results support the ecological validity of SCIPA Com in increasing physical activity levels and health benefits in the SCI population

Intra and interobserver reliability of the anterior trunk flexion angle measurements by the Whistance method

O objetivo do estudo foi avaliar a confiabilidade intra e interobservador damensuração do ângulo de Whistance por meio da análise cinemática angular. Participaram 50 voluntários, que foram submetidos a duas fotos: a primeira em ortostatismo e a segunda em flexão anterior máxima de tronco. O ângulo de flexão foi medido por dois avaliadores, analisando-se a confiabilidade intra e interobservadores da mensuração pelo método de Whistance com os testes estatísticos coeficiente de correlação intraclasse (CCI) e Bland & Altman. A média do ângulo de Whistance mensurado pelo avaliador 1 foi de 78,9º±11,4° e em seu re-teste, x=78,9°±10,9°. O avaliador 2 obteve média de 79,5°±11,1°. O CCI intra-observador foi de 0,94, com IC 95% [0,91;0,97]; e, no teste de Bland & Altman, foi de 0,04, com IC 95% [-0,99;1,07]. Os valores intra-observador foram de 0,98, com IC 95% [0,97;0,99] e -0,62 IC 95% [-1,09;-0,14], respectivamente. O presente estudo demonstrou alta confiabilidade intra e interobservadores para a mensuração do ângulo de flexão do tronco pelo método de Whistance.The purpose of this study was to evaluate intra and inter-rater reliability of the Whistance angle measurements through kinematic angular analysis. Two photographs of fifty subjects were registered: the first in standing position and the second performing trunk maximal anterior flexion. Two observers measured the trunk flexion angle. The intra and inter-rater reliability of the measurements made were analysed by two statistical analyses: intraclass correlation coefficient (ICC) and Bland & Altman’s. The mean Whistance angle measured by the first observer was 78.9º±11.4° and his testretest was x=78.9°±10.9°. The second evaluator obtained a mean of 79.5°±11.1°. The ICC for the intrarater was 0.94, with 95% CI [0.91;0.97] and for Bland and Altman, 0.04 with 95% CI [-0.99;1.07]. The inter-rater values were, respectively, 0.98 with 95% CI [0.97;0.99] and –0.62 95% CI [-1.09;- 0.14]. Both intra and inter-rater reliability thus was high for both statistical analyses. The present study showed high intra and inter-rater reliability for the Whistance method of measuring the trunk flexion angle

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Automated formative assessments are associated to successful academic outcomes among first year anatomy students

Introduction: Formative assessments can be useful in motivating student academic success through feedback and can be particularly helpful for first year anatomy students. However, this is often precluded by large student numbers. In order to enable formative assessments to large student numbers, an automated assessment system was utilised. The main aims were to assess if automated formative scores were associated to improved summative scores and if they could ultimately be used to predict academic outcomes among first year anatomy students. Material and Methods: A quasi-experimental study assessed 220 students enrolled in an anatomy course over six time points: formative assessments 1 (FAx 1) and 2 (FAx2) before the Mid-semester summative assessment, and formative assessments 3 (FAx 3) and 4 (FAx4) before the Final summative assessment. Linear models were used to assess if formative scores were associated with summative scores to predict academic outcomes. Results: Mean Mid-semester scores (x ̅=60.28%) improved by 28.73% and 21% compared to FAx1 (x ̅=31.55%) and FAx2 (x ̅= 39.28). FAx1 and FAx2 scores were moderately-to-strongly correlated with Mid-semester scores (FAx1: r= 0.710, p<0.001; FAx2: 0.682, p<0.001). Mean Final scores (x ̅=70.32%) also improved by 34.03% and 30.03% compared to FAx3 (x ̅=36.29%) and FAx4 (x ̅=39.47%). FAx3 and FAx4 were also moderately-to-strongly correlated to Final scores (FAx3: r= 0.706, p<0.001; FAx4: r= 0.719, p<0.001). Conclusion: Students performed progressively better on automated formative assessments in the lead-up to automated summative assessments and formative scores can be used to predict academic outcomes among a large number of first year anatomy students

Analysis of erector spinae muscle fatigue in healthy subjects in the sitting position

The aim of this study was to evaluate the frequency and amplitude of surface electromyography during erector spinae fatigue in healthy subjects in the sitting position. Eleven healthy males without low back pain participated in the study. The electromyographic parameters were collected with a surface electromyograph. Four electrodes were positioned lateral to the first and fifth lumbar vertebrae. The electromyographic signals were recorded during isometric trunk extension against a load cell in the sitting position. Loads of 50% and 75% of maximal voluntary isometric contraction were applied for 25 seconds to induce muscle fatigue. The signals processed using a Fast Fourier Transform algorithm and root mean square were submitted to linear regression to determine the fatigue index. The median frequency of the power spectrum presented negative values and the root mean square presented positive values, indicating muscle fatigue. No significant differences were observed when comparing level and side, or between loads (P > 0.05). The sitting position provides a better pelvis fixation and reproduces the usual position of occupational activities. The protocol used did not cause pain. Although all subjects presented erector spinae fatigue, no differences were observed between lumbar regions. The concomitant use of median frequency and root mean square in fatigue studies is suggested

<b>Analysis of erector spinae muscle fatigue in healthy subjects in the sitting position</b>

The aim of this study was to evaluate the frequency and amplitude of surface electromyography during erector spinae fatigue in healthy subjects in the sitting position. Eleven healthy males without low back pain participated in the study. The electromyographic parameters were collected with a surface electromyograph. Four electrodes were positioned lateral to the first and fifth lumbar vertebrae. The electromyographic signals were recorded during isometric trunk extension against a load cell in the sitting position. Loads of 50% and 75% of maximal voluntary isometric contraction were applied for 25 seconds to induce muscle fatigue. The signals processed using a Fast Fourier Transform algorithm and root mean square were submitted to linear regression to determine the fatigue index. The median frequency of the power spectrum presented negative values and the root mean square presented positive values, indicating muscle fatigue. No significant differences were observed when comparing level and side, or between loads (P > 0.05). The sitting position provides a better pelvis fixation and reproduces the usual position of occupational activities. The protocol used did not cause pain. Although all subjects presented erector spinae fatigue, no differences were observed between lumbar regions. The concomitant use of median frequency and root mean square in fatigue studies is suggested

Illness perceptions of people with chronic hip pain: A qualitative investigation

Background: Chronic hip pain is one of the leading causes of global disability. It can lead to significant physical and functional impairments, sleep disturbances and psychological distress. The biomedical model of illness is insufficient to explain persistent hip pain as it fails to consider biopsychosocial components strongly associated to musculoskeletal pain and disability. In particular, negative illness perceptions can lead to emotional distress, and progressive pain and disability. In this context, the Common Sense Model links illness perceptions with behavioural and emotional responses to manage health threats. To date, in-depth illness perceptions of people with persistent hip pain have not been investigated. Purpose: The purpose of this study was to explore illness perceptions, coping strategies and care seeking history of patients experiencing chronic hip pain within the Common Sense Model. Methods: This was a cross-sectional qualitative study with a deductive framework analysis approach. It was conducted between 2016 and 2017 as the initial stage of a prospective intervention study for hip pain management. Patients with chronic hip pain were referred to this study by two orthopaedic surgeons from a private clinic in Perth, Western Australia. Sixteen patients (µ age = 51 [SD 10.7]) participated in face-to-face interviews following a semi-structured interview guide based on Leventhal's Common Sense Model. This included seven key categories of beliefs: interpretation, identity, cause, consequences, time line, controllability, and action and appraisal. The seven categories were applied onto the framework analysis comprised of six steps: familiarisation, application of the framework, indexing, charting, mapping and interpretation of the data. Results: Four key themes emerged: 1. Discrepancies between what patients believed to be the cause(s) of their hip pain and how health professionals explained their symptoms based on the biomedical model (e.g. patients believed their pain was the result of exercise-related injuries that could be treated whilst health professionals interpreted altered hip alignment and aging as the cause); 2. Illness perceptions informed by pathoanatomical explanations provided by health professionals negatively impacted emotional state and behavioural responses (e.g. patients reported that medical imaging revealed extensive structural hip damage, leading to fear, anxiety or frustration); 3. Differentiation between strategies to “fix the damage” to their hip and “control the symptoms” (e.g. patients described unsuccessful attempts to “fix their hip” through physiotherapy, stem cell injections, or tried to “control their symptoms” through activity-avoidance, acupuncture, cortisone injections; but many believed hip replacement was the only solution); and 4. The negative impact of hip pain on the ability to exercise and sleep and the consequences to their psychosocial health (e.g. patients exercised to maintain psychosocial health but this strategy was compromised by pain). Conclusion(s): People with chronic hip pain presenting for surgical consultation have illness perceptions that are heavily influenced by a pathoanatomical framework which negatively affects emotional and behavioural responses. Implications: The recognition of illness perceptions and their role in perpetuating disability, avoidance and distress is important for clinicians treating chronic hip pain. Clinicians can play an important role in minimising patients' disability and distress by positively modifying illness perceptions

Worldwide trends in population-based survival for children, adolescents, and young adults diagnosed with leukaemia, by subtype, during 2000–14 (CONCORD-3): analysis of individual data from 258 cancer registries in 61 countries

Background: Leukaemias comprise a heterogenous group of haematological malignancies. In CONCORD-3, we analysed data for children (aged 0–14 years) and adults (aged 15–99 years) diagnosed with a haematological malignancy during 2000–14 in 61 countries. Here, we aimed to examine worldwide trends in survival from leukaemia, by age and morphology, in young patients (aged 0–24 years). Methods: We analysed data from 258 population-based cancer registries in 61 countries participating in CONCORD-3 that submitted data on patients diagnosed with leukaemia. We grouped patients by age as children (0–14 years), adolescents (15–19 years), and young adults (20–24 years). We categorised leukaemia subtypes according to the International Classification of Childhood Cancer (ICCC-3), updated with International Classification of Diseases for Oncology, third edition (ICD-O-3) codes. We estimated 5-year net survival by age and morphology, with 95% CIs, using the non-parametric Pohar-Perme estimator. To control for background mortality, we used life tables by country or region, single year of age, single calendar year and sex, and, where possible, by race or ethnicity. All-age survival estimates were standardised to the marginal distribution of young people with leukaemia included in the analysis. Findings: 164 563 young people were included in this analysis: 121 328 (73·7%) children, 22 963 (14·0%) adolescents, and 20 272 (12·3%) young adults. In 2010–14, the most common subtypes were lymphoid leukaemia (28 205 [68·2%] patients) and acute myeloid leukaemia (7863 [19·0%] patients). Age-standardised 5-year net survival in children, adolescents, and young adults for all leukaemias combined during 2010–14 varied widely, ranging from 46% in Mexico to more than 85% in Canada, Cyprus, Belgium, Denmark, Finland, and Australia. Individuals with lymphoid leukaemia had better age-standardised survival (from 43% in Ecuador to ≥80% in parts of Europe, North America, Oceania, and Asia) than those with acute myeloid leukaemia (from 32% in Peru to ≥70% in most high-income countries in Europe, North America, and Oceania). Throughout 2000–14, survival from all leukaemias combined remained consistently higher for children than adolescents and young adults, and minimal improvement was seen for adolescents and young adults in most countries. Interpretation: This study offers the first worldwide picture of population-based survival from leukaemia in children, adolescents, and young adults. Adolescents and young adults diagnosed with leukaemia continue to have lower survival than children. Trends in survival from leukaemia for adolescents and young adults are important indicators of the quality of cancer management in this age group