The gait and balance of patients with diabetes can be improved: a randomised controlled trial

Item does not contain fulltextAIMS/HYPOTHESIS: Gait characteristics and balance are altered in diabetic patients. Little is known about possible treatment strategies. This study evaluates the effect of a specific training programme on gait and balance of diabetic patients. METHODS: This was a randomised controlled trial (n=71) with an intervention (n=35) and control group (n=36). The intervention consisted of physiotherapeutic group training including gait and balance exercises with function-orientated strengthening (twice weekly over 12 weeks). Controls received no treatment. Individuals were allocated to the groups in a central office. Gait, balance, fear of falls, muscle strength and joint mobility were measured at baseline, after intervention and at 6-month follow-up. RESULTS: The trial is closed to recruitment and follow-up. After training, the intervention group increased habitual walking speed by 0.149 m/s (p<0.001) compared with the control group. Patients in the intervention group also significantly improved their balance (time to walk over a beam, balance index recorded on Biodex balance system), their performance-oriented mobility, their degree of concern about falling, their hip and ankle plantar flexor strength, and their hip flexion mobility compared with the control group. After 6 months, all these variables remained significant except for the Biodex sway index and ankle plantar flexor strength. Two patients developed pain in their Achilles tendon: the progression for two related exercises was slowed down. CONCLUSIONS/INTERPRETATION: Specific training can improve gait speed, balance, muscle strength and joint mobility in diabetic patients. Further studies are needed to explore the influence of these improvements on the number of reported falls, patients' physical activity levels and quality of life. TRIAL REGISTRATION: ClinicalTrials.gov NCT00637546 FUNDING: This work was supported by the Swiss National Foundation (SNF): PBSKP-123446/1/1 maart 201

Three-Nucleon Force Effects in Nucleon Induced Deuteron Breakup: Comparison to Data (II)

Selected Nd breakup data over a wide energy range are compared to solutions of Faddeev equations based on modern high precision NN interactions alone and adding current three-nucleon force models. Unfortunately currently available data probe phase space regions for the final three nucleon momenta which are rather insensitive to 3NF effects as predicted by current models. Overall there is good to fair agreement between present day theory and experiment but also some cases exist with striking discrepancies. Regions in the phase space are suggested where large 3NF effects can be expected.Comment: 33 pages, 24 ps figures, 9 gif figure

Three-Nucleon Forces from Chiral Effective Field Theory

We perform the first complete analysis of nd scattering at next-to-next-to-leading order in chiral effective field theory including the corresponding three-nucleon force and extending our previous work, where only the two-nucleon interaction has been taken into account. The three-nucleon force appears first at this order in the chiral expansion and depends on two unknown parameters. These two parameters are determined from the triton binding energy and the nd doublet scattering length. We find an improved description of various scattering observables in relation to the next-to-leading order results especially at moderate energies (E_lab = 65 MeV). It is demonstrated that the long-standing A_y-problem in nd elastic scattering is still not solved by the leading 3NF, although some visible improvement is observed. We discuss possibilities of solving this puzzle. The predicted binding energy for the alpha-particle agrees with the empirical value.Comment: 36 pp, 20 figure

Tests of electron flavor conservation with the Sudbury Neutrino Observatory

We analyze tests of electron flavor conservation that can be performed at the Sudbury Neutrino Observatory (SNO). These tests, which utilize $^8$B solar neutrinos interacting with deuterium, measure: 1) the shape of the recoil electron spectrum in charged-current (CC) interactions (the CC spectrum shape); and 2) the ratio of the number of charged current to neutral current (NC) events (the CC/NC ratio). We determine standard model predictions for the CC spectral shape and for the CC/NC ratio, together with realistic estimates of their errors and the correlations between errors. We consider systematic uncertainties in the standard neutrino spectrum and in the charged-current and neutral current cross-sections, the SNO energy resolution and absolute energy scale, and the SNO detection efficiencies. Assuming that either matter-enhanced or vacuum neutrino oscillations solve the solar neutrino problems, we calculate the confidence levels with which electron flavor non-conservation can be detected using either the CC spectrum shape or the CC/NC ratio, or both. If the SNO detector works as expected, the neutrino oscillation solutions that best-fit the results of the four operating solar neutrino experiments can be distinguished unambiguously from the standard predictions of electron flavor conservation.Comment: 31 pages (RevTeX) + 10 figures (postscript). Requires epsfig.sty. Gzipped figures also available at ftp://ftp.sns.ias.edu/pub/lisi/snopaper . To appear in Phys. Rev.

Model Analysis of Time Reversal Symmetry Test in the Caltech Fe-57 Gamma-Transition Experiment

The CALTECH gamma-transition experiment testing time reversal symmetry via the E2/M1 mulipole mixing ratio of the 122 keV gamma-line in Fe-57 has already been performed in 1977. Extending an earlier analysis in terms of an effective one-body potential, this experiment is now analyzed in terms of effective one boson exchange T-odd P-even nucleon nucleon potentials. Within the model space considered for the Fe-57 nucleus no contribution from isovector rho-type exchange is possible. The bound on the coupling strength phi_A from effective short range axial-vector type exchange induced by the experimental bound on sin(eta) leads to phi_A < 10^{-2}.Comment: 5 pages, RevTex 3.

Getting the right balance: insole design alters the static balance of people with diabetes and neuropathy

BACKGROUND: Over 1 in 3 older people with diabetes sustain a fall each year. Postural instability has been identified as independent risk factor for falls within people with Diabetic Peripheral Neuropathy (DPN). People with DPN, at increased risk of falls, are routinely required to wear offloading insoles, yet the impact of these insoles on postural stability and postural control is unknown. The aim of this study was to evaluate the effect of a standard offloading insole and its constituent parts on the balance in people with DPN. METHODS: A random sample of 50 patients with DPN were observed standing for 3 × 30 s, and stepping in response to a light, under five conditions presented in a random order; as defined by a computer program; 1) no insole, 2) standard diabetic: a standard offloading insole made from EVA/poron®, and three other insoles with one design component systematically altered 3) flat: diabetic offloading insole with arch fill removed, 4) low resilient memory: diabetic offloading insole with the cover substituted with low resilience memory V9, 5) textured: diabetic offloading insole with a textured PVC surface added (Algeos Ltd). After each condition participants self-rated perceived steadiness. RESULTS: Insole design effected static balance and balance perception, but not stepping reaction time in people with DPN. The diabetic and memory shaped insoles (with arch fill) significantly increased centre of pressure velocity (14 %, P = 0.006), (13 %, P = 0.001), and path length (14 %, P = 0.006), (13 %, P = 001), when compared to the no insole condition. The textured shaped and flat soft insole had no effect on static balance when compared to the no insole condition (P > 0.05). CONCLUSION: Insoles have an effect on static balance but not stepping reaction time. This effect is independent of neuropathy severity. The addition of a textured cover seems to counter the negative effect of an arch fill, even in participants with severe sensation loss. Static balance is unaffected by material softness or resilience. Current best practice of providing offloading insoles, with arch fill, to increase contact area and reduce peak pressure could be making people more unstable. Whilst flat, soft insoles maybe the preferable design option for those with poor balance. There is a need to develop an offloading insole that can reduce diabetic foot ulcer risk, without compromising balance

Risk factors for treatment delay in pulmonary tuberculosis in Recife, Brazil

BACKGROUND: Tuberculosis is still a great challenge to public health in Brazil and worldwide. Early detection followed by effective therapy is extremely important in controlling the disease. Recent studies have investigated reasons for delays in treatment, but there is no agreed definition of what constitutes an "acceptable" delay. This study investigates factors associated with total delay in treatment of tuberculosis. METHODS: A cohort of adult cases of pulmonary tuberculosis diagnosed over a two-year period was studied. Patients were interviewed on entry, reporting the duration of symptoms before the start of treatment, and sputum and blood samples were collected. It was decided that sixty days was an acceptable total delay. Associations were investigated using univariable and multivariable analysis and the population attributable fraction was estimated. RESULTS: Of 1105 patients, 62% had a delay of longer than 60 days. Age, sex, alcoholism and difficulty of access were not associated with delays, but associations were found in the case of unemployment, having given up smoking, having lost weight and being treated in two of the six health districts. The proportion attributable to: not being an ex-smoker was 31%; unemployment, 18%; weight loss, 12%, and going to the two worst health districts, 25%. CONCLUSION: In this urban area, delays seem to be related to unemployment and general attitudes towards health. Although they reflect the way health services are organized, delays are not associated with access to care