Demonstration of the test-retest reliability and sensitivity of the Lower Limb Functional Index-10 as a measure of functional recovery post burn injury: a cross-sectional repeated measures study design

Background: Lower limb burns can significantly delay recovery of function. Measuring lower limb functional outcomes is challenging in the unique burn patient population and necessitates the use of reliable and valid tools. The aims of this study were to examine the test-retest reliability, sensitivity, and internal consistency of Sections 1 and 3 of the Lower Limb Functional Index-10 (LLFI-10) questionnaire for measuring functional ability in patients with lower limb burns over time. Methods: Twenty-nine adult patients who had sustained a lower limb burn injury in the previous 12 months completed the test-retest procedure of the study. In addition, the minimal detectable change (MDC) was calculated for Section 1 and 3 of the LLFI-10. Section 1 is focused on the activity limitations experienced by patients with a lower limb disorder whereas Section 3 involves patients indicating their current percentage of pre-injury duties. Results: Section 1 of the LLFI-10 demonstrated excellent test-retest reliability (intra-class correlation coefficient (ICC) 0.98, 95 % CI 0.96–0.99) whilst Section 3 demonstrated high test-retest reliability (ICC 0.88, 95 % CI 0.79–0.94). MDC scores for Sections 1 and 3 were 1.27 points and 30.22 %, respectively. Internal consistency was demonstrated with a significant negative association (r s = −0.83) between Sections 1 and 3 of the LLFI-10 (p < 0.001). Conclusions: This study demonstrates that Section 1 and 3 of the LLFI-10 are reliable for measuring functional ability in patients who have sustained lower limb burns in the previous 12 months, and furthermore, Section 1 is sensitive to changes in patient function over time

Fluorescence devices for the detection of dental caries

BACKGROUND: Caries is one of the most prevalent and preventable conditions worldwide. If identified early enough then non‐invasive techniques can be applied, and therefore this review focusses on early caries involving the enamel surface of the tooth. The cornerstone of caries detection is a visual and tactile dental examination, however alternative methods of detection are available, and these include fluorescence‐based devices. There are three categories of fluorescence‐based device each primarily defined by the different wavelengths they exploit; we have labelled these groups as red, blue, and green fluorescence. These devices could support the visual examination for the detection and diagnosis of caries at an early stage of decay. OBJECTIVES: Our primary objectives were to estimate the diagnostic test accuracy of fluorescence‐based devices for the detection and diagnosis of enamel caries in children or adults. We planned to investigate the following potential sources of heterogeneity: tooth surface (occlusal, proximal, smooth surface or adjacent to a restoration); single point measurement devices versus imaging or surface assessment devices; and the prevalence of more severe disease in each study sample, at the level of caries into dentine. SEARCH METHODS: Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 30 May 2019); Embase Ovid (1980 to 30 May 2019); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 30 May 2019); and the World Health Organization International Clinical Trials Registry Platform (to 30 May 2019). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA: We included diagnostic accuracy study designs that compared a fluorescence‐based device with a reference standard. This included prospective studies that evaluated the diagnostic accuracy of single index tests and studies that directly compared two or more index tests. Studies that explicitly recruited participants with caries into dentine or frank cavitation were excluded. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently using a piloted study data extraction form based on the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS‐2). Sensitivity and specificity with 95% confidence intervals (CIs) were reported for each study. This information has been displayed as coupled forest plots and summary receiver operating characteristic (SROC) plots, displaying the sensitivity‐specificity points for each study. We estimated diagnostic accuracy using hierarchical summary receiver operating characteristic (HSROC) methods. We reported sensitivities at fixed values of specificity (median 0.78, upper quartile 0.90). MAIN RESULTS: We included a total of 133 studies, 55 did not report data in the 2 x 2 format and could not be included in the meta‐analysis. 79 studies which provided 114 datasets and evaluated 21,283 tooth surfaces were included in the meta‐analysis. There was a high risk of bias for the participant selection domain. The index test, reference standard, and flow and timing domains all showed a high proportion of studies to be at low risk of bias. Concerns regarding the applicability of the evidence were high or unclear for all domains, the highest proportion being seen in participant selection. Selective participant recruitment, poorly defined diagnostic thresholds, and in vitro studies being non‐generalisable to the clinical scenario of a routine dental examination were the main reasons for these findings. The dominance of in vitro studies also means that the information on how the results of these devices are used to support diagnosis, as opposed to pure detection, was extremely limited. There was substantial variability in the results which could not be explained by the different devices or dentition or other sources of heterogeneity that we investigated. The diagnostic odds ratio (DOR) was 14.12 (95% CI 11.17 to 17.84). The estimated sensitivity, at a fixed median specificity of 0.78, was 0.70 (95% CI 0.64 to 0.75). In a hypothetical cohort of 1000 tooth sites or surfaces, with a prevalence of enamel caries of 57%, obtained from the included studies, the estimated sensitivity of 0.70 and specificity of 0.78 would result in 171 missed tooth sites or surfaces with enamel caries (false negatives) and 95 incorrectly classed as having early caries (false positives). We used meta‐regression to compare the accuracy of the different devices for red fluorescence (84 datasets, 14,514 tooth sites), blue fluorescence (21 datasets, 3429 tooth sites), and green fluorescence (9 datasets, 3340 tooth sites) devices. Initially, we allowed threshold, shape, and accuracy to vary according to device type by including covariates in the model. Allowing consistency of shape, removal of the covariates for accuracy had only a negligible effect (Chi(2) = 3.91, degrees of freedom (df) = 2, P = 0.14). Despite the relatively large volume of evidence we rated the certainty of the evidence as low, downgraded two levels in total, for risk of bias due to limitations in the design and conduct of the included studies, indirectness arising from the high number of in vitro studies, and inconsistency due to the substantial variability of results. AUTHORS' CONCLUSIONS: There is considerable variation in the performance of these fluorescence‐based devices that could not be explained by the different wavelengths of the devices assessed, participant, or study characteristics. Blue and green fluorescence‐based devices appeared to outperform red fluorescence‐based devices but this difference was not supported by the results of a formal statistical comparison. The evidence base was considerable, but we were only able to include 79 studies out of 133 in the meta‐analysis as estimates of sensitivity or specificity values or both could not be extracted or derived. In terms of applicability, any future studies should be carried out in a clinical setting, where difficulties of caries assessment within the oral cavity include plaque, staining, and restorations. Other considerations include the potential of fluorescence devices to be used in combination with other technologies and comparative diagnostic accuracy studies

Study of Physical Layer Security in Wireless Communications

This thesis has investigated security in wireless communications at physical layer. Security is an important issue for wireless communications and poses many challenges. Most security schemes have been applied to the upper layers of communications networks. Since in a typical wireless communication, transmission of data is over the air, third party receiver(s) may have easy access to the transmitted data. This work discusses a new security technique at the physical layer for the MIMO (802.11n) transmitters. For this project, the wireless medium is secured by transmitting a noise signal that is only recoverable by the receiver. This report includes an analysis of a wireless system that shows the bit error rate (BER) of the data signal in a two dimensional map. The map is a view of the free space, which has a receiver and transmitter at the ends. This work demonstrates that the proposed security technique can significantly complement other security approaches implemented in the upper layers of the communication network. Advisers: Hamid Sharif and Michael Hempe

Respiratory muscle strength, exercise capacity, resting oxygen consumption and resting energy consumption relationship with disability level caused by low back pain

European Respiratory So

Is balance exercise training as effective as aerobic exercise training in fibromyalgia syndrome?

WOS: 000353354800008PubMed: 25903448The aim was to compare the effect of aerobic and balance exercises on pain severity, myalgic score, quality of life, exercise capacity and balance in fibromyalgia syndrome (FMS). A total of 33 females diagnosed with FMS by the American College of Rheumatology criteria were recruited in this randomised controlled study and allocated to aerobic exercise (AE) or balance exercise (BE) groups. Exercises were performed three times a week, for 6 weeks on a treadmill or with a Tetrax interactive balance system (TIBS). Outcome measures were characterised by myalgic score, visual analogue scale, Fibromyalgia Impact Questionnaire (FIQ), exercise testing, Timed Up-Go (TUG) and TIBS measurements. Comparisons from baseline to 6 weeks were evaluated using Wilcoxon test. Mann-Whitney U test was used to compare differences between groups. Effect sizes were also calculated. Improvements in pain, myalgic score and FIQ were found in both groups (p < 0.05). While comparing groups, myalgic score was significant (p = 0.02, d = -1.77), the value was higher in AE. Exercise duration, Borg scale, resting blood pressures (RBP) and maximal heart rate were significant in AE. In BE, Borg scale, exercise duration was significant (p < 0.05). While comparing groups, diastolic RBP (p = 0.04, d = -0.92), exercise duration (p = 0.00, d = -1.64) were significant, with higher values in AE. TUG significantly changed in groups (p < 0.05, d a parts per thousand yen -1.22). Stability scores, eyes open while standing on elastic pads (p = 0.00, d = -0.98) and head back (p = 0.03, d = -0.74), were significant, with higher values in BE. This study showed that BE provided some improvements in FMS, but AE training led to greater gains. BE training should be included in comprehensive programs.Baskent UniversityBaskent UniversityThis study was supported by Baskent University Research Fund

Activity performance problems of patients with cardiac diseases and their impact on quality of life

[Purpose] To describe the functional consequences of patients with cardiac diseases and analyze associations between activity limitations and quality of life. [Subjects and Methods] Seventy subjects (mean age: 60.1+/-12.0 years) were being treated by Physical Medicine and Rehabilitation and Cardiology Departments were included in the study. Activity limitations and participation restrictions as perceived by the individual were measured by the Canadian Occupational Performance Measure (COPM). The Nottingham Extended Activities of Daily Living (NEADL) Scale was used to describe limitations in daily living activities. To detect the impact of activity limitations on quality of life the Nottingham Health Profile (NHP) was used. [Results] The subjects described 46 different types of problematic activities. The five most identified problems were walking (45.7%), climbing up the stairs (41.4%), bathing (30%), dressing (28.6%) and outings (27.1%). The associations between COPM performance score with all subgroups of NEADL and NHP; total, energy, physical abilities subgroups, were statistically significant. [Conclusion] Our results showed that patients with cardiac diseases reported problems with a wide range of activities, and that also quality of life may be affected by activities of daily living. COPM can be provided as a patient-focused outcome measure, and it may be a useful tool for identifying those problems

Effects of two different quadriceps strengthening exercise approaches on cardiovascular fitness in healthy female subjects: A single blind randomized study

WOS: 000304912300002PubMed: 22684198Objective: There are limited number of documents showing the relations between cardiovascular fitness and muscle strength. This study aimed to determine the effects of two different quadriceps strengthening exercise approaches on cardiovascular fitness in healthy female subjects. Methods: Forty female university students participated in this study on a voluntary basis. The participants were randomly assigned to do either isokinetic exercise (IE) or progressive resistive exercise (PRE) in two different groups. Both training schemes were performed three times a week for a period of two weeks. The subjects were given a maximum symptom limited exercise test on a treadmill before and after (each) training period. Results: Total exercise duration increased and Borg scale level decreased significantly after training in the two groups (p < 0.05). Maximal systolic blood pressure, recovery heart rate, and recovery diastolic blood pressure decreased significantly in the IE Group (p < 0.05). Resting and recovery systolic blood pressure decreased significantly in the PRE Group (p < 0.05). Compared to PRE group, improvement for Borg Scale level, recovery heart rate and recovery diastolic blood pressure were more obvious in IE Group (p < 0.05). Conclusions: This study demonstrated that both quadriceps strengthening methods have displayed improvements in cardiovascular fitness. Further research with larger sample groups may need to be carried out