Normative and critical criteria for iliotibial band and iliopsoas muscle flexibility

Context: The Ober and Thomas tests are subjective and involve a "negative" or "positive" assessment, making them difficult to apply within the paradigm of evidence-based medicine. No authors have combined the subjective clinical assessment with an objective measurement for these special tests. Objective: To compare the subjective assessment of iliotibial band and iliopsoas flexibility with the objective measurement of a digital inclinometer, to establish normative values, and to provide an evidence-based critical criterion for determining tissue tightness. Design: Cross-sectional study. Setting: Clinical research laboratory. Patients or Other Participants: Three hundred recreational athletes (125 men, 175 women; 250 in injured group, 50 in control group). Main Outcome Measure(s): Iliotibial band and iliopsoas muscle flexibility were determined subjectively using the modified Ober and Thomas tests, respectively. Using a digital inclinometer, we objectively measured limb position. lnterrater reliability for the subjective assessment was compared between 2 clinicians for a random sample of 100 injured participants, who were classified subjectively as either negative or positive for iliotibial band and iliopsoas tightness. Percentage of agreement indicated interrater reliability for the subjective assessment. Results: For iliotibial band flexibility, the average inclinometer angle was -24.59 degrees +/- 7.27 degrees. A total of 432 limbs were subjectively assessed as negative (-27.13 degrees +/- 5.53 degrees) and 168 as positive (-16.29 degrees +/- 6.87 degrees). For iliopsoas flexibility, the average inclinometer angle was -10.60 degrees +/- 9.61 degrees. A total of 392 limbs were subjectively assessed as negative (-15.51 degrees +/- 5.82 degrees) and 208 as positive (0.34 degrees +/- 7.00 degrees). The critical criteria for iliotibial band and iliopsoas flexibility were determined to be -23.16 degrees and -9.69 degrees, respectively. Between-clinicians agreement was very good, ranging from 95.0% to 97.6% for the Thomas and Ober tests, respectively. Conclusions: Subjective assessments and instrumented measurements were combined to establish normative values and critical criterions for tissue flexibility for the modified Ober and Thomas tests

Liberal arts student learning outcomes: An integrated approach

Researchers completing a study of liberal arts education sought to identify learning outcomes associated with both wisdom and citizenship. They have synthesized these themes into seven outcomes that facilitate effective student learning and development.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/57388/1/222_ftp.pd

Resistance Training and Quality of Life Among Younger and Older Adults

Older adults are at risk for sarcopenia, which can lead to reduced physical function, physical activity, and quality of life (QoL). PURPOSE: To determine the effects of aging and sedentary behavior on risk for sarcopenia, the purpose was to compare resistance trained and nonresistance trained younger and older adults on two sarcopenia-related outcomes: QoL and physical activity level (PA). METHODS: Younger (23.8 ± 0.4) and older (68.5 ± 1.2) healthy adults were categorized into 4 groups: young trained (YT: n = 22), young not trained (YNT: n = 16), old trained (OT: n = 17), and old not trained (ONT: n = 21). Resistance trained participants trained ≥ 2X per week, for the past ≥ 6 months. Participants completed a survey to assess health-related QoL, using the Sarcopenia and Quality of Life Questionnaire (SarQoL), and PA, using the Leisure Time Exercise Questionnaire (LTEQ). The SarQoL provides a total QoL score based on 7 dimensions. We were interested in total QoL and the following 3 dimensions: physical and mental health, functionality, and activities of daily living (ADLs). Scores range from 0 (worst health) to 100 (best health). The LTEQ provides a score for PA units, based on vigorous, moderate, and light PA in the past week, with higher scores indicating more PA. ANOVAs were used to determine group differences for each variable, p ≤ 0.05. Data are reported as mean ± SE. RESULTS: Group differences emerged for all variables (p ≤ 0.05). For total QoL, YT (94.5 ± 1.4) was significantly higher than all other groups (YNT: 86.4 ± 1.6, p \u3c 0.001; OT: 87.1 ± 1.6, p = 0.001; ONT: 81.9 ± 1.4, p \u3c 0.001). OT (p = 0.017) and YNT (p = 0.039) were significantly higher than ONT. For physical and mental health, YT (94.2 ± 2.4) was significantly higher than all groups (YNT: 82.2 ± 2.8, p = 0.002; OT: 85.8 ± 2.7, p = 0.022; ONT: 77.9 ± 2.4, p \u3c 0.001). OT was significantly higher than ONT (p = 0.035). For functionality (e.g., balance, climbing stairs), YT (97.5 ± 1.4) again was significantly higher than the other groups (YNT: 92.0 ± 1.6, p = 0.012; OT: 88.9 ± 1.6, p \u3c 0.001; ONT: 85.6 ± 1.4, p \u3c 0.001). YNT was significantly higher than ONT (p= 0.004). For ADLs (e.g., difficulty, fatigue, or pain during physical effort), YT (95.4 ± 1.7) was significantly higher than all groups (YNT: 87.3 ± 1.9, p = 0.002; OT: 87.9 ± 1.9, p = 0.004; ONT: 84.7 ± 1.7, p \u3c 0.001). For all QoL variables, OT did not differ from YNT (p \u3e 0.05). For PA, YT (58.5 ± 6.1 AU) had the same activity level as OT (50.0 ± 6.9 AU, p = 0.356). YT was significantly higher than YNT (31.1 ± 7.3 AU, p = 0.005) and ONT (32.4 ± 6.4 AU, p = 0.004). All other group comparisons were not different (p \u3e 0.05). CONCLUSION: Interestingly, OT was similar to YT on PA and similar to YNT on QoL outcomes. Further, OT was higher than ONT on perceptions of physical and mental health and total QoL. These data suggest that resistance training may be an effective modality to improve or maintain QoL as individuals age

A double blind randomised controlled trial comparing standard dose of iron supplementation for pregnant women with two screen-and-treat approaches using hepcidin as a biomarker for ready and safe to receive iron.

BACKGROUND: Until recently, WHO recommended daily iron supplementation for all pregnant women (60 mg/d iron combined with 400ug/d folic acid) where anaemia rates exceeded 40 %. Recent studies indicate that this may pose a risk to pregnant women. Therefore, there is a need to explore screen-and-treat options to minimise iron exposure during pregnancy using an overall lower dosage of iron that would achieve equivalent results as being currently recommended by the WHO. However, there is a lack of agreement on how to best assess iron deficiency when infections are prevalent. Here, we test the use of hepcidin a peptide hormone and key regulator of iron metabolism, as a potential index for 'safe and ready to receive' iron. DESIGN/METHODS: This is a 3-arm randomised-controlled proof-of-concept trial. We will test the hypothesis that a screen-and-treat approach to iron supplementation using a pre-determined hepcidin cut-off value of <2.5 ng/ml will achieve similar efficacy in preventing iron deficiency and anaemia at a lower iron dose and hence will improve safety. A sample of 462 pregnant women in rural Gambia will be randomly assigned to receive: a) UNU/UNICEF/WHO international multiple micronutrient preparation (UNIMMAP) containing 60 mg/d iron (reference arm); b) UNIMMAP containing 60 mg/d iron but based on a weekly hepcidin screening indicating if iron can be given for the next 7 days or not; c) or UNIMMAP containing 30 mg/d iron as in (b) for 12 weeks in rural Gambia. The study will test if the screen-and-treat approach is non-inferior to the reference arm using the primary endpoint of haemoglobin levels at a non-inferiority margin of 0.5 g/dl. Secondary outcomes of adverse effects, compliance and the impact of iron supplementation on susceptibility to infections will also be assessed. DISCUSSION: This trial is expected to contribute towards minimising the exposure of pregnant women to iron that may not be needed and therefore potentially harmful. If the evidence in this study shows that the overall lower dosage of iron is non-inferior to 60 mg/day iron, this may help decrease side-effects, improve compliance and increase safety. The potential for the use of hepcidin for a simple point-of-care (PoC) diagnostic for when it is most safe and effective to give iron may improve maternal health outcomes. TRIAL REGISTRATION: ISRCTN21955180

Effects of Resistance Training Status on Exercise Patterns and Body Composition Among Younger and Older Adults

As individuals age, percent body fat tends to increase and lean muscle mass decreases, which may limit the ability to engage in higher intensity exercise. Moderate to vigorous physical activity has been shown to improve body composition, but it is unclear whether exercise patterns, such as amount of moderate and high intensity exercise performed, are impacted by resistance training status in younger and older adults. PURPOSE: To examine whether resistance trained and untrained younger and older adults differ on duration of high, moderate, and low intensity exercise and percent body fat (%BF). METHODS: Younger (23.8 ± 0.4 years) and older (68.5 ± 1.2 years) healthy adults were categorized into 4 groups based on resistance training status: young resistance trained (YT: n = 22), young not resistance trained (YNT: n = 16), old resistance trained (OT: n = 17), and old not resistance trained (ONT: n = 20). Resistance trained participants had been training ≥ 2X per week, for the past ≥ 6 months. Participants completed a survey to assess the intensity and duration of exercise, and a dual x-ray absorptiometry (DEXA) scan was used to determine %BF. The survey asked how many minutes/hours per week participants engaged in high intensity exercise (e.g., jogging, hiking), moderate intensity exercise (e.g., light bicycling, walking briskly), and low intensity exercise (e.g., slow walking, easy yoga). Responses were coded as 1 = none, 2 = 30-60 minutes, 3 = 1-2 hours, 4 = 2-3 hours, 5 = 3-5 hours, and 6 = more than 5 hours. ANOVAs were used to determine group differences for each variable, p ≤ 0.05. Data are reported as mean ± SE. RESULTS: Group differences emerged for high and moderate intensity exercise (p \u3c 0.05), but not for low intensity (p \u3e 0.05). For high intensity, YT (3.64 ± 0.31) was significantly higher than YNT and ONT (YNT: 1.63 ± 0.37, p \u3c 0.001; ONT: 1.55 ± 0.33, p \u3c 0.001), and OT (2.82 ± 0.36) was significantly higher than YNT and ONT (YNT: p = 0.022; ONT: p = 0.010). For moderate intensity, YT (4.91 ± 0.31) was significantly higher than YNT and ONT (YNT: 2.40 ± 0.38, p \u3c 0.001; ONT: 3.52 ± 0.32, p = 0.003), and OT (4.77 ± 0.35) was significantly greater than YNT and ONT (YNT: p \u3c 0.001; ONT: p = 0.011). Also for moderate intensity, ONT was significantly greater than YNT (p = 0.025). For %BF, YT (25.06 ± 2.1%) was significantly lower than YNT and ONT (YNT: 33.55 ± 1.87%, p = 0.001; ONT: 36.47 ± 1.28%, p \u3c 0.001), and OT (29.37 ± 1.11%) was significantly lower than ONT (p = 0.003). All other group comparisons were not different (p \u3e 0.05). CONCLUSION: The older resistance trained individuals did not differ from the younger trained participants on exercise patterns or percent body fat, suggesting the enduring positive effects of resistance training as individuals age. These resistance trained individuals also performed more moderate and high intensity exercise than non-resistance trained groups, likely contributing to their favorable body composition. Funded by Texas American College of Sports Medicine Student Research Development Award to H. Kendall, J. Mettler, and L. Kipp, and Thesis Fellowship Award to H. Kendall

Resistance Training may Mitigate Age-related Decline in Physical Function

Aging is often accompanied with the onset of sarcopenia, defined by low muscle mass, strength, and physical function. Regular resistance exercise may mitigate this loss; however, data are lacking that compare younger and older adults who do and do not perform resistance training for general health on skeletal muscle mass and physical function. PURPOSE: The aim of this study was to identify differences in muscle mass and physical function between younger and older adults who did and did not perform resistance training for general health. METHODS: Healthy younger (23.8 ± 0.4 yrs) and older (68.5 ± 1.2 yrs) men and women (n = 76) who either did or did not regularly participate in resistance training were placed into 4 groups: young trained (YT: n = 22), young not trained (YNT: n = 16), old trained (OT: n = 17), and old not trained (ONT: n = 21). Dual energy x-ray absorptiometry assessed appendicular skeletal muscle mass (SMI). Participants performed 4 physical function tests: stair climb (SC), 30s sit-to-stand (30sSTS), 6-min walk test (6MWT), and timed-up-and-go (TUG). ANOVAs were used to compare groups for all measures, p ≤ 0.05. Data are reported as mean ± SE. RESULTS: Differences were found between groups for SMI, SC, 30sSTS, 6MWT, and TUG (p ≤ 0.05). SMI was higher for YT compared to YNT (p = 0.001), ONT (p \u3c 0.0001) and OT (p = 0.032) (YT: 8.67 ± 0.36 kg/m2, YNT: 7.08 ± 0.23 kg/m2, OT: 7.73 ± 0.29 kg/m2, ONT: 7.11 ± 0.27 kg/m2). SC performance was slower for ONT compared to YT (p \u3c 0.0001), YNT (p \u3c 0.0001), and OT (p = 0.032); however, YT and was faster than OT (p = 0.002) (YT: 2.37 ± 0.05s, YNT: 2.60 ± 0.10s, OT: 2.94± 0.15s, ONT: 3.32 ± 0.16s). For 30sSTS, OT completed more reps than ONT (p \u3c 0.0001) and YNT (p = 0.001). YT completed more reps than YNT (p \u3c 0.0001) and ONT (p \u3c 0.0001) (YT: 22.8 ± 0.5 reps, YNT: 18.4 ± 0.7 reps, OT: 22.1 ± 1.1 reps, ONT: 16.7 ± 0.6 reps). OT (p = 0.001), YT (p \u3c 0.0001), and YNT (p = 0.046) walked farther in the 6MWT compared to ONT, and YT walked farther than YNT (p = 0.048) (YT: 837.0 ± 16.7 yds, YNT: 783.2 ± 14.5 yds, OT: 819.9 ± 23.3 yds, ONT: 728.3 ± 18.9 yds). For TUG, OT (p = 0.001) and YT (p = 0.046) were faster than ONT (YT: 5.81 ± 0.17s, YNT: 5.87 ± 0.25s, OT: 5.31 ± 0.19s, ONT: 6.35 ± 0.21s). 30sSTS, 6MWT and TUG were not different between OT and YT. 6MWT and SC were not different between OT and YNT (p \u3e 0.05). All other comparisons were not significantly different (p \u3e 0.05). CONCLUSION: Resistance trained older adults outperformed their nonresistance trained peers and these data suggest that older adults who engage in regular resistance training may maintain physical function similar to that of younger adults

Efficacy and safety of hepcidin-based screen-and-treat approaches using two different doses versus a standard universal approach of iron supplementation in young children in rural Gambia: a double-blind randomised controlled trial.

BACKGROUND: Iron deficiency prevalence rates frequently exceed 50 % in young children in low-income countries. The World Health Organization (WHO) recommended universal supplementation of young children where anaemia rates are >40 %. However, large randomized trials have revealed that provision of iron to young children caused serious adverse effects because iron powerfully promotes microbial growth. Hepcidin - the master regulator of iron metabolism that integrates signals of infection and iron deficiency - offers the possibility of new solutions to diagnose and combat global iron deficiency. We aim to evaluate a hepcidin-screening-based iron supplementation intervention using hepcidin cut-offs designed to indicate that an individual requires iron, is safe to receive it and will absorb it. METHODS: The study is a proof-of-concept, three-arm, double blind, randomised controlled, prospective, parallel-group non-inferiority trial. Children will be randomised to receive, for a duration of 12 weeks, one of three multiple micronutrient powders (MNP) containing: A) 12 mg iron daily; B) 12 mg or 0 mg iron daily based on a weekly hepcidin screening indicating if iron can be given for the next seven days or not; C) 6 mg or 0 mg iron daily based on a weekly hepcidin screening indicating if iron can be given for the next seven days or not. The inclusion criteria are age 6-23 months, haemoglobin (Hb) concentration between 7 and 11 g/dL, z-scores for Height-for-Age, Weight-for-Age and Weight-for-Height > -3 SD and free of malaria. Hb concentration at 12 weeks will be used to test whether the screen-and-treat approaches are non-inferior to universal supplementation. Safety will be assessed using caregiver reports of infections, in vitro bacterial and P. falciparum growth assays and by determining the changes in the gut microbiota during the study period. DISCUSSION: A screen-and-treat approach using hepcidin has the potential to make iron administration safer in areas with widespread infections. If this proof-of-concept study shows promising results the development of a point-of-care diagnostic test will be the next step. TRIAL REGISTRATION: ISRCTN07210906 , 07/16/2014

Prevalence and risk factors for Staphylococcus aureus nasopharyngeal carriage during a PCV trial.

BACKGROUND: We conducted an ancillary study among individuals who had participated in a cluster-randomized PCV-7 trial in rural Gambia (some clusters were wholly-vaccinated while in others only young children had been vaccinated), to determine the prevalence and risk factors for Staphylococcus aureus nasopharyngeal carriage. METHODS: Two hundred thirty-two children aged 5-10 years were recruited and followed from 4 to 20 months after vaccination started. We collected 1264 nasopharyngeal swabs (NPS). S. aureus was isolated following conventional microbiological methods. Risk factors for carriage were assessed by logistic regression. RESULTS: Prevalence of S. aureus carriage was 25.9%. In the univariable analysis, prevalence of S. aureus carriage was higher among children living in villages wholly-vaccinated with PCV-7 [OR = 1.57 95%CI (1.14 to 2.15)] and children with least 1 year of education [OR = 1.44 95%CI (1.07 to 1.92)]. S. aureus carriage was also higher during the rainy season [OR = 1.59 95%CI (1.20 to 2.11)]. Carriage of S. pneumoniae did not have any effect on S. aureus carriage for any pneumococcal, vaccine-type (VT) or non-vaccine-type (NVT) carriage. Multivariate analysis showed that the higher prevalence of S. aureus observed among children living in villages wholly-vaccinated with PCV-7 occurred only during the rainy season OR 2.72 95%CI (1.61-4.60) and not in the dry season OR 1.28 95%CI (0.78-2.09). CONCLUSIONS: Prevalence of nasopharyngeal carriage of S. aureus among Gambian children increased during the rainy season among those children living in PCV-7 wholly vaccinated communities. However, carriage of S. aureus is not associated with carriage of S. pneumoniae. TRIAL REGISTRATION: ISRCTN51695599 . Registered August 04th 2006

Genetic Factors and Orofacial Motor Learning Selectively Influence Variability in Central Sulcus Morphology in Chimpanzees (Pan troglodytes)

International audienceCaptive chimpanzees (Pan troglodytes) have been shown to learn the use of novel attention-getting (AG) sounds to capture the attention of humans as a means of requesting or drawing their attention to a desired object or food. There are significant individual differences in the use of AG sounds by chimpanzees and, here, we examined whether changes in cortical organization of the central sulcus (CS) were associated with AG sound production. MRI scans were collected from 240 chimpanzees, including 122 that reliably produced AG sounds and 118 that did not. For each subject, the depth of CS was quantified along the superior-inferior plane with specific interest in the inferior portion corresponding to the region of the motor cortex where the mouth and orofacial movements are controlled. Results indicated that CS depth in the inferior, but not superior, portion was significantly greater in chimpanzees that reliably produced AG sounds compared with those who did not. Quantitative genetic analyses indicated that overall CS surface area and depth were significantly heritable, particularly in the superior regions, but less so in the inferior and central portions. Further, heritability in CS depth was altered as a function of acquisition of AG sounds. The collective results suggest that learning to produce AG sounds resulted in region-specific cortical reorganization within the inferior portion of the CS, a finding previously undocumented in chimpanzees or any nonhuman primate