Movements of older adults during exergaming interventions that are associated with the Systems Framework for Postural Control: A systematic review

One in three older adults fall annually, in part due to impairments in the physiological systems that make up the postural control (PC) system. Exercise, particularly balance training, helps to prevent deterioration and even to improve outcomes in the PC system. Exergaming (exercise-gaming) is interactive computer gaming whereby an individual moves the body in response to onscreen cues in a playful format. Exergaming is an alternative method to standard practice for improving PC outcomes, which has been shown to reduce the risk of falling. Exergaming has received research attention, yet the intervention is still in its infancy. There could be benefit in exploring the movements trained with respect to a framework known for identifying underlying deficits in the PC system, the Systems Framework for Postural Control (SFPC). This may help target areas for improvement in balance training using exergames and shed light on the impact for fall prevention. A literature search was therefore conducted across six databases (CINAHL, EMBASE, PubMed, ISI, SPORTdiscus and Science Direct) using a range of search terms and combinations relating to exergaming, balance, exercise, falls and elderly. Quality assessment was conducted using the PEDro Scale and a custom-made quality assessment tool. Movements were rated by two reviewers based on the 9 operational definitions of the SFPC. Eighteen publications were included in the analysis, with a mean PEDro score of 5.6 (1.5). Overall, 4.99 (1.27) of the 9 operational definitions of the SFPC are trained in exergaming interventions. Exergaming does encourage individuals to stand up (3), lean while standing (4), move upper limbs and turn heads (6) and dual-task while standing (9), to some extent move the body forwards, backwards and sideways (1), and coordinate movements (2) but hardly at all to kick, hop, jump or walk (7), or to force a postural reaction from a physical force to the individual (5) and it does not mimic actual changes in sensory context (8). This is the first review, to our knowledge, that synthesises the literature on movements trained in exergaming interventions with respect to an established theoretical framework for PC. This review could provide useful information for designing exergames with PC outcomes in mind, which could help target specific exergames for multi-factorial training to overcome balance deficits. Some elements of PC are too unsafe to be trained using exergames, such as restricting sensory inputs or applying physical perturbations to an individual to elicit postural responses

A systematic review and meta-analysis of outcome measures to assess postural control in older adults who undertake exergaming

Exergaming has been shown to be an effective tool to improve postural control (PC) in older community-dwelling individuals. The outcome measures (OMs) used to assess PC are varied and this could limit the estimation of the effectiveness of the intervention. This systematic review and meta-analysis aims to explore the OMs currently used to assess PC in exergaming interventions, for healthy elderly individuals aged over 60 years. The literature search was conducted across five databases (CINAHL, EMBASE, PubMed, ISI, SPORTdiscus and Science Direct) using a range of search terms and combinations relating to exergaming, balance, exercise, falls and elderly. Quality assessment was conducted using the PEDro Scale and a custom-made quality assessment tool. Eleven trials were included in the meta-analysis, with a mean (SD) PEDro score of 5.36 (1.57). Primary and secondary OMs showed small effects in favour of alternative training modes, although these effects were statistically insignificant for all primary OMs. Tertiary OMs could not be included in the meta-analysis due to varying output parameters from different instruments. Heterogeneity remained high across trials and no studies performed long-term follow-up. Exergaming is a potential alternative to PC training, although still in its infancy. Strong and well-designed RCTs are needed, targeting specific populations aged over 60 years. Variability in instrumented OMs prevents generalisation of results. Technological improvements may provide data not currently available from clinical and laboratory-based methods, and may allow PC to be assessed more realistically and specifically in relation to a population’s activities of daily living, though this remains a new area of research

The Scurfy mutation of FoxP3 in the thymus stroma leads to defective thymopoiesis

The Scurfy mutation of the FoxP3 gene (FoxP3sf) in the mouse and analogous mutations in human result in lethal autoimmunity. The mutation of FoxP3 in the hematopoietic cells impairs the development of regulatory T cells. In addition, development of the Scurfy disease also may require mutation of the gene in nonhematopoietic cells. The T cell–extrinsic function of FoxP3 has not been characterized. Here we show that the FoxP3sf mutation leads to defective thymopoiesis, which is caused by inactivation of FoxP3 in the thymic stromal cells. FoxP3 mutation also results in overexpression of ErbB2 in the thymic stroma, which may be involved in defective thymopoiesis. Our data reveal a novel T cell–extrinsic function of FoxP3. In combination, the T cell–intrinsic and –extrinsic defects provide plausible explanation for the severity of the autoimmune diseases in the scurfy mice and in patients who have immunodysregulation, polyendocrinopathy, enteropathy, and X-linked syndrome

The Grizzly, February 2, 2012

Birk Launches Graphic Novel at UC • Myrin Welcomes New Library Intern • Resumania Preps Students for Job, Internship Fair • Organic Farm Names New Student Director • Ursinus Introduces Zumba Class for Students • Jablonowski Gains Experience at Academy of Natural Sciences • St. Christopher\u27s Offers Volunteer Opportunity for UC Students • Opinion: SOPA had Right Idea, but was Misguided; Major and Minor Expo Offers Great Information • Senior Spotlight: Sean Whelan, Football • Buckley\u27s Bears Battle Through Adversity • Ursinus Community Remembers Daniel Gloverhttps://digitalcommons.ursinus.edu/grizzlynews/1850/thumbnail.jp

Tropical Indian Ocean basin hydroclimate at the Mid- to Late-Holocene transition and the double drying hypothesis

The spatial pattern of Holocene climate anomalies is crucial to determining the mechanisms of change, distinguishing between unforced and forced climate variability, and understanding potential impacts on past and future human societies. The 4.2 ka event is often regarded as one of the largest and best documented abrupt climate disturbances of the Holocene. Yet outside the data-rich Northern Hemisphere mid-latitudes, the global pattern of climate anomalies is uncertain. In this study we investigate the spatial and temporal variability of the tropical Indian Ocean hydroclimate at the Mid- to Late-Holocene transition. We conducted Monte-Carlo principal component analysis, considering full age uncertainty, on ten high-resolution, precisely dated paleohydroclimate records from around the tropical Indian Ocean basin, all growing continuously or almost continuously between 5 and 3 kyr BP. The results indicate the dominant mode of variability in the region was a drying between 3.97 kyr BP (±0.08 kyr standard error) and 3.76 kyr BP (±0.07 kyr standard error) with dry conditions lasting for an additional 300 years in some records, and a permanent change in others. This drying in PC1, which we interpret as a proxy of summer monsoon variability, fits with a previously recognised tropic wide change in hydroclimate around 4.0 kyr BP. An abrupt event from 4.2 to 3.9 kyr BP is seen locally in individual records but lacks regional coherence. A lack of apparent 4.2 ka event in tropical Indian Ocean hydroclimate has ramifications for climate variability in the Indus valley, and for the Harappan civilization. Through a comparison of existing Indian subcontinent paleoclimate records, upstream climatic variability in the Indian Summer Monsoon and winter Westerly Disturbances source regions, and modern climatology, we present the “Double Drying hypothesis”. A winter rainfall drying between 4.2 and 3.9 kyr BP was followed by a summer rainfall drying between 3.97 kyr BP and at least 3.4 kyr BP. The Double Drying hypothesis provides more detailed climatic context for the Harappan civilization, resolves the cropping paradox, and fits the spatial-temporal pattern of urban abandonment. The consequences for the new Mid- to Late-Holocene Global Boundary Stratotype Section and Point in a stalagmite from Meghalaya are explored

Southern Hemisphere controls on ITCZ variability in southwest Madagascar over the past 117,000 years

Migration of the inter-tropical convergence zone, driven by changes in seasonal insolation and high northern latitude temperatures, is the primary control on tropical rainfall on geologic timescales. We test this paradigm using the timing of growth of stalagmites from southwest Madagascar to infer the timing of expansion of the ITCZ to the south at its southern limit. Over the past 117 ky, speleothems grew in the study area primarily when two conditions are met: summer insolation greater than the mean and relatively high Southern Hemisphere temperatures as indicted by maxima in Antarctic ice core oxygen isotope ratios. We observe little influence of Northern Hemisphere, millennial scale temperature variability on the pluvial periods. Further, we observe periods during which the ITCZ simultaneously expands or contracts in both hemispheres. Because Antarctic isotope maxima are periods of increased atmospheric CO2, our results have implications for how tropical rainfall in the Southern Hemisphere might respond to global warming

Hydroclimate variability in the Madagascar and Southeast African summer monsoons at the Mid- to Late-Holocene transition

The 4.2 ka event at the Mid- to Late-Holocene transition is often regarded as one of the largest and best documented abrupt climate disturbances of the Holocene. The event is most clearly manifested in the Mediterranean and Middle East as a regional dry anomaly beginning abruptly at 4.26 kyr BP and extending until 3.97 kyr BP. Yet the impacts of this regional drought are often extended to other regions and sometimes globally. In particular, the nature and spatial extent of the 4.2 ka event in the tropics have not been established. Here, we present a new stalagmite stable isotope record from Anjohikely, northwest Madagascar. Growing between 5.22 and 2.00 kyr BP, stalagmite AK1 shows a hiatus between 4.31 and 3.93 kyr BP (±40 and ± 35 yrs), replicating a hiatus in another stalagmite from nearby Anjohibe, and therefore indicating a significant drying at the Mid- to Late-Holocene transition. This result is the opposite to wet conditions at the 8.2 ka event, suggesting fundamentally different forcing mechanisms. Dry conditions are also recorded in sediment cores in Lake Malawi, Lake Masoko and the Tatos Basin on Mauritius, also in the southeast African monsoon domain. However, no notable event is recorded at the northern (equatorial East Africa) and eastern (Rodrigues) peripheries of the monsoon domain, while a wet event is recorded in sediment cores at Lake Muzi and Mkhuze Delta to the south. The spatial pattern is largely consistent with the modern rainfall anomaly pattern associated a with weak Mozambique Channel Trough and a northerly austral summer Intertropical Convergence Zone position. Within age error, the observed peak climate anomalies overlap with the 4.2 ka event. However regional hydrological change consistently begins earlier than a 4.26 kyr BP event onset. Gradual hydrological change frequently begins around 4.5 kyr BP, raising doubt as to whether any coherent regional hydrological change is merely coincident with the 4.2 ka event or part of a global climatic anomaly

Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial

Objective To evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in primary care.The hypothesis was that more intensive intervention would result in a greater reduction in hazardous or harmful drinking. Design Pragmatic cluster randomised controlled trial.Setting Primary care practices in the north east and south east of England and in London.Participants 3562 patients aged 18 or more routinely presenting in primary care, of whom 2991 (84.0%) were eligible to enter the trial: 900(30.1%) screened positive for hazardous or harmful drinking and 756(84.0%) received a brief intervention. The sample was predominantly male (62%) and white (92%), and 34% were current smokers. Interventions Practices were randomised to three interventions, each of which built on the previous one: a patient information leaflet control group, five minutes of structured brief advice, and 20 minutes of brief lifestyle counselling. Delivery of the patient leaflet and brief advice occurred directly after screening and brief lifestyle counselling in a subsequent consultation. Main outcome measures The primary outcome was patients’ self reported hazardous or harmful drinking status as measured by the alcohol use disorders identification test (AUDIT) at six months. A negative AUDITresult (score <8) indicated non-hazardous or non-harmful drinking.Secondary outcomes were a negative AUDIT result at 12 months,experience of alcohol related problems (alcohol problems questionnaire),health utility (EQ-5D), service utilisation, and patients’ motivation to change drinking behaviour (readiness to change) as measured by a modified readiness ruler.Results Patient follow-up rates were 83% at six months (n=644) and 79% at 12 months (n=617). At both time points an intention to treat analysis found no significant differences in AUDIT negative status between the three interventions. Compared with the patient information leaflet group, the odds ratio of having a negative AUDIT result for briefa dvice was 0.85 (95% confidence interval 0.52 to 1.39) and for brief lifestyle counselling was 0.78 (0.48 to 1.25). A per protocol analysis confirmed these findings. Conclusions All patients received simple feedback on their screening outcome. Beyond this input, however, evidence that brief advice or brief lifestyle counselling provided important additional benefit in reducing hazardous or harmful drinking compared with the patient information leaflet was lacking

Screening and brief interventions for hazardous and harmful alcohol use in probation services: a cluster randomised controlled trial protocol

Background: A large number of randomised controlled trials in health settings have consistently reported positive effects of brief intervention in terms of reductions in alcohol use. However, although alcohol misuse is common amongst offenders, there is limited evidence of alcohol brief interventions in the criminal justice field. This factorial pragmatic cluster randomised controlled trial with Offender Managers (OMs) as the unit of randomisation will evaluate the effectiveness and cost-effectiveness of different models of screening to identify hazardous and harmful drinkers in probation and different intensities of brief intervention to reduce excessive drinking in probation clients. Methods and design: Ninety-six OMs from 9 probation areas across 3 English regions (the North East Region (n = 4) and London and the South East Regions (n = 5)) will be recruited. OMs will be randomly allocated to one of three intervention conditions: a client information leaflet control condition (n = 32 OMs); 5-minute simple structured advice (n = 32 OMs) and 20-minute brief lifestyle counselling delivered by an Alcohol Health Worker (n = 32 OMs). Randomisation will be stratified by probation area. To test the relative effectiveness of different screening methods all OMs will be randomised to either the Modified Single Item Screening Questionnaire (M-SASQ) or the Fast Alcohol Screening Test (FAST). There will be a minimum of 480 clients recruited into the trial. There will be an intention to treat analysis of study outcomes at 6 and 12 months post intervention. Analysis will include client measures (screening result, weekly alcohol consumption, alcohol-related problems, re-offending, public service use and quality of life) and implementation measures from OMs (the extent of screening and brief intervention beyond the minimum recruitment threshold will provide data on acceptability and feasibility of different models of brief intervention). We will also examine the practitioner and organisational factors associated with successful implementation. Discussion. The trial will evaluate the impact of screening and brief alcohol intervention in routine probation work and therefore its findings will be highly relevant to probation teams and thus the criminal justice system in the UK. © 2009 Newbury-Birch et al; licensee BioMed Central Ltd