An open source approach for regional cortical bone mineral density analysis

Objective: Cortical porosity, particularly at the endocortical region, is recognised to play a central role in the pathogenesis of bone fragility. Therefore, the purpose of this study was to: 1) demonstrate how cortical volumetric BMD (vBMD) distribution can be analysed from (p)QCT images and 2) highlight the clinical significance of assessing regional density distribution of cortical bone.&nbsp; Methods: We used pQCT to compare mid-tibial cortical volumetric BMD distribution of 20 young (age 24(SD2) years, mass 77(11) kg, height 178(6) cm) and 25 elderly (72(4) years, 75(9) kg, 172(5) cm) men. Radial and polar cortical vBMD distributions were analysed using a custom built open source analysis tool which allowed the cortex to be divided into three concentric cortical divisions and in 36 cortical sectors originating from the centroid of the bone. Results: Mean vBMD did not differ between the groups (1135(16) vs. 1130(28) mg/cm, P=0.696). In contrast, there was a significant age-group by radial division interaction for radial cortical vBMD (P&lt;0.001). Conclusions: The proposed analysis method for analysing cortical bone density distribution of pQCT images was effective for detecting regional differences in cortical density between young and elderly men, which would have been missed by just looking at mean vBMD values.<br /

An integrated wireless communication architecture for maritime sector

The rapid evolution of terrestrial wireless systems has brought mobile users more and more desired communication services. Maritime customers are asking for the same, such as the concepts of “Broadband at Sea” and “Maritime Internet”. Quite a lot of research work has focused on the development of new and better maritime communication technologies, but less attention has been paid on interworking of multiple maritime wireless networks or on satisfying service provisioning. To address this, an integrated wireless Communication Architecture for Maritime Sector (CAMS) has been introduced in this article. CAMS is aimed at 1) granting maritime customers uninterrupted connectivity through the best available network and 2) providing them with the best-provisioned communication services in terms of mobility, security and Quality of Experience (QoE). To address mobility challenge, the IEEE 802.21 standard is recommended to be used in CAMS in order to achieve seamless handover. CAMS provides application-level QoE support attending to the limited communication resources (e.g. bandwidth) at sea. Certain security considerations have also been proposed to supplement this architecture

Kuntoutujan osallistaminen tavoitteenasettamisprosessiin ja tavoitteiden saavuttamisen arviointiin : Loppuraportti

Kuntoutujan osallisuus omassa kuntoutumisprosessissaan on ensiarvoisen tärkeää, jotta kuntoutumista edistävät toimet nivoutuvat osaksi kuntoutujan arkea ja kuntoutuja motivoituu ja sitoutuu muutokseen. Tässä Kelan rahoittamassa vuosina 2015 ja 2016 toteutetussa tutkimuksessa tarkasteltiin kuntoutujan osallistamista kuntoutumistavoitteiden asettamiseen ja tavoitteiden seurantaan Goal Attainment Scaling -menetelmällä (GAS). Tutkimuksen tavoitteena oli 1) tarkastella kuntoutujan osallisuutta ja siihen vaikuttavia tekijöitä tavoitteita asettaessa, 2) arvioida tavoitteiden saavuttamista ja siihen liittyviä tekijöitä sekä 3) vertailla kahden kuntoutujaryhmän yhtäläisyyksiä ja eroavaisuuksia tavoitetyöskentelyssä. Tutkimus toteutettiin arviointitutkimuksena, jossa Keski-Suomen keskussairaalan vaativan kuntoutuksen osaston kuntoutujat (n = 20) sekä Uudenmaan ja Etelä-Hämeen erityishuoltopiirin kuntayhtymän eli Etevan kehitysvammapsykiatrian yksiköiden kuntoutujat (n = 20) asettivat omat tavoitteensa yhdessä moniammatillisen työryhmän kanssa käyttäen GAS-menetelmää. Tutkimuksen alussa ammattilaiset perehdytettiin kuntoutujan osallistamisen ideologiaan sekä GAS-menetelmään. Ammattilaisten tietämystä kartoitettiin kyselyllä alussa ja lopussa. Tutkija havainnoi kunkin kuntoutujan ja työryhmän tavoitekeskustelua, minkä jälkeen hän haastatteli yksilöllisesti kuntoutujaa ja omaisia sekä ryhmähaastatteluna moniammatillista työryhmää. Puolen vuoden kuluttua arvioitiin tavoitteen saavuttamista ja siihen vaikuttavia tekijöitä haastattelemalla kuntoutujaa ja omaisia sekä ammattilaisia. Tavoitekeskustelut ja haastattelut nauhoitettiin ja litteroitiin. Aineiston analyysissä painottuivat laadulliset menetelmät. Kuntoutujan osallistaminen tavoitekeskusteluun näyttäytyi täysivaltaisena ja osittaisena osallistumisena. Täysivaltaisen osallistumisen alatyyppeinä olivat kuntoutuja aktiivisena vallan- ja vastuunkäyttäjänä sekä kuntoutuja tuetusti osallistuvana. Osittaisen osallistumisen alatyyppeinä olivat kuntoutujan jättäytyminen sivuun jossain vaiheessa keskustelua, kuntoutujan jättäminen sivuun jossain vaiheessa keskustelua sekä kuntoutujan jääminen sivuun epätarkoituksenmukaisen tuen vuoksi. Kuntoutujan osallistumista tavoitteenasettamisprosessiin edistivät seuraavat asiat: Yksilölliset tarpeet ohjasivat päämäärätietoista tavoitekeskustelussa etenemistä, kuntoutujalla oli valmius asettaa omia tavoitteitaan, ammattilaiset käyttivät tarkoituksenmukaisia osallistamisen työtapoja sekä omaiset olivat mukana tavoitteen asettamisessa. Vaativan kuntoutuksen osaston kuntoutujat saavuttivat tavoitteensa keskimääräistä paremmin (T-lukuarvo 57, hajonta 12). Kehitysvammapsykiatrian kuntoutujilla oli tavoitteensaavuttamisessa vaihtelua, ryhmätasolla tavoitteen saavuttaminen jäi keskimääräistä heikommaksi (T-lukuarvo 45, hajonta 15). Tavoitteen saavuttamiseen vaikuttavat tekijät liittyivät kuntoutujaan, kuntoutumisen tukimuotoihin sekä lähi-ihmisiin ja asuinympäristöön. Johtopäätöksenä voidaan todeta, että kuntoutujan osallistuminen omien tavoitteiden asettamiseen sekä motivoi että sitouttaa kuntoutujaa kuntoutumisprosessiin. Kognitiiviset ongelmat ja kehitysvammaisuus eivät estä kuntoutujan aktiivista osallistumista tavoitteen asettamisprosessiin, mikäli ammattilaiset osaavat tukea ja kannustaa kuntoutujan osallisuutta ja päätöksentekoa. Kuntoutujan osallistaminen vaatii opettelua ja harjoittelua niin kuntoutujalta, yksittäiseltä ammattilaiselta, työyhteisöltä kuin koko organisaatiolta

Näyttöön perustuva tuki- ja liikuntaelinsairauksien kuntoutus

Kelan rahoittaman TULES- eli tuki- ja liikuntaelinsairauksien kuntoutuksen standardien kehittämistä tukevan tutkimuksen (11/2013–8/2014) yhtenä osatavoitteena oli kartoittaa keskeisin tutkimusnäyttö tuki- ja liikuntaelinsairauksien vaikuttavasta kuntoutuksesta. Tämän työpaperin tarkoitus on antaa kuntoutuksen suunnittelijoille ja käytännön työntekijöille tietoa tämänhetkisen TULES-kuntoutuksen tutkimuksen tuloksista. Järjestelmällinen kirjallisuuskatsaus tuo esille vaikuttavaksi osoitettuja kuntoutusmuotoja. Tähän kirjallisuuskatsaukseen on lisäksi kerätty tietoa eri maiden kuntoutussuosituksista alaselän, niskan, olkapään sekä polven ja lonkan TULE-sairauksien osalta sekä kuntouttavan liikuntaharjoittelun perusteista. Järjestelmällinen tiedonhaku suoritettiin viiden vuoden ajalta; vuoden 2009 alusta vuoden 2013 loppuun saakka. Järjestelmällisen katsauksen päätulokset osoittivat aktiiviseen terapeuttiseen harjoitteluun perustuvien ohjelmien olevan vaikuttavia kaikkien katsauksessa mukana olleiden TULE-sairauksien kuntoutuksessa. Lisäksi todettiin manuaalisen terapian olevan vaikuttavaa alaselän ja niskan kuntoutuksessa. Kohtalaista tutkimusnäyttöä löytyi tiettyjen fysikaalisten hoitojen, mm. akupunktion, laserterapian ja pulsoivan magneettiterapian vaikuttavuudesta jokaisessa tutkitussa TULE-sairaudessa. Ohjauksellisista interventioista ainoastaan behavioraalisen terapian vaikuttavuus on osoitettu kohtalaiseksi alaselän kuntoutuksessa. Eri maiden ja yhdistysten suositukset painottavat tutkimusnäytön mukaisesti aktiivista harjoittelua niin selkä-, niska- kuin nivelkuntoutuksessa

Hip and spine bone mineral density are greater in master sprinters, but not endurance runners compared with non-athletic controls

Summary: We examined bone density in older athletes and controls. Sprinters had greater hip and spine bone density than endurance athletes and controls, whereas values were similar in the latter two groups. These results could not be explained by differences in impact, muscle size or power between sprint and endurance athletes. Purpose: We examined the relationship between prolonged participation in regular sprint or endurance running and skeletal health at key clinical sites in older age, and the factors responsible for any associations which we observed. Methods: We recruited 38 master sprint runners (28 males, 10 females, mean age 71 ± 7 years), 149 master endurance runners (111 males, 38 females, mean age 70 ± 6 years) and 59 non-athletic controls (29 males, 30 females, mean age 74 ± 5 years). Dual X-ray absorptiometry was used to assess hip and spine bone mineral density (BMD), body composition (lean and fat mass), whilst jump power was assessed with jumping mechanography. In athletes, vertical impacts were recorded over 7 days from a waist-worn accelerometer, and details of starting age, age-graded performance and training hours were recorded. Results: In ANOVA models adjusted for sex, age, height, body composition, and jump power, sprinter hip BMD was 10 and 14% greater than that of endurance runners and controls respectively. Sprinter spine BMD was also greater than that of both endurance runners and controls. There were no differences in hip or spine BMD between endurance runners and controls. Stepwise regression showed only discipline (sprint/endurance), sex, and age as predictors of athlete spine BMD, whilst these variables and starting age were predictive of hip BMD. Conclusions: Regular running is associated with greater BMD at the fracture-prone hip and spine sites in master sprinters but not endurance runners. These benefits cannot be explained by indicators of mechanical loading measured in this study including vertical impacts, body composition or muscular output

Подростки-спортсмены строят двойную карьеру и благополучие в условиях двойного карьерного роста: роль факторов окружающей среды

Рукопись поступила в редакцию: 20.12.2021.Received: 20.12.2021.Цель исследования заключалась в изучении карьерного роста и благополучия спортсменов-подростков в условиях двойного карьерного роста. В исследовании выявлены особенности адаптивности к карьере в старших классах спортивной школы. В статье представлены данные относительно того, в какой степени самооценка и пол связаны с адаптивностью к двойной карьере, определены профили адаптации к карьере спортсменов-подростков, выявлены как ожидания студентов-спортсменов в зависимости от их успехов в спорте и учебе и соответствующие ожидания их родителей связаны с их профилями адаптации к карьере. Получены новые данные относительно того, как организационная культура спортивной школы влияет на построение карьеры спортсменов-подростков.The purpose of the scientific research was to study the career growth and well-being of adolescent athletes in conditions of dual career growth. The study revealed the features of adaptability to a career in high school of sports school. The article presents data on the extent to which self-esteem and gender are associated with adaptability to a dual career, the profiles of adaptation to the career of adolescent athletes have been defined, it is also revealed how the expectations of student-athletes depending on their success in sports and studies and the corresponding expectations of their parents are associated with their profiles of adaptation to a career. The new data on how the organizational culture of a sports school affects the career development of teenage athletes have been obtained

Time-course of exercise and its association with 12-month bone changes

<p>Abstract</p> <p>Background</p> <p>Exercise has been shown to have positive effects on bone density and strength. However, knowledge of the time-course of exercise and bone changes is scarce due to lack of methods to quantify and qualify daily physical activity in long-term. The aim was to evaluate the association between exercise intensity at 3, 6 and 12 month intervals and 12-month changes in upper femur areal bone mineral density (aBMD) and mid-femur geometry in healthy premenopausal women.</p> <p>Methods</p> <p>Physical activity was continuously assessed with a waist-worn accelerometer in 35 healthy women (35-40 years) participating in progressive high-impact training. To describe exercise intensity, individual average daily numbers of impacts were calculated at five acceleration levels (range 0.3-9.2 <it>g</it>) during time intervals of 0-3, 0-6, and 0-12 months. Proximal femur aBMD was measured with dual x-ray absorptiometry and mid-femur geometry was evaluated with quantitative computed tomography at the baseline and after 12 months. Physical activity data were correlated with yearly changes in bone density and geometry, and adjusted for confounding factors and impacts at later months of the trial using multivariate analysis.</p> <p>Results</p> <p>Femoral neck aBMD changes were significantly correlated with 6 and 12 months' impact activity at high intensity levels (> 3.9 <it>g</it>, <it>r </it>being up to 0.42). Trochanteric aBMD changes were associated even with first three months of exercise exceeding 1.1 <it>g </it>(<it>r </it>= 0.39-0.59, <it>p </it>< 0.05). Similarly, mid-femoral cortical bone geometry changes were related to even first three months' activity (<it>r </it>= 0.38-0.52, <it>p </it>< 0.05). In multivariate analysis, 0-3 months' activity did not correlate with bone change at any site after adjusting for impacts at later months. Instead, 0-6 months' impacts were significant correlates of 12-month changes in femoral neck and trochanter aBMD, mid-femur bone circumference and cortical bone attenuation even after adjustment. No significant correlations were found at the proximal or distal tibia.</p> <p>Conclusion</p> <p>The number of high acceleration impacts during 6 months of training was positively associated with 12-month bone changes at the femoral neck, trochanter and mid-femur. These results can be utilized when designing feasible training programs to prevent bone loss in premenopausal women.</p> <p>Trial registration</p> <p>Clinical trials.gov NCT00697957</p

Isometric muscle training of the spine musculature in patients with spinal bony metastases under radiation therapy

<p/> <p>Background</p> <p>Osseous metastatic involvement of the spinal column affects many patients with a primary tumour disease of all entities. The consequences are pain both at rest and under exertion, impairments in going about day-to-day activities, diminished performance, the risk of pathological fractures, and neurological deficits. Palliative percutaneous radiotherapy is one of the therapeutical options available in this connection. The aim of this explorative study is to investigate the feasibility of muscle-training exercises and to evaluate the progression- and fracture-free survival time and the improvement of bone density, as well as to assess other clinical parameters such as pain, quality of life, and fatigue as secondary endpoints.</p> <p>Methods/Design</p> <p>This study is a prospective, randomized, monocentre, controlled explorative intervention study in the parallel-group design to determine the multidimensional effects of a course of exercises at first under physiotherapeutic instruction and subsequently performed by the patients independently for strengthening the paravertebral muscles of patients with metastases of the vertebral column parallel to their percutaneous radiotherapy. On the days of radiation treatment the patients in the control group shall be given physical treatment in the form of respiratory therapy and the so-called "hot roll". The patients will be randomized into one of the two groups: differentiated muscle training or physiotherapy with thirty patients in each group.</p> <p>Discussion</p> <p>The aim of the study is to evaluate the feasibility of the training programme described here. Progression-free and fracture-free survival, improved response to radiotherapy by means of bone density, and clinical parameters such as pain, quality of life, and fatigue constitute secondary study objectives.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01409720">NCT01409720</a></p

Options for early breast cancer follow-up in primary and secondary care : a systematic review

Background Both incidence of breast cancer and survival have increased in recent years and there is a need to review follow up strategies. This study aims to assess the evidence for benefits of follow-up in different settings for women who have had treatment for early breast cancer. Method A systematic review to identify key criteria for follow up and then address research questions. Key criteria were: 1) Risk of second breast cancer over time - incidence compared to general population. 2) Incidence and method of detection of local recurrence and second ipsi and contra-lateral breast cancer. 3) Level 1–4 evidence of the benefits of hospital or alternative setting follow-up for survival and well-being. Data sources to identify criteria were MEDLINE, EMBASE, AMED, CINAHL, PSYCHINFO, ZETOC, Health Management Information Consortium, Science Direct. For the systematic review to address research questions searches were performed using MEDLINE (2011). Studies included were population studies using cancer registry data for incidence of new cancers, cohort studies with long term follow up for recurrence and detection of new primaries and RCTs not restricted to special populations for trials of alternative follow up and lifestyle interventions. Results Women who have had breast cancer have an increased risk of a second primary breast cancer for at least 20 years compared to the general population. Mammographically detected local recurrences or those detected by women themselves gave better survival than those detected by clinical examination. Follow up in alternative settings to the specialist clinic is acceptable to women but trials are underpowered for survival. Conclusions Long term support, surveillance mammography and fast access to medical treatment at point of need may be better than hospital based surveillance limited to five years but further large, randomised controlled trials are needed

A novel accelerometer-based method to describe day-to-day exposure to potentially osteogenic vertical impacts in older adults: findings from a multi-cohort study

Summary: This observational study assessed vertical impacts experienced in older adults as part of their day-to-day physical activity using accelerometry and questionnaire data. Population-based older adults experienced very limited high-impact activity. The accelerometry method utilised appeared to be valid based on comparisons between different cohorts and with self-reported activity. Introduction: We aimed to validate a novel method for evaluating day-to-day higher impact weight-bearing physical activity (PA) in older adults, thought to be important in protecting against osteoporosis, by comparing results between four cohorts varying in age and activity levels, and with self-reported PA levels. Methods: Participants were from three population-based cohorts, MRC National Survey of Health and Development (NSHD), Hertfordshire Cohort Study (HCS) and Cohort for Skeletal Health in Bristol and Avon (COSHIBA), and the Master Athlete Cohort (MAC). Y-axis peaks (reflecting the vertical when an individual is upright) from a triaxial accelerometer (sampling frequency 50 Hz, range 0–16 g) worn at the waist for 7 days were classified as low (0.5–1.0 g), medium (1.0–1.5 g) or higher (≥1.5 g) impacts. Results: There were a median of 90, 41 and 39 higher impacts/week in NSHD (age 69.5), COSHIBA (age 76.8) and HCS (age 78.5) participants, respectively (total n = 1512). In contrast, MAC participants (age 68.5) had a median of 14,322 higher impacts/week. In the three population cohorts combined, based on comparison of beta coefficients, moderate-high-impact activities as assessed by PA questionnaire were suggestive of stronger association with higher impacts from accelerometers (0.25 [0.17, 0.34]), compared with medium (0.18 [0.09, 0.27]) and low impacts (0.13 [0.07,0.19]) (beta coefficient, with 95 % CI). Likewise in MAC, reported moderate-high-impact activities showed a stronger association with higher impacts (0.26 [0.14, 0.37]), compared with medium (0.14 [0.05, 0.22]) and low impacts (0.03 [−0.02, 0.08]). Conclusions: Our new accelerometer method appears to provide valid measures of higher vertical impacts in older adults. Results obtained from the three population-based cohorts indicate that older adults generally experience very limited higher impact weight-bearing PA