Gait and balance in Parkinson's disease : psychometric properties and effects of training

Aim: The overarching aims of this thesis were to: evaluate the psychometric properties of a new clinical balance tool in People with Parkinson’s disease (PwPD) with mild to moderate disease severity; as well as to investigate the effects of a new gait and balance training regime, developed to target specific symptoms commonly observed in this population. Methods: Paper one entailed the evaluation of a balance tool’s (the Mini-BESTest) reproducibility in a clinical context, when used in PwPD. In order to investigate how the reproducibility was affected by different administrators, 27 PwPD performed the Mini- BESTest with two physiotherapists who administered the test separately. In order to evaluate how the reproducibility was affected between test occasions, the participants returned 7 days later to be reassessed by one of the physiotherapists. Paper two entailed the evaluation of the Mini-BESTest’s validity by means of hypotheses testing, which included, for example, the test’s ability to distinguish between PwPD and healthy controls; and between PwPD with mild and moderate severity. A total of 105 PwPD and 47 healthy controls participated in this evaluation. Papers III & IV evaluated, in form of a randomised controlled trial (RCT), if participation in 10-weeks of symptom-specific and challenging training affected gait and balance abilities, fall related concerns, physical activity and activities of daily living (ADL). In addition, the training effects on the abilities to walk while simultaneously performing an added task were also specifically addressed. One-hundred PwPD were recruited to this study and were randomised to either the training or control group (care as usual). Results: The reliability of the Mini-BESTest was found to be good. However the measurement error on individual level was considered high, reflecting more than 10 percent of the total score. When the agreement is related to a group level (in this case, 91 individuals), the measurement error only reflected 2 percent of the total score. Moreover, the Mini- BESTest was able to adequately distinguish between PwPD and healthy controls, as well as between PwPD with mild and moderate disease severity, respectively. The findings from the RCT showed that the participants in the training group, when compared to the control group, improved balance, gait, ADL and showed tendencies towards increased physical activity, whereas fall related concerns were unaffected. During gait with an added task, the performance of the added task was improved while the gait remained unaffected. Conclusions: The psychometric properties of the Mini-BESTest make it appropriate for research purposes. Although the measurement error on individual level is considered large, the clinical value of the test is considered to exceed its flaws. Specific and challenging training can improve gait and balance abilities amongst PwPD, effects that might influence improved physical activity. Future research should investigate the importance of the added cognitive task when performed during gait

Supervisory control of integrated continuous downstream processes

Smart downstream processing can be performed with a sequence of integrated purification steps, which minimize the number of storage tanks and reduce hold-up time. The result is an integrated unit operation sequence that performs straight through processing of the target protein, with minimal time from expression to formulation. This downstream processing technique is well suited to be connected to a continuous upstream process based on perfusion. To develop these kinds of processes it is important to do studies in small-scale in a convenient way. This paper presents a methodology for supervisory control of integrated continuous downstream processes in lab-scale. A general platform in lab-scale for sequential processing of integrated downstream processes is developed using ÄKTA/UNICORN-systems. The modification of the physical setup to handle multiple processing steps in sequence on one single machine makes it possible to study advanced and complex process configurations without a lot of resources. To make it easy to program and run the complicated setup a new supervisory controller is developed on top of UNICORN. The new controller, called orbit, is extendable and flexible to handle very different configurations and processes. To facilitate the usage even further the actual controller code is automatically generated from a high level presentation of the separation problem. Tools for design, control and verification makes it possible to virtual test the concept before making the actual experiment. The power of this concept is illustrated by some case studies. Please click Additional Files below to see the full abstract

Conversion of an industrial batch separation process to an autonomous integrated downstream process – A case study Anton Lofgren, Lund University, Sweden

In this contribution an industrial case study, consisting of several unit operations operated in batch mode, was converted to an integrated separation process. The complete downstream process consisted of an anion exchange step, followed by virus inactivation and finally a hydrophobic interaction step. Moving from batch to integrated separation minimizes hold-up times, storage tanks and required equipment. The conversion from batch to integrated mode was achieved by extracting operating points and separation data from batch chromatograms. The integrated separation process was realized on an ÄKTA Pure controlled by a newly developed software called Orbit. The setup consisted of two column valves which were used alternatively. In order to send the sample or the buffers from one column to another, two versatile valves were used before and after the column valves. In addition, an outlet valve after the second versatile valve sent the pool back to the first versatile valve to begin a new phase. Orbit works on top of UNICORN through an OPC interface. The new controller is very flexible and can handle different column configurations. There is great power in being able to control every valve and pump. This is exploited by Orbit which allows both high and low level inputs. High level inputs are operating conditions (i.e flow rate and flow path). The high level inputs are automatically transformed into low level inputs (i.e. valve positions) that the OPC server can read. The processes that can be controlled are among others end-to-end downstream processes as well as integrated filtration systems such as UF/DF

On the preconditions for large-scale collective action

The phenomenon of collective action and the origin of collective action problems have been extensively and systematically studied in the social sciences. Yet, while we have substantial knowledge about the factors promoting collective action at the local level, we know far less about how these insights travel to large-scale collective action problems. Such problems, however, are at the heart of humanity’s most pressing challenges, including climate change, large-scale natural resource depletion, biodiversity loss, nuclear proliferation, antibiotic resistance due to overconsumption of antibiotics, and pollution. In this paper, we suggest an analytical framework that captures the theoretical understanding of preconditions for large-scale collective action. This analytical framework aims at supporting future empirical analyses of how to cope with and overcome larger-scale collective action problems. More specifically, we (i) define and describe the main characteristics of a large-scale collective action problem and (ii) explain why voluntary and, in particular, spontaneous large-scale collective action among individual actors becomes more improbable as the collective action problem becomes larger, thus demanding interventions by an external authority (a third party) for such action to be generated. Based on this, we (iii) outline an analytical framework that illustrates the connection between third-party interventions and large-scale collective action. We conclude by suggesting avenues for future research.</p

Cost-effectiveness of the HiBalance training program for elderly with Parkinson’s disease: analysis of data from a randomized controlled trial

OBJECTIVE: To determine the cost-effectiveness of the HiBalance training program for managing Parkinson’s disease (PD)-related balance and gait disorders. DESIGN: Cost comparison design following the randomized controlled trial comparing a novel balance training intervention with care as usual. SUBJECTS: A total of 100 participants with mild–moderate PD were randomized to either the intervention (n = 51) or the control group (n = 49). INTERVENTION: A 10-week (three times per week), group-based, progressive balance training program, led by two physical therapists. MAIN OUTCOMES: All program costs were collected for both groups. Cost-utility was evaluated using quality-adjusted life years (QALYs) and cost-effectiveness measures were the Mini Balance Evaluation Systems Test (Mini-BESTest; assessing balance performance) and gait velocity. Incremental cost-effectiveness ratios were calculated and a probabilistic sensitivity analysis was conducted. RESULTS: The between-group difference in QALYs was 0.043 (95% confidence interval (CI): 0.011–0.075), favoring the intervention group. Between-group differences in balance performance and gait velocity were 2.16 points (95% CI: 1.19–3.13) and 8.2 cm/second (95% CI: 2.9–13.6), respectively, favoring the intervention group. The mean cost per participant in the intervention group was 16,222 SEK (€1649) compared to 2696 SEK (€274) for controls. The estimated incremental cost-effectiveness ratios were 314,558 SEK (€31,969) for an additional QALY, 6262 SEK (€631) for one point improvement in balance performance, and 1650 SEK (€166) for 1 cm/second increase in gait velocity. Sensitivity analyses indicated a high probability (85%) of program success. CONCLUSION: In terms of QALYs, the HiBalance program demonstrated a high probability of cost-effectiveness in the short-term perspective when considering the willingness-to-pay thresholds used in Europe

Designing for Extensibility: An action research study of maximizing extensibility by means of design principles

This paper presents an action research study on how a set of design principles applicable to object oriented languages can be used to counteract code rot and consequentially enhance system extensibility. The study describes how these principles help support the system quality attributes of modifiability, maintainability and scalability, as well as how these quality attributes correlate to extensibility. Furthermore, it also elaborates on the relationship between extensibility and code rot and how the absence of the first can lead to the latter. The study thus contributes by illustrating how a design science approach can be useful in action research

Kultur och syntax: expliciteringar i en litteraturvetenskaplig text

Denna magisteruppsats baseras på en översättning av drygt 6000 ord av en komparativ litteraturvetenskaplig text av Herman Beavers om de amerikanska författarna James Baldwin och Ralph Ellison. Uppsatsen består av tre delar. Den första delen är en källtextanalys där textens kontext och viktigaste drag presenteras enligt den analysmodell som presenteras i Hellspongs & Ledins bok Vägar genom texten (1997). Därefter följer överväganden inför översättningen med en kort diskussion om den strategi som valts ut inför översättningsprocessen. Arbetet avslutas med en fördjupning och analys av ett översättningsproblem. Där analyserar jag expliciteringar av kulturspecifika begrepp och syntaktiskt svåra konstruktioner