Psychometric properties of a standardized protocol of muscle strength assessment by hand-held dynamometry in healthy adults: a reliability study

Background Maximal isometric muscle strength (MIMS) assessment is a key component of physiotherapists’ work. Hand-held dynamometry (HHD) is a simple and quick method to obtain quantified MIMS values that have been shown to be valid, reliable, and more responsive than manual muscle testing. However, the lack of MIMS reference values for several muscle groups in healthy adults with well-known psychometric properties limits the use and the interpretation of these measures obtained with HHD in clinic. Objective To determine the intra- and inter-rater reliability, standard error of measurement (SEM) and minimal detectable change (MDC) of MIMS torque values obtained with HHD. Methods Intra and Inter-rater Reliability Study. The MIMS torque of 17 muscle groups was assessed by two independent raters at three different times in 30 healthy adults using a standardized HHD protocol using the MEDup™ (Atlas Medic, Québec, Canada). Participants were excluded if they presented any of the following criteria: 1) participation in sport at a competitive level; 2) degenerative or neuromusculoskeletal disease that could affect torque measurements; 3) traumatic experience or disease in the previous years that could affect their muscle function; and 4) use of medication that could impact muscle strength (e.g., muscle relaxants, analgesics, opioids) at the time of the evaluation. Intra- and inter-rater reliability were determined using two-way mixed (intra) and random effects (inter) absolute agreement intraclass correlation coefficients (ICC: 95% confidence interval) models. SEM and MDC were calculated from these data. Results Intra- and inter-rater reliability were excellent with ICC (95% confidence interval) varying from 0.90 to 0.99 (0.85–0.99) and 0.89 to 0.99 (0.55–0.995), respectively. Absolute SEM and MDC for intra-rater reliability ranged from 0.14 to 3.20 Nm and 0.38 to 8.87 Nm, respectively, and from 0.17 to 5.80 Nm and 0.47 to 16.06 Nm for inter-rater reliability, respectively. Conclusions The excellent reliability obtained in this study suggest that the use of such a standardized HHD protocol is a method of choice for MIMS torque measurements in both clinical and research settings. And the identification of the now known metrological qualities of such a protocol should encourage and promote the optimal use of manual dynamometry

Policy combinations to navigate between private and public monopolies in emerging technological sectors

Finance is one of the main critical issues for the development of a low carbon society especially during times of economic recession. Closing this green investment gap will require policy intervention. This paper is part of a larger research project – the ALPI project – which aims at analysing and designing relevant instruments to accelerate the transition towards a low carbon society. As a showcase of emerging technologies in Belgium, the Hasselt University, the University of Liège and the Geological Survey of Belgium are investigating the regional potential for geothermal electricity production. Deep geothermal energy appears to be currently on the edge of a take-off. But the actual emergence of this technology is subject to developments in legislation and incentives from regional governments. Different risk/return expectations across stages of the investment continuum exist and the financial structures that are employed at each stage may require different types of public support. Considering the particularities of the development of geothermal energy in Belgium, we present different combinations of incentives to support geothermal energy, and we review different sector evolutions through a broad stakeholder consultation (policy makers, sector federations, industry, researchers, banking sector, investors, etc.). However, a review of the learning effects shows that neither of the two combinations can prevent a regional monopolisation of the underground as a natural resource either by a private first-mover, or a public investor. Therefore, intermediary solutions are proposed to provide a balance between the two extremes, and to ensure an improved sector growth and a continuous open market.Assessment of Low Carbon Society Policy Instruments (ALPI) http://www.alpi.ugent.be/index.htm

A mathematical model to predict BNP levels in hemodialysis patients

International audienceAim: Clinical interpretation of B-Type Natriuretic Peptide (BNP) levels in hemodialysis patients (HD) for fluid management remains elusive.Method: We conducted a retrospective observational monocentric study. We built a mathematical model to predict BNP levels, using multiple linear regressions. Fifteen clinical/biological associated with BNP variation were selected. A first cohort of 150 prevalent HD (from September 2015 to march 2016) was used to build several models. Thebest model proposed was internally validated in an independent cohort of 62 incidents HD (from March 2016 to September 2017).Results: In cohort 1, mean BNP Level was 630±717 ng/ml. Cardiac disease (CD = Stable Coronary Artery Disease and/or Atrial Fibrillation) was present in 45% of patient. The final model includes: Age, systolic Blood Pressure (sBP), Albumin, CD, Normo-hydrated Weight (NHW) and the Fluid Overload (FO) assessed by bio-impedancemetry. The correlationbetween the measured and the predicted log-BNP was 0.567 and 0.543 in cohort-1 and 2 respectively. Age (β=3.175e-2, p<0.00), CD (β=5.243e-1, p<0.001) and FO (β=1.227e-1, p<0.001) contribute the most significantly to the BNP level, respectively, but within a certain range. We observed a logistic relationship between BNP and age between 30 to 60 years, after which this relationship was lost. BNP level was inversely correlated with NHW independently of CD. Finally, our model allows us to predict the BNP level according to the FO.Conclusion: We developed a mathematical model capable of predicting the BNP level in HD. Our results show the complex contribution of age, CD and FO on BNP level

Atherosclerotic burden findings in young cryptogenic stroke patients with and without a patent foramen ovale

BACKGROUND AND PURPOSE: To further determine the mechanisms of cryptogenic stroke or transient ischemic attack in young patients, we evaluated indices of atherosclerosis in patients <or=55 years old diagnosed with cryptogenic cerebrovascular event comparing those with patent foramen ovale (PFO) with those without PFO. METHODS: This was a prospective study including 100 consecutive patients <or=55 years old (mean age, 45+/-8 years; 56 males) diagnosed with cryptogenic stroke/transient ischemic attack. PFO was identified in 59 of these patients with the use of transesophageal echocardiography with contrast study. The following surrogate markers of atherosclerosis were evaluated in all patients: carotid intima media thickness as measured by carotid ultrasonography and endothelial function as determined by brachial flow-mediated vasodilation. The same measurements were obtained in a control group of 50 age- and sex-matched control subjects. RESULTS: Patients without PFO were more likely to be current smokers and obese and more frequently had a history of hypertension and dyslipidemia. Carotid intima media thickness measurements were higher (P<0.0001) in patients without PFO (1.03+/-0.31 mm) compared with those with PFO (0.75+/-0.20 mm) and control subjects (0.79+/-0.17 mm). The absence of PFO was also associated with lower brachial flow-mediated vasodilation (without PFO: 5.04+/-3.39%; with PFO: 7.16+/-4.09%; control subjects: 7.33+/-4.07%; P=0.02). There were no differences in carotid intima media thickness and flow-mediated vasodilation between patients with stroke/transient ischemic attack with PFO and control subjects. The presence of PFO was independently associated with reduced carotid intima media thickness (P<0.0001) and increased flow-mediated vasodilation (P=0.019). CONCLUSIONS: In patients <or=55 years old diagnosed with cryptogenic stroke/transient ischemic attack, the presence of PFO was associated with a lower atherosclerotic burden as measured by carotid intima media thickness and endothelial function with no differences compared with a control group without cerebrovascular event. These results suggest that an atherosclerotic-mediated mechanism may be involved in cryptogenic stroke/transient ischemic attack in patients without PFO, whereas a nonatherosclerotic mechanism may mediate the cerebrovascular event in the presence of PFO

Surveillance of Avian Influenza in the Caribbean Through the Caribbean Animal Health Network: Surveillance Tools and Epidemiologic Studies

International audienc

A Delphi-Based Consensus Statement on the Management of Anticoagulated Patients With Botulinum Toxin for Limb Spasticity.

Objective To create a consensus statement on the considerations for treatment of anticoagulated patients with botulinum toxin A (BoNTA) intramuscular injections for limb spasticity. Design We used the Delphi method. Setting A multiquestion electronic survey. Participants Canadian physicians (N=39) who use BoNTA injections for spasticity management in their practice. Interventions After the survey was sent, there were e-mail discussions to facilitate an understanding of the issues underlying the responses. Consensus for each question was reached when agreement level was ≥75%. Main Outcome Measures Not applicable. Results When injecting BoNTA in anticoagulated patients: (1) BoNTA injections should not be withheld regardless of muscles injected; (2) a 25G or smaller size needle should be used when injecting into the deep leg compartment muscles; (3) international normalized ratio (INR) level should be ≤3.5 when injecting the deep leg compartment muscles; (4) if there are clinical concerns such as history of a fluctuating INR, recent bleeding, excessive or new bruising, then an INR value on the day of injection with point-of-care testing or within the preceding 2-3 days should be taken into consideration when injecting deep compartment muscles; (5) the concern regarding bleeding when using direct oral anticoagulants (DOACs) should be the same as with warfarin (when INR is in the therapeutic range); (6) the dose and scheduling of DOACs should not be altered for the purpose of minimizing the risk of bleeding prior to BoNTA injections. Conclusions These consensus statements provide a framework for physicians to consider when injecting BoNTA for spasticity in anticoagulated patients. These consensus statements are not strict guidelines or decision-making steps, but rather an effort to generate common understanding in the absence of evidence in the literature