Robot-assisted end-effector-based stair climbing for cardiopulmonary exercise testing: feasibility, reliability and repeatability

Neurological impairments can limit the implementation of conventional cardiopulmonary exercise testing (CPET) and cardiovascular training strategies. A promising approach to provoke cardiovascular stress while facilitating task-specific exercise in people with disabilities is feedback-controlled robot-assisted end-effector-based stair climbing (RASC). The aim of this study was to evaluate the feasibility, reliability, and repeatability of augmented RASC-based CPET in able-bodied subjects, with a view towards future research and applications in neurologically impaired populations.Twenty able-bodied subjects performed a familiarisation session and 2 consecutive incremental CPETs using augmented RASC. Outcome measures focussed on standard cardiopulmonary performance parameters and on accuracy of work rate tracking (RMSEP-root mean square error). Criteria for feasibility were cardiopulmonary responsiveness and technical implementation. Relative and absolute test-retest reliability were assessed by intraclass correlation coefficients (ICC), standard error of the measurement (SEM), and minimal detectable change (MDC). Mean differences, limits of agreement, and coefficients of variation (CoV) were estimated to assess repeatability.All criteria for feasibility were achieved. Mean V'O2peak was 106±9% of predicted V'O2max and mean HRpeak was 99±3% of predicted HRmax. 95% of the subjects achieved at least 1 criterion for V'O2max, and the detection of the sub-maximal ventilatory thresholds was successful (ventilatory anaerobic threshold 100%, respiratory compensation point 90% of the subjects). Excellent reliability was found for peak cardiopulmonary outcome measures (ICC ≥ 0.890, SEM ≤ 0.60%, MDC ≤ 1.67%). Repeatability for the primary outcomes was good (CoV ≤ 0.12).RASC-based CPET with feedback-guided exercise intensity demonstrated comparable or higher peak cardiopulmonary performance variables relative to predicted values, achieved the criteria for V'O2max, and allowed determination of sub-maximal ventilatory thresholds. The reliability and repeatability were found to be high. There is potential for augmented RASC to be used for exercise testing and prescription in populations with neurological impairments who would benefit from repetitive task-specific training

Adaptação cultural e análise da confiabilidade do instrumento Modified Dyspnea Index para a cultura brasileira

This study aims to present the cross-cultural adaptation process of the Modified Dyspnea Index to the Brazilian culture and to investigate its content validity and reliability. This process included the steps of translation, back translation and review by two experts to assess semantic, conceptual, idiomatic, cultural and metabolic equivalence. The Index of Content Validity was used to evaluate the extent of inter-observer agreement. A Guide to implement the Modified Dyspnea Index was developed and validated. Two different professionals assessed the reliability of the Brazilian version of the Modified Dyspnea Index, according to the inter-observer equivalence criterion, with 31 patients, indicating a Kappa coefficient=0.960 (pEste estudio presenta el proceso de adaptación cultural del Modified Dyspnea Index para la cultura brasileña y la evaluación de su validad de contenido y confiabilidad. Este proceso incluyó las etapas de traducción, retrotraducción y evaluación de la equivalencia semántica, idiomática, conceptual, cultural/experimental y metabólica. El Índice de Validad de Contenido fue utilizado para evaluar la proporción de concordancia entre los jueces. Fue desarrollado y validado un guión para orientar la aplicación del Modified Dyspnea Index. Dos diferentes profesionales evaluaron la confiabilidad de la versión brasileña del Modified Dyspnea Index, de acuerdo con el criterio de la equivalencia inter-observador, en 31 pacientes, apuntando para un coeficiente Kappa=0,960 (pEste estudo apresenta o processo de adaptação cultural do Modified Dyspnea Index para a cultura brasileira e a avaliação de sua validade de conteúdo e confiabilidade. Esse processo incluiu as etapas de tradução, retrotradução e avaliação da equivalência semântica, idiomática, conceitual, cultural/experimental e metabólica. Utilizou-se o Índice de Validade de Conteúdo para avaliar a proporção de concordância entre os juízes. Foi desenvolvido e validado um roteiro para nortear a aplicação do Modified Dyspnea Index. Dois diferentes profissionais avaliaram a confiabilidade da versão brasileira do Modified Dyspnea Index, de acordo com o critério da equivalência interobservador, em 31 pacientes, apontando para um coeficiente Kappa=0,960 (

Cultural Adaptation And Reliability Analysis Of The Modified Dyspnea Index For The Brazilian Culture.

This study aims to present the cross-cultural adaptation process of the Modified Dyspnea Index to the Brazilian culture and to investigate its content validity and reliability. This process included the steps of translation, back translation and review by two experts to assess semantic, conceptual, idiomatic, cultural and metabolic equivalence. The Index of Content Validity was used to evaluate the extent of inter-observer agreement. A Guide to implement the Modified Dyspnea Index was developed and validated. Two different professionals assessed the reliability of the Brazilian version of the Modified Dyspnea Index, according to the inter-observer equivalence criterion, with 31 patients, indicating a Kappa coefficient=0.960 (p<0.001). In conclusion, the Brazilian version of MDI presented evidence of interobserver equivalence when applied by different health professionals in the population of cardiac patients.181020-3

α1-Antitrypsin deficiency.

α1-Antitrypsin deficiency (A1ATD) is an inherited disorder caused by mutations in SERPINA1, leading to liver and lung disease. It is not a rare disorder but frequently goes underdiagnosed or misdiagnosed as asthma, chronic obstructive pulmonary disease (COPD) or cryptogenic liver disease. The most frequent disease-associated mutations include the S allele and the Z allele of SERPINA1, which lead to the accumulation of misfolded α1-antitrypsin in hepatocytes, endoplasmic reticulum stress, low circulating levels of α1-antitrypsin and liver disease. Currently, there is no cure for severe liver disease and the only management option is liver transplantation when liver failure is life-threatening. A1ATD-associated lung disease predominately occurs in adults and is caused principally by inadequate protease inhibition. Treatment of A1ATD-associated lung disease includes standard therapies that are also used for the treatment of COPD, in addition to the use of augmentation therapy (that is, infusions of human plasma-derived, purified α1-antitrypsin). New therapies that target the misfolded α1-antitrypsin or attempt to correct the underlying genetic mutation are currently under development

Adaptación cultural y análisis de la confiabilidad del instrumento Modified Dyspnea Index para la cultura brasileña

This study aims to present the cross-cultural adaptation process of the Modified Dyspnea Index to the Brazilian culture and to investigate its content validity and reliability. This process included the steps of translation, back translation and review by two experts to assess semantic, conceptual, idiomatic, cultural and metabolic equivalence. The Index of Content Validity was used to evaluate the extent of inter-observer agreement. A Guide to implement the Modified Dyspnea Index was developed and validated. Two different professionals assessed the reliability of the Brazilian version of the Modified Dyspnea Index, according to the inter-observer equivalence criterion, with 31 patients, indicating a Kappa coefficient=0.960 (p<0.001). In conclusion, the Brazilian version of MDI presented evidence of interobserver equivalence when applied by different health professionals in the population of cardiac patients.Este estudo apresenta o processo de adaptação cultural do Modified Dyspnea Index para a cultura brasileira e a avaliação de sua validade de conteúdo e confiabilidade. Esse processo incluiu as etapas de tradução, retrotradução e avaliação da equivalência semântica, idiomática, conceitual, cultural/experimental e metabólica. Utilizou-se o Índice de Validade de Conteúdo para avaliar a proporção de concordância entre os juízes. Foi desenvolvido e validado um roteiro para nortear a aplicação do Modified Dyspnea Index. Dois diferentes profissionais avaliaram a confiabilidade da versão brasileira do Modified Dyspnea Index, de acordo com o critério da equivalência interobservador, em 31 pacientes, apontando para um coeficiente Kappa=0,960 (p<0,001). A versão brasileira do Modified Dyspnea Index apresentou provas de equivalência interobservador em amostra de pacientes cardíacos.Este estudio presenta el proceso de adaptación cultural del Modified Dyspnea Index para la cultura brasileña y la evaluación de su validad de contenido y confiabilidad. Este proceso incluyó las etapas de traducción, retrotraducción y evaluación de la equivalencia semántica, idiomática, conceptual, cultural/experimental y metabólica. El Índice de Validad de Contenido fue utilizado para evaluar la proporción de concordancia entre los jueces. Fue desarrollado y validado un guión para orientar la aplicación del Modified Dyspnea Index. Dos diferentes profesionales evaluaron la confiabilidad de la versión brasileña del Modified Dyspnea Index, de acuerdo con el criterio de la equivalencia inter-observador, en 31 pacientes, apuntando para un coeficiente Kappa=0,960 (p<0,001). La versión brasileña del Modified Dyspnea Index presentó pruebas de equivalencia inter-observador en una muestra de pacientes cardíacos.1020103

Short-time weight-bearing capacity assessment for non-ambulatory patients with subacute stroke: reliabiltiy and discriminative power

BACKGROUND: Weight-bearing capacity (WBC) on the hemiparetic leg is crucial for independent walking, and is thus an important outcome to monitor after a stroke. A specific and practical assessment in non-ambulatory patients is not available. This is of importance considering the increasing administration of high intensive gait training for the severely impaired stroke population. The aim was to develop a fast and easy-to-perform assessment for WBC on a foot pressure plate to be used in clinical routine. METHODS: WBC was assessed in the frontal plane in 30 non-ambulatory patients with subacute stroke and 10 healthy controls under 3 conditions: static, dynamic, and rhythmic. Force–time curves for the hemiparetic leg (patients with stroke) and the non-dominant leg (healthy controls) were normalised as a percentage of body weight (%BW), and the means analysed over 60, 30, and 15 s (static) and the mean of the peak values for 15, 10, 5, 4, and 3 repetition trials (dynamic, rhythmic). The data were tested for discriminative power and reliability. Dynamic and rhythmic tests could discriminate between patients with stroke and healthy controls over all periods (15, 10, 5, 4, and 3 repetitions) (p < 0.001), but not the static test (60 s, p = 0.639; 30 s, p = 0.708; 15 s, p = 0.685). Excellent relative intra-session [intra-class correlation (ICC) >0.829] and inter-session reliability (ICC = 0.740) were found for 3 repetitions in the dynamic test with acceptable absolute reliability [standard error of measurement (SEM) <5 %BW, minimal detectable difference (MDD) <12.4 %BW] and no within- or between-test differences (trial 1, p = 0.792; trial 2, p = 0.067; between trials, p = 0.102). CONCLUSIONS: Three dynamic repetitions of loading the hemiparetic leg are sufficient to assess WBC in non-ambulatory patients with subacute stroke. This is an important finding regarding the implementation of a fast and easy-to-perform assessment for routine clinical usage in patients with limited standing ability

Association of IREB2 and CHRNA3 polymorphisms with airflow obstruction in severe alpha-1 antitrypsin deficiency

Background: The development of COPD in subjects with alpha-1 antitrypsin (AAT) deficiency is likely to be influenced by modifier genes. Genome-wide association studies and integrative genomics approaches in COPD have demonstrated significant associations with SNPs in the chromosome 15q region that includes CHRNA3 (cholinergic nicotine receptor alpha3) and IREB2 (iron regulatory binding protein 2). We investigated whether SNPs in the chromosome 15q region would be modifiers for lung function and COPD in AAT deficiency. Methods The current analysis included 378 PIZZ subjects in the AAT Genetic Modifiers Study and a replication cohort of 458 subjects from the UK AAT Deficiency National Registry. Nine SNPs in LOC123688, CHRNA3 and IREB2 were selected for genotyping. Fev$_1$ percent of predicted and Fev$_1$/FVC ratio were analyzed as quantitative phenotypes. Family-based association analysis was performed in the AAT Genetic Modifiers Study. In the replication set, general linear models were used for quantitative phenotypes and logistic regression models were used for the presence/absence of emphysema or COPD. Results: Three SNPs (rs2568494 in IREB2, rs8034191 in LOC123688, and rs1051730 in CHRNA3) were associated with pre-bronchodilator Fev$_1$ percent of predicted in the AAT Genetic Modifiers Study. Two SNPs (rs2568494 and rs1051730) were associated with the post-bronchodilator Fev$_1$ percent of predicted and pre-bronchodilator Fev$_1$/FVC ratio; SNP-by-gender interactions were observed. In the UK National Registry dataset, rs2568494 was significantly associated with emphysema in the male subgroup; significant SNP-by-smoking interactions were observed. Conclusions: IREB2 and CHRNA3 are potential genetic modifiers of COPD phenotypes in individuals with severe AAT deficiency and may be sex-specific in their impact

BBC Experiments in local radio broadcasting 1961-62

In the early 1960s, the BBC was given the opportunity to demonstrate that it had the skills and resources to create localized broadcasting, by organizing a series of experimental stations across the UK. Although the output was not heard publicly, the results were played to the Pilkington Committee on Broadcasting, who were deliberating about the future direction of radio and television. Using archival research, featuring contemporary BBC documents, this paper argues that these experimental stations helped senior managers at the BBC to harness technological innovation with changing attitudes in society and culture, thus enabling them to formulate a strategy that put the BBC in the leading position to launch local radio a few years later in 1967

Hepatic-targeted RNA interference provides robust and persistent knockdown of alpha-1 antitrypsin levels in ZZ patients

Pathogenesis and treatment of chronic pulmonary disease

LMDA Review, volume 10, issue 1

Contents include: Photo of Conference Participants Annual Conference 1999, Send in your Ballot, A Note to Ourselves, Increase in Dues and New Annual Membership Expiration Date, LMDA Archive, LMDA Administrator; LMDA Interns, Mid-Year Meeting, Early Career Dramaturg Program, Elliot Hayes Award 2000, Report on Canadian Caucus, Script Exchange, Report on the Dramaturgy Focus Group ATHE 1999, Elliot Hayes Award Winners Lue Douthit and Michel Volansky, Acceptance Speech Lue Morgan Douthit, Elliot Hayes Award Presentation to Michele Volansky for Space, On the Elliot Hayes Award Michele Volansky, Day One of the Conference, Day Two of the Conference, Day Three of the Conference, Day Four of the Conference, The Advocacy Caucus Presentation at the Conference, Final Thoughts, Conference 1999 Many Thanks, Arthur Ballet and the Office for Advanced Drama Research, Spotlight on Early Career Dramaturg Vanessa Porteous, A Working History of LMDA The Early Years, From Academia to Arena A Dramaturg\u27s Education in the Real World, Tony Creamer and Death of a Salesman, Two Moments, Jobs and Projects, Scriptseeker.com, LMDA Online Listserv Instructions, Note from James Magruder, Literary Managers and Dramaturgs of the Americas Bibliography 1999, Noted with Pleasure, and Internship Questionnaire.https://soundideas.pugetsound.edu/lmdareview/1020/thumbnail.jp