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In clinical settings, significant resources are spent on data collection and monitoring patients' health parameters to improve decision-making and provide better care. With increased digitization, the healthcare sector is shifting towards implementing digital technologies for data management and in administration. New technologies offer better treatment opportunities and streamline clinical workflow, but the complexity can cause ineffectiveness, frustration, and errors. To address this, we believe digital solutions alone are not sufficient. Therefore, we take a human-centred design approach for AI development, and apply systems engineering methods to identify system leverage points. We demonstrate how automation enables monitoring clinical parameters, using existing non-intrusive sensor technology, resulting in more resources toward patient care. Furthermore, we provide a framework on digitization of clinical data for integration with data management.
Introduction:
In children, the impact of hearing loss on biomechanical gait parameters is not well understood. Thus, the objectives of this study were to examine three-dimensional lower limb joint torques in deaf compared to age-matched healthy (hearing) children while walking at preferred gait speed.
Methods:
Thirty prepubertal boys aged 8-14 were enrolled in this study and divided into a group with hearing loss (deaf group) and an age-matched healthy control. Three-dimensional joint torques were analyzed during barefoot walking at preferred speed using Kistler force plates and a Vicon motion capture system.
Results:
Findings revealed that boys with hearing loss showed lower joint torques in ankle evertors, knee flexors, abductors and internal rotators as well as in hip internal rotators in both, the dominant and non-dominant lower limbs (all p < 0.05; d = 1.23-7.00; 14-79%). Further, in the dominant limb, larger peak ankle dorsiflexor (p < 0.001; d = 1.83; 129%), knee adductor (p < 0.001; d = 3.20; 800%), and hip adductor torques (p < 0.001; d = 2.62; 350%) were found in deaf participants compared with controls.
Conclusion:
The observed altered lower limb torques during walking are indicative of unstable gait in children with hearing loss. More research is needed to elucidate whether physical training (e.g., balance and/or gait training) has the potential to improve walking performance in this patient group. (C) 2019 Elsevier Ltd. All rights reserved.
Background Recent shoulder injury prevention programs have utilized resistance exercises combined with different forms of instability, with the goal of eliciting functional adaptations and thereby reducing the risk of injury. However, it is still unknown how an unstable weight mass (UWM) affects the muscular activity of the shoulder stabilizers. Aim of the study was to assess neuromuscular activity of dynamic shoulder stabilizers under four conditions of stable and UWM during three shoulder exercises. It was hypothesized that a combined condition of weight with UWM would elicit greater activation due to the increased stabilization demand. Methods Sixteen participants (7 m/9 f) were included in this cross-sectional study and prepared with an EMG-setup for the: Mm. upper/lower trapezius (U.TA/L.TA), lateral deltoid (DE), latissimus dorsi (LD), serratus anterior (SA) and pectoralis major (PE). A maximal voluntary isometric contraction test (MVIC; 5 s.) was performed on an isokinetic dynamometer. Next, internal/external rotation (In/Ex), abduction/adduction (Ab/Ad) and diagonal flexion/extension (F/E) exercises (5 reps.) were performed with four custom-made-pipes representing different exercise conditions. First, the empty-pipe (P; 0.5 kg) and then, randomly ordered, water-filled-pipe (PW; 1 kg), weight-pipe (PG; 4.5 kg) and weight + water-filled-pipe (PWG; 4.5 kg), while EMG was recorded. Raw root-mean-square values (RMS) were normalized to MVIC (%MVIC). Differences between conditions for RMS%MVIC, scapular stabilizer (SR: U.TA/L.TA; U.TA/SA) and contraction (CR: concentric/eccentric) ratios were analyzed (paired t-test; p <= 0.05; Bonferroni adjusted alpha = 0.008). Results PWG showed significantly greater muscle activity for all exercises and all muscles except for PE compared to P and PW. Condition PG elicited muscular activity comparable to PWG (p > 0.008) with significantly lower activation of L.TA and SA in the In/Ex rotation. The SR ratio was significantly higher in PWG compared to P and PW. No significant differences were found for the CR ratio in all exercises and for all muscles. Conclusion Higher weight generated greater muscle activation whereas an UWM raised the neuromuscular activity, increasing the stabilization demands. Especially in the In/Ex rotation, an UWM increased the RMS%MVIC and SR ratio. This might improve training effects in shoulder prevention and rehabilitation programs.
The manual muscle test (MMT) is a flexible diagnostic tool, which is used in many disciplines, applied in several ways. The main problem is the subjectivity of the test. The MMT in the version of a “break test” depends on the tester’s force rise and the patient’s ability to resist the applied force. As a first step, the investigation of the reproducibility of the testers’ force profile is required for valid application. The study examined the force profiles of n = 29 testers (n = 9 experiences (Exp), n = 8 little experienced (LitExp), n = 12 beginners (Beg)). The testers performed 10 MMTs according to the test of hip flexors, but against a fixed leg to exclude the patient’s reaction. A handheld device recorded the temporal course of the applied force. The results show significant differences between Exp and Beg concerning the starting force (padj = 0.029), the ratio of starting to maximum force (padj = 0.005) and the normalized mean Euclidean distances between the 10 trials (padj = 0.015). The slope is significantly higher in Exp vs. LitExp (p = 0.006) and Beg (p = 0.005). The results also indicate that experienced testers show inter-tester differences and partly even a low intra-tester reproducibility. This highlights the necessity of an objective MMT-assessment. Furthermore, an agreement on a standardized force profile is required. A suggestion for this is given.
When pandemic hits
(2020)
The governmental lockdowns related to the COVID-19 pandemic have forced people to change their behavior in many ways including changes in exercise. We used the brief window of global lockdown in the months of March/April/May 2020 as an opportunity to investigate the effects of externally imposed restrictions on exercise-related routines and related changes in subjective well-being. Statistical analyses are based on data from 13,696 respondents in 18 countries using a cross-sectional online survey. A mixed effects modeling approach was used to analyze data. We tested whether exercise frequency before and during the pandemic would influence mood during the pandemic. Additionally, we used the COVID-19 pandemic data to build a prediction model, while controlling for national differences, to estimate changes in exercise frequency during similar future lockdown conditions depending on prelockdown exercise frequency. According to the prediction model, those who rarely exercise before a lockdown tend to increase their exercise frequency during it, and those who are frequent exercisers before a lockdown tend to maintain it. With regards to subjective well-being, the data show that those who exercised almost every day during this pandemic had the best mood, regardless of whether or not they exercised prepandemic. Those who were inactive prepandemic and slightly increased their exercise frequency during the pandemic, reported no change in mood compared to those who remained inactive during the pandemic. Those who reduced their exercise frequency during the pandemic reported worse mood compared to those who maintained or increased their prepandemic exercise frequency. This study suggests that under similar lockdown conditions, about two thirds of those who never or rarely exercise before a lockdown might adopt an exercise behavior or increase their exercise frequency. However, such changes do not always immediately result in improvement in subjective well-being. These results may inform national policies, as well as health behavior and exercise psychology research on the importance of exercise promotion, and prediction of changes in exercise behavior during future pandemics.
Cardiac remodeling in child and adolescent athletes in association with sport discipline and sex
(2020)
Continuous high training loads are associated with structural cardiac adaptations and development of an athletic heart in adult athletes, especially in sport disciplines with high dynamic training components. In child and adolescent athletes these effects are increasingly reported. However, study populations are still very small.
Teachers' attitudes toward inclusion are frequently cited as being an important predictor of how successfully a given inclusive school system is implemented. At the same time, beliefs about the nature of teaching and learning are discussed as a possible predictor of attitudes toward inclusion. However, more recent research emphasizes the need of considering implicit processes, such as automatic evaluations, when describing attitudes and beliefs. Previous evidence on the association of attitudes toward inclusion and beliefs about teaching and learning is solely based on explicit reports. Therefore, this study aims to examine the relationship between attitudes toward inclusion, beliefs about teaching and learning, and the subsequent automatic evaluations of pre-service teachers (N = 197). The results revealed differences between pre-service teachers' explicit attitudes/beliefs and their subsequent automatic evaluations. Differences in the relationship between attitudes toward inclusion and beliefs about teaching and learning occur when teachers focus either on explicit measures or automatic evaluations. These differences might be due to different facets of the same attitude object being represented. Relying solely on either explicit measures or automatic evaluations at the exclusion of the other might lead to erroneous assumptions about the relation of attitudes toward inclusion and beliefs about teaching and learning.
Performance- and healthrelated benefits of yoThere is ample evidence that youth resistance training (RT) is safe, joyful, and effective for different markers of performance (e.g., muscle strength, power, linear sprint speed) and health (e.g., injury prevention). Accordingly, the first aim of this narrative review is to present and discuss the relevance of muscle strength for youth physical development. The second purpose is to report evidence on the effectiveness of RT on muscular fitness (muscle strength, power, muscle endurance), on movement skill performance and injury prevention in youth. There is evidence that RT is effective in enhancing measures of muscle fitness in children and adolescents, irrespective of sex. Additionally, numerous studies indicate that RT has positive effects on fundamental movement skills (e.g., jumping, running, throwing) in youth regardless of age, maturity, training status, and sex. Further, irrespective of age, sex, and training status, regular exposure to RT (e.g., plyometric training) decreases the risk of sustaining injuries in youth. This implies that RT should be a meaningful element of youths’ exercise programming. This has been acknowledged by global (e.g., World Health Organization) and national (e.g., National Strength and Conditioning Association) health- and performance-related organizations which is why they recommended to perform RT as an integral part of weekly exercise programs to promote muscular strength, fundamental movement skills, and to resist injuries in youth.uth resistance training
Background
Change-of-direction (CoD) speed is a physical fitness attribute in many field-based team and individual sports. To date, no systematic review with meta-analysis available has examined the effects of resistance training (RT) on CoD speed in youth and adults.
Objective
To aggregate the effects of RT on CoD speed in youth and young physically active and athletic adults, and to identify the key RT programme variables for training prescription.
Data sources
A systematic literature search was conducted with PubMed, Web of Science, and Google Scholar, with no date restrictions, up to October 2019, to identify studies related to the effects of RT on CoD speed.
Study Eligibility Criteria
Only controlled studies with baseline and follow-up measures were included if they examined the effects of RT (i.e., muscle actions against external resistances) on CoD speed in healthy youth (8-18 years) and young physically active/athletic male or female adults (19-28 years).
Study Appraisal and Synthesis Methods
A random-effects model was used to calculate weighted standardised mean differences (SMD) between intervention and control groups. In addition, an independent single training factor analysis (i.e., RT frequency, intensity, volume) was undertaken. Further, to verify if any RT variable moderated effects on CoD speed, a multivariate random-effects meta-regression was conducted. The methodological quality of the included studies was assessed using the physiotherapy evidence database (PEDro) scale.
Results
Fifteen studies, comprising 19 experimental groups, were included. The methodological quality of the studies was acceptable with a median PEDro score of 6. There was a significant large effect size of RT on CoD speed across all studies (SMD = - 0.82 [- 1.14 to - 0.49]). Subgroup analyses showed large effect sizes on CoD speed in males (SMD = - 0.95) contrasting with moderate improvements in females (SMD = - 0.60). There were large effect sizes on CoD speed in children (SMD = - 1.28) and adolescents (SMD = - 1.21) contrasting with moderate effects in adults (SMD = - 0.63). There was a moderate effect in elite athletes (SMD = - 0.69) contrasting with a large effect in subelite athletes (SMD = - 0.86). Differences between subgroups were not statistically significant. Similar improvements were observed regarding the effects of independently computed training variables. In terms of RT frequency, our results indicated that two sessions per week induced large effects on CoD speed (SMD = - 1.07) while programmes with three sessions resulted in moderate effects (SMD = - 0.53). For total training intervention duration, we observed large effects for <= 8 weeks (SMD = - 0.81) and > 8 weeks (SMD = - 0.85). For single session duration, we found large effects for <= 30 min and >= 45 min (both SMD = - 1.00). In terms of number of training sessions, we identified large effects for <= 16 sessions (SMD = - 0.83) and > 16 sessions (SMD = - 0.81). For training intensity, we found moderate effects for light-to-moderate (SMD = - 0.76) and vigorous-to-near maximal intensities (SMD = - 0.77). With regards to RT type, we observed large effects for free weights (SMD = - 0.99) and machine-based training (SMD = - 0.80). For combined free weights and machine-based training, moderate effects were identified (SMD = - 0.77). The meta-regression outcomes showed that none of the included training variables significantly predicted the effects of RT on CoD speed (R-2 = 0.00).
Conclusions
RT seems to be an effective means to improve CoD speed in youth and young physically active and athletic adults. Our findings indicate that the impact of RT on CoD speed may be more prominent in males than in females and in youth than in adults. Additionally, independently computed single factor analyses for different training variables showed that higher compared with lower RT intensities, frequencies, and volumes appear not to have an advantage on the magnitude of CoD speed improvements. In terms of RT type, similar improvements were observed following machine-based and free weights training.
Dysregulation of physiological stress reactivity plays a key role in the development and relapse risk of alcohol dependence. This article reviews studies investigating physiological responses to experimentally induced acute stress in patients with alcohol dependence. A systematic search from electronic databases resulted in 3641 articles found and after screening 62 articles were included in our review. Studies are analyzed based on stress types (i.e., social stress tasks and nonsocial stress tasks) and physiological markers (i.e., the nervous system, the endocrine system, somatic responses and the immune system). In studies applying nonsocial stress tasks, alcohol-dependent patients were reported to show a blunted stress response compared with healthy controls in the majority of studies applying markers of adrenocorticotropic hormone and cortisol. In studies applying social stress tasks, findings are inconsistent, with less than half of the studies reporting altered physiological stress responses in patients. We discuss the impact of duration of abstinence, comorbidities, baseline physiological arousal and intervention on the discrepancy of study findings. Furthermore, we review evidence for an associationbetween blunted physiological stress responses and the relapse risk among patients with alcohol dependence. (c) 2020 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)