Can social dancing prevent falls in older adults? a protocol of the Dance, Aging, Cognition,Economics (DAnCE) fall prevention randomised controlled trial

Background:  Falls are one of the most common health problems among older people and pose a major economic burden on health care systems. Exercise is an accepted stand-alone fall prevention strategy particularly if it is balance training or regular participation in Tai chi. Dance shares the ‘holistic’ approach of practices such as Tai chi. It is a complex sensorimotor rhythmic activity integrating multiple physical, cognitive and social elements. Small-scale randomised controlled trials have indicated that diverse dance styles can improve measures of balance and mobility in older people, but none of these studies has examined the effect of dance on falls or cognition. This study aims to determine whether participation in social dancing: i) reduces the number of falls; and ii) improves cognitive functions associated with fall risk in older people.

Methods/design: A single-blind, cluster randomised controlled trial of 12 months duration will be conducted. Approximately 450 participants will be recruited from 24 self-care retirement villages that house at least 60 residents each in Sydney, Australia. Village residents without cognitive impairment and obtain medical clearance will be eligible. After comprehensive baseline measurements including physiological and cognitive tests and self-completed questionnaires, villages will be randomised to intervention sites (ballroom or folk dance) or to a wait-listed control using a computer randomisation method that minimises imbalances between villages based on two baseline fall risk measures. Main outcome measures are falls, prospectively measured, and the Trail Making cognitive function test. Cost-effectiveness and cost-utility analyses will be performed.

Discussion: This study offers a novel approach to balance training for older people. As a community-based approach to fall prevention, dance offers older people an opportunity for greater social engagement, thereby making a major contribution to healthy ageing. Providing diversity in exercise programs targeting seniors recognises the heterogeneity of multicultural populations and may further increase the number of taking part in exercise.

Additional Saturday rehabilitation improves functional independence and quality of life and reduces length of stay: a randomised controlled trial

Background

Many inpatients receive little or no rehabilitation on weekends. Our aim was to determine what effect providing additional Saturday rehabilitation during inpatient rehabilitation had on functional independence, quality of life and length of stay compared to 5 days per week of rehabilitation.

This was a multicenter, single-blind (assessors) randomized controlled trial with concealed allocation and 12-month follow-up conducted in two publically funded metropolitan inpatient rehabilitation facilities in Melbourne, Australia. Patients were eligible if they were adults (aged ≥18 years) admitted for rehabilitation for any orthopedic, neurological or other disabling conditions excluding those admitted for slow stream rehabilitation/geriatric evaluation and management. Participants were randomly allocated to usual care Monday to Friday rehabilitation (control) or to Monday to Saturday rehabilitation (intervention). The additional Saturday rehabilitation comprised physiotherapy and occupational therapy. The primary outcomes were functional independence (functional independence measure (FIM); measured on an 18 to 126 point scale), health-related quality of life (EQ-5D utility index; measured on a 0 to 1 scale, and EQ-5D visual analog scale; measured on a 0 to 100 scale), and patient length of stay. Outcome measures were assessed on admission, discharge (primary endpoint), and at 6 and 12 months post discharge.

We randomly assigned 996 adults (mean (SD) age 74 (13) years) to Monday to Saturday rehabilitation (n = 496) or usual care Monday to Friday rehabilitation (n = 500). Relative to admission scores, intervention group participants had higher functional independence (mean difference (MD) 2.3, 95% confidence interval (CI) 0.5 to 4.1, P = 0.01) and health-related quality of life (MD 0.04, 95% CI 0.01 to 0.07, P = 0.009) on discharge and may have had a shorter length of stay by 2 days (95% CI 0 to 4, P = 0.1) when compared to control group participants. Intervention group participants were 17% more likely to have achieved a clinically significant change in functional independence of 22 FIM points or more (risk ratio (RR) 1.17, 95% CI 1.03 to 1.34) and 18% more likely to have achieved a clinically significant change in health-related quality of life (RR 1.18, 95% CI 1.04 to 1.34) on discharge compared to the control group. There was some maintenance of effect for functional independence and health-related quality of life at 6-month follow-up but not at 12-month follow-up. There was no difference in the number of adverse events between the groups (incidence rate ratio = 0.81, 95% CI 0.61 to 1.08).

Providing an additional day of rehabilitation improved functional independence and health-related quality of life at discharge and may have reduced length of stay for patients receiving inpatient rehabilitation. 

Modeling intermittent cycling performance in hypoxia using the critical power concept

PURPOSE: This study investigated the efficacy of an intermittent critical power model, termed the "work-balance" (W'BAL) model, during high-intensity exercise in hypoxia. METHODS: Eleven trained, male cyclists (mean ± SD; age 27 ± 6.6 yr, V[Combining Dot Above]O2peak 4.79 ± 0.56 L.min) completed a maximal ramp test and a 3 min "all-out" test to determine critical power (CP) and work performed above CP (W'). On another day an intermittent exercise test to task failure was performed. All procedures were performed in normoxia (NORM) and hypoxia (HYPO; FiO2 ≈ 0.155) in a single-blind, randomized and counter-balanced experimental design. The W'BAL model was used to calculate the minimum W' (W'BALmin) achieved during the intermittent test. W'BALmin in HYPO was also calculated using CP + W' derived in NORM (N+H). RESULTS: In HYPO there was an 18% decrease in V[Combining Dot Above]O2peak (4.79 ± 0.56 vs 3.93 ± 0.47 L.min ; P<0.001) and a 9% decrease in CP (347 ± 45 vs 316 ± 46 W; P<0.001). No significant change for W' occurred (13.4 ± 3.9 vs 13.7 ± 4.9 kJ; P=0.69; NORM vs HYPO). The change in V[Combining Dot Above]O2peak was significantly correlated with the change in CP (r = 0.72; P=0.01). There was no difference between NORM and HYPO for W'BALmin (1.1 ± 0.9 kJ vs 1.2 ± 0.6 kJ). The N+H analysis grossly overestimated W'BALmin (7.8 ± 3.4 kJ) compared with HYPO (P<0.001). CONCLUSION: The W'BAL model produced similar results in hypoxia and normoxia, but only when model parameters were determined under the same environmental conditions as the performance task. Application of the W'BAL model at altitude requires a modification of the model, or that CP and W' are measured at altitude.

A mobile phone intervention increases physical activity in people with cardiovascular disease: Results from the HEART randomized controlled trial.

AIM: To determine the effectiveness and cost-effectiveness of a mobile phone intervention to improve exercise capacity and physical activity behaviour in people with ischaemic heart disease (IHD).

METHODS AND RESULTS: In this single-blind, parallel, two-arm, randomized controlled trial adults (n = 171) with IHD were randomized to receive a mobile phone delivered intervention (HEART; n = 85) plus usual care, or usual care alone (n = 86). Adult participants aged 18 years or more, with a diagnosis of IHD, were clinically stable as outpatients, able to perform exercise, able to understand and write English, and had access to the Internet. The HEART (Heart Exercise And Remote Technologies) intervention involved a personalized, automated package of text messages and a secure website with video messages aimed at increasing exercise behaviour, delivered over 24 weeks. All participants were able to access usual community-based cardiac rehabilitation, which involves encouragement of physical activity and an offer to join a local cardiac support club. All outcomes were assessed at baseline and 24 weeks and included peak oxygen uptake (PVO2; primary outcome), self-reported physical activity, health-related quality of life, self-efficacy and motivation (secondary outcomes). Results showed no differences in PVO2 between the two groups (difference -0.21 ml kg(-1)min(-1), 95% CI: -1.1, 0.7; p = 0.65) at 24 weeks. However significant treatment effects were observed for selected secondary outcomes, including leisure time physical activity (difference 110.2 min/week, 95% CI: -0.8, 221.3; p = 0.05) and walking (difference 151.4 min/week, 95% CI: 27.6, 275.2; p = 0.02). There were also significant improvements in self-efficacy to be active (difference 6.2%, 95% CI: 0.2, 12.2; p = 0.04) and the general health domain of the SF36 (difference 2.1, 95% CI: 0.1, 4.1; p = 0.03) at 24 weeks. The HEART programme was considered likely to be cost-effective for leisure time activity and walking.

CONCLUSIONS: A mobile phone intervention was not effective at increasing exercise capacity over and above usual care. The intervention was effective and probably cost-effective for increasing physical activity and may have the potential to augment existing cardiac rehabilitation services.

Guided imagery to improve functional outcomes post-anterior cruciate ligament repair: randomized-controlled pilot trial

Imagery can improve functional outcomes post-anterior cruciate ligament repair (ACLR). Research is needed to investigate potential mechanisms for this effect. The aim of this study was to (a) evaluate the effectiveness of an imagery intervention to improve functional outcomes post-ACLR, and (b) explore potential mechanisms. A randomized-controlled pilot trial was conducted. Participants were randomized to guided imagery and standard rehabilitation or standard rehabilitation alone (control). The primary outcome was knee strength 6-month post-operatively. Secondary outcomes were knee laxity at 6-months, and change in psychological (self-efficacy) and neurohormonal (adrenaline, noradrenaline, dopamine) variables. Participants (n=21; 62% male) were 34.86 (SD 8.84) years. Following the intervention, no statistical differences between groups for knee strength extension at 180°/s (t=-0.43, P=0.67), or at 60°/s (t=-0.72, P=0.48) were found. A statistically significant effect was found for knee laxity, F=4.67, P<0.05, mean difference of -3.02 (95% CI -4.44 to -1.60), favoring the intervention. No differences were found for self-efficacy; however, an overall effect was found for noradrenaline, F(1, 19) 19.65, P<0.001, η(2) =0.52, and dopamine, F(1, 19) 6.23, P=0.02, η(2) =0.29, favoring the intervention. This imagery intervention improved knee laxity and healing-related neurobiological factors.

Randomised controlled trial of an iPad based early intervention for autism: TOBY playpad study protocol

BACKGROUND: Evidence for early intensive behavioural interventions (EIBI) by therapists as an effective treatment for children with an Autism Spectrum Disorder (ASD) is growing. High-intensity and sustained delivery of quality EIBI is expensive. The TOBY (Therapy Outcomes by You) Playpad is an App-based platform delivering EIBI to facilitate learning for young children with ASD, while enabling parents to become co-therapists. Intervention targets include increasing joint attention, imitation and communication of children with ASD. The primary aim of the study presented in this protocol is to determine the effectiveness of the TOBY App in reducing ASD symptoms when used as a complement to conventional EIBI. The secondary aim is to examine parental attributes as a result of TOBY App use.

METHODS AND DESIGN: Children aged less than 4;3 years diagnosed with ASD and parents will be recruited into this single-blind, randomised controlled trial using a pragmatic approach. Eligible participants will be randomised to the treatment group 'TOBY therapy + therapy as usual' or, the control group 'therapy as usual' for six months. The treatment will be provided by the TOBY App and parent where a combination of learning environments such as on-iPad child only (solo), partner (with parent) and off-iPad - Natural Environment (with parent) Tasks will be implemented. Parents in the treatment group will participate in a TOBY training workshop. Treatment fidelity will be monitored via an App-based reporting system and parent diaries. The primary outcome measure is the Autism Treatment Evaluation Checklist. The secondary outcome measures involve diagnostics, functional and developmental assessments, including parent questionnaires at baseline (T0), three months (T1) and six months (T2).

DISCUSSION: This trial will determine the effectiveness of the TOBY App as a therapeutic complement to other early interventions children with ASD receive. The trial will also determine the feasibility of a parent delivered early intervention using the iPad as an educational platform, and assess the impact of the TOBY App on parents' self-efficacy and empowerment in an effort to reduce children's ASD symptoms. The outcomes of this trial may have EIBI services implications for newly diagnosed children with ASD and parents.

CM-based blind equalization of time-varying SIMO-FIR channel with single pulsation estimation

It is known that the constant modulus (CM) property of the source signal can be exploited to blindly equalize time-invariant single-inputmultiple-output (SIMO) and finite-impulse-response (FIR) channels. However, the time-invariance assumption about the channel cannot be satisfied in several practical applications, e.g., mobile communication. In this paper, we show that, under some mild conditions, the CM criterion can be extended to the blind equalization of a time-varying channel that is described by the complex exponential basis expansion model (CE-BEM). Although several existing blind equalization methods that are based on the CE-BEM have to employ higher order statistics to estimate all nonzero channel pulsations, the CM-based method only needs to estimate one pulsation using second-order statistics, which yields better estimation results. It also relaxes the restriction on the source signal and is applicable to some classes of signals with which the existing methods cannot deal.

Mixing vector construction for single channel semi-blind source separation using empirical mode decomposition

The Empirical Mode Decomposition (EMD) method is a commonly used method for solving the problem of single channel blind source separation (SCBSS) in signal processing. However, the mixing vector of SCBSS, which is the base of the EMD method, has not yet been effectively constructed. The mixing vector reflects the weights of original signal sources that form the single channel blind signal source. In this paper, we propose a novel method to construct a mixing vector for a single channel blind signal source to approximate the actual mixing vector in terms of keeping the same ratios between signal weights. The constructed mixing vector can be used to improve signal separations. Our method incorporates the adaptive filter, least square method, EMD method and signal source samples to construct the mixing vector. Experimental tests using audio signal evaluations were conducted and the results indicated that our method can improve the similar values of sources energy ratio from 0.2644 to 0.8366. This kind of recognition is very important in weak signal detection.

Blind identification of FIR MIMO channels by decorrelating subchannels

We study blind identification and equalization of finite impulse response (FIR) and multi-input and multi-output (MIMO) channels driven by colored signals. We first show a sufficient condition for an FIR MIMO channel to be identifiable up to a scaling and permutation using the second-order statistics of the channel output. This condition is that the channel matrix is irreducible (but not necessarily column-reduced), and the input signals are mutually uncorrelated and of distinct power spectra. We also show that this condition is necessary in the sense that no single part of the condition can be further weakened without another part being strengthened. While the above condition is a strong result that sets a fundamental limit of blind identification, there does not yet exist a working algorithm under that condition. In the second part of this paper, we show that a method called blind identification via decorrelating subchannels (BIDS) can uniquely identify an FIR MIMO channel if a) the channel matrix is nonsingular (almost everywhere) and column-wise coprime and b) the input signals are mutually uncorrelated and of sufficiently diverse power spectra. The BIDS method requires a weaker condition on the channel matrix than that required by most existing methods for the same problem.

A new blind-equalization algorithm for an FIR SIMO system driven by MPSK signal

We consider the problem of blind equalization of a finite impulse response and single-input multiple-output system driven by an M-ary phase-shift-keying signal. The existing single-mode algorithms for this problem include the constant modulus algorithm (CMA) and the multimodulus algorithm (MMA). It has been shown that the MMA outperforms the CMA when the input signal has no more than four constellation points, i.e., Mles4. In this brief, we present a new adaptive equalization algorithm that jointly exploits the amplitude and phase information of the input signal. Theoretical analysis shows that the proposed algorithm has less mean square error, i.e., better equalization performance, at steady state than the CMA regardless of the value of M. The superior performance of our algorithm to the CMA and the MMA is validated by simulation examples

Nurses´ attitudes to single checking medications : before and after its use

We report nurses' attitudes towards the single checking of medications before and after the implementation of this procedure in an acute health-care setting. Data from a pre-implementation survey confirmed that some nurses held strong views against single checking. Following this survey, the hospital's medication administration policy was revised, a single checking resource manual was developed, 1–2 h nurse education sessions were held, the competencies of nurses to single check and to administer medications were assessed, and single checking was successfully piloted before hospital-wide implementation. Data from a survey conducted 18 months after the implementation indicated that nurses welcomed the single checking medication procedure, felt more confident using single checking and perceived that it made them more accountable for administering medications. The findings provide evidence that nurses' attitudes to single checking change remarkably in favour of its use with education and experience using this procedure.

Single vs. two steroid injections for carpal tunnel syndrome: a randomised clinical trial

We investigated the efficacy of a single vs. double steroid injections in the treatment of carpal tunnel syndrome (CTS) in a randomised double-blind controlled trial. Patients with idiopathic CTS were randomised into (i) one group receiving a baseline methylprednisolone acetate injection plus a saline injection 8 weeks later and (ii) a second group receiving methylprednisolone acetate injection at baseline and at 8 weeks. The primary outcome was the Global Symptom Score (GSS). Forty patients were recruited. By 40 weeks, the mean GSS improved from 25.6 to 14.1 in the single-injection group whereas from 26.7 to 12.6 in the reinjection group, but there was no significant difference in GSS between the two groups (p = 0.26). There were also no significant differences in terms of electrophysiological and functional outcomes. The results suggest that an additional steroid injection confers no added benefit to a single injection in terms of symptom relief.

A new adaptive blind channel identification algorithm

This paper addresses the blind identification of single-input multiple-output (SIMO) finite-impulse-response (FIR) systems. We first propose a new adaptive algorithm for the blind identification of SIMO FIR systems. Then, its convergence property is analyzed systematically. It is shown that under some mild conditions, the proposed algorithm is guaranteed to converge in the mean to the true channel impulse responses in both noisy and noiseless cases. Simulations are carried out to demonstrate the theoretical results.

Pareto archived simulated annealing for single machine job shop scheduling with multiple objectives

In this paper, the single machine job shop scheduling problem is studied with the objectives of minimizing the tardiness and the material cost of jobs. The simultaneous consideration of these objectives is the multi-criteria optimization problem under study. A metaheuristic procedure based on simulated annealing is proposed to find the approximate Pareto optimal (non-dominated) solutions. The two objectives are combined in one composite utility function based on the decision maker’s interest in having a schedule with weighted combination. In view of the unknown nature of the weights for the defined objectives, a priori approach is applied to search for the non-dominated set of solutions based on the Pareto dominance. The obtained solutions set is presented to the decision maker to choose the best solution according to his preferences. The performance of the algorithm is evaluated in terms of the number of non-dominated schedules generated and the proximity of the obtained non-dominated front to the true Pareto front. Results show that the produced solutions do not differ significantly from the optimal solutions.