Neuromuscular Changes in Older Adults during the Lateral Step Task

Older adults may have trouble when performing activities of daily living due to decrease in physical strength and degradation of neuromotor and musculoskeletal function. Motor activation patterns during Lateral Step Down and Step Up from 4-inch and 8-inch step heights was assessed in younger (n=8, 24.4 years) and older adults (n=8, 58.9 years) using joint angle kinematics and electromyography of lower extremity muscles. Ground reaction forces were used to ascertain the loading, stabilization and unloading phases of the tasks. Older adults had an altered muscle activation sequence and significantly longer muscle bursts during loading for the tibialis anterior, gastrocnemius, vastus medialis, bicep femoris, gluteus medius and gluteus maximus muscles of the stationary leg. They also demonstrated a significantly larger swing time (579.1 ms vs. 444.8 ms) during the step down task for the moving leg. The novel data suggests presence of age-related differences in motor coordination during lateral stepping.

Discriminative ability of functional loading tests for adolescent jumper's knee

Objective. To investigate the reliability and validity of five squat-based loading tests that are clinically appropriate for jumper's knee. The loading tests were step up, double leg squat, double leg squat on a 25-degree decline (decline squat), single leg decline squat, and decline hop. Design. Cross-sectional controlled cohort. Subjects without knee pain comprised controls, those with extensor tendon pain comprised the jumper's knee group. Setting. Institutional athlete study group in Australia Participants. Fifty-six elite adolescent basketball players participated in this study, thirteen comprised the jumper's knee group, fifteen athletes formed a control group. Intervention. Each subject performed each loading test for baseline and reliability data on the first testing day. Subjects then performed three days of intensive (6 h daily) basketball training, after which each loading test was reexamined. Main outcome measures. Eleven point interval scale for pain. Results. The tests that best detected a change in pain due to intensive workload were the single leg decline squat and single leg decline hop. This study found that decline tests have better discriminative ability than the standard squat to detect change in jumper's knee pain due to intensive training. The typical error for these tests ranged from 0.3 to 0.5, however, caution should be exercised in the interpretation of these reliability figures due to relatively low scores. Conclusions. The single leg decline squat is recommended in the physical assessment of adolescent jumper's knee. The decline squat was selected as the best clinical test over the decline hop because it was easier to standardise performance.

How can IT professionals make the step into leadership roles?

Last year, Jisc began work with EDUCAUSE - the US organisation for IT professionals in higher education - to find out the skillset of the CIO of the future. One of the findings of our project was that many aspiring technology leaders find it difficult to make the step up. Louisa Dale, director Jisc group sector intelligence, talks through the learnings and opens a call for IT professionals to get involved in the next phase of work.

Uveítis pediática no infecciosa, una experiencia de una cohorte colombiana

Resumen: •Antecedentes: La uveítis pediátrica no infecciosa tiene el potencial de desencadenar severas complicaciones visuales y su manejo farmacológico convencional está asociado a importantes efectos secundarios. 1 Infliximab (INF) y Adalimumab (ADA), son dos medicamentos biológicos disponibles para el manejo de la uveítis pediátrica refractaria. Se unen específicamente al TNFα y previenen la unión del mismo con los receptores celulares; interacción directamente implicada en el proceso inflamatorio y el subsecuente daño tisular. 2,3 •Métodos: Se realizó estudio de tipo cohorte retrospectiva mediante revisión de historias clínicas de 35 pacientes pediátricos diagnosticados con uveítis durante los años 2009-2015. Se comparó control de la inflamación ocular, tiempo de respuesta y eventos adversos en pacientes tratados con ADA o INF con dosis bajas de Metotrexate vs. Metotrexate (MTX) como única terapia. •Resultados: El 45.7% de la población estudiada correspondía al sexo femenino, cuya edad promedio de inicio de síntomas y de diagnósticos fue de 9 años. El 80% de los casos fueron uveítis idiopáticas, seguido por Vogt-Koyanagi-Harada (8,5%) y AIJ (5,7%). El 91,4% presentó compromiso ocular bilateral y se documentaron 2 casos de ambliopía. El 12,9% de los pacientes que recibieron MTX como tratamiento de primera línea requirieron escalonamiento terapéutico por presentar eventos adversos (Elevación de enzimas hepáticas e intolerancia gastrointestinal (GI)). El tiempo promedio para alcanzar control de la inflamación con MTX fue 9 semanas, y para Adalimumab fue de 8,75 semanas (P: 0,90). Se comparó la capacidad de controlar la inflamación del MTX vs Anti-TNF, y no se observaron diferencias significativas (P: 0.88).

Enhancing recovery rates: lessons from year one of IAPT

BACKGROUND: The English Improving Access to Psychological Therapies (IAPT) initiative aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the National Health Service (NHS). 32 IAPT services based on a stepped care model were established in the first year of the programme. We report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery at patient level, service level, and as a function of compliance with National Institute of Health and Care Excellence (NICE) Treatment Guidelines. METHOD: Data from 19,395 patients who were clinical cases at intake, attended at least two sessions, had at least two outcomes scores and had completed their treatment during the period were analysed. Outcome was assessed with the patient health questionnaire depression scale (PHQ-9) and the anxiety scale (GAD-7). RESULTS: Data completeness was high for a routine cohort study. Over 91% of treated patients had paired (pre-post) outcome scores. Overall, 40.3% of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. Most patients received treatments that were recommended by NICE. When a treatment not recommended by NICE was provided, recovery rates were reduced. Service characteristics that predicted higher reliable recovery rates were: high average number of therapy sessions; higher step-up rates among individuals who started with low intensity treatment; larger services; and a larger proportion of experienced staff. CONCLUSIONS: Compliance with the IAPT clinical model is associated with enhanced rates of reliable recovery.

"Roll Up and Spend Your Last Dime". The Merry-go-round of Children`s Extra-curricular Activities in Modern Society.

"Step up and play" begins the famous hit song 'Penny Arcade'. And so it
was for thousands of Australian families, as their eldest child began school
this year, and the associated endless merry-go-round of extra-curricular
activities also began. But how many of those families realise that the song ends "Roll up and spend your last dime!"? While the perceived benefits of
children's involvement in extracurricular activities are many and are widely accepted, there are also costs, not only in terms of money but also in terms
of time. Evidence from a study conducted in Melbourne highlights the fact that, for many families such as those on low incomes and those headed by a single parent, both the time and the money costs may be prohibitive. This article highlights parents' perceptions of the benefits·and costs of children's extra-curricular activities, and explores the implications of changing family and household structures for families' capacity to sustain such activities.

Improving outcomes of preschool language delay in the community : protocol for the Language for Learning randomised controlled trial

Background

Early language delay is a high-prevalence condition of concern to parents and professionals. It may result in lifelong deficits not only in language function, but also in social, emotional/behavioural, academic and economic well-being. Such delays can lead to considerable costs to the individual, the family and to society more widely. The Language for Learning trial tests a population-based intervention in 4 year olds with measured language delay, to determine (1) if it improves language and associated outcomes at ages 5 and 6 years and (2) its cost-effectiveness for families and the health care system.

Methods/Design

A large-scale randomised trial of a year-long intervention targeting preschoolers with language delay, nested within a well-documented, prospective, population-based cohort of 1464 children in Melbourne, Australia. All children received a 1.25-1.5 hour formal language assessment at their 4th birthday. The 200 children with expressive and/or receptive language scores more than 1.25 standard deviations below the mean were randomised into intervention or ‘usual care’ control arms. The 20-session intervention program comprises 18 one-hour home-based therapeutic sessions in three 6-week blocks, an outcome assessment, and a final feed-back/forward planning session. The therapy utilises a ‘step up-step down’ therapeutic approach depending on the child’s language profile, severity and progress, with standardised, manualised activities covering the four language development domains of: vocabulary and grammar; narrative skills; comprehension monitoring; and phonological awareness/pre-literacy skills. Blinded follow-up assessments at ages 5 and 6 years measure the primary outcome of receptive and expressive language, and secondary outcomes of vocabulary, narrative, and phonological skills.

Discussion

A key strength of this robust study is the implementation of a therapeutic framework that provides a standardised yet tailored approach for each child, with a focus on specific language domains known to be associated with later language and literacy. The trial responds to identified evidence gaps, has outcomes of direct relevance to families and the community, includes a well-developed economic analysis, and has the potential to improve long-term consequences of early language delay within a public health framework.

COPD: A stepwise or a hit hard approach?

Current guidelines differ slightly on the recommendations for treatment of Chronic Obstructive Pulmonary Disease (COPD) patients, and although there are some undisputed recommendations, there is still debate regarding the management of COPD. One of the hindrances to deciding which therapeutic approach to choose is late diagnosis or misdiagnosis of COPD. After a proper diagnosis is achieved and severity assessed, the choice between a stepwise or "hit hard" approach has to be made. For GOLD A patients the stepwise approach is recommended, whilst for B, C and D patients this remains debatable. Moreover, in patients for whom inhaled corticosteroids (ICS) are recommended, a step-up or "hit hard" approach with triple therapy will depend on the patient's characteristics and, for patients who are being over-treated with ICS, ICS withdrawal should be performed, in order to optimize therapy and reduce excessive medications. This paper discusses and proposes stepwise, "hit hard", step-up and ICS withdrawal therapeutic approaches for COPD patients based on their GOLD group. We conclude that all approaches have benefits, and only a careful patient selection will determine which approach is better, and which patients will benefit the most from each approach.

Application of Dynamic Hysteresis Band Height Control to Improve Output Voltage Transient in Boost and Positive Buck-Boost Converters

This paper presents dynamic hysteresis band height control to reduce the overshoot and undershoot issue on output voltage caused by load change. The converters in this study are Boost and Positive Buck-Boost (PBB) converters. PBB has been controlled to work in a step up conversion and avoid overshoot when load is changed. Simulation and experimental results have been presented to verify the proposed method.

Utilizing robustness of positive buck-boost converter against input voltage and load current disturbances

A Positive Buck- Boost (PBB) converter is a known DC-DC converter that can operate in step up and step down modes. Unlike Buck, Boost, and Inverting Buck Boost converters, the inductor current of a PBB can be controlled independently of its voltage conversion ratio. In other words, the inductor of PBB can be utilised as an energy storage unit in addition to its main function of energy transfer. In this paper, the capability of PBB to store energy has been utilised to achieve robustness against input voltage fluctuations and output current changes. The control strategy has been developed to keep accuracy, affordability, and simplicity acceptable. To improve the efficiency of the system a Smart Load Controller (SLC) has been suggested. Applying SLC extra current storage occurs when there is sudden loads change otherwise little extra current is stored.

Multilevel converters in renewable energy systems

In photovoltaic, fuel cells and storage batteries, the low output DC voltage should be boosted. Therefore, a step-up converter is necessary to boost the low DC voltage for the DC link voltage of the inverter. The main contribution of this chapter is to electrical energy conversion in renewable energy systems based on multilevel inverters. Different configuration of renewable energy systems based on power converters will be discussed in detail. Finally, a new single inductor Multi-Output Boost (MOB) converter is proposed, which is compatible with the diode-clamped configuration. Steady state and dynamic analyses have been carried out in order to show the validity of the proposed topology. Then the joint circuit of the proposed DC-DC converter with a three-level diode-clamped converter is presented in order to have a series regulated voltage at the DC link voltage of the diode-clamped inverter. MOB converter can boost the low input DC voltage of the renewable energy sources and at the same time adjust the voltage across each capacitor to the desired voltage levels, thereby solving the main problem associated with capacitor voltage imbalance in this type of multilevel converter.

Multi-output buck-boost converter with enhanced dynamic response to load and input voltage changes

This paper presents a new multi-output DC/DC converter topology that has step-up and step-down conversion capabilities. In this topology, several output voltages can be generated which can be used in different applications such as multilevel converters with diode-clamped topology or power supplies with several voltage levels. Steady state and dynamic equations of the proposed multi-output converter have been developed, that can be used for steady state and transient analysis. Two control techniques have been proposed for this topology based on constant and dynamic hysteresis band height control to address different applications. Simulations have been performed for different operating modes and load conditions to verify the proposed topology and its control technique. Additionally, a laboratory prototype is designed and implemented to verify the simulation results.

The Proposal [Film Review]

The Proposal is a well-executed romantic comedy that easily meets its low ambitions. Director Anne Fletcher (Step Up, 27 Dresses) and newcomer writer Peter Chiarelli team up to deliver a lighthearted comedy termpered with heartwarming family values. The cute and lovable cast, headed by Sandra Bullock and Ryan Reynolds, enriches this simple tale...

The leader in you : developing your leadership potential

Leadership research demonstrates that there are serious shortcomings in the quality and competence of leaders in our organizations. The recent global financial crisis has also reminded us that, if our society and economies are to move forward sustainability, we must have the right kind of leaders and the right kind of leadership throughout our organizations. "The Leader in You: Developing Your Leadership Potential" has been framed to be useful to all individuals who are currently in leadership roles, from chief executives to frontline managers, and for those who wish to step up to a leadership role. Organizations can also utilize this book to assist their leaders to increase their leadership potential or to complement leadership development programs. If you want to search for and develop leadership qualities in yourself, then this book is for you. If you want to set a higher standard in your organization and you think leadership is a serious matter in the lives of other people, then this book is for you. In the process of self-reflection, "The Leader in You: Developing Your Leadership Potential" will enable you to develop an individual leadership profile and an individual skills profile, culminating in the development of a plan for leadership improvement. This book aims to couple these outcomes with exposure to some practical skills that leaders need to lead in every day environments. The first four chapters allow the reader to develop an understanding of the concepts that underpin leadership performance, and to undertake exercises to develop a comprehensive understanding of their values, behaviors and personality. That is, to understand who they are and why they behave the way they do. An individual leadership profile is developed at the end of these chapters. Then, the remaining chapters look at issues that leaders will face in contemporary society, and at the skills required to address them in everyday environments. An individual skills profile is developed at the end of these chapters culminating in the development of a plan for leadership improvement.

Join the party : networking for wallflowers

The LIS profession in Australia is a small world where connections are vital for career success and developing resilience. So what about those of us who feel like wallflowers at the party, always on the margins? It can be difficult for quieter souls to step up, get involved and build relationships. A major hurdle for many people, both introverts and extroverts, is figuring out how to proclaim their awesomeness to the world but in a way that is unique to them. The aim of this session is to inspire and challenge students, new grads and anyone who has a fear of networking to take risks and explore a different more social side of themselves without changing their personalities. This is a deeply personal topic with plenty of fear and self-image issues at stake. As well, most of us have had very few opportunities to find role models or a chance to practice in a comfortable environment. Therefore the authors will present strategies for success based on their personal experiences. We will demonstrate the actual benefits we have attained through our networking and volunteer activities. We hope that attendees will come away with some realistic strategies and goals to create lasting relationships with present and future colleagues such as we have enjoyed. Our networking tips may not transform you into the belle of the ball but you will have more confidence to get out on the dance floor and dance to your own beat.