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Comprehensive and repetitive assessments are needed to detect physical changes in an older population to prevent functional decline at the earliest possible stage and to initiate preventive interventions. Established instruments like the Timed &ldquo, Up &amp, Go&rdquo, (TUG) Test and the Sit-to-Stand Test (SST) require a trained person (e.g., physiotherapist) to assess physical performance. More often, these tests are only applied to a selected group of persons already functionally impaired and not to those who are at potential risk of functional decline. The article introduces the Unsupervised Screening System (USS) for unsupervised self-assessments by older adults and evaluates its validity for the TUG and SST. The USS included ambient and wearable movement sensors to measure the user&rsquo, s test performance. Sensor datasets of the USS&rsquo, s light barriers and Inertial Measurement Units (IMU) were analyzed for 91 users aged 73 to 89 years compared to conventional stopwatch measurement. A significant correlation coefficient of 0.89 for the TUG test and of 0.73 for the SST were confirmed among USS&rsquo, s light barriers. Correspondingly, for the inertial data-based measures, a high and significant correlation of 0.78 for the TUG test and of 0.87 for SST were also found. The USS was a validated and reliable tool to assess TUG and SST.

Comprehensive and repetitive assessments are needed to detect physical changes in an older population to prevent functional decline at the earliest possible stage and to initiate preventive interventions. Established instruments like the Timed “Up & Go” (TUG) Test and the Sit-to-Stand Test (SST) require a trained person (e.g., physiotherapist) to assess physical performance. More often, these tests are only applied to a selected group of persons already functionally impaired and not to those who are at potential risk of functional decline. The article introduces the Unsupervised Screening System (USS) for unsupervised self-assessments by older adults and evaluates its validity for the TUG and SST. The USS included ambient and wearable movement sensors to measure the user’s test performance. Sensor datasets of the USS’s light barriers and Inertial Measurement Units (IMU) were analyzed for 91 users aged 73 to 89 years compared to conventional stopwatch measurement. A significant correlation coefficient of 0.89 for the TUG test and of 0.73 for the SST were confirmed among USS’s light barriers. Correspondingly, for the inertial data-based measures, a high and significant correlation of 0.78 for the TUG test and of 0.87 for SST were also found. The USS was a validated and reliable tool to assess TUG and SST.

Background: Diabetes Mellitus (DM) is a chronic disease and it is characterized by reduced insulin sensitivity and/or impaired insulin production. It affects approximately 415 million people worldwide and involves a variety of complications. DM has a number of complications, including diabetic neuropathy. All of these complications can have effects on body composition, vibration perception threshold (VPT), foot health and health-related quality of life (HRQoL). Objective: The aim of this study is to determine the correlation between the Timed Up and Go (TUG), VPT, Foot Health Status Questionnaire and 15-D Questionnaire in type 2 diabetes mellitus (T2DM) patients. Methodology: A total of 90 T2DM patients (56 men and 34 women) were evaluated on their body composition, VPT, the foot health status through the FHSQ, the HRQoL was evaluated through the 15-D Questionnaire and the TUG test was performed. Results: Statistically significant associations were found between TUG and lean and fat mass, VPT, the sections &ldquo, General Foot Health&rdquo, and &ldquo, Physical Activity&rdquo, in the FHSQ questionnaire, and the 15D total score and its sections &ldquo, Mobility&rdquo, Depression&rdquo, Conclusions: There is a moderate direct correlation between the Timed Up and Go and the fat mass percentage and the vibration perception threshold. Moreover, there is a moderate inverse correlation between Timed Up and Go and fat-free mass, foot health and health-related quality of life in T2DM patients. Therefore, Timed Up and Go can be a tool to assist clinicians in monitoring and managing T2DM patients.

The aim of this study was to analyze the effects of an 8-week whole-body vibration (WBV) on the quality of life, physical fitness, body composition, glycosylate hemoglobin (HbA1c), lipid profile, and foot health status in people with type II diabetes mellitus (T2DM). It was performed as a double-blinded randomized controlled trial of 90 people with T2DM. Primary care facilities were used. The 8-week WBV training consisted of maintaining a knee flexion at 45° during five to nine series of 30−60 s in a vibration frequency that oscillated between 12.5−18.5 and 30 s of recovery between series. The placebo group had to perform the same protocol but without vibration. Participants performed the protocol three times per week. The WBV training significantly reduced the fat mass (%) of people with T2DM. However, significant effects of WBV training were not found in the quality of life, physical fitness, foot health status, lipid profile, blood pressure, fasting blood glucose, or HbA1c. Nevertheless, within groups enhances were found in HbA1c, blood pressure, fasting blood glucose, foot health status, health-related quality of life, timed-up and go test, and chair-stand test in both WBV and placebo groups. WBV was shown to be beneficial for reducing the fat mass and lipid profile of people with T2DM. The improvements of the placebo group could be due to both the social benefits of enrolling in an intervention and the physical fitness benefits of isometric contractions. Further studies are needed to clarify the effects of WBV and to establish a dose−response relationship in people with T2DM.

Kontext / Ziel / Fragestellung: Klinische Assessments sollen reliable Testungen ermöglichen. Aus diesem Grund wurde ein Studienprotokoll zur Überprüfung der Inter- und Intrarater-Reliabilität von einer funktio-nellen Testbatterie, welche aus dem 10 Meter Walking Test, Single Leg Stance Test, Stair Ascend/Descend Test und Timed Up And Go Test besteht, in der Rehabilitation bei Pati-ent*innen mit Hüft- oder Knie-Totalendoprothese erstellt. Hauptergebnisse: Die Assessments 10 Meter Walking Test, Single Leg Stance Test, Stair Ascend/Descend Test und Timed Up And Go Test liefern reliable Ergebnisse bei Patient*innen mit Patholo-gien und Operationen an der unteren Extremität. Schlussfolgerung: Die funktionelle Testbatterie des in dieser Arbeit erstellten Studienprotokolls kann im klini-schen Setting auf dessen Inter- und Intrarater-Reliabilität überprüft werden. Context / Objective / Question: Clinical assessments should provide reliable outcomes. Therefore, a study protocol testing interrater and intrarater reliability of a functional test battery containing 10 Meter Walking Test, Single Leg Stance Test, Stair Ascend/Descend Test and Timed Up And Go Test for patients with total hip or knee arthroplasty undergoing rehabilitation was developed. Main results: Reliable outcomes in patients with lower extremity pathologies or surgeries were achieved using the assessments 10 Meter Walking Test, Single Leg Stance Test, Stair As-cend/Descend Test und Timed Up And Go Test. Conclusion: To examine the test batteries interrater and intrarater reliability clinical testing should be considered.

Diese Arbeit beschäftigt sich mit der kritischen Auseinandersetzung der OARSI Core Assessments (30sCST, SCT, 40mFPWT) in der Frührehabilitation. Es wurde gesucht ab welchem postoperativen Zeitpunkt und mit welchen Voraussetzungen die OARSI Core Assessments valide und aussagekräftige Ergebnisse in Bezug auf die Kniefunktion liefern. Eine systematische Literaturrecherche nach Primärstudien wurde in den Datenbanken von PubMed und Cochrane Library durchgeführt. Es konnte gezeigt werden, dass bereits nach einer postoperativen Woche 30sCST, SCT valide Messdaten liefern können, der 40mFPWT hat derzeit keine ausreichende Evidenz. Voraussetzung für die Durchführung der Assessments sind: abgeklungener Entzündungszeichen, keine reduzierte Kniegelenksbeweglichkeit, kein, vor der Operation nicht bekannter Hüft- oder Rückenschmerz, kein unwohl sein, keine unmittelbar entstandene Beinlängendifferenz, keine zusätzlichen funktionslimitierenden internistischen, orthopädischen oder neurologischen Erkrankungen. Die Einhaltung diese Kriterien ermöglichen Physiotherapeut*innen die Erhöhung der Validität von Testung in der Praxis nach dem Einsatz von KTEPs. Außerdem wird möglich in der Zukunft anhand dieser ein funktionsbasiertes Rehabilitationskonzept zu erstellen. This thesis deals with the critical discussion of the OARSI core assessments (30sCST, SCT, 40mFPWT) during the early rehabilitation. The earliest time and its requirements for a valid and meaningful testing regarding the knee function were sought. In order to be able to find the answers, a systematic literature search was done in the databases of PubMed and the Cochrane Library. It was shown, that after one postoperative week 30sCST and SCT could provide valid data, nevertheless the 40mFPWT has not enough evidence. The following requirements for the testing should be fulfilled: closed inflammation, no reduced range of motion on the knee, no unknown hip or back pain, not feeling unwell no newly appeared leg length difference, no additional function-limiting internistic, orthopaedic or neurologic diseases. Following these requirements would allow physiotherapist to increase the validity of the testing in practice after total knee arthroplasty. Furthermore, by using these criteria, it would be possible in the future to establish a function-based rehabilitation concept.

MÖ. 2. bin yılın en büyük imparatorluklarından birisi olan Hitit ile ilgili bilgilere, Hititçe çivi yazılı metinler sayesinde ulaşabilmekteyiz. Siyasi, ekonomik, dinî vs. gibi birçok içeriğe sahip farklı belgelerin yer aldığı bu tabletlerden Hitit ülkesinin dokuma alanındaki gelişimini de takip edebilmekteyiz. Dokuma ürünleri, Hitit hayatının hemen her sahasında kendini göstermiştir. Bu ürünler, bir kıyafet olarak giyilmelerinin yanında kimi zaman bir ip ve kimi zaman da bir kumaş veya bez olarak karşımıza çıkmıştır. Büyücü kadınların en önemli ritüel malzemelerinden birisi olan dokuma ürünleri, ekonomik anlamda çeşitli fiyatlara sahip olmasının yanında devletler arası ilişkilerde de kendine yer bulmuş ve kimi zaman bir hediye kimi zaman da vergi olarak metinlerdeki yerini almıştır. Elimizdeki belgelerden yola çıkarak onlarca dokuma ürününün varlığından söz edebiliriz. Kitabımızda, bu ürünlerin öncelikle anlamlarını açıklayarak, ardından siyasi, ekonomik ve dinî hayattaki kullanım yerleri ve şekilleri hakkında bilgiler sunmaya çalıştık.

Kontext: Morbus Parkinson zählt zu den häufigsten neurodegenerativen Störungen weltweit. Im Verlauf der Krankheit werden zunehmend Beeinträchtigungen in der Motorik sichtbar. Diese zeigen sich in einer Störung des Gangbildes und damit einhergehend zunehmende Gangunsicherheit, Verlust des Gleichgewichts und erhöhte Sturzgefahr. Ziel: Ziel der vorliegenden Arbeit ist es, jene bereits zu ICF-Kategorien zugewiesenen Assessments zu identifizieren, welche sich als praktikabel, valide, reliabel, ausreichend messempfindlich und in der Therapie bei Patient*innen mit Morbus Parkinson als am besten umsetzbar erweisen. Damit soll eine individuelle Vorgehensweise bei der Beurteilung von Gangsicherheit und Sturzgefahr ermöglicht und die Wahrscheinlichkeit eines Therapieerfolges erhöht werden. Fragestellung: Welche Assessments können zur Beurteilung der Gangsicherheit und der Sturzgefahr bei Patient*innen mit Morbus Parkinson auf Aktivitäts- und Partizipationsebene in der Physiotherapie empfohlen werden? Suchstrategie: Im Zuge der systematischen Literatursuche wird neben der Verwendung von Fachliteratur diverser Hochschulbibliotheken, mit Hilfe von Pubmed, PEDro und Google Scholar nach wissenschaftlichen Studien und Fachartikeln recherchiert. Zusätzlich wird die Schneeballmethode angewandt. Hauptergebnisse: In der vorliegenden Arbeit werden drei Assessments untersucht. Ein Fragenbogen – die FES-I und zwei funktionelle Assessments – die BBS und der TUG. Insgesamt erreichen Reliabilität, Validität und Praktikabilität aller untersuchten Assessments moderate bis exzellente Werte. Unzureichende Forschungsergebnisse liegen hingegen bei der Responsivität dieser drei Assessments vor. Schlussfolgerung: Unter Berücksichtigung der festgelegten Auswahlkriterien decken die analysierten Assessments – BBS, TUG, FES-I – einen Großteil der ausgewählten ICF-Kategorien auf Aktivitäts- und Partizipationsebene ab und ermöglichen dadurch einen fundierten Einblick in die Gangsicherheit, Gleichgewichtssituation sowie Sturzgefahr der an Morbus Parkinson erkrankten Patient*innen. Vor dem Hintergrund der Ergebnisse zahlreicher Studien, ist die Anwendung mehrerer Assessments in Kombination empfohlen, um die Wahrscheinlichkeit zu erhöhen, eine sturzgefährdete Person auch als solche zu identifizieren. Context: Parkinson's disease is one of the most common neurodegenerative disorders worldwide. In the course of the disease the impairments in motor function become increasingly visible. These impairments manifest themselves in the disturbance of gait pattern, associated with rising insecurity in walking, loss of balance and increased risk of falling. Objective: The aim of the present study is to identify assessments already assigned to ICF-categories, which prove to be practicable, valid, reliable, and responsive and which are best implemented in the therapy of patients with Parkinson's disease. They should enable an individual approach to the assessment of gait safety and risk of falling and increase the probability of therapy success. Research question: Which physiotherapeutic assessments can be recommended to evaluate gait safety and risk of falling in patients with Parkinson's disease at the activity and participation level? Search strategy: For systematic literature search, scientific literature from various libraries is used and in addition, scientific studies and specialist articles are researched with the help of Pubmed, PEDro and Google Scholar. Furthermore, the snowball method is used. Main results: In this thesis three assessments are examined. One questionnaire – the FES-I and two functional assessments – the BBS and the TUG. The reliability, validity and practicability of the considered assessments range from moderate to excellent. For responsiveness insufficient research results are available. Conclusion: Taking the defined selection criteria into account, the analyzed assessments – BBS, TUG, FES-I – cover a large part of the selected ICF-categories at the activity and participation level and thus provide a good insight into gait safety, balance situation and risk of falling of patients with Parkinson's disease. Based on the results of numerous studies, it is recommended to use several assessments to increase the probability of identifying a person who is at risk of falling.

Hintergrund: Arthrose ist in Europa auf dem Vormarsch, insbesondere Hüfttotalendoprothesen werden immer häufiger eingesetzt, wenn konservative physikalische Therapien bei der Schmerz- oder Bewegungssituation nicht helfen können. Diese Entwicklung erfordert von Klinikern und Therapeut*innen schnelle, zuverlässige und praktische Assessments, um die Funktionsfähigkeit der Patient*innen während des Rehabilitationsprozesses zu bestimmen. Hierfür bietet der Four Square Step Test (FSST) mit seinen einzigartigen Merkmalen einen tieferen Einblick in die Fähigkeiten von Patient*innen hinsichtlich des Gleichgewichtes und der Mobilität. Zentrale Fragestellungen: Inwieweit ist der FSST im klinischen Alltag ein geeignetes funktionelles Assessment für Hüft-TEP Patient*innen zur prä- und postoperativen Beurteilung? Welche Aussage liefert der FSST im Vergleich zum Timed Up and Go Test (TUG) oder der Berg-Balance-Scale (BBS)? Ziel: In der vorliegenden Bachelorarbeit werden die zentralen Fragestellungen durch eine systematische Literaturrecherche beantwortet. Dabei wird ein Überblick über den aktuellen Wissenstand des FSST für Hüftarthrosepatient*innen gegeben und die Ergebnisse im Sinne einer analysierenden Darstellung diskutiert. Methode: Die Datenbanken PubMed, PEDro, Cochrane und Google Scholar wurden nach relevanten Studien mithilfe des PICO-Schemas durchsucht. Unter Berücksichtigung der Selektionskriterien wurden vier relevante Studien für die Auseinandersetzung in dieser Bachelorarbeit gefunden. Ergebnisse: Der FSST erweist sich als valide und reliabel, zeigt einen geringen Ressourcenbedarf und bietet aussagekräftige Parameter zur Beurteilung der Gait Performance von Hüftarthrose Patient*innen. Zwischen dem FSST und dem TUG wurde eine starke positive Korrelation, verglichen mit der BBS eine moderate negative Korrelation gefunden. Für den Einsatz des FSST in der Praxis wird eine Kombination mit anderen etablierten Balance Assessments empfohlen, wie z.B. den TUG. Conclusio: Der FSST ist ein unterschätztes klinisches Assessment zur Beurteilung des Gleichgewichts und der Mobilität von Hüftarthrose Patient*innen. Zur Voraussage des Sturzrisikos wird der FSST bereits erfolgreich bei anderen Krankheitsbildern eingesetzt. Leider erlaubt die aktuell begrenzte Studienlage keine Aussage für Hüftarthrose Patient*innen und es bedarf weiterer Forschungen. Weitere Studien könnten für Hüftarthrose Patient*innen Adaptionen des Testsettings validieren und Grenzwerte des Sturzrisikos definieren. Background: Osteoarthritis is on the rise in Europe, especially total hip replacements get more common when conservative physical therapies can´t help with the pain or movement situation. This development requires clinicians and therapists to have fast, reliable and practical assessments to determine the functional capacity of patients during the rehabilitation process. For this application, the four square step test (FSST) offers with its unique features a deeper insight into the patient's abilities regarding balance and mobility. Central Questions: To what extent is the FSST a suitable functional assessment for hip osteoarthritis patients in everyday clinical practice for pre- and post-operative evaluation? What does the FSST provide in comparison to the Timed Up and Go test (TUG) or Berg-Balance-Scale (BBS)? Aim: In the present bachelor thesis, the central questions are answered by systematic literature research. An overview of the current state of knowledge of the FSST for hip arthrosis patients is given and the results are discussed in terms of an analytical presentation. Method: The databases PubMed, PEDro, Cochrane and Google Scholar were searched for relevant studies using the PICO Model. Considering the selection criteria, four relevant studies were found for the discussion in this bachelor thesis. Results: The FSST proves to be valid and reliable, shows a low resource requirement and offers meaningful parameters for assessing the gait performance of hip osteoarthritis patients. Between the FSST and the TUG, a strong positive correlation and compared to the BBS a moderate negative correlation was found. For the use of the FSST in medical practice, a combination with other established balance assessments is recommended, such as the TUG. Conclusion: The FSST is an underestimated clinical assessment to evaluate the balance and mobility of hip osteoarthrosis patients. The FSST is already successfully used to predict the risk of falling in other clinical conditions. Unfortunately, the current limited number of studies does not allow a prediction for hip osteoarthritis patients and further research is needed. Further studies could validate the adaptations of the test setting for hip osteoarthritis patients and define cut-off scores for the risk of falling.

RESUMEN Introducción: Los síntomas vestibulares son motivo frecuente de consulta en la atención médica, el adulto mayor y en especial el género femenino está expuesto a riesgo de caída por esta causa. Es común que el tratamiento de este grupo de pacientes sea los supresores vestibulares, y la terapia de rehabilitación vestibular (RV) se indique excepcionalmente, olvidando en ocasiones que los elementos anatomofuncionales involucrados en las disfunciones vestibulares son la integración del aparato visual, vestibular, y somatosensorial, pilares en los que se fundamenta la RV. Objetivo: El objetivo de este estudio es determinar si cinco sesiones RV son suficientes para disminuir la discapacidad funcional y el riesgo de caída en un grupo de pacientes con patología vestibular. Material y método: Estudio prospectivo con 14 pacientes de género femenino mayores de 61 años con diagnóstico de patología vestibular periférica. Se realizó evaluación de (dizziness handicap inventory) DHI, (timed up and go) TUG y (video head impulse test) vHIT previo y posterior a la intervención de cinco sesiones de RV. Resultados: Las tres variables estudiadas (DHI, TUG y vHIT) demostraron mejorías estadísticamente significativas en el grupo de pacientes. Conclusión: Los resultados obtenidos en este estudio permiten sugerir que la terapia de RV en pacientes adultos mayores, con patología vestibular periférica y sin medicación de supresores vestibulares, es una modalidad terapéutica adecuada y eficiente.

Object and purpose of research. This paper studies inland and mixed navigation towed barge trains to provide the analysis of the emergencies aboard Russian towed barge trains, their tugs and barges. Materials and methods. The analysis relies on the database of the Marine Engineering Bureau, reports of Classification Societies and supervisory bodies. The risk assessment was performed as per the IMO-suggested procedure improved by the author. The methods of statistical data analysis were also used. Main results. The paper analyses the emergencies suffered by towed barge trains since 1991. In total, 533 emergency cases were investigated. The study identified the main hazards leading to accidents and catastrophes. Conclusion. The rate of emergencies grows steadily for the ships more than 14 years old, with the peak for the age group of 22-25 years. To ensure sufficient reliability and safety of towed barge train, keeping the economic efficiency level within ac- ceptable limits, is only possible if all the life cycle stages of these ships, including classification of the requirements stated in the Rules, design, construction, operation, certifications, repair and retrofitting are regarded as per the system approach.

Bu çalışmanın amacı T2DM’li bireylerde dual task(ikili görev) ve fonksiyonel kapasitenin incelenmesi ve sağlıklı olgularla karşılaştırılmasıdır. Çalışmaya yaş ortalaması 55,09± 7,08 olan 11 sağlıklı, 11 nöropatisi olan ve 11 nöropatisi olmayan T2 DM’li birey dahil edilmiştir. Tüm olgularda fonksiyonel kapasite; otur kalk testi, 6 dakika yürüme testi ve Zamanlı Kalk Yürü Testi (ZKYT) ile değerlendirilmiştir. İkili görev değerlendirmesi 4 dolu su bardağının bulunduğu tepsi taşıtılarak 3 metre yürüme testi ile değerlendirilmiştir. Değerlendirmeler aynı fizyoterapist tarafından yapılmıştır. Bu çalışma sonucunda fonksiyonel kapasite değerlendirmelerinde; Otur-kalk testinde nöropatili ve nöropatili olmayan T2DM’li olgulara kıyasla, sağlıklı bireylerin test sonuçları istatistiksel olarak daha yüksek bulunmuştur(p0,05). İkili görev aktivitesinin değerlendirmesinde; nöropatisi olan ve olmayan T2DM’li olgularla sağlıklı olguların ikili görevi gerçekleştirme sürelerinin benzer olduğu belirlenmiştir (p>0,05). Nöropatisi olan ve olmayan T2DM’li bireylerde sağlıklı bireylere göre fonksiyonel kapasite olumsuz etkilenmektedir. İkili motor görev aktivitelerinde ise diyabetli ve sağlıklı olguların sonuçları benzerdir. The aim of this study was to assess dual task and functional capacity of subjects with type 2 diabetes and compare with healthy subjects. Eleven healthy subjects, 11 T2DM subjects with neuropathy and 11 T2DM subjects without neuropathy, with a mean age of 55,09 ±7,08 were included to the study.For the assessment of functional capacity, sit and stand test, six minute walking test and timed up and go tests were used. The dual task examination included, 3 meter walking test with a tray which has 4 glasses of water. All of the assesments has been done to every subject by the same physiotherapist. As a result of this study,for functional capacity assesments; it has been observed that, healthy individuals had significantly higher results in sit-stand test compared to T2DM with neuropathy and without neuropathy (p0,05). In dual task test, all of the groups had similar results (p>0,05). In conclusion, functional capacity of T2DM with and without neuropathy was found to be affected in a negatively. For dual motor task activities, all groups had similar results.

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OBJECTIVEPatient-reported outcome measures (PROMs) are standard of care for the assessment of functional impairment. Subjective outcome measures are increasingly complemented by objective ones, such as the “Timed Up and Go” (TUG) test. Currently, only a few studies report pre- and postoperative TUG test assessments in patients with lumbar spinal stenosis (LSS).METHODSA prospective two-center database was reviewed to identify patients with LSS who underwent lumbar decompression with or without fusion. The subjective functional status was estimated using PROMs for pain (visual analog scale [VAS]), disability (Roland-Morris Disability Index [RMDI] and Oswestry Disability Index [ODI]), and health-related quality of life (HRQoL; 12-Item Short-Form Physical Component Summary [SF-12 PCS] and the EQ-5D) preoperatively, as well as on postoperative day 3 (D3) and week 6 (W6). Objective functional impairment (OFI) was measured using age- and sex-standardized TUG test results.RESULTSSixty-four patients (n = 32 [50%] male, mean age 66.8 ± 11.7 years) were included. Preoperatively, they reported a mean VAS back pain score of 4.1 ± 2.7, VAS leg pain score of 5.4 ± 2.7, RMDI of 10.4 ± 5.3, ODI of 41.9 ± 16.2, SF-12 PCS score of 32.7 ± 8.3, and an EQ-5D index of 0.517 ± 0.226. The preoperative rates of severe, moderate, and mild OFI were 4.7% (n = 3), 12.5% (n = 8), and 7.8% (n = 5), respectively, and the mean OFI T-score was 116.3 ± 23.7. At W6, 60 (93.8%) of 64 patients had a TUG test result within the normal population range (no OFI); 3 patients (4.7%) had mild and 1 patient (1.6%) severe OFI. The mean W6 OFI T-score was significantly decreased (103.1 ± 13.6; p < 0.001). Correspondingly, the PROMs showed a decrease in subjective VAS back pain (1.6 ± 1.7, p < 0.001) and leg pain (1.0 ± 1.8, p < 0.001) scores, disability (RMDI 5.3 ± 4.7, p < 0.001; ODI 21.3 ± 16.1, p < 0.001), and increase in HRQoL (SF-12 PCS 40.1 ± 8.3, p < 0.001; EQ-5D 0.737 ± 0.192, p < 0.001) at W6. The W6 responder status (clinically meaningful improvement) ranged between 81.3% (VAS leg pain) and 29.7% (EQ-5D index) of patients.CONCLUSIONSThe TUG test is a quick and easily applicable tool that reliably measures OFI in patients with LSS. Objective tests incorporating longer walking time should be considered if OFI is suspected but fails to be proven by the TUG test, taking into account that neurogenic claudication may not clinically manifest during the brief TUG examination. Objective tests do not replace the subjective PROM-based assessment, but add valuable information to a comprehensive patient evaluation.

The article is looking into the history and present practice in reformed churches with a connection to the Dutch Reformed Church of the 16th and 17th century, on the restoration of deposed preachers or ministers in the church office. Out of the Dutch Reformed history comes a tendency to list certain sins in church orders as serious enough to make it impossible for the relevant church assemblies to restore someone in office, regardless of the specific context. This list prevents assemblies from using their own discretion when a matter of restoration as a minister is attended to. It thereby kills the pastoral-judicial character of church affairs. Against this stoned approach, writers and churches opt for room for the said assemblies to decide in their own pastoral orientated discretion over matters of restoration in the office as a minister. A room to which a certain framework of broad guidelines is applied.

This paper examines multi-battle contests whose extensive form can be represented in terms of a finite state machine. We start by showing that any contest that satisfies our assumptions decomposes into two phases, a principal phase (in which states cannot be revisited) and a concluding tie-breaking phase (in which all non-terminal states can be revisited). Degenerate cases are the finite-horizon contests on the one hand (e.g., the match race), and the tug-of-war on the other. Next, assuming a probabilistic technology in each battle, we show that any contest satisfying our assumptions, with either finite or infinite horizon, admits a unique symmetric and interior Markov perfect equilibrium. This entails, in particular, a complete characterization of the equilibrium in the tug-of-war. Finally, we explore, both analytically and numerically, the intricate problem of a contest designer that maximizes expected total effort. In the absence of a complexity constraint, the revenue-maximizing contest is always a match race, where the optimal length of the race increases as the technology of the component contest becomes more noisy. If, however, the complexity constraint is binding, then the optimal contest is typically (but not always) a tug-of-war.

Background The current guidelines for fall prevention in community-dwelling older adults issued by the American Geriatrics Society and British Geriatrics Society (AGS/BGS) indicate an algorithm for identifying who is at increased risk of falling. The predictive accuracy of this algorithm has never been assessed, nor have the consequences that its introduction in clinical practice would bring about. Aims To evaluate this risk screening algorithm, estimating its predictive accuracy and its potential impact. Methods The analyses are based on 438 community-dwelling older adults, participating in the InCHIANTI study. We analysed different tests for gait and balance assessment. We compared the AGS/BGS algorithm with alternative strategies for fall prevention not based on fall risk evaluation. Results The AGS/BGS screening algorithm (using TUG, cut-off 13.5 s) has a sensitivity for single falls of 35.8% (95% confidence interval 23.2%–52.7%) and a specificity of 84.0% (79.3%–88.4%). It marks 18.0% (13.7%–22.4%) of the older population as at high risk. A policy of targeting people with preventive intervention regardless of their individual risk could be as effective as the policy based on risk screening but at the price of intervening on 17.3% (4.1%–34.0%) more people of the older population. Discussion This study is the first that validates and estimates the impact of the screening algorithm of these guidelines. Main limitations are related to some modelling assumptions. Conclusions The AGS/BGS screening algorithm has low sensitivity. Nevertheless, its adoption would bring benefits with respect to policies of preventive interventions that act regardless of individual risk assessment. Electronic supplementary material The online version of this article (10.1007/s40520-018-1051-5) contains supplementary material, which is available to authorized users.

Введение. Заготовка и транспортировка древесины была важным начальным этапом строительства каждого военного корабля в эпоху парусного флота. Эти работы требовали огромных усилий, особых навыков и умений, а порой и рискованных операций. Изучение техники этих работ позволяет осознать масштабы сил, которые мобилизовались для создания и поддержания в боевом состоянии военно-морских сил Российской Империи. Раскрыты технические аспекты организации различных видов и этапов транспортировки − подготовка бревен к перевозу, погрузка, разгрузка, осмотры корабельными мастерами, гуж, молевой и плотовой сплав, доставка на барках; показана роль транспортировки в ценообразовании. Методы. Статья подготовлена в русле традиции технологической истории. Изучение технологий важно для понимания исторических реалий, так как именно технологии во многом определяют возможности развития производства, торговли, армии и соответственно – экономики страны и социально-политических отношений. Технологии заготовления, транспортировки и хранения древесины играли особую роль в XVIII–XIX вв., определяли само существование боеспособного флота империи, качества боевых кораблей и сроки их службы. В статье предпринята попытка системного изучения процесса транспортировки древесины на петербургские верфи. Заключение. Рассмотренные в статье материалы позволяют сделать выводы о том, что цена материалов во многом зависела от усилий, необходимых для их транспортировки; проблемы порчи древесины при доставке и хранении подчас сводили на нет усилия по заготовке и транспортировке., Introduction. Timber cutting and transportation was an important part preparations to a sailing ship building. The questions of techniques and organization of different kinds and stages of transportation are under consideration in the article. They are the preparation of logs to the transportation, loading, unloading, ship-masters’ inspections, tug, rafting, steam driving, barging; the role of transportation in price formation is shown as well. Methods. The study of technologies is important for understanding of historic realities, as technologies determined the possibilities of industry, trade, army and together with it – the economy of state, social and political relations. The technologies of timber stockpiling, transportation and storage played a special role in the 18-19th centuries as they were the stages of preparation to a sailing ship building and so the existence of Empire’s capable navy depended on the success of these activities. The article is an attempt of complex study of the wood transportation process. Conclusion. The studies materials lead to the conclusions that the price of the materials depended on the efforts needed for the transportation; the problems of the material damaging during the transportation and storage sometimes stultified the transporting efforts. The author describes the technique of tug and different kinds of drive.

PURPOSE: Results on reliability and normative data for the Timed Up and Go test (TUG) in children who are developing typically are systematically reviewed. SUMMARY OF KEY POINTS: Six different TUG protocols are presented for which normative data are available for ages 3 to 18 years. TUG time is consistent within and between raters and sessions and is influenced by age. The choice of protocol, self-selected versus fastest walking speed, and use of a motivational aspect and of the outcome calculation affect TUG time as well as its consistency within and between sessions. CONCLUSIONS: A standard protocol for the TUG is lacking and should be developed with attention to reliability. RECOMMENDATIONS FOR CLINICAL PRACTICE: If the TUG is to be used as a screening tool for dynamic balance control, clinicians need to apply protocols that include fastest walking speed motivation. ispartof: PEDIATRIC PHYSICAL THERAPY vol:31 issue:1 pages:22-31 ispartof: location:United States status: published

Background: Muscle health is recognized for its critical role in the functionality and well-being of older adults. Readily accessible, reliable, and inexpensive methods of measuring muscle health are needed to advance research and clinical care. Methods: In this prospective, blinded study, 27 patients underwent quantitative muscle ultrasound (QMUS), standard electrical impedance myography (sEIM), and handheld electrical impedance myography (hEIM) of the anterior thigh musculature by two independent examiners. Subjects also had dual-energy X-ray absorptiometry (DEXA) scans and standardized tests of physical function and strength. Data were analyzed for intra- and inter-rater reliability, along with correlations with DEXA and physical measures. Results: Measures of intra- and inter-rater reliability were excellent (&gt, 0.90) for all QMUS, sEIM, and hEIM parameters except intra-rater reliability of rectus femoris echointensity (0.87&ndash, 0.89). There were moderate, inverse correlations between QMUS, sEIM, and hEIM parameters and measures of knee extensor strength. Moderate to strong correlations (0.57&ndash, 0.81) were noted between investigational measures and DEXA-measured fat mass. Conclusions: QMUS, sEIM and hEIM were highly reliable in a controlled, same-day testing protocol. Multiple correlations with measures of strength and body composition were noted for each method. Point-of-care technologies may provide an alternative means of measuring health.

Identifying factors that affect mortality requires a robust statistical approach. This study’s objective is to assess an optimal set of variables that are independently associated with the mortality risk of 433 older comorbid adults that have been discharged from the geriatric ward. We used both the stepwise backward variable selection and the iterative Bayesian model averaging (BMA) approaches to the Cox proportional hazards models. Potential predictors of the mortality rate were based on a broad range of clinical data, functional and laboratory tests, including geriatric nutritional risk index (GNRI), lymphocyte count, vitamin D, and the age-weighted Charlson comorbidity index. The results of the multivariable analysis identified seven explanatory variables that are independently associated with the length of survival. The mortality rate was higher in males than in females, it increased with the comorbidity level and C-reactive proteins plasma level but was negatively affected by a person’s mobility, GNRI and lymphocyte count, as well as the vitamin D plasma level.

Fibromyalgia is a syndrome that is characterized by widespread pain; fatigue; stiffness; reduced physical fitness; sleep disturbances; psychological symptoms, such as anxiety and depression; and deficits in cognitive functions, such as attention, executive function, and verbal memory deficits. It is important to analyze the potentially different performance on the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) test in patients with fibromyalgia as well as examine the relationship of that performance with physical and cognitive performance. A total of 36 women with fibromyalgia participated in the study. Participants completed the MoCA test, the MMSE, and the TUG physical fitness test under dual-task conditions. The results obtained on cognitive tests were 28.19 (1.74) on the MMSE and 25.17 (2.79) on the MoCA. The participants’ performance on cognitive tests was significantly related to the results of the TUG dual-task test. In this way, cognitive performance on a dual-task test can be used to support the diagnosis of cognitive impairment in patients with fibromyalgia. The MoCA test may be a more sensitive cognitive screening tool than the MMSE for patients with fibromyalgia.

A stroke and aging process can modify the postural control. We aimed to compare the postural control of health elderly individuals to that of individuals with stroke sequelae. This cross-sectional transversal study was made with individuals capable of walking without any assistance and that were considered clinically stable. The study had 18 individuals in the group with stroke sequelae (SG) and 34 in the healthy elderly control group (CG). The participants were evaluated for the timed up and go test (TUG) and force platform. The SG showed the worst results in relation to the time of execution of the TUG and the force platform evaluation. The displacement of center of pressure was worse for both groups in the eyes-closed situation, especially in the anteroposterior direction for the CG. The GS showed worse results in the static and dynamic postural control. The healthy elderly showed more dependence on sight to maintain their static balance and there was no difference in the balance tests in relation to the side affected by the stroke.

Background: A two center retrospective cohort study of simultaneous bilateral breast reconstructions using double deep inferior epigastric perforator (DIEP) flaps and double transverse myocutaneous/upper gracilis (TMG) flaps was conducted. The aim of this study was to compare surgical procedures, complications, and overall outcome. Patients and Methods: Two study groups, either receiving a simultaneous bilateral breast reconstruction, with double DIEP flaps (n = 152) in group 1, or double TMG flaps (n = 86) in group 2, were compared. A detailed risk and complication analysis was performed. Patient characteristics, operative time and the need for further operations were evaluated. Results: Double DIEP patients had donor site complications in 23.7% and double TMG patients in 16.3% (p = 0.9075, RR 1.45). Flap loss rates of 3.5% (double TMG) and 2.6% (double DIEP) were recorded (p = 0.7071, RR 1.33). The need for postoperative lipofilling was significantly higher in double TMG patients (65.1% vs. 38.2 %, p = 0.0047, RR 1.71). Conclusion: Complication analysis favors the double DIEP procedure. Donor site morbidity was lower and less severe in the double TMG group. Later fat grafting was more frequently needed after double TMG reconstructions. Further studies, preferably of prospective nature, are needed to evaluate the benefit of bilateral simultaneous breast reconstructions.

Summary In this case-control study, we concluded that women with distal radial fractures who were surgically treated showed lower grip strength and dynamic body balancing than those of controls. These results suggest that measurements of grip strength and dynamic body balance may be useful screening tools to assess future fracture risk. Introduction Patients with distal radial fractures (DRFs) are at risk of future fragility fractures. However, their physical characteristics and tendencies for falls remain unclear. We aimed to compare the physical characteristics of women with and without distal radial fractures. Methods We included 128 women with a DRF as their first fragility fracture (fracture group) who underwent surgical treatment. Concurrently, 128 age- and sex-matched participants without a history of fragility fractures were selected as controls (control group). The participants underwent assessments of grip strength and the body balancing ability test. Measurements were taken twice in the fracture group, at 2 weeks and 6 months postoperatively, and once in the control group. The body balancing ability test included the Functional Reach Test, Timed Up and Go test (TUG), 2-Step test (2ST), and Timed Uni-pedal Stance test. The participants also completed questionnaires about their health. Results There were no significant differences (p > 0.05) in patient characteristics between the groups. The fracture group showed lower grip strength across all age groups. In the DRF group, prolonged TUG time was observed at 2 weeks postoperatively in all age groups and at 6 months in participants aged 55–74 years; the 2ST score was significantly lower in participants aged between 65 and 74 years. Conclusions Women with DRF demonstrated lower grip strength and dynamic body balancing ability. Lower grip strength and dynamic body balancing ability were identified as significant risk factors in women with DRF, suggesting that these may be useful screening tools to assess fracture risk. Electronic supplementary material The online version of this article (10.1007/s00198-018-04816-4) contains supplementary material, which is available to authorized users.

RESUMEN Introducción: Los síntomas vestibulares son motivo frecuente de consulta en la atención médica, el adulto mayor y en especial el género femenino está expuesto a riesgo de caída por esta causa. Es común que el tratamiento de este grupo de pacientes sea los supresores vestibulares, y la terapia de rehabilitación vestibular (RV) se indique excepcionalmente, olvidando en ocasiones que los elementos anatomofuncionales involucrados en las disfunciones vestibulares son la integración del aparato visual, vestibular, y somatosensorial, pilares en los que se fundamenta la RV. Objetivo: El objetivo de este estudio es determinar si cinco sesiones RV son suficientes para disminuir la discapacidad funcional y el riesgo de caída en un grupo de pacientes con patología vestibular. Material y método: Estudio prospectivo con 14 pacientes de género femenino mayores de 61 años con diagnóstico de patología vestibular periférica. Se realizó evaluación de (dizziness handicap inventory) DHI, (timed up and go) TUG y (video head impulse test) vHIT previo y posterior a la intervención de cinco sesiones de RV. Resultados: Las tres variables estudiadas (DHI, TUG y vHIT) demostraron mejorías estadísticamente significativas en el grupo de pacientes. Conclusión: Los resultados obtenidos en este estudio permiten sugerir que la terapia de RV en pacientes adultos mayores, con patología vestibular periférica y sin medicación de supresores vestibulares, es una modalidad terapéutica adecuada y eficiente. ABSTRACT Introduction: Vestibular symptoms are frequent reason for consultation in medical care, the elderly and especially the female gender is exposed to fall risk from this cause. It is common for the treatment of this group of patients to be vestibular suppressors while vestibular rehabilitation therapy is indicated exceptionally, sometimes forgetting that the anatomic and functional elements involved in vestibular dysfunctions are the integration of the visual, vestibular, and somatosensory, pillars in those that are based on vestibular rehabilitation (VR). Aim: The objective of this study is to determine if five VR sessions are sufficient to provide concrete quantitative data on the decrease of disability and risk of falling in a group of patients with vestibular pathology. Material and method: This prospective study included 14 female patients over 61 years of age with diagnoses of peripheral vestibular pathology. Dizziness handicap inventory (DHI), timed up and go (TUG) and video head impulse test (vHIT) were performed and after the intervention of five sessions of vestibular rehabilitation. Results: The three variables studied (DHI, TUG and vHIT) showed statistically significant improvements in the group of patients. Conclusions: The results obtained in this study allow us to suggest that VR therapy in elderly patients with peripheral vestibular pathology and without vestibular suppressor medication is an adequate, efficient and promising therapeutic modality.

The aim of the paper is to describe an industrial-academic collaboration whose main goal is the design of a new escort tug family characterized by high intact/damage stability margins, good maneuvering capability and stable behavior during escort indirect assistance. The project addresses three main research areas: hydrodynamic design of the hull with escort capability, simulation of the escort capabilities in different operational scenario, development of control logics that will allow autonomous or unmanned operations. The paper describes the methodological approach adopted for the design and will show some preliminary results. The results refer to the first part of the project. CFD calculations and towing tank tests have been performed onto a prototype tug hull in order to assess the hull design and to infer simulation models able to describe the behavior of a family of vessels. In particular, the propulsion and maneuverability aspects in escort operations are deeply investigated. Results of the project will form the bases for the conceptual application to a remotely controlled or autonomous escort tug.

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