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IntroductionWildlife represents an increasingly important source of pathogens of medical and veterinary importance. Surveillance in wildlife offers an insight on current epidemiological status of selected pathogens and help to prevent spillovers to humans and livestock.Material and methodsOur study included 312 wild ruminants belonging to five species: Roe deer (n = 134), red deer (n = 113), Alpine chamois (n = 53), European mouflon (n = 10) and Alpine ibex (n = 2). Seven pathogens that may have profound effect on human/livestock health and economic viability of the farms were tested using serological methods.ResultsAntibodies against Toxoplasma gondii, Neospora caninum, Coxiella burnetii, Brucella spp., Chlamydophila abortus, Mycobacterium avium subsp. paratuberculosis (MAP) and Mycobacterium bovis were detected in 34.62% (108/312), 0.96% (3/312), 2.24% (7/312), 0, 0.96% (3/312), 0, 0.64% (2/312) of animals tested, respectively. Because of low prevalences, risk factors were assessed only for T. gondii. Sex (female>male) and species (roe deer>red deer, roe deer>Alpine chamois) were significantly associated with the T. gondii positive outcome, while age was not.DiscussionAdult males had the lowest T. gondii prevalence which offers future research opportunities. The lower seroprevalence of most investigated pathogens suggests game meat, if properly cooked, as being relatively safe for human consumption. This is the first study investigating the seroprevalence and associated risk factors of selected pathogens in wild ruminants in Slovenia.

IntroductionLameness originating from the distal limb is common in sport horses and can vary depending on the dynamics of movement and the surface, with differences in shoeing exacerbating this variability. Driving horses work primarily on hard surfaces (pavement), whereas dressage horses work primarily on soft surfaces (riding arenas with sand). Driving horses are traditionally shod with small fixed studs made of hard metal, which are attached to the horseshoe at 4 points, while dressage horses are shod with a simple horseshoe. We investigated the hypothesis that there is a difference in the pathological radiographic findings of the distal limbs between driving and dressage horses. The variability in the stable management and training program was minimized by including horses from the same farm.MethodsTwenty horses in a driving training program and 20 horses in a dressage program were included in the study. Radiographs of the both front feet were obtained and quantitatively evaluated for radiographic changes by three surgery/diagnostic imaging specialists. Interrater reliability was measured, and multivariate analysis was performed to compare differences in pathological radiographic findings of the distal limbs between the two groups.ResultsKendal’s concordance coefficient indicated an agreement among raters (Kw ≠ 0) for all observations. Radiographic signs of degenerative joint disease of the distal interphalangeal joint were more common in the group of driving horses compared to dressage horses.ConclusionOur hypothesis was confirmed, as there were significant pathological differences between groups in distal articular margin of middle phalanx, joint space narrowing, and irregular joint surface of the middle phalanx.

Not much is known about the fall risk among the adult population of those who rarely visit doctors. We wanted to determine the prevalence of increased fall risk in a population of family practice non-attenders and the factors associated with it.

Abstract Using the population-based data we aim to estimate the general population trends of multiple components of physical fitness of children, identify critical structural changes in these trends, and evaluate the potential changes in differences in the test scores between the children. During the entire study period, 1989–2019, median body mass index and triceps skinfold increased in both genders and all age groups. Muscular fitness, in general, showed negative trends, with some exceptions: during the post-2010 period, children were mostly experiencing the improvement of isometric strength of the upper body. The neuromuscular components of physical fitness showed positive trends, especially in girls. Cardiorespiratory fitness has been declining in all age groups until the last decade, with the largest decreases occurring before 2000. In the last decade, the trends reversed. The flexibility indicator revealed the largest differences between boys and girls, with boys mainly experiencing negative and girls mostly positive trends. The variability of the test scores mostly increased during the study period. This increasing variance suggests that—despite generally favourable trends in the last decade—children in Slovenia have been facing increasing inequalities in their development, which can potentially lead to future inequalities in health.

Abstract Background In binary logistic regression data are ‘separable’ if there exists a linear combination of explanatory variables which perfectly predicts the observed outcome, leading to non-existence of some of the maximum likelihood coefficient estimates. A popular solution to obtain finite estimates even with separable data is Firth’s logistic regression (FL), which was originally proposed to reduce the bias in coefficient estimates. The question of convergence becomes more involved when analyzing clustered data as frequently encountered in clinical research, e.g. data collected in several study centers or when individuals contribute multiple observations, using marginal logistic regression models fitted by generalized estimating equations (GEE). From our experience we suspect that separable data are a sufficient, but not a necessary condition for non-convergence of GEE. Thus, we expect that generalizations of approaches that can handle separable uncorrelated data may reduce but not fully remove the non-convergence issues of GEE. Methods We investigate one recently proposed and two new extensions of FL to GEE. With ‘penalized GEE’ the GEE are treated as score equations, i.e. as derivatives of a log-likelihood set to zero, which are then modified as in FL. We introduce two approaches motivated by the equivalence of FL and maximum likelihood estimation with iteratively augmented data. Specifically, we consider fully iterated and single-step versions of this ‘augmented GEE’ approach. We compare the three approaches with respect to convergence behavior, practical applicability and performance using simulated data and a real data example. Results Our simulations indicate that all three extensions of FL to GEE substantially improve convergence compared to ordinary GEE, while showing a similar or even better performance in terms of accuracy of coefficient estimates and predictions. Penalized GEE often slightly outperforms the augmented GEE approaches, but this comes at the cost of a higher burden of implementation. Conclusions When fitting marginal logistic regression models using GEE on sparse data we recommend to apply penalized GEE if one has access to a suitable software implementation and single-step augmented GEE otherwise.

ABSTRACT Introduction/Aims Methods Results Discussion We aimed to determine differences in diaphragm thickness by including/excluding pleural and peritoneal membranes, the variability in diaphragm thickness over the apposition zone, and the predictors of diaphragm thickness and excursion measurements.At least 10 male and female subjects were recruited for each decade of life. Spirometry, respiratory muscle strength, and the diaphragm ultrasound (US) measurements were performed. Multivariate linear regression was applied to determine associations between diaphragm US parameters, subject characteristics, spirometry, and respiratory muscle strength.In 156 subjects (mean 47.8 ± 17.7; 20–80 years of age), a significant difference in diaphragm thickness was found when comparing measurements that included and excluded the pleural and peritoneal membranes (mean 2.3 vs. 1.7 mm; average difference of 35% (95% CI [15.3–60]); p < 0.001), as well as the minimum and maximum diaphragm thicknesses at different locations over the apposition zone (mean 1.4 vs. 2.1 mm; p < 0.001). Adjusting for sex, age, height, sniff nasal inspiratory pressure, and forced vital capacity, a positive association was found between body mass index (BMI) and diaphragm thickness (β =0.024, p < 0.001, partial R2 = 0.31, 95% CI [0.018, 0.030]); a negative association was found with the thickening ratio (β = −0.013, p = 0.050, partial R2 = 0.04, 95% CI [−0.024, −0.002]).Caliper placement and the location of measurement over the apposition zone greatly affect diaphragm thickness, which is also associated with BMI. Therefore, a standardized protocol for measuring diaphragmatic thickness and excursion is desirable, and BMI should be considered when interpreting the results. [ABSTRACT FROM AUTHOR]

This retrospective study aimed to estimate the differences between selected indicators of physical fitness and body composition in young tennis players during the COVID-19 pandemic (2020 and 2021) and their values as predicted using the pre-pandemic trend (2015–2019). Data were collected from selected boys (mean ± SD; 13.2 ± 1.7 years) and girls (13.1 ± 1.9 years) during annual tests. Data were analyzed with linear mixed-effects models for males and females, separately, to predict body composition and physical fitness test scores, adjusting for age and pre-pandemic trends in the data. Compared with expected values, body fat mass increased in boys (2020: 0.68; 0.44–0.92, 2021: 1.08; 0.72–1.43), whereas muscle mass decreased (2020: −0.22; −0.34–−0.10, 2021: −0.28; −0.46–−0.10) throughout the pandemic. Interestingly, boys’ age-adjusted squat jump test scores improved relative to their expected scores during COVID-19 (2020: 0.19; 0.00–0.38, 2021: 0.35; 0.06–0.63). No other differences between predicted and measured values were noted across the observation period. The results of this study suggest that the sustained reduction in sports activity caused by the pandemic may have negatively affected the body composition of athletes; however, this did not affect selected performance indicators.

Abstract Background For finite samples with binary outcomes penalized logistic regression such as ridge logistic regression has the potential of achieving smaller mean squared errors (MSE) of coefficients and predictions than maximum likelihood estimation. There is evidence, however, that ridge logistic regression can result in highly variable calibration slopes in small or sparse data situations. Methods In this paper, we elaborate this issue further by performing a comprehensive simulation study, investigating the performance of ridge logistic regression in terms of coefficients and predictions and comparing it to Firth’s correction that has been shown to perform well in low-dimensional settings. In addition to tuned ridge regression where the penalty strength is estimated from the data by minimizing some measure of the out-of-sample prediction error or information criterion, we also considered ridge regression with pre-specified degree of shrinkage. We included ‘oracle’ models in the simulation study in which the complexity parameter was chosen based on the true event probabilities (prediction oracle) or regression coefficients (explanation oracle) to demonstrate the capability of ridge regression if truth was known. Results Performance of ridge regression strongly depends on the choice of complexity parameter. As shown in our simulation and illustrated by a data example, values optimized in small or sparse datasets are negatively correlated with optimal values and suffer from substantial variability which translates into large MSE of coefficients and large variability of calibration slopes. In contrast, in our simulations pre-specifying the degree of shrinkage prior to fitting led to accurate coefficients and predictions even in non-ideal settings such as encountered in the context of rare outcomes or sparse predictors. Conclusions Applying tuned ridge regression in small or sparse datasets is problematic as it results in unstable coefficients and predictions. In contrast, determining the degree of shrinkage according to some meaningful prior assumptions about true effects has the potential to reduce bias and stabilize the estimates.

SLOfit Lifelong is a public health initiative which was created to upgrade a well-established, national physical fitness surveillance system for Slovenian schoolchildren that has been collecting annual fitness and health data for over three decades. The ultimate objective of creating SLOfit Lifelong was to build a modern societal infrastructure with the capacity and ability to detect future causal associations between childhood physical fitness trends and future health outcomes based on the lifelong surveillance of one's own fitness status. By instilling citizens with an ambition to test, understand, and follow-up their own physical fitness and health status (including related health risk factors), this initiative provides the technical support and expert feedback needed to engender greater individual control over understanding (and thus modulating), one's own physical fitness status as they progress into older adulthood. This perspective paper details the extensive approach taken to devise appropriate fitness test batteries for adults and older adults which can also relate to the student version of the original SLOfit test database, including establishing criterion health risk zones and a public approach to establish this national, citizen-driven health feedback framework. Through its sophisticated online web applications, social media, print media, and outreach workshops, SLOfit Lifelong provides the expert support for public health engagement by fostering positive lifelong physical literacy experiences an individual can enjoy across their aging journey.

Abstract Introduction The role of host immune responses in the pathogenesis of borrelial dissemination in early Lyme borreliosis (LB) in the form of multiple erythema migrans (MEM) or LB‐associated symptoms is incompletely understood. Methods In this study, fifteen cytokine or chemokine levels, representative of innate, Th1, and Th17 immune responses, were assessed using a bead‐based Luminex multiplex assay in acute sera from 76 adult patients with skin culture‐positive Borrelia afzelii solitary erythema migrans (SEM) and 58 patients with MEM at a single‐center university hospital. Differences between the groups were tested by modeling each cytokine or chemokine concentration by means of left‐censored regression using the classic Tobit model. Results Mean serum cytokine or chemokine levels were low. When taking into account the proportion of patients with cytokine or chemokine concentrations below the lowest detectable limit, only levels of CXCL10 (p = .03) and CCL19 (p = .02), representatives of the Th1 immune response, differed between patients with SEM and those with MEM; however, the differences did not reach statistical significance when adjusted for multiple comparisons. In addition, we did not find differences in systemic inflammatory responses when comparing patients with and those without LB‐associated constitutional symptoms. Conclusion No significant differences in systemic immune responses represented by selected cytokines or chemokines in serum samples of patients with EM infected with B. afzelii suggest that systemic mediators are not pivotal in the pathogenesis of dissemination of early infection in the form of MEM or LB‐associated symptoms. Localized immune responses in the skin or other pathogenetic mechanisms may be more important in this regard.

Izhodišče: v članku ocenjujemo vpliv uveljavljenih ukrepov za obvladovanje epidemije okužbe z virusom SARS-CoV-2 na stopnjo reprodukcije okužbe z virusom in delež okuženih za Slovenijo. Metode: uporabimo Bayesov model, ki predpostavlja enako učinkovitost ukrepov v različnih državah in je zgrajen na podlagi podatkov o številu umrlih za 12 (model A) oz. 10 evropskih držav (izločeni Španija in Italija, model B). Rezultati: ocenjena stopnja reprodukcije v Sloveniji po sprejetih ukrepih je 0,6; pod 1 je celoten 95 % kredibilni interval [0,3 - 0,9]. Če pri gradnji modela izločimo Italijo in Španijo (model B), je ocenjena stopnja reprodukcije v Sloveniji po sprejetih ukrepih 0,8 (95 % kredibilni interval [0,5 - 1,2]). Ocenjeni delež okuženih v Sloveniji je manjši od enega odstotka (0,53 [0,23 - 1,01] % pri modelu A in 0,66 [0,26 - 1,45] % pri modelu B), uradno število potrjenih primerov pa podcenjuje dejansko število za približno faktor 10. Zaključek: dosedanji sprejeti ukrepi so bili uspešni, saj menimo, da je trenutna stopnja reprodukcije virusa SARS-CoV-2 pod 1. Pri sproščanju ukrepov je smiselno počakati vsaj 2 tedna, saj ocenjujemo, da to pomeni vsaj dodatnih 5 tednov zamika do ponovnih zaostritev.

Introduction: Wildlife represents an increasingly important source of pathogens of medical and veterinary importance. Surveillance in wildlife offers an insight on current epidemiological status of selected pathogens and help to prevent spillovers to humans and livestock. Material and methods: Our study included 312 wild ruminants belonging to five species: Roe deer (n = 134), red deer (n = 113), Alpine chamois (n = 53), European mouflon (n = 10) and Alpine ibex (n = 2). Seven pathogens that may have profound effect on human/livestock health and economic viability of the farms were tested using serological methods. Results: Antibodies against Toxoplasma gondii, Neospora caninum, Coxiella burnetii, Brucella spp., Chlamydophila abortus, Mycobacterium avium subsp. paratuberculosis (MAP) and Mycobacterium bovis were detected in 34.62% (108/312), 0.96% (3/312), 2.24% (7/312), 0, 0.96% (3/312), 0, 0.64% (2/312) of animals tested, respectively. Because of low prevalences, risk factors were assessed only for T. gondii. Sex (female>male) and species (roe deer>red deer, roe deer>Alpine chamois) were significantly associated with the T. gondii positive outcome, while age was not. Discussion: Adult males had the lowest T. gondii prevalence which offers future research opportunities. The lower seroprevalence of most investigated pathogens suggests game meat, if properly cooked, as being relatively safe for human consumption. This is the first study investigating the seroprevalence and associated risk factors of selected pathogens in wild ruminants in Slovenia. [ABSTRACT FROM AUTHOR]

Wild carnivores are definitive hosts and potential reservoirs for the tapeworm Echinococcus sp. which can cause cystic and alveolar echinococcosis. Both are considered neglected and important food-borne pandemics. This study is the first to molecularly test Slovenian wild carnivores for Echinococcus species that can cause disease in humans. Fecal samples from 210 red foxes (Vulpes vulpes), 42 wolves (Canis lupus), 39 golden jackals (Canis aureus), 18 martens (Marten sp.), 2 Eurasian lynx (Lynx lynx), 2 European badger (Meles meles), and 1 Eurasian otter (Lutra lutra) were examined for Echinococcus granulosus sensu lato (EGsl: E. granulosus sensu stricto, E. canadensis) and E. multilocularis (EM) using real-time PCR. Red foxes (29.1%) and golden jackals (18%) were positive for EM. All animals examined were negative for EGsl. Univariate analysis showed no significant differences in EM prevalence with respect to animal species (red fox vs., golden jackal) (p = 0.22), age (p = 0.12), and sex (p = 0.18). Prevalence of EM was associated with the region (p < 0.001), with regions in central and southern Slovenia having higher EM prevalence and risk of infection. Due to the increase in population and expansion of habitat, the golden jackal may soon become as important definitive host for EM as the red fox.

BackgroundIndependence in daily activities is defined as the ability to perform functions related to daily living, i.e. the capacity of living independently in the community with little or no help from others.ObjectiveWe focused on non-attenders as a subgroup of patients whose health status is not well known to family practice teams. Our goal was to estimate the prevalence of dependence and its severity level in the daily activities of patients, and to determine the factors that are associated with the occurrence of dependence.DesignCross-sectional observational study.Settings and participantsData was obtained in family medicine settings. Participants in the study were adults living in the community (aged 18 or over) who had not visited their chosen family physician in the last 5 years (non-attenders) and who were able to participate in the study. Through the electronic system, we identified 2,025 non-attenders. Community nurses collected data in the participants' homes. The outcome measure was dependence in daily activities, assessed through eight items: personal hygiene; eating and drinking; mobility; dressing and undressing; urination and defecation; continence; avoiding hazards in the environment; and communication.ResultsThe final sample consisted of 1,999 patients (98.7% response rate). The mean age was 59.9 (range 20 to 99). Dependence in daily activities was determined in 466 or 23.3% (95% CI: [21.5, 25.2]) of the patients. Older patients (over 60 years), with at least one chronic disease, increased risk of falling, moderate feelings of loneliness and a lower self-assessment of health were statistically significantly more likely to be dependent in their daily activities, according to our multivariate model.ConclusionsA considerable proportion of family practice non-attenders were found to be dependent in daily activities, though at a low level. We identified several factors associated with this dependence. This could help to identify people at risk of being dependent in daily activities in the general adult population, and enable specific interventions that would improve their health status.

BackgroundStatins were shown to inhibit borrelial growth in vitro and promote clearance of spirochetes in a murine model of Lyme borreliosis (LB). We investigated the impact of statin use in patients with early LB.MethodsIn this post-hoc analysis, the association between statin use and clinical and microbiologic characteristics was investigated in 1520 adult patients with early LB manifesting as erythema migrans (EM), enrolled prospectively in several clinical trials between June 2006 and October 2019 at a single-center university hospital. Patients were assessed at enrollment and followed for 12 months.ResultsStatin users were older than patients not using statins, but statin use was not associated with Borrelia seropositivity rate, Borrelia skin culture positivity rate, or disease severity as assessed by erythema size or the presence of LB-associated symptoms. The time to resolution of EM was comparable in both groups. The odds for incomplete recovery decreased with time from enrollment, were higher in women, in patients with multiple EM, and in those reporting LB-associated symptoms at enrollment, but were unaffected by statin use.ConclusionStatin use was not associated with clinical and microbiologic characteristics or long-term outcome in early LB.

Abstract Background Community acquired Clostridioides (Clostridium) difficile infection (CA-CDI) is a significant health problem in human and veterinary medicine. Animals are often considered as potential reservoirs for CA-CDI. In Europe, family farming is the most predominant farming operation, with a complex interaction between animals and the community. Therefore, it is pertinent to evaluate transmission patterns of C. difficile on such prominent European farming model. Fecal samples from calves (n = 2442) were collected biweekly over a period of one year on 20 mid-size family dairy farms. Environmental samples (n = 475) were collected in a three month interval. Clostridioides difficile was detected using qPCR in 243 fecal samples (243/2442); positive samples were then quantified. Association between prevalence/load of C. difficile and age of the calves was estimated with logistic regression model. Most common C. difficile isolate from calves (n = 76) and the environment (n = 14) was C. difficile ribotype 033, which was further analyzed using multilocus variable-number tandem-repeat analysis (MLVA) to assess intra- and between-farm relatedness. Results Clostridioides difficile was detected in feces of calves less than 24 h old. Results showed a non-linear statistically significant decrease in shedding load of C. difficile with age (P

The purpose of the study was to find out whether there is a difference in the early parameters of cardiotoxicity (left ventricular ejection fraction [LVEF] and N-terminal pro-B-type natriuretic peptide [NT-proBNP]) between the two groups of patients: the patients treated for left breast cancer (left breast cancer group) and those treated for the right breast cancer (right breast cancer group), after the treatment had been completed.

Toxoplasma gondii is a zoonotic parasite of great public health concern. Wild boars could be considered an emerging source of toxoplasmosis in humans due to the popularity of venison and their increasing population. The aim of this study was to determine the seroprevalence of T. gondii in the Slovenian wild boar population and evaluate risk factors for human infection. Of 353 samples, 62% were positive for T. gondii using ELISA tests. This is the highest T. gondii seroprevalence reported to date in wild boar worldwide. The increase in prevalence with increasing age (p = 0.003) and weight (p = 0.002) were statistically significant, whereas gender was not (p = 0.781). Odds for being T. gondii-positive increased with age with the largest difference being between 2–3-year-old and 1–2-year-old animals (OR = 2.66, 95%CI: 1.03–6.85). Animals weighing 20–40 kg had a higher risk than animals weighing 0–20 kg (OR = 2.74, 95%CI: 1.21–6.20), whereas a further increase in the weight was not associated with increasing the odds. Due to the high Toxoplasma prevalence, the study concluded that the risk of exposure to T. gondii from handling raw or undercooked wild boar meat is high. Surveillance protocols should be established at the national level together with increased awareness within the hunting community.

During the first wave of the COVID-19 pandemic in spring 2020, Slovenia was among the least affected countries, but the situation became drastically worse during the second wave in autumn 2020 with high numbers of deaths per number of inhabitants, ranking Slovenia among the most affected countries. This was true even though strict non-pharmaceutical interventions (NPIs) to control the progression of the epidemic were being enforced. Using a semi-parametric Bayesian model developed for the purpose of this study, we explore if and how the changes in mobility, their timing and the activation of contact tracing can explain the differences in the epidemic progression of the two waves. To fit the model, we use data on daily numbers of deaths, patients in hospitals, intensive care units, etc., and allow transmission intensity to be affected by contact tracing and mobility (data obtained from Google Mobility Reports). Our results imply that though there is some heterogeneity not explained by mobility levels and contact tracing, implementing interventions at a similar stage as in the first wave would keep the death toll and the health system burden low in the second wave as well. On the other hand, sticking to the same timeline of interventions as observed in the second wave and focusing on enforcing a higher decrease in mobility would not be as beneficial. According to our model, the ‘dance’ strategy, i.e., first allowing the numbers to rise and then implementing strict interventions to make them drop again, has been played at too-late stages of the epidemic. In contrast, a 15–20% reduction of mobility compared to pre-COVID level, if started at the beginning and maintained for the entire duration of the second wave and coupled with contact tracing, could suffice to control the epidemic. A very important factor in this result is the presence of contact tracing; without it, the reduction in mobility needs to be substantially larger. The flexibility of our proposed model allows similar analyses to be conducted for other regions even with slightly different data sources for the progression of the epidemic; the extension to more than two waves is straightforward. The model could help policymakers worldwide to make better decisions in terms of the timing and severity of the adopted NPIs.

Commercial enteral formulas are generally recommended for gastrostomy feeding in patients with severe neurologic impairment. However, pureed food diets are still widely used and even gaining popularity among certain groups. We tried to compare the effectiveness of gastrostomy feeding for treatment of severe malnutrition with either enteral formulas or pureed feeds.

Sport climbing is a multifaceted sport that also requires appropriate techniques to optimize movements. As augmented feedback is known to facilitate motor learning, we investigated the utility of adding video analysis and expert modelling to standardized verbal feedback for the acquisition of three climbing-specific techniques (drop knee, heel hook and high step). Twenty-six novice climbers (12 women) completed two testing sessions before and after a training intervention that consisted of three coached climbing sessions targeting the three techniques. Participants were randomly assigned to a control group, which solely received standardized verbal feedback or an experimental group that additionally received standardized video analysis and expert modelling using the Dartfish tablet application. Video recordings were subsequently evaluated by two climbing experts on a 7-point scale. The expert scores were higher in the experimental than in the control group for the high step (causal total effect (CTE) 0.38, 95% confidence interval (CI) [0.06, 0.68]). Improvements for the drop knee (CTE = 0.12, 95% CI [−0.24, 0.48]) and heel hook (CTE = −0.05, 95% CI [−0.42, 0.31]) were similar in both groups. For the drop knee, we, however, observed a positive causal direct effect (CDE = 0.38, 95% CI [0.07, 0.68]), which was comparable to that observed for the high step but also a negative causal mediator effect via the perceived difficulty (CME = −0.26, 95% CI [−0.51, −0.04]). Compared to verbal feedback solely, the addition of video analysis and expert modelling might facilitate the acquisition of certain climbing techniques, such as high step, in novice climbers. [ABSTRACT FROM AUTHOR]