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PubMed1990

Relationship of sensory organization to balance function in patients with hemiplegia.

Standing balance and dynamic weight shifting were evaluated in 10 subjects with hemiplegia using a sensory organization balance test (SOT) and the Fugl-Meyer sensorimotor assessment (FMSA). The SOT is a timed balance test that evaluates somatosensory, visual, and vestibular function for maintenance of upright posture. In contrast, the FMSA is a functional status assessment that indicates the amount of assistance needed during various balance tasks and the tolerated duration of the task. The results of both clinical tests were compared to determine whether the SOT correlated with functional ability. The SOT scores were significantly correlated with the FMSA balance subscores and the FMSA total lower extremity scores. Based on the results of this preliminary study, the authors concluded that the SOT may be useful for evaluating a patient's functional status. Further implications for the evaluation and treatment of balance dysfunction in persons with hemiplegia are discussed.

Adult↗

PubMedDate not supplied

Accidents in elderly care: a randomised controlled trial (part 3).

This paper reports the data on accidents from a randomised controlled trial evaluating health authority-funded nursing home and long stay care of the elderly ward care in one inner London health district. Respondents randomised to NHS nursing homes experienced a higher accident rate than respondents randomised to conventional long stay hospital wards for elderly people. Respondents in the homes also experienced an earlier decline in functional and mental ability than those in hospital. These disadvantages have to be balanced against the previously published observational data from the evaluation, which clearly indicated that quality of life in the homes was superior to that in the wards. The conclusion from this study is that earlier decline in functional and mental ability and increased accident risk in the more flexible environments of the nursing homes have to be balanced against an inferior quality of life in the large traditional hospital wards; such assessments are not easy to make on behalf of other people. This final part of the report details the authors' conclusions.

Accidental Falls↗

PubMedDate not supplied

Accidents in elderly care: a randomised controlled trial (Part 1).

Accidental Falls↗

PubMedDate not supplied

Accidents in elderly care: a randomised controlled trial (Part 2).

This paper reports the data on accidents from a randomised controlled trial evaluating health authority-funded nursing home and long stay care of the elderly ward care in one inner London health district. Respondents randomised to NHS nursing homes experienced a higher accident rate than respondents randomised to conventional long stay hospital wards for elderly people. Respondents in the homes also experienced an earlier decline in functional and mental ability than those in hospital. These disadvantages have to be balanced against the previously published observational data from the evaluation, which clearly indicated that quality of life in the homes was superior to that in the wards. The conclusion from this study is that earlier decline in functional and mental ability and increased accident risk in the more flexible environments of the nursing homes have to be balanced against an inferior quality of life in the large traditional hospital wards; such assessments are not easy to make on behalf of other people. The report is divided into three parts. This week, the results of the trial are presented.

Accidental Falls↗

PubMed2005

Negative feedback regulation of T helper type 1 (Th1)/Th2 cytokine balance via dendritic cell and natural killer T cell interactions.

The ability of extracellular stimuli to modulate dendritic cell (DC) activation of natural killer T (NKT) cells was not well understood. We investigated the effects of the T helper type 1 (Th1)/Th2-cytokine environment on DC induction of NKT cell-mediated cytokine production in mice. Pretreatment of myeloid DCs with Th1 or Th2 cytokines, interleukin (IL)-4 or interferon (IFN)-gamma, led to the enhanced production of reciprocal cytokines by NKT cells (eg, IL-4 pretreatment led to the enhanced production of Th1 cytokines) in vitro and in vivo. Thus, the recognition of Th1 or Th2 cytokines by DCs acts as a negative feedback loop to maintain Th1/Th2-cytokine balance via NKT cell functions. Using these data, we manipulated cytokine levels and innate cytolytic activity in vivo to increase an antitumor response. This is the first description of a novel regulation system governing Th1/Th2 cytokine balance involving DCs and NKT cells.

Animals↗

PubMed2026

CRISPR/Cas9-Mediated Generation and Characterization of an Ent2*/CyO Drosophila melanogaster Strain.

In this study, a CRISPR/Cas9-based genome-editing approach was used to introduce mutations in the equilibrative nucleoside transporter 2 (Ent2) gene in Drosophila melanogaster. Guide RNAs targeting the coding region of Ent2 were designed and co-injected with Cas9 mRNA into w1118 embryos. Mutant alleles were identified by Sanger sequencing and maintained as a stable Ent2*/CyO heterozygous line using a balancer chromosome. Subsequently, we evaluated body weight, climbing ability, survival rate, and the activities of superoxide dismutase (SOD) and catalase (CAT) in fruit flies at 22 °C and 25 °C, respectively. The results indicate that at both 22 °C and 25 °C, the body length and weight of Ent2*/CyO fruit flies were significantly reduced compared to the w1118, and their development was delayed. At 22 °C, the overall lifespan of Ent2*/CyO flies was slightly longer than that of the w1118, whereas at 25 °C, no significant difference was observed. Regarding locomotor ability, the climbing performance of heterozygous flies was significantly lower than that of the w1118 at both temperatures, with males being more severely affected. In addition, the antioxidant enzyme activities of CAT and SOD in Ent2*/CyO fruit flies were significantly reduced, indicating a clear impairment of antioxidant capacity. These results describe the phenotypic profile of a CRISPR-generated Ent2 mutant line and demonstrate the feasibility of combining genome editing with balancer chromosome strategies in Drosophila. This study provides a methodological framework and a genetic resource for future investigations of genes associated with metabolism and environmental responses.

Animals↗

PubMed2005

Impact of genetic selection on management of boar replacement.

Boars in an artificial insemination centre have been selected for their superior genetic potential, with 'superior' being defined as having traits the customer wants transmitted to his herd. The ability to meet the customers' needs depends on the heritability of the trait, the geneticist's success in devising a selection scheme for the trait in balance with other economically important traits, and the boar's ability to produce sperm that can fertilise oocytes. Genetic evaluation research over the past 20 years has greatly increased the number of traits for which a boar can be selected: currently in the Canadian national program, these include age at 100 kg, backfat at 100 kg, feed efficiency, lean yield and litter size. In the near future, traits that are very likely to be added to this selection list include piglet survival, marbling, loin eye area and structure traits. In Canada, sires are ranked on two estimated breeding value (EBV) indices; one, focused on development of terminal sire lines, is based on the growth and yield traits and another, primarily focused on maternal line development, de-emphasises these traits and incorporates litter size. Boars that are in Canadian AI centres because of their excellent growth traits are typically in the top 5-10% of the national population for terminal sire line index, but they may be only average or substandard for litter size. Conversely, boars selected to be in the top 5-10% for conveying such reproductive traits as litter size may only be in the top 33% for growth traits. The more offspring from a superior boar in either of these indices, the faster the population average for the trait improves. The original sire gets knocked out of the elite group, is culled and replaced by a higher ranked young boar from the now improved general population. Although genetic superiority should govern an AI centre's selection and culling of boars, decision-making in real life is seldom that simple. Selection criteria may be contradictory as above, or a boar with truly superior traits may be excluded because a newly-developed molecular genetics test determines he carries an undesirable gene such as PSS, RN or others being developed. Selection for terminal sire or maternal line traits can ignore important practical factors that affect an AI centre--boars with superior genetics may not produce good semen because skeletal or penile problems prevent ejaculation, or because sperm production is poor due to a genetic flaw, disease, or some other cause. Interestingly, selection pressure for one trait may inadvertently select for a trait that is linked but whose linkage is unrecognised, and such unintentionally selected genes could benefit, harm, or have no effect on production traits. An AI centre serving a variety of customers must select boars in anticipation of their customers' needs (including new, foreign and niche markets). A centre should also review its genetic evaluation results and progeny records, both to critique its own selection success and to try to detect unexpected linkages. Finally, an AI centre needs to predict its own future, selecting not just for production traits for the swine producer, but also for factors that enhance the centre's efficiency including boar conformation and temperament, and sperm quantity, quality and hardiness. Can we select for efficiency? Our colleagues in dairy cattle AI evaluate bull performance--should the swine industry consider evaluation of male fertility traits?

Animals↗

PubMed1981

The ability of primary care physicians to recognize the common dermatoses.

Although the balance between the number of primary care physicians and the number of specialists has been the subject of much attention, there has been little investigation of the quality and cost-effectiveness of various provider groups. To a large extent, dermatologic care is rendered by primary care physicians. In this study, the ability of primary care physicians to recognize the 20 most frequently encountered dermatoses was examined. Results indicate that, in comparison to dermatologists, primary care physicians are deficient in their ability to recognize common dermatoses. This study emphasizes the need for reevaluation of the training and, possibly, manner in which health care is delegated to personnel who deal with cutaneous disease.

Clinical Competence↗

PubMed1994

Detecting clinical and balanced selection using spatial autocorrelation analysis under kin-structured migration.

Recently spatial autocorrelation has been employed to infer microevolutionary processes from patterns of genetic variation. In theory, different processes should show characteristic signature correlograms; e.g., clinal selection should produce correlograms decreasing from positive to negative autocorrelation, whereas uniform balanced selection should lead to no spatial autocorrelation. The ability of a statistical method such as spatial autocorrelation analysis to distinguish between these selective regimes or even to detect departures from neutrality is dependent on the strength of the evolutionary force and the population structure. Weak selection or migration will not be apparent against the expected background of stochastic noise. Moreover, the population structure may generate sufficient stochastic variation such that even strong evolutionary forces may fail to be detected. This study uses computer simulation to examine the effects of kin-structured migration and three different selective regimes on the shape of spatial correlograms to assess the ability of this technique to detect different microevolutionary processes. Genetic variation among 8 loci is simulated in a linear set of 25 artificial populations. Kin-structured stepping-stone migration among adjacent populations is modeled; directional, balanced, and clinal selection, as well as neutral loci are considered. These experiments show that strong selection produces correlograms of the predicted shape. However, with an anthropologically reasonable population structure, considerable stochastic variation among correlograms for different alleles may still exist. This suggests the need for caution in inferring genetic process from spatial patterns.

Bias↗

PubMed1997

Renal adaptation to dietary sodium restriction and loading in rats treated neonatally with enalapril.

Neonatal treatment of rats with angiotensin-converting enzyme inhibitors or the angiotensin II type 1 receptor antagonist losartan induces irreversible renal histological abnormalities, mainly papillary atrophy, in association with an impairment in urinary concentrating ability. In the present study, sodium and potassium balance were assessed during high and low sodium intake and dietary potassium restriction in adult Wistar rats treated neonatally with enalapril (10 mg x kg(-1) x day(-1)) from 3 to 24 days of age. During balance studies, neonatally enalapril-treated rats showed 1) normal adaptation to dietary sodium restriction, 2) sodium retention during dietary sodium loading, and 3) a transient, modest, renal potassium wastage during dietary potassium restriction. Renal clearance determinations under pentobarbital anesthesia showed elevated fractional excretions of sodium and potassium and osmolar clearance without changes in glomerular filtration rate or effective renal plasma flow in enalapril-treated compared with vehicle-treated rats. Thus, in addition to the impaired urinary concentrating ability, adult rats treated neonatally with enalapril demonstrated alterations in renal sodium and potassium handling, which may be related to the prevailing papillary atrophy.

Adaptation, Physiological↗

PubMed2004

Occupational balance: exploring the relationships among daily occupations and their influence on well-being.

In this lecture, I have reviewed theoretical discussions and definitions of occupational balance, findings from selected studies, and highlighted some methods for measuring aspects of occupational balance. Are any of these ideas directly applicable to occupational therapy practice, education and research? Consider the hassles of everyday life, and add the complicating factors of illness, injury, disability, and limited income. Life, and the pursuit of necessary, desirable and obligatory occupations, can become overwhelming. Given that occupational therapists aim to enable individuals, regardless of ability, to successfully engage in a range of occupations, the answer to the question is yes. Furthering our understanding of occupational balance can improve our ability to serve individual clients and society. In 2001, Fearing stated in her Muriel Driver Memorial Lecture: We will not only recognize and value the skill of maintaining balance, our own and that of our clients, but we will live it. Balance will not be viewed as a set of scales that has equal parts such as work on one side and play on the other but rather the kind of balance that comes from being centred so that we act from a stable base. From that stable base, we will gain a keen sensitivity to rhythm--knowing when to move and when to let go. (Fearing, 2001 pp. 214-215) Perhaps these reflections have added a little coherence to the study of occupational balance. Occupational balance is a relative state, recognizable by a happy or pleasant integration of life activities and demands. There are indicators of imbalance, more so than tangible ways to measure it, and once recognized occupational therapists have the strategies to help restore a sense of occupational balance. Given our collective history and skill in client-centred practice, occupational therapists are capable of both advancing this line of inquiry and attaining occupational balance for ourselves and our clients.

Family Relations↗

PubMedDate not supplied

Cell targeting by glycosidic telomers. Specific recognition of the Kb CWL1 lectin by galactosylated telomers.

This work deals with the synthesis and lectinic recognition ability of galactosylated telomers. To investigate if telomeric carriers could exhibit cellular recognition properties, we have synthesized mono- and polygalactosylated tris(hydroxymethyl)acrylamidomethane (THAM) telomers. The affinity of such macromolecular drug carriers toward a receptor, the yeast Kb CWL1 lectin, was defined, and the influence of mono- or polygalactosylation of THAM units on the recognition phenomenon was assessed. The lectinic affinity of the compounds was estimated by measuring the inhibition of yeast aggregation. The average degree of polymerization as well as the hydrophilic-lipophilic balance of such galactosylated telomers affects their recognition ability for the lectin.

Chemical Phenomena↗

PubMed2006

Research recruitment through US central cancer registries: balancing privacy and scientific issues.

Cancer registries are a valuable resource for recruiting participants for public health-oriented research, although such recruitment raises potentially competing concerns about patient privacy and participant accrual. We surveyed US central cancer registries about their policies for research contact with patients, and results showed substantial variation. The strategy used most frequently (37.5% of those that allowed patient contact), which was among the least restrictive, was for investigators to notify patients' physicians and then contact patients with an opt-out approach. The most restrictive strategy was for registry staff to obtain physician permission and contact patients with an opt-in approach. Population-based studies enhance cancer control efforts, and registry policies can affect researchers' ability to conduct such studies. Further discussion about balanced recruitment approaches that protect patient privacy and encourage beneficial research is needed.

Certification↗

PubMed2005

Trunk repositioning errors are increased in balance-impaired older adults.

BACKGROUND: Controlling the flexing trunk is critical in recovering from a loss of balance and avoiding a fall. To investigate the relationship between trunk control and balance in older adults, we measured trunk repositioning accuracy in young and balance-impaired and unimpaired older adults. METHODS: Young adults (N = 8, mean age 24.3 years) and two groups of community-dwelling older adults defined by unipedal stance time (UST)-a balance-unimpaired group (UST > 30 seconds, N = 7, mean age 73.9 years) and a balance-impaired group (UST < 5 seconds, N = 8, mean age 79.6 years)-were tested in standing trunk control ability by reproducing a approximately 30 degrees trunk flexion angle under three visual-surface conditions: eyes opened and closed on the floor, and eyes opened on foam. Errors in reproducing the angle were defined as trunk repositioning errors (TREs). Clinical measures related to balance, trunk extensor strength, and self-reported disability were obtained. RESULTS: TREs were significantly greater in the balance-impaired group than in the other groups, even when controlling for trunk extensor strength and body mass. In older adults, there were significant correlations between TREs and three clinical measures of balance and fall risk, UST and maximum step length (-0.65 to -0.75), and Timed Up & Go score (0.55), and between TREs and age (0.63-0.76). In each group TREs were similar under the three visual-surface conditions. Test-retest reliability for TREs was good to excellent (intraclass correlation coefficients > or =0.74). CONCLUSIONS: Older balance-impaired adults have larger TREs, and thus poorer trunk control, than do balance-unimpaired older individuals. TREs are reliable and valid measures of underlying balance impairment in older adults, and may eventually prove to be useful in predicting the ability to recover from losses of balance and to avoid falls.

Adolescent↗

PubMed2006

Community-dwelling seniors who present to the emergency department with a fall do not receive Guideline care and their fall risk profile worsens significantly: a 6-month prospective study.

INTRODUCTION: Fall risk is a major contributor to fracture risk; implementing fall reduction programmes remains a challenge for health professionals and policy-makers. MATERIALS AND METHODS: We aimed to (1) ascertain whether the care received by 54 older adults after an emergency department (ED) fall presentation met internationally recommended 'Guideline Care', and (2) prospectively evaluate this cohort's 6-month change in fall risk profile. Participants were men and women aged 70 years or older who were discharged back into the community after presenting to an urban university tertiary-care hospital emergency department with a fall-related complaint. American Geriatric Society (AGS) guideline care was documented by post-presentation emergency department chart examination, daily patient diary of falls submitted monthly, patient interview and physician reconciliation where needed. Both at study entry and at a 6-month followup, we measured participants physiological characteristics by Lord's Physiological Profile Assessment (PPA), functional status, balance confidence, depression, physical activity and other factors. RESULTS: We found that only 2 of 54 (3.7%) of the fallers who presented to the ED received care consistent with AGS Guidelines. Baseline physiological fall risk scores classified the study population at a 1.7 SD higher risk than a 65-year-old comparison group, and during the 6-month followup period the mean fall-risk score increased significantly (i.e. greater risk of falls) (1.7+/-1.6 versus 2.2+/-1.6, p=0.000; 29.5% greater risk of falls). Also, functional ability [100 (15) versus 95 (25), p=0.002], balance confidence [82.5 (44.4) versus 71.3 (58.7), p=0.000] and depression [0 (2) versus 0 (3), p=0.000] all worsened over 6 months. Within 6 months of the index ED visit, five participants had suffered six fall-related fractures. DISCUSSION: We conclude that this group of community-dwelling fallers, who presented for ED care with a clinical profile suggesting a high risk of further falls and fracture, did not receive Guideline care and worsened in their fall risk profile by 29.5%. This gap in care, at least in one centre, suggests further investigation into alternative approaches to delivering Guideline standard health service.

Accidental Falls↗

PubMed2005

Assessing environmentally determined mobility disability: self-report versus observed community mobility.

OBJECTIVES: To examine the test-retest reliability and concurrent validity of a new self-report measure of mobility function by comparing it with observed mobility, self-reported activity of daily living (ADL) function, and performance-based measures of gait and balance. DESIGN: Cross-sectional study involving two groups of older adults. SETTING: Community sites in Seattle, Washington, and Waterloo, Ontario, Canada. PARTICIPANTS: Fifty-four adults aged 70 and older, recruited. MEASUREMENTS: Subjects completed the Environmental Analysis of Mobility Questionnaire (EAMQ), reporting frequency of encounter and avoidance of 24 features of the physical environment, grouped into eight dimensions, on two occasions 1 week apart. Subjects were observed and videotaped during six trips into the community; frequency of encounters with environmental features within the eight dimensions was recorded. EAMQ encounter and avoidance scores were compared with observed environmental encounters, with disability in ADLs and instrumental ADLs (IADLs), and lower extremity functional measures including the Short Physical Performance Battery (SPPB) and the Berg Balance Test. RESULTS: EAMQ test-retest reliability was high for all eight dimensions (intraclass correlation coefficient range=0.81-1.0) and for summary encounter (0.98) and avoidance (0.96) scores. Observed mobility was significantly correlated (Spearman correlation = r) with EAMQ summary encounter (r=0.66) and avoidance (r=-0.58) scores. Moderate correlations were present between the EAMQ (encounter or avoidance) and observed mobility in the distance, temporal, terrain, posture, load, and density dimensions but not in the attention and ambient dimensions. EAMQ encounter/avoidance was significantly associated with ADL and IADL ability and performance on the SPPB and Berg Balance Test. CONCLUSION: Self-reported frequency of encounter and avoidance of specific environmental features appears to be a valid method for determining environmentally specific mobility disability but needs to be confirmed in a larger sample.

Activities of Daily Living↗

PubMed1999

Sensory organization for balance: specific deficits in Alzheimer's but not in Parkinson's disease.

BACKGROUND: The cause of frequent falling in patients with dementia of the Alzheimer type (AD) is not well understood. Distraction from incongruent visual stimuli may be an important factor as suggested by their poor performance in tests of shifting visual attention in other studies. The purpose of this study was to determine whether AD patients have difficulty maintaining upright balance under absent and/or incongruent visual and other sensory conditions compared to nondemented healthy elderly persons and individuals with Parkinson's disease (PD). METHODS: Seventeen healthy older adults, 15 medicated PD subjects, and 11 AD subjects underwent the Sensory Organization Test protocol. The incidence of loss of balance ("falls"), and the peak-to-peak amplitude of body center of mass sway during stance in the six sensory conditions were used to infer the ability to use visual, somatosensory, and vestibular signals when they provided useful information for balance, and to suppress them when they were incongruent as an orientation reference. Vestibular reflex tests were conducted to ensure normal vestibular function in the subjects. RESULTS: AD subjects had normal vestibular function but had trouble using it in condition 6, where they had to concurrently suppress both incongruent visual and somatosensory inputs. All 11 AD subjects fell in the first trial of this condition. With repeated trials, only three AD subjects were able to stay balanced. AD subjects were able to keep their balance when only somatosensory input was incongruent. In this condition, all AD subjects were able to maintain balance whereas some falls occurred in the other groups. In all conditions, when AD subjects did not fall, they were able to control as large a sway as the healthy controls, except when standing with eyes closed in condition 2: AD subjects did not increase their sway whereas the other groups did. In the PD group, the total fall incidence was similar to the AD group, but the distribution was generalized across more sensory conditions. PD subjects were also able to improve with repeated trials in condition 6. CONCLUSION: Patients with dementia of the Alzheimer type have decreased ability to suppress incongruent visual stimuli when trying to maintain balance. However, they did not seem to be dependent on vision for balance because they did not increase their sway when vision was absent. Parkinsonian patients have a more general balance control problem in the sensory organization test, possibly related to difficulty changing set.

Accidental Falls↗

PubMed1995

Non-surgical alternative in the treatment of skeletal Class III problems.

The dental profession is not static, but dynamic. New research findings, along with medical and technological advances, necessitate constant re-examination of treatment philosophies and techniques. What were acceptable treatment techniques in the past may not necessarily be the most effective and best techniques for our patients today. Currently, many practitioners feel that the only treatment for the correction of a skeletal Class III abnormality is via orthognathic surgery in older patients. In some cases it may be the only treatment option. But in most cases today, there are more conservative, non-surgical treatment alternatives in correcting Class III problems in younger aged children. In treating facial-skeletal problems, it must be emphasized that the human face is a biological masterpiece of form and function. Its importance has been documented in arts and sciences since the beginning of modern civilization. It is important enough so that individuals who are blessed with attractive features are afforded greater opportunities in our society. Attractive faces are associated with intelligence, honesty and good work ethics. With the advent of orthognathic surgery, functional appliance, functional regulator, and myofunctional therapy, the dental profession has the capability of leveling out the playing field for many individuals in our society. It does so by being able to correct problems closely associated with the human psyche--the human face. The ability to change facial features brings tremendous prestige to our profession. Along with this prestige comes greater responsibility. Our ability to change facial features entails greater understanding of facial balance and harmony. Ricketts states that the face must conform to stringent proportions known as the "divine proportion" in order for it to be esthetically pleasing. Also, our ability to move facial-skeletal structures entails greater understanding of the biomechanics of the human face. Without this knowledge practitioners can cause iatrogenic problems, such as temporomandibular disorders. Conversely, correcting facial-skeletal abnormalities have been found to alleviate many medical problems, such as chronic headaches, neck-back-shoulder pain, respiratory disorders, auditory disorders, etc. As more and more information is gathered, it is becoming clear that the physical, emotional and psychological health of a human being is intimately related to craniomandibular anatomy. In fact, the jaw and dental structures (with the exception of the tooth enamel) is formed from the neural crest cells along with the endocrine system, while the central nervous system is formed from the neural tube. The entire nervous system, the endocrine system and the dental system are formed from common tissue origin. This can explain why many facial-skeletal corrections are often accompanied by alleviation of many medical and physiological problems. These are exciting times for our profession. However, if we wish to address the needs of our patients well into the next century, we must continue to seek greater and greater knowledge in the area of the craniomandibular anatomy relative to the rest of the human body. It has much to do with facial esthetics, physiologic and psychologic harmony, and TMJ health. This knowledge will enable our profession to have the power to change human lives in a very positive way. As doctors, there can be no greater personal and professional satisfaction than to realize that, through our professional intervention, we are able to offer our patients the possibility of achieving greater happiness and quality of life.

Cephalometry↗