Does cognitive learning potential measured with the dynamic Wisconsin Card Sorting Test predict rehabilitation outcome in elderly patients post-stroke?

OBJECTIVE

To determine whether cognitive learning potential measured with the dynamic Wisconsin Card Sorting Test has added value in predicting rehabilitation outcome in elderly patients post-stroke after controlling for age, ADL independence at admission, global cognitive functioning and depressive symptoms.

METHODS

Participants were patients with stroke admitted to a geriatric rehabilitation unit. ADL independence (Barthel Index) at discharge was used as measure for rehabilitation outcome. Predictor variables included age, ADL independence at admission, global cognitive functioning (Montreal Cognitive Assessment), depressive symptoms (Geriatric Depression Scale) and cognitive learning potential measured with the dWCST.

RESULTS

Thirty participants were included. Bivariate analyses showed that rehabilitation outcome was significantly correlated with ADL independence at admission (r = 0.443, p = 0.014) and global cognitive functioning (r = 0.491, p = 0.006). Regression analyses showed that the dWCST was not an independent predictor of rehabilitation outcome. ADL independence at admission was the only significant predictor of rehabilitation outcome (beta = 0.480, p = 0.007).

CONCLUSIONS

Cognitive learning potential, measured with the dWCST has no added value in predicting rehabilitation outcome in elderly patients post-stroke. ADL independence at admission was the only significant predictor of rehabilitation outcome.

REGISTRATION NUMBER NETHERLANDS TRIAL REGISTER

Trial NL7947.

Two-body wear of novel monolithic lithium-silicate ceramic materials and their corresponding different antagonists

OBJECTIVES

Evaluation of the two-body wear of lithium-silicate ceramics against different antagonists compared to a direct resin composite and human teeth.

METHODS

Initial LiSi Block [LISI], IPS e.max CAD [EMA], and CEREC Tessera [TESE] were investigated and compared with direct resin composite [FILL] and human teeth [tooth]. As antagonists were used: steatite, ceramic, and human enamel. The control group tooth was only tested with enamel antagonist. The combinations underwent thermomechanical aging using a chewing simulator. Material losses were calculated using GOM-analysis software. Kolmogorov-Smirnov test, Kruskal-Wallis H, Mann-Whitney-U-test with Bonferroni correction and Spearman-rho correlation were calculated. A fractographic analysis was performed.

RESULTS

Within TESE, enamel antagonists led to lower restoration losses than steatite and ceramic antagonists. Within FILL, enamel and steatite antagonists caused lower material losses compared to ceramic antagonists. Against steatite antagonists, LISI showed lowest material losses. Against ceramic antagonists, the use of LISI led to lower material losses compared to FILL. Against tooth antagonists, TESE showed lower material losses than tooth and FILL and LISI lower than FILL. Within LISI, steatite antagonists showed lower material losses on the antagonist than ceramic. Within EMA, steatite antagonists showed higher material losses than ceramic ones. Within ceramic antagonists, LISI restoration material showed lower material losses than FILL and EMA.

CONCLUSIONS

Regardless of the antagonist material, the material losses of LISI and EMA were comparable. However, the abrasion resistance of LISI tended to be higher than EMA.

CLINICAL SIGNIFICANCE

LISI is a fully crystallized lithium-silicate ceramic and no longer needs to be processed after milling. In addition, the abrasion resistance is very good, regardless of the antagonist material chosen.

In-vitro investigation of endothelial monolayer retention on an inflow VAD cannula inside a beating heart phantom

Ventricular assist devices (VADs) provide an alternative solution to heart transplantation for patients with end-stage heart failure. Insufficient hemocompatibility of VAD components can result in severe adverse events, such as thromboembolic stroke, and readmissions. To enhance VAD hemocompatibility, and avoid thrombus formation, surface modification techniques and endothelialization strategies are employed. In this work, a free form patterning topography is selected to facilitate the endothelialization of the outer surface of the inflow cannula (IC) of a commercial VAD. An endothelialization protocol for convoluted surfaces such as the IC is produced, and the retainment of the endothelial cell (EC) monolayer is evaluated. To allow this evaluation, a dedicated experimental setup is developed to simulate realistic flow phenomena inside an artificial, beating heart phantom with a VAD implanted on its apex. The procedural steps of mounting the system result to the impairment of the EC monolayer, which is further compromised by the developed flow and pressure conditions, as well as by the contact with the moving inner structures of the heart phantom. Importantly, the EC monolayer is better maintained in the lower part of the IC, which is more susceptible to thrombus formation and may therefore aid in minimizing the hemocompatibility related adverse events after the VAD implantation.

Assessing learning potential in elderly stroke patients: The validity of the dynamic Clock Drawing Task in comparison with the dynamic Wisconsin Card Sorting Test

Currently, there is no valid and feasible dynamic test available for assessing learning potential in elderly stroke patients. We designed a dynamic version of the Clock Drawing Task (dCDT) which we compared to the dynamic Wisconsin Card Sorting Test (dWCST). The dWCST has shown adequate validity in adult patients with brain injury but has a long administration time. Participants were 47 stroke patients admitted to a geriatric rehabilitation unit. All participants completed the dCDT, the mean administration time was 7 min. 90.7% of the participants were able to complete the dWCST, the mean administration time was 36 min. The numerical learning potential indices of the dCDT were not significantly correlated. Based on the dCDT, 70.2% of the participants were classified as high achiever, 10.6% as strong learner, 19.2% as poor learner, and none as decliner. The numerical learning potential indices of the dWCST correlated significantly. Based on the dWCST, 5.3% of the participants were classified as high achiever, 42.1% as strong learner, 50% as poor learner, and 2.6% as decliner. The learning potential indices of the dCDT and those of the dWCST were not significantly correlated, indicating poor convergent validity of the dCDT. The results provide no clear support for the use of the dCDT in elderly stroke patients. The dWCST does show adequate validity and feasibility in the elderly stroke population, despite longer administration time. Future research should focus on examining the validity of the dCDT in a larger sample as well as examining the predictive validity of the dWCST.

Accuracy of a local positioning system for time-series speed and acceleration and performance indicators in game sports

The objective was to determine the reliability and validity of a local positioning system (LPS) promising high accuracy at reduced product costs. Fifty-five random static positions in a gym (54.8  × 26.0 m) were obtained 10 times via LPS (50 Hz) and measuring tape. An athlete's LPS-derived peak and time-series speed and acceleration during dynamic movements (n = 80) were compared with Vicon (100 Hz). Reliability and validity were assessed via Intraclass and Concordance Correlation Coefficients (ICC/CCC), root mean square errors, Bland-Altman plots, and analysis of variance. ICC3,1 (≥0.999) and CCC (0.387-0.999) were calculated for static positions (errors <0.22 m). CCC for time-series speed and acceleration, and peak speed, acceleration, and deceleration were 0.884-0.902, 0.777-0.854, 0.923, 0.486, and 0.731, respectively. Errors were larger in time-series acceleration (14.37 ± 3.77%) than in speed (11.99 ± 5.78%) (η p 2  = 0.472, p < 0.001) and in peak acceleration (28.04 ± 14.34%) and deceleration (25.07 ± 14.90%) than in speed (7.34 ± 6.07%) (η p 2  = 0.091, p < 0.01). LPS achieved excellent reliability and moderate-to-excellent validity of time-series speed and acceleration. The system accurately measured peak speed but not peak acceleration and deceleration. The system is suitable for analyses based on instantaneous speed and acceleration in game sports (e.g., energy estimations).

Impact of varying step-stress protocols on the fatigue behavior of 3Y-TZP, 4Y-TZP and 5Y-TZP ceramic

OBJECTIVE

To test the impact of three varying step-stress protocols on the fatigue behavior of two 3Y-TZP, one 4Y-TZP and one 5Y-TZP zirconia materials.

METHODS

Eight specimens per zirconia material (N = 32) were selected for static testing to determine the start load for dynamic tests (30% of the mean value of static fracture load). 45 specimens per material (N = 180) were used for dynamic load tests using three step-stress protocols: 1. 50 N/5000 cycles; 2. 5% of static load/5000 cycles, and 3. 10 N/1000 cycles. Following materials were tested: 3Y-TZP_{(<0.25 Al2O3)} (O: opaque) 3Y-TZP_{(<0.05 Al2O3)} (T: translucent), 4Y-TZP_{(<0.01 Al2O3)} (ET: extra translucent) and 5Y-TZP_{(<0.01 Al2O3)} (HT: high translucent). The specimens (4 ± 0.02 × 3 ± 0.02 × 45 mm) were placed centrally on the support rolls and the load was applied perpendicularly over the 4 mm specimen side (∼4-point flexural strength according to the DIN 6872:2019). Data was analyzed with Kolmogorov-Smirnov-test, t-test, one-way ANOVA with post-hoc Scheffé-test, Chi-square-test, Kaplan-Meier with Log-Rank-test and two-parametric Weibull analysis (p < 0.05).

RESULTS

The step-stress protocols showed no impact on the fracture load or Weibull modulus within one zirconia material. However, the zirconia materials T, ET and HT showed differences in cycle number to fracture between the step-stress protocols (T: 3 > 2 > 1; ET: 2 > 3 > 1; HT: 2, 3 > 1) with lowest cycle number to fracture for protocol 1. Within one step-stress protocol, the cycle number to fracture varied according to the zirconia material as follows: 1: T, O ≥ O, ET > HT; 2: ET > O, T, HT; 3: O, T, ET > HT. Cracking started at the tensile side of the specimens at all times. All specimens showed typical compression curls (single or double). Fragmentation patterns were similar for all materials with a lot of crack branching and fragmentation due to secondary cracks indicating high energy fractures.

SIGNIFICANCE

Dynamic fatigue tests seem to provide important information on the long-term stability of zirconia materials. Zirconia materials with higher opacity seem to be more robust towards varying step-stress protocols than translucent zirconia materials. Regarding expenditure of time, a step-stress protocol with a load increase of 50 N every 5000 cycles seems favorable to gain information on the long-term stability of zirconia materials.

Fatigue resistance of monolithic strength-gradient zirconia materials

PURPOSE

Evaluation of the effect of three different dynamic fatigue protocols on the fracture resistance of two monolithic strength-gradient zirconia materials.

MATERIALS AND METHODS

A total of 240 specimens (3 × 4 × 45 mm) was milled from two different layers (incisal and middle) of two types of strength-gradient zirconia blanks (IPS e. max ZirCAD MT Multi A2 vs. IPS e. max ZirCAD Prime A2), resulting in 60 specimens per material and layer group (IPS e. max ZirCAD MT Multi A2: incisal (MI), middle (MM); IPS e. max ZirCAD Prime A2: incisal (PI), middle (PM)). Each group was divided into one static (n = 15) and three dynamic fatigue protocols (N = 45, n = 15): i. 50 N increase every 5000 cycles ii. Increase by 5% of static fracture load every 5000 cycles iii. 10 N increase every 1000 cycles until facture. All specimens were loaded until facture in CeraTest 2 k. Kaplan-Meier, Log-Rank and Chi-squared-test as well as Weibull statistics were performed. A fractographic analysis was performed. The specimens were classified according to the number of crack origins and evaluated using the Ciba-Geigy table.

RESULTS

With regard to the fracture load, in the static loading MI and PI showed a higher fracture load and in dynamic fatigue protocol 2 PI showed a lower fracture load. The number of cycles until fracture only differed within three groups: MM and MI survived a higher number of cycles in dynamic fatigue protocol 2; PI survived a higher number of cycles in dynamic fatigue protocol 2 than in protocol 1. Within dynamic fatigue protocols, PM resisted the highest number of cycles in protocol 1 and 3 and MI in protocol 2. Comparing groups, Weibull modulus differed only within the static loading, with PI showing lower values than MM and MI. Within the material groups, MI showed higher values in static loading than in dynamic fatigue protocol 1 and 2, and PI showed higher values in the dynamic fatigue protocol 3 than in static loading. With regard to fracture patterns, no differences were found between the groups.

CONCLUSIONS

Dynamic fatigue protocols provide clinically relevant information on the long-term stability and reliability of monolithic strength-gradient zirconia materials. However, no definitive instructions for dynamic testing can be provided from this investigation.

A new perspective on mechanical characterisation of Arabidopsis stems through vibration tests

The mechanical properties of plants are important for understanding plant biomechanics and for breeding new plants that can survive in challenging environments. Thus, accurate and reliable methods are required for the determination of mechanical properties such as stiffness and Young's modulus of elasticity. Much attention has been paid to the application of static methods to plants, while dynamic methods have received considerably less attention. In the present study, a dynamic forced vibration method for mechanical characterisation of Arabidopsis inflorescence stems was developed and validated against the conventional three-point bending test. Compared to dynamic tests based on free vibration, the current method allows to determine simultaneously more than one natural frequency, thus increasing the overall accuracy of the results. In addition, this method can be applied to the top parts of the stems that are more flexible, and where application of the three-point bending test is often limited. To demonstrate one of the potential applications of this method, it was applied to evaluate the influence of turgor pressure on the mechanical properties of Arabidopsis stems. Overall, the new dynamic testing approach has been shown to provide reliable data for the local mechanical properties along the Arabidopsis inflorescence stem.

Dynamic Testing for Evaluation of Adrenal and Gonadal Function in Pediatric and Adult Endocrinology: An Overview

Dynamic tests are often considered as the backbone of endocrinology. These tests involve the use of an exogenous agent to manipulate the body's hormonal milieu for the diagnosis and characterization of an endocrine disorder. They are especially helpful in the evaluation of certain endocrine conditions, such as disorders of growth and pubertal maturation and disorders of sex development. A great deal of heterogeneity exists across clinicians with regard to the usage, methodology, and interpretation of these tests. This review outlines various dynamic tests used to evaluate adrenal and gonadal function in pediatric and adult endocrinology, along with their clinical application and interpretation.

The assessment of single-leg drop jump landing performance by means of ground reaction forces: A methodological study

BACKGROUND

Time to stabilization (TTS) and dynamic postural stability index (DPSI) are outcome measures based on ground reaction force (GRF) that are often used to quantify dynamic postural stability performance following a drop jump landing. However, their interrelations, as well as the overlap with other dynamic measures and static single-leg postural sway, are unknown.

RESEARCH QUESTION

What is the relation among TTS and DPSI, how are they related to impact forces and dynamic postural sway, and how are all these dynamic measures related to static postural sway?

METHODS

A sample of 190 elite soccer players performed four single-leg drop jump landings. TTS in three directions (vertical, anteroposterior, and mediolateral), and DPSI were intercorrelated (Pearson's r), and related to impact forces and the magnitude of horizontal GRF (HGRF) from 0.4 to 2.4 s and 3.0-5.0 s following landing. All these measures were also correlated to HGRF in the static phase (i.e., 5.3-11.7 s).

RESULTS

The TTS measures were significantly interrelated (r = 0.28-0.53), but were not significantly correlated to DPSI. TTS was more strongly related to HGRF0.4-2.4 s (r = 0.54-0.75) than to HGRF3.0-5.0 s (r = 0.32-0.54) or impact forces (r=-0.28-0.36). Vertical TTS was not significantly related to impact forces. The DPSI was most strongly related to the vertical peak force (r = 0.85), and was not significantly related to HGRF of the dynamic periods. Furthermore, TTS and dynamic HGRF were significantly related to static HGRF (r = 0.34-0.80), while DPSI and impact forces were not.

SIGNIFICANCE

TTS and DPSI do not represent similar aspects of single-leg jump landing performance. The ability to stabilize posture seems to be represented by TTS and dynamic postural sway, which partly overlaps with static postural sway. In contrast, DPSI and vertical peak force mainly reflect the kinetic energy absorption during impact. The findings can help to better understand the meaning of the outcome measures, and to translate results to rehabilitation or prevention programs.

Comparison of fasted basal insulin with the combined glucose-insulin test in horses and ponies with suspected insulin dysregulation

Fasting horses for measurement of basal serum insulin concentration (fasting insulin; FI) has been recommended to standardise testing for insulin dysregulation (ID), yet limited data exist comparing it to dynamic tests. This study aimed to compare FI with the combined glucose-insulin test (CGIT) in horses suspect for ID. We hypothesised that FI would have poor sensitivity for detecting ID compared to CGIT using conventional cut-offs. Records were retrieved from CGITs performed in horses fasted for approximately 8h. Serum insulin and glucose concentrations were measured before and for 150min following an IV bolus of glucose followed by insulin. Correlations between FI and CGIT values were assessed. Youden's index analysis was used to determine the optimal cut-off for FI. Logistic regression and Mann-Whitney U tests were used to determine factors affecting the results. CGITs (n=130) from 62 horses were evaluated. Compared to CGIT, sensitivity and specificity of FI for diagnosis of ID were 14.6% and 100% at a cut-off of 20μIU/mL and 63.4% and 87.2% at a cut-off of 5.2μIU/mL, respectively. FI was significantly correlated with insulin at 45min (r_s=0.66) and 75min (r_s=0.72); area under the curve for insulin (AUC_insulin; r_s=0.67); glucose at 45min (r_s=0.53); and AUC_glucose (r_s=0.50). Obesity was significantly associated with increased odds of a positive CGIT and horses with a positive CGIT were significantly older (P<0.05). In conclusion, FI correlated well with CGIT results and had adequate sensitivity and specificity at lower cut-offs, despite poor sensitivity at conventional cut-off values. Further research to derive cut-off values relevant to the fasting period is warranted.

Is planning related to dynamic testing outcomes? Investigating the potential for learning of gifted and average-ability children

This study investigated the potential of dynamic testing of geometric analogical reasoning in differentiating between the potential for learning of gifted and average-ability children (aged 9-10 years old). In doing so, it was analysed whether planning, a higher-order executive function, was related to outcomes of the dynamic test, and to instructional needs during training. Employing a pretest-training-post-test control group design, participants were split into four subgroups: gifted dynamic testing (n = 24), gifted control (n = 26), average-ability dynamic testing (n = 48) and average-ability control (n = 50). The results revealed that children who were dynamically tested progressed more in accuracy from pre-test to post-test than their peers who received practice opportunities only. Gifted children outperformed their average-ability peers in accuracy, but showed similar levels of improvement after training or practice only. Moreover, gifted children showed they needed fewer prompts during training than their average-ability peers. Planning was found to be related only to pre-test accuracy, and the number of prompts needed at the first training session, but not to post-test accuracy or the number of prompts needed at the second training session. In the discussion, educational implications of the findings were discussed.

Elastic, Viscoelastic and Fibril-Reinforced Poroelastic Material Properties of Healthy and Osteoarthritic Human Tibial Cartilage

Articular cartilage constituents (collagen, proteoglycans, fluid) are significantly altered during osteoarthritis (OA). A fibril-reinforced poroelastic (FRPE) material model can separate the contribution of each constituent on the mechanical response of cartilage. Yet, these properties and their OA related alterations are not known for human tibial cartilage. To answer this gap in the knowledge, we characterized the FRPE as well as elastic and viscoelastic properties of healthy and osteoarthritic human tibial cartilage. Tibial osteochondral explants (n = 27) harvested from 7 cadavers were mechanically tested in indentation followed by a quantification of elastic, viscoelastic and FRPE properties. Then they were histopathologically OARSI graded for the severity of OA. FRPE modeling revealed that non-fibrillar matrix modulus was higher in the healthy group compared to the early OA (p = 0.003) and advanced OA (p < 0.001) groups. The initial fibril network modulus was also higher in the healthy group compared to the early OA (p = 0.009) and advanced OA (p < 0.001) groups. The permeability correlated with the OARSI grade (p = 0.002, r = 0.56). For the first time, the FRPE properties were characterized for human tibial cartilage. This knowledge is crucial to improve the accuracy of computational knee joint models.

Progression paths in children's problem solving: The influence of dynamic testing, initial variability, and working memory

The current study investigated developmental trajectories of analogical reasoning performance of 104 7- and 8-year-old children. We employed a microgenetic research method and multilevel analysis to examine the influence of several background variables and experimental treatment on the children's developmental trajectories. Our participants were divided into two treatment groups: repeated practice alone and repeated practice with training. Each child received an initial working memory assessment and was subsequently asked to solve figural analogies on each of several sessions. We examined children's analogical problem-solving behavior and their subsequent verbal accounts of their employed solving processes. We also investigated the influence of verbal and visual-spatial working memory capacity and initial variability in strategy use on analogical reasoning development. Results indicated that children in both treatment groups improved but that gains were greater for those who had received training. Training also reduced the influence of children's initial variability in the use of analogical strategies with the degree of improvement in reasoning largely unrelated to working memory capacity. Findings from this study demonstrate the value of a microgenetic research method and the use of multilevel analysis to examine inter- and intra-individual change in problem-solving processes.

A device for characterising the mechanical properties of the plantar soft tissue of the foot

The plantar soft tissue is a highly functional viscoelastic structure involved in transferring load to the human body during walking. A Soft Tissue Response Imaging Device was developed to apply a vertical compression to the plantar soft tissue whilst measuring the mechanical response via a combined load cell and ultrasound imaging arrangement. Accuracy of motion compared to input profiles; validation of the response measured for standard materials in compression; variability of force and displacement measures for consecutive compressive cycles; and implementation in vivo with five healthy participants. Static displacement displayed average error of 0.04 mm (range of 15 mm), and static load displayed average error of 0.15 N (range of 250 N). Validation tests showed acceptable agreement compared to a Houndsfield tensometer for both displacement (CMC > 0.99 RMSE > 0.18 mm) and load (CMC > 0.95 RMSE < 4.86 N). Device motion was highly repeatable for bench-top tests (ICC = 0.99) and participant trials (CMC = 1.00). Soft tissue response was found repeatable for intra (CMC > 0.98) and inter trials (CMC > 0.70). The device has been shown to be capable of implementing complex loading patterns similar to gait, and of capturing the compressive response of the plantar soft tissue for a range of loading conditions in vivo.

Tensile strength of flexor tendon repair using barbed suture material in a dynamic ex vivo model

The purpose of this study was to compare two sutures; a knotted polydioxane with a knotless barbed in a 4-strand Kirchmayr-Kessler suture technique. Human flexor digitorum tendons were separated into four groups. Group 1 - polydioxane; Group 2 - barbed suture; Group 3 and 4 - same as group 1 and 2 with an additional peripheral running suture. In each group the repaired tendons were subjected to linear and cyclical loads. No difference in maximum tensile strength after linear and cyclical force could be detected between the knotted polydioxane suture and the knotless barbed suture. On linear force tests an additional circumferential repair increased the maximum tensile strength of both sutures. Cyclical force loading did not lead to a reduction of maximum strength. Following linear and cyclical loading the 4-strand barbed suture achieved maximum tensile strengths comparable to the 4-strand repair using the polydioxane suture. Barbed suture repair may offer the advantage of knotless suture techniques.