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Hematokrit merupakan perbandingan jumlah eritrosit dengan volume darah keseluruhan yang dihitung dalam persentase. Hematokrit dapat diperiksa menggunakan metode mikrohematokrit dan hematology analyzer.Terganggunya fungsi ginjal dalam tubuh, maka mengakibatkan ginjal tidak dapat memproduksi eritroprotein sehingga menyebabkan penurunan nilai hematokrit.Tujuan penelitian ini untuk mengetahui perbedaan nilai hematokrit metode mikrohematokrit dan hematology analyzer pada pasien hemodialisa Metode penelitian ini penelitian kuantitatif dengan jenis penelitian observasional analitik dengan desain penelitian cross sectional. Manfaat dari penelitian yang telah dilakukan yaitu sebagai Pemantapan mutu internal laboratorium pada tahap analitik, dimana seorang Ahli Teknologi Laboratorium Medik dapat memilih metode pemeriksaan yang akurat, waktu pemeriksaan yang singkat dan parameter pemeriksaan darah lengkap dapat dilakukan pada satu alat yaitu hematology analyzer. Sampel yang digunakan berjumlah 18 pasien yang memenuhi kriteria inklusi dan eksklusi.Analisa data menggunakan uji t dependen.Hasil penelitian diketahui rata-rata nilai hematokrit metode mikrohematokrit lebih tinggi 25.28 % dibandingkan metode hematology analyzer 24.32%. Hasil uji t dependen didapatkan nilai p sig 0.00 lebih kecil dari 0.005 nilai (p= 0.00 < 0.005), secara statistik ada perbedaan nilai hematokrit metode mikrohematokrit dan hematology analyzer, namun tidak mempengaruhi secara klinis terhadap hasil pemeriksaan hematokrit pada pasien.

The article looks into psychological characteristics of self-attitude in juvenile suspects, ac-cused and convicts of violent crimes held in detention facilities. Using the “Self-portrait” projective methodology, observation and psychodiagnostic structured counselling made it possible to reveal the psychological characteristics of self-attitude in such minors. It has been found that the structure of self-attitude components in juvenile suspects, accused and convicts is closely interrelated and organized and is characterised with inadequacy of their self-rating (upward or downward bias), difficulties in controlling one's drives of the body, aggressivity, egotism, proneness to depression, dependency, emotional immaturity, demon-strative behavior, proneness to internal conflict, “criminal contamination”, difficulties in communication.

Introduction: First-pass effect (FPE) is associated with improved clinical outcomes and reduced mortality in mechanical thrombectomy (MT) for large vessel occlusion strokes (LVOS). However, FPE is achieved in only 30-40% of patients with the current devices. The RapidPulse TM Cyclic Aspiration System (RP) is a novel technology consisting of a valve box that precisely cycles pressure from full to no vacuum multiple times per second adding kinetic energy to the suction forces. Initial clinical evaluation suggests that the system can achieve FPE rates in the 70% range. We aim to evaluate the RP as a frontline approach in LVOS. Methods: Prospective, multicenter, open-label, core lab adjudicated, two-arm study comparing the safety and efficacy of the RP System with non-randomized retrospective controls who were consecutively treated at the study sites based on similar eligibility criteria. Patients with LVOS involving the anterior or posterior circulations in whom the target lesion could be treated with the Medtronic React 71 aspiration catheter up to 24 hours from stroke onset were included in the RP arm. Controls consisted of comparable patients treated with 070-072 ID catheters. The primary outcome was the rate of FPE (complete/near reperfusion [mTICI ≥2c] after a single pass). Secondary outcomes include frontline technical success (defined as mTICI ≥2b after final device pass with no rescue therapy), final mTICI after all passes, symptomatic ICH, device-related complications, the proportion of patients achieving a modified Rankin Scale score of 0-2 at 90 days, and all-cause 90-day mortality. The study will enroll a maximum of 100 participants in the RP and 200 in the control arm at 5 centers in Spain, Turkey, Denmark, Latvia, and Brazil. Results: Final results will be presented at the conference. Conclusion: RapidPulseFS is the first prospective clinical trial aiming to compare cyclic versus standard aspiration technologies. This novel device may allow clinicians to achieve faster and better reperfusion while significantly reducing the disposable device costs associated with treating LVOS (ClinicalTrials.gov Identifier: NCT05122637).

Tuberkulosis (TB) merupakan penyakit infeksi bakteri menahun yang disebabkan oleh Mycobacterium tuberkulosis, suatu basil tahan asam yang ditularkan melalui udara. Tujuan penelitian ini Untuk mengetahui hubungan hasil pemeriksaan GeneXpert dengan tingkat positivitas pemeriksaan BTA Metode Ziehl Neelsen pada penderita Suspek TB Paru. Jenis penelitian ini merupakan penelitian analitik observasi desain cross sectional. Hasil Penelitian penderita Suspek TB Paru sebanyak 190 sampel dengan jenis kelamin laki-laki sebanyak 97 sampel (51,1%) dan perempuan sebanyak 93 sampel (48,9%), Hasil pemeriksaan GeneXpert pada penderita Suspek TB Paru didapatkan hasil pada metode GeneXpert, MTB Not Detection sebanyak 147 orang, MTB Detection Low sebanyak 20 orang, MTB Detection Medium sebanyak 17 orang, MTB Detection High sebanyak 6 orang. Tingkat Positivitas hasil pemeriksaan BTA Metode Ziehl Neelsen metode Ziehl Neelsen didapatkan hasil negatif sebanyak 147 orang, hasil positif Satu (1+) sebanyak 20 orang, hasil positif Dua (2+) sebanyak 17 orang dan hasil positif Tiga (3+) sebanyak 6 orang. Terdapat hubungan yang bermakna antara metode GeneXpert dengan BTA metode Ziehl Neelsen yang mana nilai significance

Institutional Research Ethics Committees (RECs) play crucial roles in the impartial and competent review of scientific research, particularly during public health emergencies. In this report, we examined their ability and capacity to provide this basic service during public health emergencies and non-emergency situations. Our qualitative documentary analysis revealed that there are currently no legal regulations guiding the activities of Kyrgyz RECs during public health emergencies. In addition, major policy gaps exist in how RECs should operate in non-emergency circumstances. This lack of guidance highlights the urgent need to develop and implement ethical guidelines to meet the evolving needs of such emergencies. Our findings underscore the growing urgency of supporting capacity building of RECs to respond effectively to future pandemics and other public health crises.

Pelaksanaan Pemilu bersifat secara LUBER (Langsung, Umum, Bebas dan Rahasia), diselenggarakan secara umum/serentak tidak membedakan kondisi fisik seseorang apakah dalam keadaan sehat maupun sakit, keadaan normal ataupun dishabilitas, Bebas dalam memilih tanpa ada paksaan dan bersifat rahasia. Tantangan kami sebagai guru PPKn di SLB Empat Lima Babat adalah siswa SMALB tunagrahita belum mengetahui cara mencontreng dengan benar. Skor Pada pra siklus sebesar 24, pada siklus I skor rata-rata 52, kemudian penulis melanjutkan tindakan perbaikan di siklus ke II skor rata-rata 80, sesuai dengan KKM yang ditentukan. Dengan demikian “Strategi Viral Desi untuk meningkatkan pemahaman penggunaan kartu suara dalam sistem demokrasi Indonesia bagi siswa SMALB Empat Lima Babat Kecamatan Babat Kabupaten Lamongan.

The histomorphometry of the rabbit bone tissue from the lower jaw was done. Authors hypothesized that local enhancement with biphasic calcium phosphate ceramic materials in the femur trochanter major area increase the trabecular bone volume outside the implantation zone in vivo. Twenty-two California female rabbits were included in this study and were divided into four groups. Four healthy rabbits composed a control group (A group), while other eighteen underwent ovariectomy. Bone defects were created in femur trochanter major region. Sham surgery group (B group) consisted of four female rabbits with osteoporosis and bone defect, but no biomaterials were implanted. In C group (seven rabbits) created defects were filled with granules of biphasic calcium phosphate ceramic (hydroxyapatite (HAP) and tricalcium phosphate (TCP) 30/70); in D group (seven rabbits) defects were filled with the same granules (HAP/TCP 30/70) together with strontium (5% by mass). Twenty-two bone samples were taken from lower jaw premolar region. Trabecular bone area was measured using Image Pro Plus 7 program, where three equal fields (0.975 mm2) of view were at random chosen in all bone samples. Results have shown that the trabecular bone area in A group was 0.201 mm2 (0.176-0.233), which is statistically significantly higher (p 2 (0.118 – 0.149), C group 0.136 mm2 (0.108 – 0.166) and D group 0.135 mm2 (0.126 – 0.164), respectively. Statistically significant differences between B, C and D groups were not found (p > 0.05).

This study employs the cognitive miser model and science literacy model as theoretical frameworks to investigate motivations behind public willingness to use driverless cars in Singapore. Findings from a large-scale survey of 1,006 adult Singaporeans indicate that public willingness to use driverless cars was strongly related to value predispositions, especially affect. Aside from having a direct relationship with willingness to use driverless cars, this study found that affect also had an indirect relationship with willingness to use driverless cars via benefit perceptions. Meanwhile, findings failed to reveal significant relationships between two types of science knowledge and willingness to use driverless cars. The findings shed light on the current public opinion on driverless cars in Singapore and lend support to the cognitive miser model over the scientific literacy model. Theoretical and practical implications are discussed. Accepted version

Bullet-proof walls are recently attractive also outside of specialized areas with the most threat of attack. Nevertheless, an average wall cannot protect us from an intentional or stray bullet. Therefore, five stands were made of gypsum wall panels, ordinary plasterboard, and Knauf bullet-proof plasterboard, fired with two different calibers of weapons. The results were documented through photography. The test results show the ballistic resistance of enhanced materials, not ordinary plasterboard. The obtained results are compared with the technical information. The aim was to test whether plasterboard, the most used material in construction, is comparable to bullet-proof structures. These results will be used to complement the standard LVS 1061 “Gypsum boards and board systems. Design and use rules”, as well as for individual use in protection against external bullet threats or to prevent ricochets.

Pertrochanteric fractures (TF) due to osteoporosis constitute nearly half of all proximal femur fractures. TFs are treated with a surgical approach and fracture fixation is achieved using metallic fixation devices. Poor quality cancellous bone in osteoporotic patients makes anchorage of a fixation device challenging, which can lead to failure of the fracture fixation. Methods to reinforce the bone-implant interface using bone cement (PMMA) and other calcium phosphate cements in TFs have been described earlier but a clear evidence on the advantage of using such biomaterials for augmentation is weak. Furthermore, there is no standardized technique for delivering these biomaterials at the bone-implant interface. In this study, we firstly describe a method to deliver a calcium sulphate/hydroxyapatite (CaS/HA) based biomaterial for the augmentation of a lag-screw commonly used for TF fixation. We then used an osteoporotic Sawbones model to study the consequence of CaS/HA augmentation on the immediate mechanical anchorage of the lag-screw to osteoporotic bone. Finally, as a proof-of-concept, the method of delivering the CaS/HA biomaterial at the bone-implant interface as well as spreading of the CaS/HA material at this interface was tested in patients undergoing treatment for TF as well as in donated femoral heads. The mechanical testing results indicated that the CaS/HA based biomaterial increased the peak extraction force of the lag-screw by 4 times compared with un-augmented lag-screws and the results were at par with PMMA. The X-ray images from the patient series showed that it was possible to inject the CaS/HA material at the bone-implant interface without applying additional pressure and the CaS/HA material spreading was observed at the interface of the lag-screw threads and the bone. Finally, the spreading of the CaS/HA material was also verified on donated femoral heads and micro-CT imaging indicated that the entire length of the lag-screw threads was covered with the CaS/HA biomaterial. In conclusion, we present a novel method for augmenting a lag-screw in TFs, which could potentially reduce the risk of fracture fixation failure and reoperation in fragile osteoporotic patients.

Background Longitudinal cohort studies provide important information about the clinical effectiveness of an intervention in the routine clinical setting, and are an opportunity to understand how a population presents for treatment and is managed. Methods INTEREST IN CD2 (NCT01753349) is a prospective, international, 3-year, longitudinal, observational study following the course of adult idiopathic cervical dystonia (CD) treated with botulinum neurotoxin type A (BoNT-A). The primary objective is to document long-term patient satisfaction with BoNT-A treatment. Here we report baseline data. Results This analysis includes 1036 subjects (67.4% of subjects were female; mean age was 54.7 years old; mean TWSTRS Total score was 31.7). BoNT-A injections were usually given in line with BoNT-A prescribing information. The most commonly injected muscles were splenius capitis (87.3%), sternocleidomastoid (82.6%), trapezius (64.3%), levator scapulae (40.9%) and semispinalis capitis (26.9%); 35.5% of subjects were injected using a guidance technique. Most subjects (87.8%) had been previously treated with BoNT-A (median interval between last pre-study injection and study baseline was 4 months); of these 84.8% reported satisfaction with BoNT-A treatment at peak effect during their previous treatment cycle and 51.5% remained satisfied at the end of the treatment. Analyses by geographical region revealed heterogeneity in the clinical characteristics and BoNT-A injection practice of CD subjects presenting for routine treatment. Conclusions These baseline analyses provide sizeable data regarding the epidemiology and clinical presentation of CD, and demonstrate an international heterogeneity of clinical practice. Future longitudinal analyses of the full 3-year study will explore how these factors impact treatment satisfaction. Electronic supplementary material The online version of this article (10.1007/s00415-017-8698-2) contains supplementary material, which is available to authorized users.

Cerebral palsy (CP) is a group of the most common developmental disorders affecting movement and posture of the body, causing activity limitations and participation restrictions. The motor disorders of persons with CP are often accompanied by disturbances of sensation, cognition, communication and perception. The symptoms of CP are very diverse and persons with CP are usually presented with a mixed type of symptoms. The non-progressive disturbances can be attributed to disorders that were developed during pregnancy, birth and/or infant stage. The aim of this study was to improve physicians' professional practice of Physical and Rehabilitation Medicine for persons with cerebral palsy in order to improve their functionality, social and community integration, and to reduce activity limitations and/or participation restrictions. A systematic review of the literature including an 18-year period and consensus procedure by means of a Delphi process was performed and involved the delegates of all European countries represented in the Union of European Medical Specialists Physical and Rehabilitation Medicine (UEMS PRM) Section. As the result of a Consensus Delphi procedure, 74 recommendations are presented together with the systematic literature review. The PRM physician's role for persons with cerebral palsy is to lead and coordinate the multiprofessional team, working in an interdisciplinary way. They should propose and manage the complex but individual PRM program developed in conjunction with other health professionals, medical specialists and importantly in agreement with the patient, their family and care giver. This should be, according to the specific medical diagnosis to improve patients' health, functioning, social and education status, considering all impairments, comorbidities and complications, activity limitations and participation restrictions. This evidence-based position paper is representing the official position of The European Union through the UEMS PRM Section and designates the professional role of PRM physicians in persons with cerebral palsy.

The ionosphere can affect a wide range of radio frequency (RF) systems operating below 2 GHz. One option for mitigating these effects is to produce assimilative models of the ionospheric density from which products can be derived for specific systems. Such models aim to optimally combine a background model of the ionospheric state with measurements of the ionosphere. This approach is analogous to the use of numerical weather prediction in the meteorological community, and has been evolving for ionospheric use for the last 10 to 15 years.Published research has demonstrated the utility of this approach. However, obstacles to providing effective data products remain due to the sparseness of ionospheric data over large parts of the world and the timeliness with which data are available. Spire is working to overcome these issues through the use of its large constellation of satellites that can measure Total Electron Content (TEC) data in both zenith looking and radio occultation (RO) geometries and its large ground station network that will allow low data latency.Spire data will be combined with an innovative data assimilation model (the Spire TEC Environment Assimilation Model, STEAM) to provide accurate and actionable ionospheric products. Data assimilation is required to overcome the limitations and assumptions of the traditional Abel Transform analysis of RO data (i.e., spherical symmetry; transmitter and receiver in free space and the same plane) and to effectively combine RO data, topside data, ground-based GNSS data, and other sources of ionospheric information (i.e., ionosondes).STEAM uses a 4D Local ensemble transform Kalman Filter (LETKF). As with other ensemble methods, the LETKF uses an ensemble of models to approximate the background error covariance matrix. However, the LETKF provides a more efficient way to solve the ensemble equations. Furthermore, 4D operation permits the use of data with varying latency. Localisation means that grid points are only modified by data within a local volume; this restricts spurious long-range spatial correlations and means that the ensemble only has to span the space locally. The LETKF transforms the problem into ensemble space which makes each grid point independent, resulting in an algorithm that is easily parallelised.This paper will describe the data collection and processing chain, the data assimilation model, and plans for the ongoing development of the combined system.

Remotely sensed flood extents obtained in near real-time can be used for emergency flood incident management and as observations for assimilation into flood forecasting models. High-resolution synthetic aperture radar (SAR) sensors have the potential to detect flood extents in urban areas through clouds during both day- and night-time. This paper considers a method for detecting flooding in urban areas by merging near real-time SAR flood extents with model-derived flood hazard maps. This allows a two-way symbiosis, whereby currently available SAR urban flood extent improves future model flood predictions, while flood hazard maps obtained after the SAR overpasses improve the SAR estimate of urban flood extents. The method estimates urban flooding using SAR backscatter only in rural areas adjacent to urban ones. It was compared to an existing method using SAR returns in both rural and urban areas. The method using SAR solely in rural areas gave an average flood detection accuracy of 94% and a false positive rate of 9% in the urban areas and was more accurate than the existing method.

Investigation of biomechanical properties of the rabbit bone tissue from a corner of the lower jaw was done. Experimental osteoporosis was induced by ovariectomy and following injections of methylprednisolone. The defects in the greater trochanter region was created and filled with granules of a hydroxyapatite and tricalcium phosphate (HAP/TCP 30/70) or HAP/TCP 30/70 together with 5% strontium ranelate. After 3 month animals were euthanased, squared samples have been cut out from a corner of the lower jaw and tested on a bend. Results of research show, that the corner of a lower jaw in rabbit becomes more rigid after filling of defects in the greater trochanter region with granules of a hydroxyapatite and tricalcium phosphate (HAP/TCP 30/70) or granules together with strontium ranelate. The ultimate strain for the bone tissue in the 2nd and 3rd group is less, than for control group. Thus, local uses calcium – phosphatic bioceramic material around the greater trochanter region improves biomechanical parameters of a bone tissue in the lower jaw of animals.

Muscle function around the shoulder girdle can be impaired by pain, which leads to abnormal movement e.g. elevation. Movement faults should be assessed specifically, therefore individual sport rehabilitation strategies can be implemented. Smart garments are efficient for upper body movement assessment. There is a lack of literature stating that smart textile garments are reliable and valid for shoulder gridle elevation. The purpose of the study was to examine reliability and validity of the DAid smart shirt during shoulder girdle elevation. Twenty-one female volunteers aged 24.3. (SD3.3), body mass index 19.3 (SD 0.5) were recruited. The DAid smart shirt and 2D movement video analysis software Quintic Biomechanics v26, UK were the assessment tools utilized. Cronbach alpha coefficient and Interclass Correlation Coefficient were calculated to assess the within-session test-retest reliability. Bland – Altman analysis was applied to determine validity. Results: reliability for the right side measures: Cronbach alpha coefficient α ≥ 0.9, ICC ≥ 0.9. Reliability for the left side measures: Cronbach alpha coefficient α ≥ 0.9, ICC ≥ 0.91. Bland -Altman analysis presents that DAid smart shirt measures are valid during shoulder girdle elevation. Conclusion: smart shirt measures are reliable and valid during shoulder girdle elevation movements.

Every year the number of vehicles on the road is increasing. But there are people that start to choose public transport or greener transportation options like bicycles or electric cars over typical fuel cars. Regarding bicycle usage, the problems that arise are related to insufficient bicycle lanes and determination of future lane locations, so that the resources used for bicycle lane construction would be properly invested. To resolve mentioned problems municipality first need to learn where the suitable bicycle lane location for cyclists should be. Such a task can be done by applying a cyclist counting system. This paper describes a portable automatic cyclist counting system’s prototype for bicycle lane location planning and also identifies the limitations for such a system. Proposed prototype is based on rubber tubes and pressure sensors, Wi-Fi module and open source electronic platform Arduino. This study is carried out within the ERANet-LAC project RETRACT (Enabling resilient urban transportation systems in smart cities).

Wearable technologies provide many possibilities for applications in medicine, and especially in physiotherapy, where tracking and evaluation of body motion are of utmost importance. Despite the existence of multiple smart garments produced for applications in physiotherapy, there is limited information available on the actual impact of these technologies on the clinical outcomes. The objective of this paper is to evaluate the impact of the Double Aid (DAid) smart shirt, a purely textile-based system, on the training process of patients with subacromial pain syndrome. A randomized controlled trial was performed where patients with subacromial pain syndrome had to perform the assigned training exercises while employing the DAid smart shirt system. The core point of each exercise was to perform a movement while holding the shoulders stationary. The smart shirt was designed to sense even slight shoulder motion thus providing the patient with feedback on the accuracy of the motion, and allowing the patient to adjust the movement. The appropriate muscles should be strengthened through an increased effort to control the shoulder motion. The recovery of patients using the feedback system at the end of the treatment was compared to that of a reference group through standardized tests—the Disabilities of the Arm, Shoulder, and Hand score (DASH score), Closed Kinetic Chain Upper Extremity Stability test (CKCUES test), and internal/external rotation ratio. The test group that used the DAid system demonstrated significantly better results of the performed tests for all applied outcome measures compared to the reference group (p < 0.001). An overall positive impact on the patient recovery was observed from the DAid smart shirt system when applied for rehabilitation training of patients with subacromial pain syndrome.

Magical and paranormal beliefs have been found in all cultures and strata of society, including medical university students. Critical thinking skills and dispositions are generally considered desirable outcomes of the educational process. Nevertheless, there is the lack of conceptual clarity about interrelations between the magical and critical thinking. Aim of the study is to explore prevalence of magical, paranormal beliefs and pseudoscientific beliefs among undergraduate medical students, as well as to explore prevalence of critical thinking dispositions among medical students and to assess interrelations and psychodynamics between “noncritical” forms of thinking – magical, paranormal and pseudoscientific beliefs, and critical thinking disposition. The results showed statistically significant negative correlation between paranormal beliefs and critical thinking disposition if students are put in optional situation between opposite statements. If statements in assessment scales do not put respondents in optional situation, their results do not show significant correlations.

BACKGROUND Low back pain (LBP) is the most common type of musculoskeletal pain, thus it is one of the most commonly encountered conditions in Physical and Rehabilitation Medicine. The physicians who are primarily responsible for the nonsurgical management of LBP are physiatrists. OBJECTIVE The present study aimed to investigate the approaches of physiatrists to low back pain across Europe. Preferences, tendencies, and priorities in the diagnosis, management, and treatment of LBP, as well as the epidemiological data pertaining to LBP in PRM practice were evaluated in this Europe-wide study. METHODS The study was conducted under the control of the European Society of Physical and Rehabilitation Medicine (ESPRM) Musculoskeletal Disorders Research Committee. A total of 576 physiatrists from most European countries participated in the survey. RESULTS The results show that physiatrists frequently deal with patients with LBP in their daily practice. Most patients are not referred to other departments and are treated with various conservative methods. Less than one-fifth of patients are primarily referred for surgery. The physiatrists believe that a clear diagnosis to account for cases of low back pain is rarely established. The most common diagnosis is discopathy. History and physical examination remain the most valuable clinical evaluation tools for low back pain according to physiatrists. Less than half the patients require a magnetic resonance imaging. Non-steroidal anti-inflammatory drugs are the most commonly prescribed drugs for low back pain. Exercise, back care information, and physical therapy are the preferred conservative treatments. More than half of the physiatrists offer interventional treatments to patients with low back pain. CONCLUSION The present study is a preliminary report that presents the attitudes of European physiatrists in the management of low back pain. Further researches are warranted to standardize the conservative management of LBP.

Shoulder impingement is the most common cause of shoulder pain. The ability to control the orientation and movement of the scapula is essential for optimal arm function and pain reduction in young adults with shoulder impingement signs. Smart garments find wide range of healthcare applications, including rehabilitation. One of the main parts of smart garment is the sensing system which can include one or several sensing elements for posture and joint motion control. The aim of present research was to verify the possibility of using DAid Smart shirt to capture and monitor shoulder gridle motion during motor control exercises and during training sessions out of laboratory environment for ballerina with shoulder impingement syndrome. Another aim was to develop method of this Smart shirt using in addition to conventional physiotherapy to reduce right side shoulder girdle elevation. As a monitoring tool, specially designed DAid Smart Shirt had been used. Specifically, embodied textile strain sensors gave possibility to capture spatiotemporally motion, but acquisition system provided visual feedback on the screen of remote electronic device. Conclusions: Designed DAid Smart shirt can be objective and convenient tool for shoulder motion monitoring for both: patient and physiotherapist. Thus, it can be used as effective assisting device to conventional physiotherapy for shoulder girdle motion control.

The White Book (WB) of Physical and Rehabilitation Medicine (PRM) in Europe is produced by the 4 European PRM Bodies (European Academy of Rehabilitation Medicine - EARM, European Society of PRM - ESPRM, European Union of Medical Specialists - PRM Section, European College of PRM-ECPRM served by the European Union of Medical Specialists-PRM Board) and constitutes the reference book for PRM physicians in Europe. It has now reached its third edition; the first was published in 1989 and the second in 2006/2007. The WB has multiple purposes, including providing a unifying framework for European countries, to inform decision-makers on European and national level, to offer educational material for PRM trainees and physicians and information about PRM to the medical community, other rehabilitation professionals and the public. The WB states the importance of PRM, a primary medical specialty that is present all over Europe, with a specific corpus disciplinae, a common background and history throughout Europe. PRM is internationally recognized and a partner of major international bodies, including the World Health Organization (WHO). PRM activities are strongly based on the documents of the United Nations (UN) and WHO, such as the Convention of the Rights of Persons with Disabilities (2006), the World Report on Disability (2011), the WHO Global Disability Action Plan 2014-2021 (2014) and the WHO initiative "Rehabilitation 2030: a call for action" (2017). The WB is organized in 4 sections, 11 chapters and some appendices. The WB starts with basic definitions and concepts of PRM and continues with why rehabilitation is needed by individuals and society. Rehabilitation focuses not only on health conditions but also on functioning. Accordingly. PRM is the medical specialty that strives to improve functioning of people with a health condition or experiencing disability. The fundamentals of PRM, the history of the PRM specialty, and the structure and activities of PRM organizations in Europe are presented, followed by a thorough presentation of the practice of PRM, i.e. knowledge and skills of PRM physicians, the clinical field of competence of PRM, the place of the PRM specialty in the healthcare system and society, education and continuous professional development of PRM physicians, specificities and challenges of science and research in PRM. The WB concludes with the way forward for the specialty: challenges and perspectives for the future of PRM.

In the context of the White Book of Physical and Rehabilitation Medicine (PRM) in Europe, this paper addresses the structure, organization and activities of PRM bodies in Europe. There are four main bodies, the Section of Physical and Rehabilitation Medicine of the European Union of Medical Specialists (UEMS) very close to the European Union and is committed to define the professional competencies of PRM, the quality management and accreditation and with the Board the educational matters. The European College of PRM is served by the UEMS PRM Board and its main activities are analyzed below in the description of the Board of the UEMS PRM Section. The European Society of Physical and Rehabilitation Medicine (ESPRM) mainly dedicated to promoting research in rehabilitation and create a network of knowledge of PRM across the Europe. The European Academy of Rehabilitation Medicine mainly dedicated to defining the ethical issues in rehabilitation and finding strategies for better educational approaches in rehabilitation. There are 2 further bodies (the regional Fora) aimed to create bridges across the Mediterranean area (Mediterranean Forum of PRM) and across the northern Europe including the eastern countries such as Russia, Belarus and Ukraine (Baltic and North Sea Forum of PRM). To support the knowledge, we have in Europe 7 main journals dedicated to Rehabilitation with a growing impact factor. Last but not least the PRM bodies have an important role across the world with a connection with the International Society of PRM and WHO. The UEMS Section approved motion of international collaboration. In conclusion, PRM activity in Europe is not limited to the official border but in the network included eastern countries and Mediterranean area. The European extended network is strongly connected with the international PRM bodies, first of all the International Society of PRM.

Study design A single centre retrospective study. Objectives To collect data and analyse the epidemiological profile of traumatic spinal cord injury and its medical complications during the subacute rehabilitation period. Setting Spinal Cord Injury Rehabilitation Programme of the National Rehabilitation Centre, ‘Vaivari’, Jurmala, Latvia. Methods Information was collected in 2015 from the medical records of 134 patients with a traumatic spinal cord injury admitted for primary rehabilitation between January 2011 and December 2014. Results During this period, the median age of patients with a traumatic spinal cord injury was 39.5 years, and the male to female ratio was 5:1. The leading causes of traumatic spinal cord injuries were falls (37%), road traffic accidents (29%), sport and leisure activities (19%), other cause (8%), unidentified causes (5%), and assault (2%). The most common medical complications were pain (77%), spasticity (48%), urinary tract infections (45%), pressure ulcers (25%), and orthostatic hypotension (14%). Conclusions Preventive measures in Latvia should be aimed primarily to address falls, road traffic accidents, and sport and leisure activities in the young male population. Medical complications are varied, and they are an important factor following traumatic spinal cord injury. The results obtained in this study comply with the data from studies in countries of the Baltic and North Sea regions of Europe.

Background and objective: An understanding of the needs of families of preschool children with cerebral palsy (CP) is of essential importance if efficient and cost-effective services are to be provided to them. The aims of this study were to identify the most frequently expressed needs of families with preschool children with CP, differences in the amount and types of family needs based on the child's gross motor function and communication function level, and the impact of the child's gross motor function and communication function level on the type and amount of family needs. Materials and methods: A total of 227 parents of preschool children with CP completed a modified version of the Family Needs Survey and a demographic questionnaire. Children's gross motor function level and communication function level was classified using the Gross Motor Function Classification System (GMFCS) and the Communication Function Classification System (CFCS), respectively. Results: The total number of family needs differed based on GMFCS and CFCS levels. Children's GMFCS and CFCS level were not significant predictors of overall family needs (adjusted R2 = 0.163). In this model the GMFCS level of children did not account for the total number of family needs, while the CFCS level did. Conclusions: Child's limitations in terms of communication and gross motor functions must be taken into consideration when planning services for families with preschool children with CP.

Transition from paediatric to adult health care services is a crucial process for young adults with long-term medical conditions and well organized and coordinated transition process has been strongly highlighted. The aims of this research were to assess the young adults with cerebral palsy overall readiness for adult life, the independency in health care management and independency impacting factors. Eighty young adults (age range 16–21 years) with CP and normal or slightly decreased mental function participated. There were done “face-to-face” structured interviews using the Rotterdam Transition Profile and the Transition Readiness Assessment Questionnaire also the characteristics of participants were obtained. It was revealed that young adults with cerebral palsy show low levels of participation in almost all domains of transition to adult life, the level of attendance of rehabilitation services is not sufficient, and the level of independency for young adults with CP in health care management is between phases of preparation and action. The most impacting factor for independency in health care management was found to be the cognitive status.

We present our study of the influence of the head 30 degrees flexion position on the changes in the muscle strength of the upper extremities. This position is typical for a person working in front of a computer.The study involved 100 healthy volunteers and was performed at the Department of Morphology in Riga Stradiņš University, Riga, Latvia. For measurements we have used the MicroFET2 Hand Held Digital Muscle Tester to determine the strength of the muscles of the hand and the arm (M. deltoideus, M. biceps brachii, M. triceps brachii, M. abductor pollicis longus). The results of measurements were then used to analyze the difference in the strength of the muscles innervated by the spinal cord cervical region (C5–C8 nerves) for the same person sitting in the vertical position and sitting with the head flexed at 30°.The results of our study support the hypothesis that the changes in the strength of the measured muscles are related to the mechanical distension of the spinal cord, which leads to changes in spinal cord’s blood supply. The kyphosis position of the cervical spine during head flexion at 30°extent shows that in the spinal cord segments C5, C6 and C7 are form mechanical distension, but the changes in segment C8 were not detectable.Using our statistical study, we can conclude that there is strong relationship in the strength change in most of the observed muscles between the vertical position and the flexion of head at 30 degrees.

For data assimilation in numerical weather prediction, the initial forecast-error covariance matrix Pf is required. For variational assimilation it is particularly important to prescribe an accurate initial matrix Pf, since Pf is either static (in the 3D-Var case) or constant at the beginning of each assimilation window (in the 4D-Var case). At large scales the atmospheric flow is well approximated by hydrostatic balance and this balance is strongly enforced in the initial matrix Pf used in operational variational assimilation systems such as that of the Met Office. However, at convective scales this balance does not necessarily hold any more. Here we examine the extent to which hydrostatic balance is valid in the vertical forecast-error covariances for high-resolution models in order to determine whether there is a need to relax this balance constraint in convective-scale data assimilation. We use the Met Office Global and Regional Ensemble Prediction System (MOGREPS) and a 1.5 km resolution version of the Unified Model for a case study characterized by the presence of convective activity. An ensemble of high-resolution forecasts valid up to three hours after the onset of convection is produced. We show that at 1.5 km resolution hydrostatic balance does not hold for forecast errors in regions of convection. This indicates that in the presence of convection hydrostatic balance should not be enforced in the covariance matrix used for variational data assimilation at this scale. The results show the need to investigate covariance models that may be better suited for convective-scale data assimilation. Finally, we give a measure of the balance present in the forecast perturbations as a function of the horizontal scale (from 3–90 km) using a set of diagnostics. Copyright © 2012 Royal Meteorological Society and British Crown Copyright, the Met Office

In numerical weather prediction (NWP) data assimilation (DA) methods are used to combine available observations with numerical model estimates. This is done by minimising measures of error on both observations and model estimates with more weight given to data that can be more trusted. For any DA method an estimate of the initial forecast error covariance matrix is required. For convective scale data assimilation, however, the properties of the error covariances are not well understood. An effective way to investigate covariance properties in the presence of convection is to use an ensemble-based method for which an estimate of the error covariance is readily available at each time step. In this work, we investigate the performance of the ensemble square root filter (EnSRF) in the presence of cloud growth applied to an idealised 1D convective column model of the atmosphere. We show that the EnSRF performs well in capturing cloud growth, but the ensemble does not cope well with discontinuities introduced into the system by parameterised rain. The state estimates lose accuracy, and more importantly the ensemble is unable to capture the spread (variance) of the estimates correctly. We also find, counter-intuitively, that by reducing the spatial frequency of observations and/or the accuracy of the observations, the ensemble is able to capture the states and their variability successfully across all regimes.

The objective is to examine and compare the usability of two physiotherapy programmes, analyzing respiratory function in patients before and after cardiac surgery in hospital during seven postoperative days (POD). Quantitative randomized prospective study of 157 patients before and after the valve replacement surgery, coronary artery bypass graft and combined surgeries, who moved independently. Participants were randomized into two groups (1 and 2) with different physiotherapy programmes. The routine physiotherapy of breath-enhancing techniques, micro-circulation improvement were used for the first group, for the second group - modified physiotherapy – the improvement of inspiration muscles, mm. quadriceps. gluteus max strength. Anthropometric measurements were defined for both groups on the day before surgery and during spirography - dynamic indicators - forced vital capacity (FVC), forced expiratory volume in the 2nd second (FEV1), Tiffeneau index (FEV1 / VC (%)), peak expiratory flow (PEF), operation parameters. By comparing the postoperative respiratory parameters between the two groups and using independent samples t test, it was found out that the difference in FVC between groups is 1.71 [95% CI: −8.25 to 4.8] and it is not statistically significant (t (155) = −0.52; p = 0.60). Based on the Leuven test results FVC the distribution variance is not statistically notably different for group 1 and group 2 (F = 0.27, p=0.60). Using routine and modified physiotherapy and comparing postoperative dynamic respiratory performance of the two groups, there was no statistically significant difference, proving that the two models are equally effective.

The society in developed countries is aging. 1.5% of seniors live in nursing homes in Latvia.Aim: to compare functional abilities and well-being between nursing home and home living Latvian seniors.Methods:280 home living seniors and 285 from nursing homes, age ≥ 65 years able to respond to questions and stand up were included in the study based on availability. They were asked to describe their well-being from very bad to very good. The functional abilities were assessed by hand grip strength, the ability to stand up without assistance, the dependence on caregivers (1 – independent, 2 – partly dependent, 3 – fully dependent), the use of walking device assistance devices.Results:The home living seniors could stand up without assistance of hands more often than nursing home residents (60.4% vs. 38.2%,p< 0.001). The handgrip strength was higher in the elderly community-dwelling women (0.3 (0.2–0.3) vs. 0.2 (0.15–0.2) Ba),p< 0.001. The nursing home residents were less often independent (62.8% vs. 83.9%,p< 0.001), more often partly dependent (30.2% vs. 14.6%,p< 0.001) and independent (7.0% vs. 1.4%,p= 0,001) while performing activities of daily living. The nursing home residents had higher walking device assistance needs (mean rank 345.7 vs. 219.2,p< 0.001) and described their well-being as “good” more often (28.4% vs. 16.8%,p= 0.001) and less often as “bad” or “very bad” (18.9% vs. 26.8%,p= 0.048). Conclusion. The subjective well-being of elderly nurse home residents is better than of home living seniors despite having less functional abilities.

The pelvis and the spine form a system balancing human skeleton. Within this system, the pelvis adapts to age-related changes in the spine. Previous studies were predominantly focused on changes of pelvic parameters in the sagittal plane. The aim of this study was to reveal age-related changes of lesser pelvic dimensions at different levels of the pelvic cavity in the sagittal and coronal planes and to explore sexual dimorphism in age-related tendencies. The computed tomography pelvimetry was performed on the three-dimensional workstation. The research sample included 211 females aged 18 to 84 years and 181 males aged 18 to 82 years, who underwent an examination at the Riga East University Hospital, Clinical Center “Gailezers,” Latvia. Three pelvic angles and transverse and sagittal diameters of the lesser pelvis were measured at four levels: the inlet, two axial planes in the mid-cavity, and the outlet. The results demonstrated that more pronounced age-related changes occurred in the inlet and the outlet of the lesser pelvis. The mid-cavity was less changing. The transverse diameter between acetabular centers and the sagittal diameter at the level of ischial spines were independent of age. In general, the common age-related trends were observed for pelvic parameters in females and males. A single exception was the proportion of diameters at the level of ischial spines, which decreased in males only. For parameters associated with pelvic floor diseases, age-related changes occurred in the direction of pathology.

In the current population we observe a rise of chronic health problems often with multiple characteristics. This results in a growing number of people who are experiencing long-term disabilities or difficulties in functioning because of disability. These conditions require a complex response over an extended period of time, that involves coordinated inputs from a wide range of health professionals. This paper argues the central role and benefit of rehabilitation and describes the rehabilitation as an integral component in the management of people with chronic disabilities. It also presents the most important related definitions: long-term care, rehabilitation for chronic disease and disability, the aim of physical and rehabilitation medicine (PRM). An interdisciplinary team is ideal for an effective implementation of rehabilitation for chronic disease and disability. However, the article mainly focuses on defining the role and contribution of the PRM physician in the rehabilitation of persons with long-term disabilities. The article includes: descriptions of his/her key role and competencies, particularly with regard to medical and functional status and prognosis, of the ability to comprehensively define the rehabilitation needs of the patient/person with respect to ICD-WHO classification domains, of the cooperation with other medical specialists and health professionals, of determining the rehabilitation potential, of developing the rehabilitation plan tailored to specific needs, as well as of the contribution of PRM physician in the follow-up care pathways.

An understanding of predictors of family needs for the families of preschool children with cerebral palsy (CP) is important for provision of efficient and cost-effective services. The aim of this study was to identify the characteristics of children, families and services that are risk factors to meeting family needs for community and financial resources. 234 parents of pre-school children with CP completed a modified version of the Family Needs Survey (FNS), the Measure of Processes of Care (MPOC-20), and a demographic questionnaire. The gross motor function level and communication function level of children were classified on the basis of the Gross Motor Function Classification System (GMFCS) and the Communication Function Classification System (CFCS) respectively. Two hierarchical multiple regression models were generated to determine the predictors of unmet family needs. The socialisation and communication skills of children, as well as caregiver employment and family income levels were significant predictors of family needs for community resources (adjusted R2=0.44). Significant risk factors in terms of family needs for financial resources included the child's gross motor limitations, caregiver employment, low levels of family income and no ability to receive services on the basis of enabling and partnership principles (adjusted R2=0.51). A child's limitations in terms of communication, gross motor functions and socialisation, as well as the socioeconomic status of the child's family, must be taken into account when planning services for families with preschool children with CP.

There are many clinical and objectively defined parameters that are used to evaluate a person's disability. Since the World Health Organisation has presented the WHODAS II as a means of objectively measuring subjectively defined functions, greater attention has been focused on self-rated health. Only a few studies, however, have been conducted about differences between self-rated health and objectively defined parameters. The survey for this study was conducted on the basis of WHODAS II and the population in Latvia with spinal cord injury. Respondents were between 18 and 65, and 98 questionnaires were analysed. The results show that people with spinal cord injury on average rate their functioning as limited (33–40 points of 100). Most respondents have been declared to be disabled, which is defined as very serious or severe functional disorders. More than 40% have paid jobs, while one-third do not work for reasons of health. The research shows that there is a close coherence (p< 0.05) between individual, objectively and clinically defined indicators on the one hand and the aspects of the questionnaire in which physical functioning was an important factor on the other hand. In order to understand the real functional abilities of patients and the individual factors that influence those abilities, it is necessary to define functional self-rated health in addition to objectively defined indicators.

The objective of the study is to examine the minimal infective dose of Staphylococcus epidermidis and Pseudomonas aeruginosa on biomaterials in vivo and in vitro. In this research originally synthesized bioactive biomaterials – 4N glass and 4NK glass-ceramics are calcium phosphate with Na2O and Nb2O5 additives with different crystallinity. For microbiological investigation of biomaterialsS.epidermidis strain ATCC 12228, Ps.aeruginosa strain ATCC 27853, 4 rabbit animal models, broth and agar, scanned electron microscope Tescan, Vortex centrifuge, sonicator and histological methods were used. We observed that different biomaterials had various attachments of S.epidermidis and Ps.aeruginosa in laboratory animal models. The minimal infective dose of S.epidermidis for biomaterial 4NK is more than 103 CFU/ml, for biomaterial 4N less than 103 CFU/ml. The minimal infective dose of Ps.aeruginosa for biomaterial 4N and biomaterial 4NK is less than 103 CFU/ml.

The emerging market of digital cephalographs and computerized cephalometry is overwhelming the need to examine the advantages and drawbacks of manual cephalometry, meanwhile, small offices continue to benefit from the economic efficacy and ease of use of analogue cephalograms. The use of modern cephalometric software requires import of digital cephalograms or digital capture of analogue data: scanning and digital photography. The validity of digital photographs of analogue headfilms rather than original headfilms in clinical practice has not been well established. Digital photography could be a fast and inexpensive method of digital capture of analogue cephalograms for use in digital cephalometry.The objective of this study was to determine the validity and reproducibility of measurements obtained from digital photographs of analogue headfilms in lateral cephalometry.Analogue cephalometric radiographs were performed on 15 human dry skulls. Each of them was traced on acetate paper and photographed three times independently. Acetate tracings and digital photographs were digitized and analyzed in cephalometric software. Linear regression model, paired t-test intergroup analysis and coefficient of repeatability were used to assess validity and reproducibility for 63 angular, linear and derivative measurements.54 out of 63 measurements were determined to have clinically acceptable reproducibility in the acetate tracing group as well as 46 out of 63 in the digital photography group. The worst reproducibility was determined for measurements dependent on landmarks of incisors and poorly defined outlines, majority of them being angular measurements. Validity was acceptable for all measurements, and although statistically significant differences between methods existed for as many as 15 parameters, they appeared to be clinically insignificant being smaller than 1 unit of measurement. Validity was acceptable for 59 of 63 measurements obtained from digital photographs, substantiating the use of digital photography for headfilm capture and computer-aided cephalometric analysis.

Experimental comparing of morphofunctional changes in implant contact tissue with same tissue involved in surgical intervention of same manner without insertion of artificial materials can clarify specific reactogenicity of implant and/or material. To evaluate early reactogenicity of porous synthetic HAp ceramic implants inserted in holes of rabbit upper jaw assessment of inflammatory response and regeneration in contact bone and soft tissue using histological and immunohistochemical methods was done. Our results demonstrated stimulation of TGFs and FGFR1 in bone after HAp implantation indicating possible osseoinductive role for the same Hap implants. Also moderate apoptosis and rich expression of FGFR1 in connective tissue around HAp implants commonly indicated intensive regeneration ability of the soft tissue with such cell death type that does not cause the fibrotic changes. Neuropeptide-containing innervation was not involved in healing processes after HAp implantation.

Better knowledge of clinical epidemiology and course of aneurysmal subarachnoid hemorrhage (ASAH) is essential for dedicated planning of the need for services. The aim of the study was to obtain a picture of epidemiology and clinical course of ASAH in Riga City (the capital of Latvia). A retrospective population-based study included residents of Riga City who suffered their first ASAH during a 5-year period from the beginning of 1996 till the end of 2000. The total number of ASAH events in the population during the study period was 292, of which 56 (19%) were fatal before reaching the hospital. There was no significant difference between age-specific incidence rates in men and women. The mean ASAH rates per 100 000 per year were 10.3 for age-adjusted incidence (in the population aged 20-79 years) and 7.2 for crude incidence. The mean age-adjusted case fatality rates were 57% for all ASAH events and 45% for those who survived admission. Our data suggest that incidence of ASAH in Baltic population can be recognized as average compared with other European regions. However, the case fatality rate of ASAH in the study population was higher than those of SAH reported from MONICA Collaborating Centers.