Search Results (18)

Introduction: Renal artery stenosis can significantly impact long-term graft survival rates following kidney transplant. Early recognition and management can improve the longevity of the kidney allograft. We aimed to evaluate the clinical role of duplex ultrasound in the diagnosis of renal artery stenosis (RAS). We also wanted to evaluate the current incidence of renal artery stenosis at our institute. Methods: A retrospective, consecutive series of 367 patients who underwent renal transplantation between 1 January 2020 and 30 December 2024 was conducted. We collected data regarding the recipients’ age, body mass index, and comorbidities. All patients diagnosed with renal artery stenosis were identified. The incidence of kidney transplant artery stenosis and presentation were recorded. All general physical parameters and laboratory data were collected and analyzed. Results: A total of 28 patients had initial suspicion of renal artery stenosis, documented via initial dedicated duplex ultrasound of the transplanted kidney. The initial mean systolic BP at initial US was 151 (99–213) mmHg, and mean creatinine was 2.43 (1.28–6.38) mg/dL. However, on repeat duplex ultrasound, three patients showed no features of renal artery stenosis and had no physical parameters consistent with RAS. A total of 25 patients diagnosed with RAS on initial duplex ultrasound underwent angiography. Twenty-four patients were confirmed with RAS on angiography, while one patient had a normal angiogram. Among patients diagnosed with TRAS, the mean resistive index was 0.71 ± 0.17 at the upper pole, 0.73 ± 0.19 at the mid pole, and 0.71 ± 0.21 at the lower pole. The mean peak systolic velocity was 462.57 ± 166.28 cm/s. Conclusions: Duplex ultrasound is an important initial tool for diagnosing transplant renal artery stenosis. An increase in peak systolic velocity was observed in our cohort; however, resistive indices were largely within acceptable limits. Management should be guided by clinical parameters (e.g., elevated systolic BP and rising creatinine) alongside imaging findings. Full article

This study investigates the spatial–temporal dynamics of vegetation indices in olive orchards across two traditionally rainfed regions of the Iberian Peninsula, namely the “Trás-os-Montes” (TM) agrarian region in Portugal and the Badajoz (BA) province in Spain, in response to drought conditions. Using satellite-derived vegetation indices, derived from the Harmonized Landsat Sentinel-2 project (HLSL30), such as the Normalized Difference Moisture Index (NDMI) and Soil-Adjusted Vegetation Index (SAVI), this study evaluates the impact of drought periods on olive tree growing conditions. The Mediterranean Palmer Drought Severity Index (MedPDSI), specifically developed for olive trees, was selected to quantify drought severity, and impacts on vegetation dynamics were assessed throughout the study period (2015–2023). The analysis reveals significant differences between the regions, with BA experiencing more intense drought conditions, particularly during the warm season, compared to TM. Seasonal variability in vegetation dynamics is clearly linked to MedPDSI, with lagged responses stronger in the previous two-months. Both the SAVI and the NDMI show vegetation vigour declines during dry seasons, particularly in the years of 2017 and 2022. The findings reported in this study highlight the vulnerability of rainfed olive orchards in BA to long-term drought-induced stress, while TM appears to have slightly higher resilience. The study underscores the value of combining satellite-derived vegetation indices with drought indicators for the effective monitoring of olive groves and to improve water use management practices in response to climate change. These insights are crucial for developing adaptation measures that ensure the sustainability, resiliency, and productivity of rainfed olive orchards in the Iberian Peninsula, particularly under climate change scenarios. Full article

Background/Objectives: The distal transradial approach (dTRA) is increasingly used in interventional cardiology. Doppler Ultrasound (DUS) effectively assesses radial artery (RA) characteristics. This study aims to identify specific RA DUS characteristics in patients undergoing coronary procedures via dTRA. Methods: Participants from the ANTARES trial who completed the intervention per-protocol and retained RA patency were included. DUS was performed at baseline, 1 day, and 60 days post-procedure. Results: Among 400 participants, 348 had either dTRA (n = 169) or conventional transradial access (cTRA) (n = 179). Distal RA lumen diameter was 12% smaller than that of the proximal RA (p < 0.001). Men had a 14% larger distal RA diameter than women (2.33 ± 0.31 mm vs. 2.04 ± 0.27 mm, p < 0.0001), similar to the proximal RA relationship. Peak flow velocities were similar between the sexes. Univariate linear regression showed that height, weight, body mass index, and body surface area (BSA) predicted arterial size, with BSA remaining significant in multivariate analysis (beta coefficient 0.62; confidence interval 0.49–0.75; p < 0.0001). Distal RA diameter correlated positively with palpable pulse at the snuffbox and wrist. The dTRA resulted in an immediate 14% and 11% increase in distal and proximal RA diameter, respectively (both p < 0.05). Sixty days after dTRA, the distal RA remained slightly dilated (p < 0.05), while the proximal RA returned to baseline. Conclusions: Distal RA diameter is significantly associated with sex, measuring smaller than the forearm segment. A strong palpable pulse correlates with larger distal RA size. The dTRA induces RA lumen expansion. A thorough understanding of distal RA anatomy is essential for optimizing patient selection and refining techniques for transradial procedures. Full article

Rainfall variability and its underlying physical mechanisms are crucial for improving the predictive accuracy of July rainfall patterns in the Sichuan-Shaanxi (SS) region of Southwestern China. This study utilized observational 24 h accumulated rainfall data from China in conjunction with reanalysis products sourced from the European Centre for Medium-Range Weather Forecasts (ECMWF). The purpose of this study was to elucidate the relationship between daily variations in the daily Asian-Pacific Oscillation (APO), atmospheric circulation, and daily rainfall patterns in the SS region, and to evaluate the impact of atmospheric circulation anomalies on these relationships. The results reveal a discernible intensification in the sea–land thermal contrast associated with atmospheric circulation anomalies transitioning from the daily extremely low APO (ELA) to the extremely high APO (EHA) days. These conditions lead to an increased presence of water vapor and widespread anomalies in rainfall that exceed normal levels in the SS region. Concurrently, the increase in stations experiencing extreme rainfall events (EREs) accounts for 21.3% of the overall increase in stations experiencing rainfall. The increase in rainfall amount contributed by EREs (RA-EREs) accounts for 73.5% of the overall increase in the total rainfall amount (TRA) across the SS region. Specifically, heavy rainfall (HR) and downpour rainfall (DR) during EREs accounted for 65.7% (HR) and 95.3% (DR) of the overall increase in the TRA, respectively. Relative to the ELA days, there was a substantial 122.6% increase in the occurrence frequency of EREs and a 23.3% increase in their intensity. The study suggests that the daily APO index emerges as a better indicator of July rainfall events in the SS region, with EREs significantly contributing to the overall increase in rainfall in this region. These findings indicate the importance of improving predictive capabilities for daily variability in the APO index and their correlation with rainfall events in the SS region. The results may inform the development of effective adaptation and mitigation strategies to manage the potential impacts of EREs on agriculture, water resources, sustainable development, and infrastructure in the region. Full article

Background: Real-world evidence of the efficacy and adverse events of JAK inhibitor treatment (Tofacitinib, Baricitinib, Upadacitinib, and Filgotinib) in rheumatoid arthritis is still limited. Methods: We studied 115 patients from the Rheumatology Unit of S. Giovanni di Dio Hospital affected by D2T-RA, according to the 2010 EULAR criteria. Out of the 115 patients, 17 had been treated with Baricitinib 8 mg/daily, 32 with Filgotinib 200 mg/daily, 21 with Tofacitinib 10 mg/daily, and 45 with Upadacitinib 15 mg/daily. We evaluated the clinical response after 3, 6, and 12 months of treatment and the follow-up from September 2022 to September 2023. All patients were evaluated according to the number of tender joints (NTJs), number of swollen joints (NSJs), visual analog scale (VAS), global assessment (GA), health assessment questionnaire (HAQ), Disease Activity Score (DAS28), and CDAI. Furthermore, laboratory parameters of efficacy and tolerability were evaluated. Results: All treatments demonstrated a statistically significant decrease in the DAS28 and CDAI scores, tender and swollen joint counts, VAS, HAQ, and patient global assessment (PGA) after 3, 6, and 12 months of treatment. All treatments showed similar behavior, and statistically significant decreases in circulating calprotectin, TNFα, and IL-6 were observed for all drugs after 12 months of treatment. In addition, soluble urokinase plasminogen activator receptor (suPAR) values showed significant differences at baseline and after 12 months of treatment for Filgotinib: 4.87 ± 4.53 vs. 3.61 ± 0.9 (0.009) and Upadacitinib: 6.64 ± 7.12 vs. 4.06 ± 3.61 (0.0003), while no statistically significant differences were found for Baricitinib: 3.4 ± 0.1 vs. 3.78 ± 0.1 and Tofacitinib: 3.95 ± 1.77 vs. 2.58 ± 0.1. The TC/HDL-C ratio (atherogenic index) showed significant differences when comparing Baricitinib vs. Filgotinib (0.0012), Filgotinib vs. Tofacitinib (0.0095), and Filgotinib vs. Upadacitinib (0.0001); furthermore, the LDL-C/HDL-C ratio in the Filgotinib group did not change (2.37 ± 0.45 vs. 2.35 ± 2.13 (NS)) after 12 months of treatment. Venous Thrombotic Events (VTEs) and major adverse cardiovascular events (MACEs) accounted for 1% of adverse events after treatment with Baricitinib. Herpes zoster reactivation accounted for 1% of adverse events after treatment with Filgotinib and Tofacitinib, while non-melanoma skin cancer (NMSC) accounted for 1% of adverse events after Upadacitinib treatment. Conclusions: Our real-world data from patients with RA show differences in some laboratory parameters and in the impact of lipid metabolism in JAK inhibitor treatment. Full article

While protected areas (PAs) are an important conservation strategy to protect vulnerable ecosystems and species, recent analyses question their effectiveness in curbing deforestation and maintaining landscape connectivity. The spatial arrangement of forests inside and outside of PAs may affect ecosystem functioning and wildlife movement. The Osa Peninsula—and Costa Rica in general—are unique conservation case studies due to their high biodiversity, extensive PA network, environmental policies, and payment for ecosystem services (PES) programs. This study explores the relationship between forest management initiatives—specifically PAs, the 1996 Forest Law, and PES—and forest cover and landscape metrics in the Osa Conservation Area (ACOSA). The Google Earth Engine API was used to process Surface Reflectance Tier 1 Landsat 5 Thematic Mapper and Landsat 8 Operational Land Imager data for 1987, 1998, and 2019, years with relatively cloud-free satellite imagery. Land use/land cover (LULC) maps were generated with the pixel-based random forest machine learning algorithm, and Normalized Difference Vegetation Index (NDVI), Enhanced Vegetation Index (EVI), and functional landscape metrics were calculated. The LULC maps are the first to track land use change, from 1987 to 2019 and the first to separately classify mature and secondary forest in the region, and have already proven useful for conservation efforts. The results suggest that forest cover, NDVI, EVI, and structural connectivity increased from 1987 to 2019 across the study area, both within and surrounding the PAs, suggesting minimal deforestation encroachment and local leakage. These changes may have contributed to the increasing vertebrate abundance observed in the region. PAs, especially national parks with stricter conservation regulations, displayed the highest forest cover and connectivity. Forest cover increased in properties receiving PES payments. Following the Forest Law’s 1996 deforestation ban, both forest conversion and reforestation rates decreased, suggesting the law curbed deforestation but did not drive reforestation across the region. Connectivity outside of PAs slightly declined following the adoption of the law, so the subsequent forest growth likely occurred in mostly previously unforested areas. Forest expansion alone does not ensure connectivity. We highlight the importance of developing policies, PES programs, and monitoring systems that emphasize conserving and restoring large, connected forest patches for biodiversity conservation and landscape resilience. Resumen: Aunque las áreas protegidas (APs) son una importante estrategia de conservación para proteger ecosistemas y especies vulnerables, algunos análisis recientes cuestionan su eficacia para frenar la deforestación y mantener la conectividad del paisaje. La distribución espacial de los bosques dentro y fuera de las AP puede afectar el funcionamiento de los ecosistemas y los movimientos de la fauna. La Península de Osa–y Costa Rica en general–constituyen casos de estudio únicos de conservación debido a su elevada biodiversidad, su extensa red de AP, sus políticas medioambientales y sus programas de Pago por Servicios Ambientales (PSA). Este estudio explora la relación entre APs, la Ley Forestal de 1996, PSA, cobertura y métricas del paisaje en el Área de Conservación Osa (ACOSA). Se utilizó la plataforma Google Earth Engine API para procesar datos de Reflectancia Superficial Tier 1 Landsat 5 Thematic Mapper y Landsat 8 Operational Land Imager para 1987, 1998 y 2019, años con imágenes satelitales relativamente libres de nubes. Se generaron mapas de uso del suelo con el algoritmo de aprendizaje automático basado en pixeles Random Forest, y se calcularon el índice de vegetación de diferencia normalizada (NDVI), el índice de vegetación mejorado (EVI) y las métricas de paisaje funcionales. Estos mapas, los primeros en clasificar por separado los bosques maduros y secundarios de la región, han demostrado su utilidad para los esfuerzos de conservación. Los resultados sugieren que la cobertura forestal, el NDVI, el EVI y la conectividad estructural aumentaron entre 1987 y 2019 en toda la región de estudio, tanto dentro de las AP como en sus alrededores, lo que sugiere una expansión mínima de la deforestación dentro y fuera de las AP. Estos cambios pueden haber contribuido al aumento de la abundancia de vertebrados observado en la región. Las AP, especialmente los parques nacionales con regulaciones de conservación más estrictas, mostraron la mayor cobertura forestal y conectividad. La cobertura forestal aumentó en aquellas propiedades que recibieron PSA. Tras la prohibición de la deforestación por la Ley Forestal de 1996, disminuyeron tanto las tasas de conversión forestal como las de reforestación, lo que sugiere que la ley frenó la deforestación, pero no impulsó la reforestación. La conectividad fuera de las AP disminuyó ligeramente tras la entrada en vigor de la ley, lo que sugiere que el crecimiento forestal posterior se produjo en zonas que antes no estaban forestadas. Por lo tanto, la expansión forestal por sí sola no garantiza la conectividad. Resaltamos la importancia de desarrollar políticas, programas PSA y sistemas de monitoreo que hagan hincapié en la conservación y restauración de grandes zonas forestales conectadas para apuntalar la conservación de la biodiversidad y la resiliencia del paisaje. Full article

The distal transradial approach (dTRA) through the anatomical snuffbox is hypothesized to offer greater benefits than the conventional transradial access (cTRA) for patients undergoing coronary procedures. Our goal was to assess the safety and efficacy of dTRA. Out of 465 consecutive Caucasian patients, 400 were randomized (1:1) to dTRA or cTRA in a prospective single-center trial. Clinical and ultrasound follow-ups were obtained at 24 h and 60 days post-procedure. The primary combined endpoint consisted of access crossover, access-related complications, and major adverse cardiovascular events (MACE). Secondary endpoints included clinical success endpoints (puncture success, crossover, and access time), access-site complications endpoints, and MACE at 60 days. The primary endpoint was significantly higher in the dTRA [odds ratio (OR): 2.31, 95% confidence interval (CI): 1.38–3.86, p = 0.001]. Clinical success endpoints, namely crossover (10% vs. 3.5%, p < 0.05) and access-time [median: 140s (85–322) vs. 80s (58–127), p < 0.001], did not favor the dTRA, despite a similar success rate in radial artery puncture between the dTRA and cTRA (99.5% vs. 99%). Radial artery spasm (19% vs. 4.5%, p < 0.0001), physical discomfort during access, and transient thumb numbness after the procedure occurred more frequently with the dTRA. However, early (2.5% vs. 4.5%, p = 0.41) and mid-term (2.5% vs. 3%, p = 0.98) forearm radial artery occlusion rates were comparable between the dTRA and cTRA. Randomization to the dTRA, lower forearm radial pulse volume, higher body mass index, and lower body surface area independently predicted the primary endpoint in multivariate analysis. In the interaction effect analysis, only diabetes increased the incidence of the primary endpoint with the dTRA (OR: 18.67, 95% CI: 3.96–88.07). The dTRA was a less favorable strategy than cTRA during routine coronary procedures due to a higher incidence of arterial spasm and the necessity for access crossover. The majority of local complications following the dTRA were clinically minor complications. Individuals with diabetes were particularly susceptible to complications associated with the dTRA. Full article

This research intends to identify factors in the adoption of mobile government services, recognizing the main mobile government acceptance factors through different models, namely, the theory of reasoned action (TRA), the theory of planned behavior (TPB), the technology acceptance model (TAM), the technology readiness index (TRI), and the unified theory of acceptance and use of technology (UTAUT). Reviewing prior studies on factors that influence mobile government acceptance in Egypt and addressing local challenges help in the development of effective strategies for successful implementation, considering opportunities and challenges in value-added services (VAS). Therefore, the main objectives of this paper are as follows: we critically review prior studies to identify the main mobile government acceptance factors, explore the identified dimensions of mobile government acceptance, and recognize further insights into the challenges that exist in the Egyptian context. Data are gathered through interviews with technology experts and customers with technological experience in Egypt. The findings of the study show that the factors affecting mobile government adoption in the Egyptian context are identified as follows: facilitating conditions, opportunities and challenges, technology and information systems, perceived usefulness, challenges like a lack of trust, cost, privacy, age, and several other obstacles. This research assists scholars and practitioners with insights into how to create and promote an application that is deemed attractive for the adoption of m-government services. Full article

Human activities are at the origin of anthropogenic threats altering ecosystems at any hierarchical level. To mitigate them, environmental managers develop projects to obtain effective outcomes on biological targets of conservation concern. Here, we carried out two new approaches (TAN = Threat Analysis and TRA = Threat Reduction Assessment) aimed at assessing the effectiveness of conservation actions on two threatened beach-nesting landbird species, the Kentish Plover (Charadrius alexandrinus) and the Little Ringed Plover (C. dubius), breeding along a coastal beach of central Italy. Using a score-based evaluation (TAN approach), a panel of experts assessed the extent, intensity, and magnitude of a set of species-specific threats, ranking them from more to less impacting. Domestic dogs, dune trampling, and synanthropic predators appeared as the threats with the most significant magnitudes. Using the TRA approach, experts obtained a rank of threats that were more urgent to solve: i.e., domestic dogs and dune trampling. To contrast with these threats, in 2021, we carried out a conservation project with specific measures that were aimed at reducing the threat magnitude on birds. They included: dune borders demarcation, anti-predatory cages on plover nests, the removal of beach-stranded fishing lines and hooks, field surveillance by volunteers, dog control, social- and mass-media communication, and alliances with stakeholders and institutions. After the project, mechanical beach grooming (>80%), dune trampling, and synanthropic predators (both >60%) showed the highest percentage of impact reduction. The project showed a medium–high level of effectiveness in reducing the total threat magnitude (TRA-I index = 63.08%). The Threat Analysis should be routinely used to arrange a causal chain that is useful for defining the relationships among human-induced threats and ecological targets, selecting the threats with the highest magnitudes. After the projects, the Threat Reduction Assessment may assess the level of threat reduction, suggesting measures for adaptive management. Full article

We applied two recent approaches largely used in biological conservation: Threat Analysis (TAN) and Threat Reduction Assessments (TRAs), assessing the effectiveness of a project focused on two water-related bird species (common tern, Sterna hirundo and little tern, Sternula albifrons), commonly breeding in some wetlands of Italy. We used the IUCN standardized lexicon for the classification of threats, utilizing a panel of experts to assess a set of regime attributes (extent, severity and magnitude) of each human-induced disturbance. Our aims were: (i) through the TAN approach, to carry out an arrangement and quantification of the main threats acting on our focal species and select the priority ones; (ii) through the TRA approach, to test the effectiveness of an operational project focused on mitigating the threats and improving the breeding success of species (i.e., building rafts and floating islands to encourage their nesting). Using the TAN approach, experts identified the following human-induced threats (IUCN code): 6.1—Generic disturbance; 7.2—Water stress; 7.3—Salinization; 8.8—Vagrant dogs; 8.8—Mediterranean gulls; 8.8—Wild boars, all significantly different in their magnitude. Among them, wild boars and Mediterranean gulls appeared the priority threats with the greatest extent, intensity and magnitude. Using the TRA approach, after the project, we assessed an overall decrease in the threat magnitude of 23.08% (21.42% when considering only the threats directly affected by our project). These data suggest that further efforts should be devoted to achieving greater effectiveness of conservation actions focused on our target species. With limited time and resources to quantify threats, expert-based approaches could be useful for rapidly assessing the effectiveness of small conservation projects by providing a range of scores obtained following an analytical procedure. In this regard, Threat Analysis and Threat Reduction Assessment could be considered useful tools to support adaptive management in project management cycles. Full article

The objectives of this study are to: estimate African countries’ Government Openness Index (AGOI) to see the updated progress of open government in those countries, examine which areas African countries should further improve for sustainable development, and compare the performance of the Open Government Partnership (OGP) member countries to that of non-OGP countries in forming AGOI. This study developed the AGOI with 32 selected countries and four factors (ACC (accountability), TRA (transparency), CPF (citizen participation and freedom) and ICT (information and communication technology)) for the period of 2006–2019. The results show that African countries have continuously increased the values of AGOI for the period. ACC has barely changed, but TRA has increased slightly. Both CPF and ICT have increased at higher growth rates during the period. The OGP group reached much better scores than their non-OGP counterparts, with positive differences in AGOI, ICT, CPF, and TRA, except ACC. The results of this study suggest that the constantly increasing CPF and ICT levels in countries that have similar conditions as African countries should be further improved to function well enough to build accountability and transparency. It is also recommended that countries join the OGP in order to move towards improving government openness and creating sustainable development. Full article

The abdominal drawing-in maneuver (ADIM) is a clinical tool used for identifying preferential activity of deep abdominal muscles. However, concurrent validity and reproducibility of palpation during the ADIM has not been formally investigated. The aims of this study were (1) to assess intra- and interrater reliability of manual palpation during the ADIM, and (2) to determine the concurrent validity of manual palpation during the ADIM by calculating preferential activation ratio cut-off as assessed with ultrasound imaging (RUSI). Thirty-two subjects (n = 16 patients with nonspecific low back pain and 16 comparable healthy individuals) performed the ADIM in a supine hook-lying position. Two experienced assessors evaluated the presence or absence of preferential contraction of the deep abdominal muscles by palpation during the ADIM on 2 different days. Intrarater (test-retest) and interrater reliability of palpation were calculated using Cohen’s kappa coefficients. Muscle thickness of the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles at rest and during the ADIM were also measured. TrA-Contraction Ratio (TrA-CR), TrA-Preferential Activation Ratio (TrA-PAR), and Modified-TrA-PR (M-TrA-PAR) were calculated. The concurrent validity of manual palpation was determined using the correlation between manual palpation and imaging and by calculating ROC curve (operating characteristics curve), Youden index, and sensitivity and specificity. Intra- and interrater reliability of manual palpation during the ADIM was excellent (k: 0.82–1.00) and good to excellent (k: 0.71–1.00), respectively. Interrater reliability for muscle thickness ranged from good to excellent (ICC3,1 0.79–0.91). Manual palpation and TrA ratio showed low to moderate correlations (r: 0.36–0.60). When evaluating the diagnostic accuracy of manual palpation, the best predictive model (ROC value: 0.89; p < 0.001) for correct a preferential contraction of TrA was obtained when the M-TrA-PAR was ≥0.08 (sensitivity: 0.95–1.00; specificity: 0.62). Good to excellent intra- and interrater reliability of manual palpation was found during the ADIM in both patients and healthy groups. Manual palpation showed concurrent validity for identifying the preferential activity of the TrA muscle supporting its use in clinical practice. Full article

A pandemic situation of COVID-19 has made a cost-minimization strategy one of the utmost priorities for commercial airliners. A relevant scheme may involve the minimization of both the fuel- and time-related costs, and the climb trajectories of both objectives were optimized to determine the optimum aircraft cruise altitude. The Hermite-Simpson method among the direct collocation methods was employed to discretize the problem domain. Novel approaches of terminal residual analysis (TRA), and a modified version, m-σ TRA, were proposed to determine the goals. The multi-objective cruise altitude (MOCA) was different by 2.5%, compared to the one statistically calculated from the commercial airliner data. The present methods, TRA and m-σ TRA were powerful tools in finding a solution to this complex problem. The value σ also worked as a transition criterion between a single- and multi-objective climb path to the cruise altitude. The exemplary MOCA was determined to be 10.91 and 11.97 km at σ = 1.1 and 2.0, respectively. The cost index (CI) varied during a flight, a more realistic approach than the one with constant CI. With validated results in this study, TRA and m-σ TRA may also be effective solutions to determine the multi-objective solutions in other complex fields. Full article

The activity of the transverse abdominal (TrA) muscle affects the stabilization of the trunk. It is known that after a stroke, people experience problems in performing daily activities. The purpose of this study was to examine whether there are differences in the transversus abdominal thickness between the two sides of the body in individuals with hemiparesis and controls. Eight patients with hemiparesis and nine controls matched for age and body mass index were examined by musculoskeletal ultrasound in four conditions: a) At rest, b) abdominal hollowing maneuver from the supine position, c) bridge, and d) abdominal hollowing maneuver from the bridge position. In each of the above conditions, the symmetry index was calculated as the absolute value of the difference in thickness between the two sides. Analysis of variance showed a lower TrA thickness at rest and exercise in patients compared to the control group (p < 0.05). Further, patients showed a lower contraction thickness ratio during exercise compared to controls (p < 0.05). The absolute symmetry of the TrA thickness was 12.59 ± 6.43% to 19.31 ± 10.43% in patients and it was significantly greater than the control group (3.01 ± 2.47% to 4.47 ± 2.87%). According to the above results, it seems that transverse abdominal activation exercises are particularly useful for improving the stability of patients with hemiparesis, as long as they are located and adapted to the deficit of each patient. Full article

A manual shoulder-training device may represent an alternative training device to improve symptoms and function in patients with subacromial shoulder pain by strengthening the external rotators. Thus, we examined the effects of a traditional versus an alternative strengthening exercise program on shoulder pain/function and physical performance in individuals with subacromial shoulder pain. Fifty-six adults with subacromial shoulder pain were randomly assigned to a passive control group (CON; n = 20), a traditional training group (TRA; n = 19), or an alternative training group (ALT; n = 17). Both training groups conducted a progressive home-based strengthening exercise program for the external rotators for eight weeks using elastic bands only (TRA group) or in combination with the shoulder-training device (Schulterhilfe^®) (ALT group). Pre- and post-training assessment included measures of shoulder pain/function (i.e., shoulder pain and disability index (SPADI)) and physical performance (i.e., shoulder flexibility, maximal isometric strength, and strength endurance). We found significant test × group interactions in most of the investigated variables. Post hoc analyses showed significant training-related improvements for proxies of shoulder pain/function, shoulder flexibility, maximal isometric strength, and strength endurance in favor of the ALT and TRA group in comparison to the CON group. Further, larger and more frequent effects were found for the ALT compared to the TRA group. Measures of shoulder pain/function and physical performance can be significantly improved by both training regimens in individuals with subacromial shoulder pain. However, strength training using elastic bands with the manual shoulder device (ALT group) as compared to elastic bands (TRA group) only was more effective and may thus be a recommendable alternative in order to mitigate subacromial shoulder pain. Full article