Rehabilitation Research Articles

Cost-effectiveness of postoperative rehabilitation after surgery for lumbar disc herniation: an analysis based on a randomized controlled trial.

The aim of this study was to examine whether routine referral to municipal postoperative rehabilitation is cost-effective in comparison to no referral after surgery for lumbar disc herniation (LDH). One hundred forty-six patients scheduled for primary discectomy due to LDH were included. This secondary analysis, based on data from a previous randomized controlled trial, compared costs and quality-adjusted life years (QALYs) between two groups of patients recovering from LDH surgery: one group of patients received a referral for municipal physical rehabilitation (REHAB) and the other group was sent home without a referral to any postoperative rehabilitation (HOME). Primary outcomes were QALYs calculated from the EQ-5D utility score, societal costs, and incremental cost-effectiveness ratios (ICERs). The main cost-effectiveness analysis used intention-to-treat data, whereas sensitivity analyses included as-treated data. Questionnaires were collected after 1, 3, 6, 12, and 24 months postoperatively. The main cost-effectiveness analysis showed a small, insignificant incremental QALY of 0.021 and an incremental cost of €211.8 for the REHAB group compared to the HOME group, resulting in an ICER of €10,085. In the as-treated sensitivity analysis, the REHAB group had poorer outcomes and higher costs compared to the HOME group. Routine referral to municipal physical rehabilitation in patients recovering from LDH surgery was not cost-effective compared to no referral.Clinical trial registration no.: NCT03505918 (clinicaltrials.gov).

Influence of chemical characteristics of RAP binders on the mechanical properties of binders and mixes

Utilization of reclaimed asphalt pavement (RAP) materials in the asphalt layer construction has emerged as an important rehab ilitation option for asphalt pavements. The properties of reclaimed asphalt material will be different from those of the initial (virgin) asphalt mixture due to the aging of the binder. Resilient modulus is an important material parameter used for the design of pavements. The mechanical behaviour of the mix and the binder is expected to be influenced by the chemical composition of the binder. In this study, the effect of the chemical composition of virgin and reclaimed asphalt pavement (RAP) binders on the resilient modulus (Mr) of RAP mixes has been evaluated. This is done by testing different RAP mixes prepared using bitumen samples containing different proportions of RAP binder. The RAP mixes prepared using one aggregate gradation (mid-point gradation recommended by the Ministry of Road Transport and Highways for Bituminous Concrete -1) and different RAP contents (0, 15, 25, 35 and 45%) with VG-30 as virgin binder, were tested for their resilient modulus values at different temperatures (15, 25 and 35°C) and frequencies (0.5, 1, 1.5 and 2 Hz). The chemical composition of the binder blends was evaluated with the help of Fourier transform infrared spectroscopy (FTIR). The relationship between the chemical indices and the rheological parameters has been examined. Ketones, aliphatics and aromatics are found to have good correlation with rheological properties. The chemical indices also are found to have good correlation with the resilient moduli of the mixes.

Study on the Injury and Rehabilitation of Racket Athletes with Disabilities

Purpose: This study examined the injury and rehabilitation of athletes with disabilities in racket sports projects (i.e., badminton, table tennis, and wheelchair tennis). In addition, the characteristics of each project and the differences among those projects are discussed. Methods: Business team athletes with disabilities in racket sport were enrolled as subjects (i.e., 19 badminton athletes, 19 table tennis athletes, and 19 wheelchair tennis athletes). The real conditions of the injury, injury severity, injury site, symptoms, and rehabilitation methods after injury were analyzed. Results: No significant differences were observed among the actual condition, injury severity, symptoms and the methods of rehabilita tion on racket sport for athletes (i.e., badminton, table tennis, and wheelchair tennis athletes) with disability. The differences were fo cused mainly on the injury sites due to the characteristics of the different projects, and specific technical actions. Conclusion: This study examined the real condition of the injury, injury severity, injury site, symptoms and rehabilitation methods after the injury on the rackets (i.e., badminton, table tennis, and wheelchair tennis) athletes with disabilities. The data can be used to eliminate the incidence of injury and minimize the injury severity for racket athletes with disabilities. In addition, it can also be used for the dis abled, who like racket projects, as the fundamental material to prevent injury and assist in recovery.

Helicobacter pylori infection in rehabilitation staff younger than 35 years: Infection surveillance for three years

Background: Screening for Helicobacter pylori infection is important because of the high risk of gastric cancer development. The H. pylori carrier rate among elderly Japanese patients is still high; therefore, rehabilitation (RH) workers who are in frequent contact with such individuals could be assumed to be at a higher risk of H. pylori infection. Aim/Objective: We surveyed RH workers to investigate the initial occurrence of H. pylori infections in adults. Methods: Urine samples of RH workers aged < 35 years were screened for H. pylori antibodies to confirm infection. H. pylori infection rates were stratified according to the type of RH work and duration of employment. Infection surveillance was performed at six-month intervals for H. pylori-negative individuals. Findings/Results: The H. pylori infection rate among 173 workers was 16.8%. Infection rates were 26.3%, 16.3% and 15.3% among speech, occupational and physiotherapists, respectively. The employment duration was divided into < 24, 24–47, 48–60 and ⩾ 61 months; the respective infection rates were 5.0%, 12.0%, 17.6% and 28.6%. However, no new H. pylori infection was detected in a total of seven surveillance studies of H. pylori-negative workers over a three-year period. Discussion: The results of the initial examination showed that the infection rate increased with the duration of employment. However, subsequent surveillance detected no new H. pylori infections.

Effects of Plank Exercises with Resistance of One-Sided Hip Adduction on the Abdominal Muscle Thickness

Purpose: The purpose of this study was to examine the effects of plank exercises with resistance of one-sided hip adduction on abdomi nal muscle thickness. Methods: Thirty subjects were divided into a group that underwent plank exercises with one-sided hip adduction resistance (n=15) and a group that underwent plank exercises only (n=15). Their changes in abdominal muscle thickness before the experiment (n=15) and three and six weeks after the experiment were analyzed using a two-way repeated analysis of variance at a statistical significance level of α=0.05. When there was any interaction between the time of measurement and each group, post hoc t-tests were conducted at a statistical significance level of α=0.01. Results: The results of the experiment showed statistically significant differences in the thickness of the rectus abdominis, internal oblique muscle, and transversus abdominis, depending on the time of measurement and the interaction between the time of measure ment and each group (p<0.05). Statistically significant differences were observed in the thickness of the external oblique, depending on the time of measurement, the interaction between the time of measurement and each group, and variances between the groups (p<0.05). Conclusion: The results of this study indicated that plank exercises with resistance of one-sided adduction are effective for increasing abdominal muscle thickness. The study’s overall findings will likely be used as basic data for lumbar stabilization exercises and rehabilita tion treatment.

Abstract TP123: Inhibition of Tropomyosin-related Kinase B (trkb) Reduces the Benefit of Cortical Stimulation Combined With Motor Rehabilitation in Experimental Stroke

Motor impairments are one of the more debilitating and persistent functional deficits following stroke. Several clinical and experimental studies suggest that combining impaired limb rehabilitation (RT) with low-frequency inhibitory contra-lesion or high-frequency excitatory ipsi-lesion motor cortical stimulation (CS) can improve motor recovery and increase neural remodeling. However, results have been mixed and there is no consensus on which CS approach is more beneficial. Further, the mechanism by which excitatory CS (ECS) and inhibitory CS (ICS) alter motor recovery after stroke are unknown. One theory is that CS may alter the expression of neurotrophic factors. Brain-derived neurotrophic factor (BDNF) and its receptor tropomyosin-related kinase B (TrkB) are important for motor learning and neural plasticity in healthy brains may be involved in motor recovery after stroke. In this study, we compared the efficacy of motor RT alone to ECS or ICS combined with RT following experimental motor cortical stroke in adult male rats. Additionally, we investigated whether inhibiting the TrkB receptor during treatment would block behavioral recovery and alter neural remodeling in the motor cortex. Methods: Adult male rats received an endothelin-1 induced unilateral focal stroke to the caudal forelimb area of the motor cortex. Bipolar electrodes were then implanted either over remaining peri-lesion motor cortex or over the contra-lesion motor cortex. Four days after stroke, rats received daily RT on a reaching task without CS or concurrent with 100 Hz ECS or 1 Hz ICS 6 days per week for 3 weeks. Three hours prior to RT, animals were injected with ANA-12 (.5mg/kg, i.p.), a small molecule TrkB antagonist, or vehicle. Preliminary results indicate that ANA-12 injections resulted in decreased functional improvements in rats receiving ECS+RT and RT compared to rats receiving these treatments with vehicle injections. Alternatively, ANA-12 had no effect on motor performance in the ICS+RT group. These data suggest that ECS and RT may be, at least in part, dependent upon TrkB receptor signaling. However, contra-lesion ICS induced functional recovery is likely not dependent upon TrkB signaling.

The communication between a doctor and his patients’ parents as a factor in the availability of medical care for disabled children

The purpose of this s tudy is the identi fi cation of types of communica tion among physi cians and parents of disabled children, who have congenital or acqui red pa thologies and who need treatment and rehabilita tion. The focal point of the s tudy is the assumption tha t the communi cation between the doctor and the child’s parents should be based on trust. It is one of the factors influencing the availability of medi cal care for children with disabilities. The study uses as tructured in-depth interview (19). There is much evi dence tha t doctors and parents prefer a paternalistic type of communication unlike partner, contractual or engineering. Our conclusion is that in a medical institution within the established bureaucratic type of organisational culture , recorded in our earlier study, the conditions for the professional activities of doctors and parents with disabled children receiving help are perceived by them as the most comfortable, since they correspond to their value orientations and expectations. Keywords: Disabled children, access to medi cal care, doctor, parents , communi ca tion.

Children with severe burn injury do not display sex differences for exercise capacity and exercise induced training adaptations

BackgroundChildren with severe burn injury sometimes undergo exercise training as part of their rehabilitation. Others have reported that females have a 50% increased risk of death from burn injury compared to males. However, whether exercise capacity and exercise induced training adaptations differ between boys and girls is unknown.PurposeThis project tested the hypothesis that girls with burn injury would have lower strength and aerobic exercise capacity compared to burned boys, and that exercise training rehabilitation (RET) adaptations would likewise differ between groups.MethodsSeverely burned girls (n=25) and boys (n=26) were matched for age, body morphology (means±SD; 13±3 yrs, 150±15 cm, 53±14 kg; each P≥0.71) and for burn injury (54±20% total body surface area burn, P=0.82). Strength (peak torque) and cardiorespiratory fitness (peak VO2) were normalized to lean body mass (LBM) and analyzed as a relative percentage of age‐sex matched non‐burned children (girls 13 yrs, n=25, boys 13 yrs, n=26). Submaximal oxygen uptake (VO2) and heart rate (HR) were expressed as a percentage of peak values and compared to their sex‐ matched non‐burned counterpart during the first 4 stages of the modified Bruce protocol. At discharge (DC) and after an aerobic and resistance rehabilitation exercise training (RET) program, 2‐way factorial ANOVA assessed interaction and main effects of group × time for peak exercise and group × stage for submaximal exercise, with significance set at P&lt;0.05.ResultsGirls had longer length of hospital stay (41±23 vs. 29±13 days, P=0.02). At DC and post‐RET, LBM was lower in burned and increased similarly after RET (DC 87.3% of non‐burned values, post‐RET 92.8%; Main effect, Time P=0.017). Peak torque was not different at DC and increased similarly after RET in both groups (DC, 56±17; after RET, 77±20%; Main effect, Time P&lt;0.0001). Likewise, the improvement in peak VO2 was not different from DC to after RET between both groups (DC, 54±12 to RET, 67±13%; Main effect, Time; P&lt;0.0001). Burned children exercise at greater percentage of their peak VO2 and peak HR during submaximal exercise compared to non‐burned children (Interaction, Group × Stage, P&lt;0.0001; see Figure 1).ConclusionThese data indicate that the initial burn injury at DC or after RET does not have sex‐dependent effects on LBM, submaximal or peak exercise capacity. Exercise capacity is improved after exercise training but remains lower than non‐burned children. Differences in relative peak VO2 and peak HR may suggest the need for burn specific exercise programs for improving the efficacy and progress of a rehabilitation exercise program.Support or Funding InformationThis study was supported in part or totally by awards from NIH P50‐GM060338, NIH R01‐GM56687, R01 HD049471, 3R01HD049471‐12S1, SHC 84080, 71008, 84090, NIDILRR 90DP0043‐01‐00This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Clinical study of electroacupuncture with different frequencies at Lianquan (CV 23) and Fengfu (GV 16) for stroke dysphagia

To observe the effects of electroacupuncture (EA) with different frequencies based on the western conventional treatment and rehabilita tion training for stroke dysphagia. Sixty patients with dysphagia after stroke were randomized assigned into a low frequency (2 Hz) group and a high frequency (100 Hz) group, 30 cases in each one. Basic treatment was applied in the two groups. The acupoints were Fengfu (GV 16) and Lianquan (CV 23). EA with continuous wave and tolerant intensity were connected for 30 min, once a day for 14 days. The main index was video fluoroscopic swallowing study (VFSS) to detect passing time at oral stage, pharynx delay time at pharyngeal stage, passing time at pharynx stage. The second indexes were water swallow test rating and standardized swallowing assessment (SSA). The clinical effect was evaluated. After treatment, the passing time at oral stage, pharynx delay time at pharyngeal stage, passing time at pharynx stage were lower than those before treatment in the two groups (all P <0.05), and the results in the low frequency group were better (all P <0.05). After treatment, the water swallow test rating improved in the two groups (both P<0.05), and that in the low frequency group was better (P<0.05). The SSA score decreased in the two groups (both P<0.05), and the improvement in the lower frequency group was superior to that in the high frequency group (P<0.05). The total effective rate in the low frequency group was 93.3% (28/30), which was better than 66.7% (20/30) in the high frequency group (P<0.05). . The effect of EA with lower frequency is better than that of EA with higher frequency for stroke dysphagia.

Effects of β-hydroxy-β-methylbutyrate on skeletal muscle mitochondrial content and dynamics, and lipids after 10 days of bed rest in older adults.

Loss of muscle mass during periods of disuse likely has negative health consequences for older adults. We have previously shown that β-hydroxy-β-methylbutyrate (HMB) supplementation during 10 days of strict bed rest (BR) attenuates the loss of lean mass in older adults. To elucidate potential molecular mechanisms of HMB effects on muscle during BR and resistance training rehabilitation (RT), we examined mediators of skeletal muscle mitochondrial dynamics, autophagy and atrophy, and intramyocellular lipids. Nineteen older adults (60-76 yr) completed 10 days BR followed by 8-wk RT rehabilitation. Subjects were randomized to either HMB (3 g/day HMB; n = 11) or control (CON; n = 8) groups. Skeletal muscle cross-sectional area (CSA) was determined by histology from percutaneous vastus lateralis biopsies. We measured protein markers of mitochondrial content [oxidative phosphorylation (OXPHOS)], fusion and fission (MFN2, OPA1, FIS1, and DRP1), autophagy (Beclin1, LC3B, and BNIP3), and atrophy [poly-ubiquinated proteins (poly-ub)] by Western blot. Fatty acid composition of several lipid classes in skeletal muscle was measured by infusion-MS analysis. Poly-ub proteins and OXPHOS complex I increased in both groups following BR (P < 0.05, main effect for time), and muscle triglyceride content tended to increase following BR in the HMB group (P = 0.055). RT rehabilitation increased OXPHOS complex II protein (P < 0.05), and total OXPHOS content tended (P = 0.0504) to be higher in HMB group. In addition, higher levels of DRP1 and MFN2 were maintained in the HMB group after RT (P < 0.05). BNIP3 and poly-ub proteins were significantly reduced following rehabilitation in both groups (P < 0.05). Collectively, these data suggest that HMB influences mitochondrial dynamics and lipid metabolism during disuse atrophy and rehabilitation.NEW & NOTEWORTHY Mitochondrial content and dynamics remained unchanged over 10 days of BR in older adults. HMB stimulated intramuscular lipid storage as triacylglycerol following 10 days of bed rest (BR) and maintained higher mitochondrial OXPHOS content and dynamics during the 8-wk resistance exercise rehabilitation program.

Aging-related effects of bed rest followed by eccentric exercise rehabilitation on skeletal muscle macrophages and insulin sensitivity

The pro- and anti-inflammatory macrophages are associated with insulin sensitivity and skeletal muscle regeneration. Infiltrating macrophages in skeletal muscle during a period of physical inactivity and subsequent reloading/rehabilitation in older adults is unknown, but may provide insight into mechanisms related to the development of metabolic disease and changes in muscle cell size. The purpose of this study was to determine if skeletal muscle macrophage infiltration is modulated differently between young and older adults after bed rest and exercise rehabilitation and if these responses are related to muscle and insulin sensitivity changes. 14 young and 9 older adults underwent 5-days of bed rest followed by 8-weeks of lower limb eccentric exercise rehabilitation (REHAB). Dual-energy X-ray absorptiometry, magnetic resonance imaging and myofiber analysis were used to identify muscle morphology and CLIX-IR and CLIX-β were used to assess insulin sensitivity. Skeletal muscle macrophages, CD68 (pan), CD11b (M1), CD163 (M2), CD206 (M2), were characterized using immunohistochemistry and gene expression. Insulin sensitivity, independent of age, decreased ~38% following bed rest and was restored following REHAB. We found robust age-related differences in muscle atrophy during bed rest, yet older and younger adults equally hypertrophied during REHAB. Interestingly, there were age-related differences in macrophage content (CD68+CD11b+ and CD68+CD11b− cells) but both young and old similarly increased macrophages with REHAB. Satellite cell changes during rehab corresponded to macrophage content changes. Muscle tissue resident macrophages and gene expression, were not associated with changes in insulin sensitivity following bed rest and REHAB. These data suggest that muscle macrophages are modulated as a result of exercise rehabilitation following bed rest and may more associated with muscle regrowth/hypertrophy rather than insulin sensitivity in young or older adults.This trial was registered at clinicaltrials.gov as NCT01669590.

Physiological and Perceived Effects of Forearm or Head Cooling During Simulated Firefighting Activity and Rehabilitation.

Cooling devices aim to protect firefighters by attenuating a rise in body temperature. Devices for head cooling (HC) while firefighting and forearm cooling (FC) during rehabilitation (RHB) intervals are commonly marketed, but research regarding their efficacy is limited. To investigate the physiological and perceived effects of HC and FC during firefighting drills and RHB. Randomized controlled clinical trial. Firefighter training center. Twenty-seven male career firefighters (age = 39 ± 7 years; height = 169 ± 7 cm; weight = 95.4 ± 16.8 kg). Firefighters were randomly assigned to 1 condition: HC (n = 9), in which participants completed drills wearing a cold gel pack inside their helmet; FC (n = 8), in which participants sat on a collapsible chair with water-immersion arm troughs during RHB; or control (n = 10), in which participants used no cooling devices. Firefighters completed four 15-minute drills (D1-D4) wearing full bunker gear and breathing apparatus. Participants had a 15-min RHB after D2 (RHB1) and D4 (RHB2). Change (Δ) in gastrointestinal temperature (TGI), heart rate (HR), physiological strain index, and perceived thermal sensation. The TGI increased similarly in the HC and control groups, respectively (D1: 0.57°C ± 0.41°C, 0.73°C ± 0.30°C; D2: 0.92°C ± 0.28°C, 0.85°C ± 0.27°C; D3: -0.37°C ± 0.34°C, -0.01°C ± 0.72°C; D4: 0.25°C ± 0.42°C, 0.57°C ± 0.26°C; P > .05). The ΔHR, Δ physiological strain index, and Δ thermal sensation were similar between the HC and control groups during drills (P > .05). The FC group demonstrated a decreased TGI compared with the control group after RHB1 (-1.61°C ± 0.35°C versus -0.23°C ± 0.34°C; P < .001) and RHB2 (-1.40°C ± 0.38°C versus -0.38°C ± 0.24°C; P < .001). The physiological strain index score decreased in the FC group compared with the control group after RHB1 (-7.9 ± 1.3 versus -2.6 ± 1.7; P < .001) and RHB2 (-7.9 ± 1.6 versus -3.6 ± 1.1; P < .001), but no differences between groups were demonstrated for ΔHR or Δ thermal sensation (P > .05). The HC did not attenuate rises in physiological or perceptual variables during firefighting drills. The FC effectively reduced TGI and the physiological strain index score but not HR or thermal sensation during RHB. Clinicians and firefighters should not recommend the use of HC during firefighting but can consider using FC during RHB intervals in the field.

Effects of a 4-Week Biomechanical Ankle Platform System Protocol on Balance in High School Athletes With Chronic Ankle Instability

Chronic ankle instability (CAI) describes the residual symptoms present after repetitive ankle sprains. Current rehabilitation programs in the high school population focus on a multistation approach or general lower-extremity injury-prevention program. Specific rehabilitation techniques for CAI have not been established. To determine the effectiveness of a 4-wk biomechanical ankle platform system (BAPS) board protocol on the balance of high school athletes with CAI. Randomized control trial. Athletic training facility. Twenty-two high school athletes with "giving way" and a history of ankle sprains (ie, CAI) were randomized into a rehabilitation (REH) (166.23 ± 0.93 cm, 67.0 ± 9.47 kg, 16.45 ± 0.93 y) or control (CON) (173.86 ± 8.88 cm, 84.51 ± 21.28 kg, 16.55 ± 1.29 y) group. After baseline measures, the REH group completed a progressive BAPS rehabilitation program (3 times/wk for 4 wk), whereas the CON group had no intervention. Each session consisted of 5 trials of clockwise/counterclockwise rotations changing direction every 10 s during each 40-s trial. After 4 wk, baseline measurements were repeated. Dependent measures included longest time (time-in-balance test), average number of errors (foot lift test), average reach distance (cm) normalized to leg length for each reach direction (Star Excursion Balance Test [SEBT]), and fastest time (side hop test [SHT]). Significant group-by-time interactions were found for TIB (F1,20 = 9.89, P = .005), FLT (F1,20 = 41.18, P < .001), SEBT-anteromedial (F1,20 = 5.34, P = .032), SEBT-medial (F1,20 = 7.51, P = .013), SEBT-posteromedial (F1,20 = 12.84, P = .002), and SHT (F1,20 = 7.50, P = .013). Post hoc testing showed that the REH group improved performance on all measures at posttest, whereas the CON group did not. A 4-wk BAPS rehabilitation protocol improved balance in high school athletes suffering from CAI. These results can allow clinicians to rehabilitate in a focused manner by using 1 rehabilitation tool that allows benefits to be accomplished in a shorter time.

PERANCANGAN STRATEGI PENGUATAN IMPLEMENTASI KEBIJAKAN REHABILITASI HUTAN DAN LAHAN STUDI KASUS DI DESA BANGUNJAYA, KECAMATAN CIGUDEG, KABUPATEN BOGOR, JAWA BARAT

This study was conducted to measure the implementation gap of forest and land rehabilitation (RHL) policy against its objectives, namely maintaining life support systems, and designing strategies to strengthen its subsequent implementation. This study took a case study on the implementation of RHL at Bangunjaya Village, Cigudeg District of Bogor. The assessment used three parameters based on Permenhut No P.39/Menhu-II/2010 including regional, institutional, and technological parameters as well as community participation. Each parameter was weighed by the ranking method based on interviews with the experts. The strategy design was conducted using the Analytic Network Process (ANP). The research results showed that the level of successful implementation in Bangunjaya RHL is 66.3%, categorized as medium level. The lowest result is in the technological conformity parameter i.e. 11.57%. The design strategy is focused on increasing the success of the conformity of the technology and increase of community participation. The results of the weighting using ANP strategic priority, the priority strategy for the following RHL policy implementation to reach its target is the strengthening of the capacity in conducting activities and involving the community with a weight of 34.8%. The strengthening of the capacity includes streamlining the RHL paradigm RHL by not only growing but also enriching knowledge of overall forest utilization and technical optimization of land use. Keywords: strategic planning, policy implementation, forest and rehabilitation, Analytic Network Process (ANP)

Medical rehabilitation effectiveness of patients with firstly diagnosed tuberculosis in local regional anti tuberculosis sanatorium

To investigate the medical rehabilitation effectiveness of patients with firstly diagnosed lung tuberculosis in local regional anti tuberculosis sanatorium «Hadyach» there have been formed 2 groups of patients, they are: the experimental group and the control one; the patients of the experimental group have been given complex medical rehabilita tion in sanatorium in addition to routine chemotherapy, and the patients of the control group have had their supportive ambulant care without sanatorium rehabilitation. The antimycobacterial therapy for patients with firstly diagnosed lung tuberculosis accompanied with the complex of rehabilitation methods in local sanatorium significantly improves its effectiveness: the resorp tion frequency increase of focal and infiltrative changes in lungs and the rise of their resorption, the increase of frequency and rate of cavi ties scarring as well as the reduction of residual changes number. There have been subsequent increase of complete recovery cases and the reduction of discontinued treatment cases compared with the patients of control group; it allows reducing the side effects frequency.

MODEL KONSERVASI SUMBERDAYA AIR SEBAGAI UPAYA MEMPERTAHANKAN KEBERLANJUTAN AIR DI SUB DAS AEK SILANG

ABSTRACT&#x0D; Continuous availability of water as a basic requirement for survival and for the purposes of production so need to be maintained. The availability of water resources is strongly influenced by environmental and natural resource management is done by humans. Water resource conservation efforts through the increased role of the parties is expected sustainability of water can be maintained. The research objective is to formulate a model of conservation of water resources and efforts needed for water sustainability can be maintained. Data were collected using questionnaires and interviews, and then analyzed descriptively by using a technique AHP (Analytical Hierarchy Process). The results of the analysis with AHP technique showed that the main priority of the alternative strategy of water resources conservation activities is to preserve water (38.70%). The effort to preserve water is technically civilian conservation, forest and land rehabilitation (RHL), control the use of water, maintenance of water resources and coaching/mentoring for communitie. Keywords: Sustainable water, Water resource conservation, AHP, Preserve water

Practical Tool for Prioritizing Rehabilitation and Preventive Maintenance in Pavements

This paper describes the development of a practical tool for selecting and prioritizing rehabilitation (RH) and preventive maintenance (PM) activities in roadway pavements. The development was based on data collected through a survey of district engineers of the Texas Department of Transportation (DOT). The survey collected data on the key factors used for selecting the projects to be treated and for deciding on RH versus PM treatments: pavement condition and distress scores, average daily traffic, surface age, ride score, and past PM expenditures. Weight factors were developed for each key factor by fitting simple logit curves to data obtained by surveying the 25 Texas DOT districts. These weights were aggregated into a prioritization score for PM treatment and another for RH treatments. This process was implemented into an Excel-based tool. The output of this tool was successfully compared with actual district decisions on the type of treatment applied and the priority assigned to pools of projects.

Stabilitas Hasil Tiga Klon Kopi Robusta Bengkulu sebagai Klon Unggul Lokal

The population of Robusta coffee in Bengkulu province were mostly old thus i t need rejuvenat ion or rehabilitat ion . Local clones of Robusta coffee, such as Sidodadi, Payung Hijau and Payung Kuning, ha ve been cultivated for rehabilitat ion in Bengkulu P rovince at an altitude of >700 m above sea level (asl). This study aimed to analyze the yield stability of the three Robusta coffee clones at medium to high altitudes. The study was conducted from January to September 2015 in Curup Regency (670 m asl) and Kepahiang Regency (900 m and 1300 m asl), Bengkulu Province. The three tested Robusta coffee clones were 5 years old Sidodadi, Payung Hijau, and Payung Kuning ,which propagated through plagiotropic grafting. Each experiment unit consisted of 5 plant samples and were obtained by randomized sampling with 5 replications respectively . The parameters observed were fresh weight of berry/plant, dry weight of beans/plant, fresh weight/berry, and dry weight/beans. The data analyzed using combined variance followed by yield stability test of Eberhart and Russell method. The results showed that Payung Hijau clone had the highest bean yield compared to the other two clones (Sidodadi and Payung kuning). The production of Payung Hijau clone reached 1.19 kg dry weight of bean/plant, 4.31 g fresh weight/berry, and 0.63 g dry weight/bean. Therefore, the Payung Hijau clone was potentially used as scions source for the coffee plantation rejuvenation or rehabilitation .

MTORC1 Nutrient Signaling and Autophagy in Young and Older Skeletal Muscle after Bed Rest and Rehabilitation

Inactivity‐induced skeletal muscle loss coupled with impaired recovery may contribute to sarcopenia in older adults. We have previously observed in older adults after bed rest that essential amino acid (EAA)‐induced mTORC1 signaling was suppressed along with a loss in lean mass. It is unknown if exercise rehabilitation can reverse nutrient impairments and whether there are age‐related differences. We also investigated muscle proteolysis as measured by markers of autophagy. Nine healthy older and 14 young adults participated in a 5‐day bed rest experiment at the local Center for Clinical and Translational Sciences. After bed rest, subjects engaged in an 8‐week eccentric resistance exercise intervention (3x/week) with a protein supplement (4.5g Leu) provided after each session. Thigh muscle biopsies were collected before and after acute EAA ingestion at 3‐time points: before (PRE) and after bed rest and after exercise rehabilitation (REHAB). Leg lean mass decreased (4%) only in older adults after bed rest (P&lt;0.05). Lean mass was restored in older adults after REHAB and increased above PRE in young adults (P&lt;0.05). mTORC1 nutrient signaling was blunted after bed rest in older and younger adults (P&lt;0.05) but returned to PRE levels after REHAB in both groups. p‐AMPKα, LC3II/I, and beclin1 modestly increased in older but not younger adults after bed rest (P&lt;0.05). These data support that exercise rehabilitation can restore bed rest‐induced decrements in mTORC1 nutrient signaling and lean mass. Alterations in mTORC1 nutrient signaling and autophagy may contribute to age‐related differences in muscle loss with bed rest. K01AG038556, AFAR, UL1TR000105

Implication for Designing a REDD+ Program in a Frontier of Oil Palm Plantation Development: Evidence in East Kalimantan, Indonesia

To examine the REDD+ (Reducing Emissions from Deforestation and Forest Degradation) program as an alternative to an oil palm plantation in West Kutai district of East Kalimantan, we determined the profitability of land use and REDD+, and the land use preferences and practices of the local people, as well as their participation in and preferences for forestry programs. Our findings indicate the following: 1) the profitability of an oil palm plantation was higher than that from other land uses and the REDD+ program; 2) the local preferences for land uses were mostly consistent with the profitability of the land uses, except for oil palm plantation due to non-financial concerns; 3) the local people combined each land use in accordance with their various needs; and 4) the local people were interested in a Forest and Land Rehabilitation (RHL) program in nonforestry zones. Considering these evidences, an improved RHL program based on an intensive agroforestry system and a conservation-based REDD+ program based on existing customary conservation forest management by the local people are proposed. Given the high opportunity cost and the low preference for an oil palm plantation, designing the REDD+ program by paying attention to the non-financial benefits for a community is a way forward. To enhance the non-financial benefits, it is important to take into consideration local preferences and livelihood activities in designing the REDD+ program. This study also implies the need for a reconsideration of the position of participation of local people in the safeguards of REDD+.