Two-step Test Research Articles

Correlation of medial longitudinal arch morphology with body characteristics and locomotive function in community-dwelling older women: A cross-sectional study.

This cross-sectional study aimed to investigate the effects of foot arch deformities on physical characteristics, muscular strength, and motor function in older women depending on the presence or absence of pain. Overall, 145 community-dwelling women aged 65 to 90 years were included in this study. We measured the foot arch height ratio (AHR, dorsal height/truncated foot length) and classified participants with AHR values above, below, or within 1.5 standard deviations into the high-arched group (HAG), Low-Arched Group (LAG), or normal-arched group (NAG), respectively. We also compared body characteristics (age, height, weight, body mass index (BMI), and skeletal mass index), muscle strength (handgrip strength and intrinsic foot strength (IFS)), and locomotive function (two-step value and gait speed) among the three groups. Locomotive examination and muscle strength showed significant differences among the three groups only in the presence of pain; in the two-step test, HAG, NAG, and LAG values were 0.98 cm/cm, 1.19 cm/cm, and 1.18 cm/cm, respectively. The IFS measured 19.2 N, 24.2 N, 31.0 N, respectively, in the HAG, NAG, and LAG. This study suggests that decreased IFS affects the mobility function of high-arched feet in older women. Although there was no significant difference in the evaluation of pain, HAG showed the highest average value, which is considered to contribute to the decreased two-step value. It has been suggested that a high-arched foot in the presence of pain is associated with IFS weakness and may affect the decline of mobility function in older women.

The effect of a brief mindfulness intervention on perception of bodily signals of satiation and hunger

An increasing number of studies investigate the effects of mindfulness on food intake and weight outcomes, while the underlying mechanisms by which mindfulness exerts its effects have received less attention. We conducted two pre-registered studies to shed light on the frequently proposed yet largely understudied hypothesis that mindfulness improves awareness of bodily signals of satiation and hunger. We assessed the ability to perceive the onset of bodily signals of satiation with the two-step water load test (Study 1) and the ability to perceive the onset of bodily signals of hunger with the preload test (Study 2). A brief mindfulness exercise (body scan) did not impact the perception of satiation but improved the ability to perceive bodily signals of hunger. After the consumption of a standardized preload, participants in the two experimental conditions felt equally satiated; nevertheless, those in the mindfulness condition perceived the onset of hunger 18min earlier than those in the control condition and this effect persisted also in the presence of control variables. These findings together suggest that even a single and short mindfulness exercise can improve perception of hunger signals substantially, while more intensive mindfulness training may be needed to impact perception of satiation signals.

Osteoporosis Detection by Physical Function Tests in Resident Health Exams: A Japanese Cohort Survey Randomly Sampled from a Basic Resident Registry.

Osteoporosis may increase fracture risk and reduce healthy quality of life in older adults. This study aimed to identify an assessment method using physical performance tests to screen for osteoporosis in community dwelling individuals. A total of 168 women aged 50–89 years without diagnosed osteoporosis were randomly selected from the resident registry of a cooperating town for the evaluation of physical characteristics, muscle strength, and several physical performance tests. The most effective combinations of evaluation items to detect osteoporosis (i.e., T-score ≤ −2.5 at the spine or hip) were selected by multivariate analysis and cutoff values were determined by likelihood ratio matrices. Thirty-six women (21.4%) were classified as having osteoporosis. By analyzing combinations of two-step test (TST) score and body mass index (BMI), osteoporosis could be reliably suspected in individuals with TST ≤ 1.30 and BMI ≤ 23.4, TST ≤ 1.32 and BMI ≤ 22.4, TST ≤ 1.34 and BMI ≤ 21.6, or TST < 1.24 and any BMI. Setting cut-off values for TST in combination with BMI represents an easy and possibly effective screening tool for osteoporosis detection in resident health exams.

Is musculoskeletal pain related to locomotive syndrome even in young and middle-aged adults?

Locomotive syndrome (LS) is the leading cause of persons needing long-term care in old age and is characterized by locomotive organ impairment including musculoskeletal pain. The aim was to examine the association between musculoskeletal pain and LS in young and middle-aged persons. A total of 836 participants (male 667, female 169; mean age 44.4 years) were examined in this cross-sectional study. The LS was evaluated by three screening tools: the two-step test, the stand-up test, and the 25-question Geriatric Locomotive Function Scale. Musculoskeletal pain, exercise habits, physical function (walkability and muscle strength), and physical activity were also assessed. The LS was found in 22.8% of participants. The number with musculoskeletal pain was significantly higher in those with the LS. A significant correlation was found between the degree of musculoskeletal pain and exercise habits. Less regular exercise was significantly associated with higher LS prevalence. Physical activity and function were greater in participants with more regular exercise. Musculoskeletal pain was significantly related to LS even in young and middle-aged persons. The present results suggest that control of musculoskeletal pain and improvement of exercise habits in young and middle-aged persons might help prevent the LS.

Saliva TwoStep for rapid detection of asymptomatic SARS-CoV-2 carriers.

Here, we develop a simple molecular test for SARS-CoV-2 in saliva based on reverse transcription loop-mediated isothermal amplification. The test has two steps: (1) heat saliva with a stabilization solution and (2) detect virus by incubating with a primer/enzyme mix. After incubation, saliva samples containing the SARS-CoV-2 genome turn bright yellow. Because this test is pH dependent, it can react falsely to some naturally acidic saliva samples. We report unique saliva stabilization protocols that rendered 295 healthy saliva samples compatible with the test, producing zero false positives. We also evaluated the test on 278 saliva samples from individuals who were infected with SARS-CoV-2 but had no symptoms at the time of saliva collection, and from 54 matched pairs of saliva and anterior nasal samples from infected individuals. The Saliva TwoStep test described herein identified infections with 94% sensitivity and >99% specificity in individuals with sub-clinical (asymptomatic or pre-symptomatic) infections.

Development of a two-step nucleic acid amplification test for accurate diagnosis of the Mycobacterium tuberculosis complex

The Mycobacterium tuberculosis complex (MTBC) remains one of the top 10 leading causes of death globally. The early diagnosis of MTBC can reduce mortality and mitigate disease transmission. However, current nucleic acid amplification diagnostic test methods are generally time-consuming and show suboptimal diagnostic performance, especially in extrapulmonary MTBC samples or acid-fast stain (AFS)-negative cases. Thus, development of an accurate assay for the diagnosis of MTBC is necessary, particularly under the above mentioned conditions. In this study, a single-tube nested real-time PCR assay (N-RTP) was developed and compared with a newly in-house-developed high-sensitivity real-time PCR assay (HS-RTP) using 134 clinical specimens (including 73 pulmonary and 61 extrapulmonary specimens). The amplification efficiency of HS-RTP and N-RTP was 99.8% and 100.7%, respectively. The sensitivity and specificity of HS-RTP and N-RTP for the diagnosis of MTBC in these specimens were 97.5% (77/79) versus 94.9% (75/79) and 80.0% (44/55) versus 89.1% (49/55), respectively. The sensitivity and specificity of HS-RTP and N-RTP for the diagnosis of MTBC in pulmonary specimens were 96.3% (52/54) versus 96.3% (52/54) and 73.7.0% (14/19) versus 89.5% (17/19), respectively; in extrapulmonary specimens, the sensitivity and specificity of HS-RTP and N-RTP were 100% (25/25) versus 92% (23/25) and 83.3% (30/36) versus 88.9% (32/36), respectively. Among the AFS-negative cases, the sensitivity and specificity of HS-RTP and N-RTP were 97.0% (32/33) versus 90.9% (30/33) and 88.0% (44/50) versus 92.0% (46/50), respectively. Overall, the sensitivity of HS-RTP was higher than that of N-RTP, and the performance was not compromised in extrapulmonary specimens and under AFS-negative conditions. In contrast, the specificity of the N-RTP assay was higher than that of the HS-RTP assay in all types of specimens. In conclusion, the HS-RTP assay would be useful for screening patients suspected of exhibiting an MTBC infection due to its higher sensitivity, while the N-RTP assay could be used for confirmation because of its higher specificity. Our results provide a two-step method (screen to confirm) that simultaneously achieves high sensitivity and specificity in the diagnosis of MTBC.

A dual antibody test for accurate surveillance of SARS-CoV-2 exposure rates

Accurate population surveillance of SARS-CoV-2 infection has been hampered by limited testing and inadequate serological assays. In a recent issue of Med, Hippich et al.1 describe a two-step antibody test with 100% specificity, revealing higher-than-reported SARS-CoV-2 exposure rates in children.

Effect of total hip arthroplasty on improving locomotive syndrome in hip disease patients: A prospective cohort study focused on total clinical decision limits stage 3

BackgroundIn 2020, the Japanese Orthopaedic Association established a new stage 3 in clinical decision limits (CDL) to evaluate the stage of locomotive syndrome (LS). This study focused on total CDL stage 3 with the aim of investigating indicators related to improvements in total CDL by evaluating the improvement of LS in patients who underwent total hip arthroplasty (THA). MethodsOf the 125 patients who underwent THA at our hospital, the subjects of the analysis were 105 patients determined to be total CDL stage 3 in an evaluation performed before THA. LS was evaluated using the stand-up test, two-step test, and 25-Question Geriatric Locomotive Function Scale (GLFS-25). Indicators related to improvements in total CDL were also investigated. All evaluation items were measured before THA and three months after THA. ResultsBefore THA, all subjects (n = 105) were classified as total CDL stage 3. Three months after THA, improvements in total CDL were seen in 49 subjects (46.7%). The results of stepwise multiple logistic regression analysis showed that the before THA stand-up test and GLFS-25 were significantly related to improvements in total CDL. ConclusionsThree months after THA, improvements in LS were seen in approximately half of the subjects. The stand-up test and GLFS-25 can be used as indicators of improvement in total CDL. DesignProspective cohort study design.

Understanding the social identity, motivations, and sustainable behaviour among backpackers: a clustering approach

ABSTRACT In eschewing reductionist segmentation in backpacker research, this study employs multi-dimensional concepts of social identity, motivation and sustainable behaviour to understand different groups of backpackers. The two-step cluster analysis and Kruskal Wallis test performed on a sample of 400 backpackers revealed that there are three segments of backpackers’ social identity, namely Pragmatist, Purist and Eccentric. Each segment is characterised by unique travel motivations and sustainable behaviour. These findings have implications for marketing destinations to different segments of backpackers as well as developing policy programs for promoting sustainable behaviour among backpackers.

Overcoming locomotive syndrome: The Yakumo Study

Objectives Improvement of life expectancy is increasingly important with the aging of society. The aim of the study was to compare physical performance in elderly people in two 3-year periods (2001–2003) and (2016–2018). Methods The participants were healthy Japanese elderly adults who attended public health check-ups in Yakumo. Results for 10 m gait time, two-step test, back muscle strength, and grip strength were examined prospectively for participants in 2001–2003 (Group A: n = 488) and 2016–2018 (Group B: n = 309) by gender and age (65–74 and 75–84 years). Results There were significant differences between Groups A and B for 10 m gait time (age 65–74: male: 5.6 vs. 5.2 s, female: 6.3 vs. 5.5 s; age 75–84: male: 6.1 vs. 5.5 s, female: 6.7 vs. 5.8 s; all p < .05) and two-step test (age 65–74: male: 1.41 vs. 1.48, female: 1.35 vs. 1.44; age 75–84: male: 1.32 vs. 1.41, female: 1.30 vs. 1.38; all p < .05), but not for back muscle strength or grip strength. Conclusion Our results suggest a phenomenon of ‘overcoming locomotive syndrome’, in which physical performance changed by aging, including motor functions such as 10 m gait time and two-step test, has improved in the current population compared with a similar population from 15 years ago.

在宅環境での歩行能力評価としての2 ステップテスト:─信頼性・妥当性の検討および歩行自立に関する基準値の作成─

在宅環境での歩行能力評価としての2 ステップテスト:─信頼性・妥当性の検討および歩行自立に関する基準値の作成─

Stochastic convergence of disaggregated energy consumption per capita and its catch-up rate: An independent analysis of MENA net oil-exporting and importing countries

Investigating the stochastic convergence of energy consumption per capita and its catch-up rate is important for policies in energy demand and supply as well as environmental management, hence, the coming up of this paper with reference to the MENA oil-exporting and importing nations for the period of 1990–2016 using advances in unit root tests including the panel KPSS test with breaks; two-step LM test with breaks and Residual Augmented Least Squares-Lagrange multiplier (RALS-LM) test with breaks. The findings from the panel test revealed stochastic convergence in total, nonrenewable, and renewable energy consumption for all the panels in both groups except the catch-up rate panel of total energy consumption of the net oil-importing nations while the univariate tests in the MENA net oil-exporting nations uncovered stochastic convergence in total (54% of the sample), nonrenewable (54% of the sample), and renewable (70% of the sample) whereas, in the MENA net oil-importing nations, total (64% of the sample), non-renewable (55% of the sample), and renewable (73% of the sample). However, in the catch-up rate of the MENA net oil-importing nations, total (45% of the sample), nonrenewable (73% of the sample), and renewable (73% of the sample). Policy implications were made.

Effects of Cistanche tubulosa Wight Extract on Locomotive Syndrome: A Placebo-Controlled, Randomized, Double-Blind Study.

In an aging society, preventing dysfunction and restoring function of the locomotive organs are necessary for long-term quality of life. Few interventional studies have investigated supplementation for locomotive syndrome. Additionally, very few interventional clinical studies on locomotive syndrome have been performed as placebo-controlled, randomized, double-blind studies. We previously found that the administration of 30% ethanolic extract of Cistanche tubulosa improved walking ability in a cast-immobilized skeletal muscle atrophy mouse model. Therefore, we conducted a clinical study to evaluate the effects of C. tubulosa (CT) extract on the locomotive syndrome. Twenty-six subjects with pre-symptomatic or mild locomotive syndrome completed all tests and were analyzed in the study. Analyses of muscle mass and physical activity were performed based on the full analysis set. Intake of CT extract for 12 weeks increased step width (two-step test) and gait speed (5 m walking test) in patients over 60 years old compared with those in a placebo control (p = 0.046). In contrast, the skeletal muscle mass of the body trunk and limbs was unchanged following administration of CT extract. Adverse effects were evaluated by blood tests; no obvious adverse events were observed following the intake of CT extract. In conclusion, this placebo-controlled, randomized, double-blind study demonstrated that treatment with CT extract significantly prevented a decline in walking ability without any notable adverse effects in patients with locomotive syndrome.

A Brand-New Exclusionary Clause to the Prohibition of Collective Expulsion of Aliens: The Applicant’s Own Conduct in N.D. and N.T. v Spain

In its ruling of 13 February 2020 in N.D. and N.T. v Spain, the Grand Chamber of the European Court of Human Rights (ECtHR or ‘the Court’) found that pushbacks at the Spanish–Moroccan land border comply with Article 4 Protocol 4 of the European Convention on Human Rights (ECHR, or ‘the Convention’), which prohibits the collective expulsion of aliens.1 Finding that Spain had exercised jurisdiction over the events, the Grand Chamber determined that the removals at stake constituted an ‘expulsion’ but lacked a ‘collective’ nature. In reversing the previous ruling of the Chamber,2 the Court added a novel exclusionary clause to Article 4 Protocol 4 and developed a two-step test to establish whether the responsibility of the respondent State should be excluded in cases where applicants (attempt to) enter a Country in an unauthorised manner. The first step is aimed at assessing whether the destination Country...

Identifying preventative measures against frailty, locomotive syndrome, and sarcopenia in young adults: a pilot study.

[Purpose] The purpose of this study was to propose potential preventive measures against future mobility impairments and muscle loss in healthy young adults by comprehensively evaluating their status of frailty, locomotive syndrome, and sarcopenia. [Participants and Methods] A total of 83 Japanese young adults were enrolled in this study and evaluated using the diagnostic criteria for frailty (Japanese version of the Cardiovascular Health Study), locomotive syndrome (calculated as scores of the LOCOMO-25, the stand-up test, and two-step test), and sarcopenia (handgrip strength, usual gait test, skeletal muscle index). [Results] The prevalence of frailty-prefrailty (45.9%) was higher than that of presarcopenia (22.3%) and locomotive syndrome (14.1%). The prevalence of combinations of frailty-prefrailty and presarcopenia; frailty-prefrailty and locomotive syndrome; and frailty-prefrailty, locomotive syndrome, and pre-sarcopenia was 9.4%, 4.7%, and 3.5%, respectively. [Conclusion] Only 40% of the participants did not meet the three diagnostic criteria. On the other hand, there were not many participants with sarcopenia and/or locomotive syndrome diagnoses, suggesting that the improvement in intrinsic skeletal muscle mass rather than physical function is important for healthy Japanese young adults and could possibly be protective against future mobility or muscle-loss disorders.

Remote Online Two-Step Stress Lifetime Acceleration Test System for Ultraviolet Light-Emitting Diodes

Ultraviolet light-emitting diodes (UV LEDs) have been widely applied in various fields, such as sewage treatment, sterilization, and disinfection medical treatment. However, the remained problems of UV LEDs mainly concern poor photoelectric stability, low efficiency, safety protection, and among others. In order to evaluate and predict the stability and lifetime of UV LEDs safely and efficiently, a comprehensive UV LEDs two-step aging test system has been designed in this work. Two steps of different temperature stresses with total aging time up to 720 h are applied to UV LEDs. The junction temperature derived from spectroscopy has been taken under consideration during the test to evaluate lifetime accurately. A smartphone-based remote control and test scheme has been developed to monitor and control the online testing and therefore ensure the safety and convenience during the aging experiment.

The impact of language and quality education on regional and economic development: a study of 99 countries

Language and quality education play an important role in enhancing the development of regions and economies. Education systems and language policies implemented by different countries depend upon their individual political, cultural, historic, and economic characteristics. However, it is important for each country to achieve a degree of harmony between their education and language policies (as is the case of Singapore and Ireland). This could help to improve their economic performance and accelerate the wheels of development. To investigate the impact of quality education and language on different regions and economies, this study used panel data from 99 non-English speaking economies during 2009–2017 period. Following the approach of Barro (1991) and Mankiw et al. (1992), a baseline model was augmented (Augmented Solow model) to include language and quality education indicators. In addition, the model was estimated using the Two-step system GMM test. The test also determined which variables could have a long-term impact on the development of the listed panel data (using STATA 15 software). The findings and estimations reveal that language and quality education have a positive impact on the regions and their economic growth. The impact of primary education quality is more significant than the impact of secondary education quality, while the impact of the English language on the development process is positive but not significant. The policy implications are that decision makers should adopt language policies which complement the education system and the economic strategy of the country.

Smoking history and the efficacy of immune checkpoint inhibitors in patients with advanced non-small cell lung cancer: a systematic review and meta-analysis.

BackgroundSome studies imply a strong correlation between smoking history and the efficacy of immune checkpoint inhibitors (ICIs) in patients with advanced non-small cell lung cancer (NSCLC). Hence, a systematic review and meta-analysis was conducted to comprehensively investigate this correlation.MethodsThree online databases including PubMed, Embase and Cochrane Library were searched. s and presentations from European Society of Medical Oncology (ESMO) and American Society of Clinical Oncology (ASCO) were also reviewed. The deadline of search was Nov 9, 2019. Randomized clinical trials (RCT) of ICIs that reported hazard ratio (HR) for overall survival (OS) or progressive-free survival (PFS) by the smoking status of NSCLC patients were eligible for our study. We focused on publications issued in English. A random effects model was implemented in the synthesis, and a two-step interaction test was used to investigate the difference of ICIs efficacy among patients with different smoking histories.ResultsTwelve RCTs involving 6,497 NACLC patients [5,569 (85.72%) current/former smokers and 928 (114.28%) never smokers] were eligible for our systematic review and meta-analysis. The pooled HRs [95% confidential interval (CI)] of OS and PFS were 0.74 (0.67, 0.81) and 0.72 (0.59, 0.88) respectively for current/former smokers in the experimental group with ICIs versus those in the control group. The pooled HRs (95% CI) of OS and PFS were 0.81 (0.60, 1.08) and 0.92 (0.55, 1.54) respectively for never smokers in the experimental group with ICIs compared with those in the control group. The difference of ICIs efficacy in terms of OS between current/former and never smokers was insignificant [interaction HR (95% CI), 0.77 (0.69, 0.86), I2=25.4%, P_hetero=0.21].ConclusionsThe efficacy of ICIs in patients with smoking history is seemingly superior over patients without smoking history, but insignificantly. The difference can be explained by several factors such as insufficient sample size of non-smokers, and confounding factors. We suggest that smoking history cannot be recognized as a predictor of immune therapy in advanced NSCLC.

Experimental and Mathematical Optimization of a Pooling Test for Detection of SARS-CoV-2 in a Population with Low Viral Load.

BackgroundA pooling test is a useful tool for mass screening of coronavirus disease 2019 (COVID-19) in the pandemic era. We aimed to optimize a simple two-step pooling test by estimating the optimal pool size using experimental and mathematical validation.Materials and MethodsExperimental pools were created by mixing one positive respiratory sample with various numbers of negative samples. We selected positive samples with cycle threshold (Ct) values greater than 32 to validate the efficiency of the pooling test assuming a high likelihood of false-negative results due to low viral loads. The positivities of the experimental pools were investigated with a single reverse-transcription polymerase chain reaction (RT-PCR) using the U-TOP™ COVID-19 Detection Kit Plus (Seasun Biomaterials, Daejeon, Korea). We used the Dorfman equation to calculate the optimal size of a pooling test mathematically.ResultsViral RNA could be detected in a pool with a size up to 11, even if the Ct value of a positive sample was about 35. The Dorfman equation showed that the optimal number of samples in a pool was 11 when the prevalence was assumed to be 0.66% based on the test positivity in Daejeon, Korea from April 1, 2020 to November 10, 2020. The efficiency of the pooling test was 6.2, which can save 83.9 of 100 individual tests.ConclusionEleven samples in a pool were validated optimal experimentally assuming a prevalence of 0.66%. The pool size needs modification as the pandemic progresses; thus, the prevalence should be carefully estimated before pooling tests are conducted.

88. Impact of a Computerized Clinical Decision Support Tool on clostridioides Difficile Testing and Oral Vancomycin Utilization as a Balancing Metric

BackgroundOver diagnosis of hospital-onset Clostridioides difficile infection (HO-CDI) is directly tied to inappropriate C. difficile testing which does not distinguish between infected or colonized individuals. This can lead to inappropriate therapy. Multiple studies have utilized Computerized Clinical Decision Support (CCDS) tools to reduce inappropriate C. difficile testing. Our study looks at the impact of a Self-Assessment CCDS tools on C. difficile testing for HO-CDI and oral vancomycin utilization as a balancing metric.MethodsOur institution utilizes a two-step test to diagnose HO-CDI that consists of toxin A/B enzyme immunoassay followed by a confirmatory PCR. We applied a self-assessment driven CCDS approach to reduce testing for HO-CDI. Our intervention was deployed in the 3rd quarter of 2018. It asked 3 questions about stool frequency, laxative use and previous C. difficile testing in the order itself. Inappropriate indications for testing included any of the following: < 3 bowel movements within 24 hours, receipt of a laxative within the past 48 hours, or a previous C. difficile test within the previous 7 days. Ordering providers would self-answer these questions. A ‘yes’ response to any of the three questions prevented further test ordering; though respondents had the freedom to change the answer and still proceed with the test order. We evaluated 3 metrics that were all calculated per 1000 inpatient census days: oral vancomycin usage, HO-CDI rates and C. difficile testing rates.ResultsCompared to baseline, our intervention resulted in a significant reduction of C. difficile testing and HO-CDI rates (Figure 1, Table 1). Oral vancomycin usage also decreased significantly (Figure 2, Table 1).Figure 1. C. difficile testing and Hospital Onset C. difficile Infection Rates by Month, Before and After Intervention Figure 2. Oral Vancomycin Utilization by Month, Before and After Intervention Table 1. Changes in Median Rates of C. difficile testing, Hospital Onset C. difficile Infections and Vancomycin Utilization, Before and After Intervention. ConclusionOur self-assessment driven CCDS-based diagnostic stewardship resulted in a significant reduction in inappropriate C. difficile testing for HO-CDI and HO-CDI rates. Oral vancomycin utilization as a balancing metric also decreased significantly. This was despite the use of a self-assessment driven approach with the freedom to change the answers in order to proceed with the test order.Disclosures All Authors: No reported disclosures