SUMMARY Seventy‐two normal children aged between three and 12 years were assessed to establish their walking function. Speed of walking and heart rate were monitored continuously, both barefoot and in shoes, over eight consecutive lengths of a 25m walkway. Since heart rate is affected by speed, the physiological cost index (PC1)—which combines the two parameters—was calculated for each child, both barefoot and in shoes. Speed tends to increase and walking heart rate to decrease with age. However, resting heart rate also decreases with age, so the PCI has the same range for all ages. The mean PCI in shoes was 0.4 and barefoot was 0. 38. The PCI for children with pathological gait is appreciably greater than that for normal children, so the PCI is a valuable quantitative indicator of the level of handicap. RÉSUMÉ Index du coût physiologique de la marche chez I'enfant normal et son utilisation comme indicateur dhandicap physique Soixante douze enfants normaux, âgés de trois a 12 ans, ont été examinés pour établir leur fonction de marche. La vitesse de marche et le rythme du coeur ont été enregistrés continuellement, à la fois en marche pied nu et en chaussures, sur huit trajets consécutifs d'une plate‐forme de 25 mètres. Le rythme cardiaque étant modifié par la vitesse de marche, I'index de coût physiologique (ICP) combinant les deux paramètres a été calculé pour chaque enfant, pied nu et en chaussures. La vitesse tend à s'accroitre et Ie rythme cardiaque de marche à décroitre avec I'âge. Cependant, le rythme cardiaque de repos décroit aussi avec I'âge, si bien que le ICP demeure constant pour tous les Lges. L'ICP moyen àété de 0·4 en chassures et de 0·38 pieds nus. L'ICP d'enfants à démarches pathologiques s'est révélé nettement plus élévé que celui de I'enfant normal et I'ICP apparait un indicateur quantitatif valable du degré de handicap. ZUSAMMENFASSUNG Physiologischer Energieumsatzindex beim Gehen für gesunde Kinder und seine Anwendung als Indikator fir körperliche Behinderung 72 gesunde Kinder im Alter zwischen drei und 12 Jahren wurden untersucht, um ihre Funktion beim Gehen zu beurteilen. Gehgeschwindigkeit und Herzfrequenz wurden über acht aufeinanderfolgende Gehstrecken von 25m. sowohl barfuβ als auch in Schuhen kontinuierlich aufgezeichnet. Da die Herzfrequenz durch die Geschwindigkeit beeinfluβ wird, wurde der physiologische Energieumsatzindex (PC1)—der die beiden Parameter verbindet—für jedes Kind für beide Versuchsanordnungen berechnet. Die Geschwindigkeit nimmt mit dem Alter zu und die Herzfrequenz beim Gehen nimmt ab. Die Ruheherzfrequenz jedoch nimmt mit dem Alter ebenfalls ab, sodaβ der PCI für alle Altersstufen denselben Bereich hat. Der mittlere PCI beim Gehen in Schuhen war 0·4 und barfup 0·8. Der PCI bei Kindern mit pathologischem Gang ist betrachtlich höher als der für gesunde Kinder, sodaβ der PCI ein guter quantitativer Indikator für den Grad einer Behinderung darstellt.

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Conceptual and cultural challenges though rare were important, as identified by formal evaluation, demonstrating that cognitive interviewing is crucial in PROM translations. Proportionately fewer problematic items were found for the full than for the simplified translation procedure, suggesting that while both are acceptable, professional PROM translation might be preferable. Coping may be a particularly challenging notion cross-culturally.

BackgroundThe current standard for Prostate Cancer (PCa) detection in biopsy-naïve men consists of 10–12 systematic biopsies under ultrasound guidance. This approach leads to underdiagnosis and undergrading of significant PCa while insignificant PCa may be overdiagnosed. The recent developments in MRI and Contrast Enhanced Ultrasound (CEUS) imaging have sparked an increasing interest in PCa imaging with the ultimate goal of replacing these “blind” systematic biopsies with reliable imaging-based targeted biopsies.Methods/designIn this trial, we evaluate and compare the PCa detection rates of multiparametric (mp)MRI-targeted biopsies, CEUS-targeted biopsies and systematic biopsies under ultrasound guidance in the same patients. After informed consent, 299 biopsy-naïve men will undergo mpMRI scanning and CEUS imaging 1 week prior to the prostate biopsy procedure. During the biopsy procedure, a systematic transrectal 12-core biopsy will be performed by one operator blinded for the imaging results and targeted biopsy procedure. Subsequently a maximum of 4 CEUS-targeted biopsies and/or 4 mpMRI-targeted biopsies of predefined locations determined by an expert CEUS reader using quantification techniques and an expert radiologist, respectively, will be taken by a second operator using an MRI-US fusion device. The primary outcome is the detection rate of PCa (all grades) and clinically significant PCa (defined as Gleason score ≥7) compared between the three biopsy protocols.DiscussionThis trial compares the detection rate of (clinically significant) PCa, between both traditional systematic biopsies and targeted biopsies based on predefined regions of interest identified by two promising imaging technologies. It follows published recommendations on study design for the evaluation of imaging guided prostate biopsy techniques, minimizing bias and allowing data pooling. It is the first trial to combine mpMRI imaging and advanced CEUS imaging with quantification.Trial registrationThe Dutch Central Committee on Research Involving Human Subjects registration number NL52851.018.15, registered on 3 Nov 2015. Clinicaltrials.gov database registration number NCT02831920, retrospectively registered on 5 July 2016.

Standardization of joint examination significantly reduces variability between assessors. The better performance of the 28-joint count is due to the lower number of joints examined, especially the foot joints, which remain difficult to assess reliably even after training.