Ephemera (Sinephemera) glaucops Pictet, 1843 has been considered regionally extinct in the Czech Republic, with the last occurrence dating from 1933. Its extinction was connected with the anthropogenic changes of lowland rivers, forming the original habitat of E.glaucops within the area of the Czech Republic. However, the species has been reported as spreading in man-made, often post-industrial waterbodies in Germany, The Netherlands and Austria since the 1970s.The mayfly E.glaucops from the Czech Republic, based on 27 larvae collected in the North Bohemia lignite basin in 2018. All individuals were found at one locality – a small kaolin pit in the shallow part near the shore, mostly without macrophytes. We provide details about the locality and morphological diagnostic characters of E.glaucops. This study highlights the importance of post-industrial sites for aquatic biodiversity as surrogate biotopes for degraded original habitats.We report  Ephemeroptera) assemblages have been affected by profound anthropogenic changes of freshwater habitats over the last century, which often resulted in local or regional species loss (e.g. Ephemeraglaucops (family Ephemeridae). It disappeared from the territory of the Czech Republic early in the 20th century, with the finding from the Elbe River published by The mayfly  danica Müller, 1764, Ephemera (Ephemera) lineata Eaton, 1870 and Ephemera (Ephemera) vulgata Linnaeus, 1758. Two of these species, E.vulgata and E.danica are common, whereas E.lineata is very rare and considered endangered . At each locality, we selected three sites of different microhabitats and sampled them by standardised methods: box trap and time standardised (5 min/site) sweeping with a kitchen strainer to maximise species capture . We alsoPictet, 1843AAAC5765-3094-52DD-937C-9B8F04CE7ADFEphemeraglaucops Pictet, 1843; Hist. nat. gen. part. Ins. Névropt., p. 132Ephemera (Sinephemera) glaucops Pictet, 1843 in Kluge (2004)Ephemera (Sinephemera) glaucops Pictet, 1843 in Bauernfeind and Soldán (2012)See general Discussion below.E.glaucops were collected in a single locality, a kaolin pit near the village of Hudcov . The measured mean values of physico-chemical parameters in the sites, where E.glaucops was found, were as follows: temperature 21.6°C, conductivity 1000.5 µS.cm-1, pH 8.58, dissolved oxygen 9.47 mg.l-1, substrate pH 6.7 and water transparency 37.7 cm. Fish, namely native Anguillaanguilla, Rutilusrutilus, Cyprinuscarpio and non-native Pseurodasboraparva, were observed at the locality . Most individuals (26) were sampled with a boxtrap and only one individual was collected by sweeping with a strainer.A total of 27 larvae of The material was preserved in denaturised ethanol (EtOH) and identified using the keys of Ephemera distributed in the Czech Republic, the larvae of E.glaucops can be distinguished by the colouration of the abdomen . In our specimens of E.glaucops, we also noted a characteristic shape of clypeus, with strongly divergent lateral margins  vulgata Linnaeus, 1758, walking/sprawling species Caenisluctuosa  and Caenishoraria  and fish-like active species Cloeon (Cloeon) dipterum  s.l. and Cloeon (Similicloeon) simile Eaton, 1870 s.l.; they are all very common in the Czech mayfly fauna  River near Cheb  and odonates, which found suitable conditions in these man-made habitats, probably due to the degradation of natural wetlands. However, the biota of kaolin pits is still unknown with the exception of dragonflies and aquatic beetles (Our study shows the remarkable value of post-industrial sites for aquatic biodiversity, which is well-known for terrestrial biota . Many re beetles . On the  beetles .E.glaucops, we recommend regular small-scale disturbances of shallow parts of the waterbody to slow down succession, especially by removing macrophyte vegetation as E.glaucops prefers the early successional stage. On the other hand, the disturbances should be applied in a mosaic i.e. with parts left overgrown, as different groups of organisms could have different habitat requirements (e.g. As an effective means of management to increase the abundances of nts e.g. .


Cancer progression is associated with the evolutionary accumulation of genetic mutations that are biologically significant. Mutations of the androgen receptor (AR) are associated with the development of prostate cancer (PCa) by responding to non-androgenic hormones, and the lack of annotations in their responsiveness to hormone ligands remains a daunting challenge. Here, we have used a yeast reporter system to quickly evaluate the responsiveness of all fifty clinical AR mutations to a variety of steroidal ligands including dihydrotestosterone (DHT), 17β-estradiol (E2), progesterone (PROG), and cyproterone acetate (CPA). Based on an AR-driven reporter that synthesizes histidine, a basic amino acid required for yeast survival and propagation, the yeast reporter system enabling clonal selection was further empowered by combining with a random DNA mutagenesis library to simulate the natural evolution of AR gene under the selective pressures of steroidal ligands. In a time-frame of 1–2 weeks, 19 AR mutants were identified, in which 11 AR mutants were validated for activation by tested steroidal compounds. The high efficiency of our artificial evolution strategy was further evidenced by a sequential selection that enabled the discovery of multipoint AR mutations and evolution directions under the pressure of steroidal ligands. In summary, our designer yeast is a portable reporter module that can be readily adapted to streamline high-throughput AR-compound screening, used as a PCa clinical reference, and combined with additional bioassay systems to further extend its potential. Androgens are a group of steroid-type sex hormones that regulate secondary sexual characteristics through interacting with the androgen receptor. Androgen-activated androgen receptor has been linked to prostate cancer progression, thus steroid drugs structurally similar to but different from androgens are clinically used to block androgen activation and to treat prostate cancers. However, mutations of the androgen receptor occur in clinics. As a result of some of these mutants, the steroidal hormone drugs become inactive and even by themselves can activate the androgen receptor exacerbating the disease conditions. Due to lack of an efficient screening method, how other clinical mutants respond to various steroidal hormone drugs remain unknown. Here, we developed a yeast-based system that allows high throughput study of the interaction between each hormone drug and androgen receptor mutant by eye-ball observation of yeast colony formation. Using this method, we thoroughly investigated all 50 clinically relevant mutants of the androgen receptor and how they individually respond to each of a variety of hormone drugs. Furthermore, the capacity of this system allowed us to perform random mutagenesis and quickly accumulate high volume of data regarding a large number of mutants, informative in guiding future precision medicine to treat prostate cancer. Cancer progression is an evolutionary process in association with stepwise mutations conferring the advantages of cell survival and proliferation –6 IntratAR is a nuclear hormone receptor that plays a central role in prostate cancer tumorigenesis and therapy –18. AberSaccharomyces cerevisiae) previously developed by us [A yeast reporter system -TATACYC1-lacZ) was cultivated in YPAD medium . YRG-2 transformants co-harboring AR-LBD mutants and SRC-1 were cultured in synthetic complete medium  without tryptophan and leucine supply (SC-Trp-Leu). The Hep3B cell lines were cultured at 37°C and 5% CO2 in Dulbecco’s Modified Eagle Medium (DMEM) supplied with 10% charcoal-stripped fetal bovine serum (CSS).600) was measured in 96-well plates by a SpectraMax M2e plate reader (Molecular Devices). For liquid yeast assay, yeast cultures were diluted with synthetic complete medium without tryptophan, leucine and histidine supply (SC-Trp-Leu-His) to a cell density roughly at 4 ×104 cells per milliliter . Steroidal ligands purchased from Sigma-Aldrich  were dissolved in ethanol and supplemented into 200 μL of diluted yeast cultures at indicated concentrations. Ligand-stimulated yeast cultures were then subjected to a static cultivation at 30°C in 96-well plates (200 μL of yeast cultures per well). OD600 values were measured 21–60 hours post-incubation. For plate yeast assay, diluted liquid yeast cultures with an initial cell density of 106 cells per milliliter  were subjected to ten-fold serial dilutions. Five microliters of each dilution were spotted on SC-Leu-Trp-His agar plates supplemented with appropriate steroidal ligands. Plates were photographed 2–3 days after static incubation at 30°C. For most liquid and plate yeast assays, an addition of 25 mM of 3-amino-1,2,4-triazole (3-AT) was added appropriately to the medium to inhibit the leaky expression of HIS3.This is a modification of a previously described yeast assay . In brieSite-directed mutagenesis on AR-LBD, and the construction of plasmids expressing cytomegalovirus (CMV) promoter-regulated full-length AR mutants for mammalian cells were performed as previously described .via error-prone polymerase chain reaction (PCR) with primers LBD-Library-F (5’-taa caa agg tca aag aca gtt gac tgt atc gcc ggg atc cgc ccg gaa gct gaa gaa act-3’) and LBD-Library-R (5’- taa atc ata aga aat tcg ccc gga att agc ttg gct gca gtc act ggg tgt gga aat aga-3’). Plasmids containing wild-type AR-LBD (pBD-AR_LBD) and Taq DNA polymerase purchased from Tiangen were employed in the error-prone PCR as DNA templates and DNA polymerases, respectively. Approximately 0.8 mM of Mn2+ was added to the Taq DNA polymerase buffer to achieve the highest single-point-mutation rate in each PCR product. The mutagenized PCR fragments were digested with BamHI and PstI and inserted into the same sites in backbone plasmids, pBD-GAL4-cam. The ligation products were transformed into E. coli. Then, plasmid libraries harboring various AR mutants were isolated from pools of E. coli transformants, and co-transformed with SRC-1-expresing plasmids, pGAD424-SRC1, into YRG-2 stains. The library of yeast clones was selected on SC-Trp-Leu-His agar plates supplemented with appropriate steroidal ligands without the presence of 3-AT. Surviving clones were respectively subjected into an overnight cultivation in liquid SC-Trp-Leu medium with shaking. Due to the large number of clones, water-washed overnight cultures were directly diluted 100-fold with SC-Trp-Leu-His medium without the measurement and adjustment of OD600 values. Liquid yeast assays were then performed. Plasmids carried in yeast clones with high-ranking OD600 values were isolated and used as DNA templates in a PCR amplification of LBD region in AR genes. PCR products were then subjected to a Sanger sequencing to identify mutagenized AR-LBD fragments. Identified AR mutants were re-transformed individually into the parental designer yeast, YRG-2, together with plasmid pGAD424-SRC1. The responsiveness of these AR mutants to related steroidal ligands were finally determined using yeast assays in the presence of 3-AT. The simulation of second-round AR evolution was performed in the same process.The library of mutagenized AR-LBD fragments was generated Hep3b cells was performed using Invitrogen Lipofectamine 3000 Transfection Reagent according to the manufacturer’s directions with a 3:1 ratio of regent to DNA (3 μL of Lipofectamine per 3000 μg of DNA). A day before transfection, Hep3B cells were seeded in 24-well plates at a density of 105 cells/well in DMEM containing 10% CSS. Four hours before transfection, the medium was replaced with DMEM containing 2% CSS to eliminate any possible disturbance generated by serum hormones. A plasmid expressing firefly luciferase under the control of an androgen-responsive promoter mouse mammary tumor virus (MMTV-LUC), pGL3-MMTV-LUC, was co-transfected into Hep3B cells with plasmids expressing full-length (FL) AR and plasmids expressing Renilla luciferase (pRLTK), an internal control in the dual luciferase assay. The medium was replaced with fresh DMEM containing 2% CSS 6 hours after transfection. The vehicle regent  and steroidal ligands were added to the medium 24 hours post-transfection. Cells were harvested 48 hours post-transfection, washed twice with phosphate-buffered saline (PBS) and resuspended in passive lysis buffer supplied by the kit, Dual-Luciferase Reporter Assay System (Promega). The AR-responsive activities of firefly luciferase normalized to Renilla luciferase activities were obtained according to manufacturer’s instructions.The assays were conducted as previously described with slight modifications . The traThe three-dimensional structure of AR-LBD from Homo sapiens (hAR_LBD) in complex with various ligands was downloaded from the RCSB protein database to characterize the AR_LBD structures. hAR_LBD-DHT (PDB ID: 2ama) were selected in this study. In addition, complex structural alignment and analysis were performed with Pymol software.HIS3 reporter system driven by the interaction between AR-LBD and steroid receptor coactivator-1 (SRC-1) that allows effective monitoring of the responsiveness of disease-associated AR mutants to clinical AR antagonists [HIS3 gene encoding histidine, an essential amino acid needed for yeast survival and propagation (LUC) reporter system [LUC reporter in human Hep3B cell lines lacking endogenous AR expression  agonists . In the pagation . In compr system –32 was dion Figs  and S1.Hep3B cells with the designer yeast growth profiling indicated a positive correlation in terms of responsiveness of mutants  to each specific compound . These n system . Differen system . These pA plate assay demonstrated that even in the absence of any added steroidal ligand, a few out of 10,000 cells harboring the wild type AR-LBD (LBD-WT) were able to form visible colonies presumably due to leaky expression of HIS3 . Such liAmong 56 clinically recorded AR mutations listed in 6 colonies. We isolated DNA from a pool of 100 random colonies and confirmed by targeted amplification and sequencing that the mutation rate of the LBD mutant library was 84%  ,56 to ra was 84% . LBD-WT  was 84% . In orde was 84% . EventuaAs a result of the above AR simulation assay, 19 LBD single-point mutations that confer substantial yeast growth were identified. To clarify complications arising within the host under the pressure of long-term culture, we individually re-transformed each of these AR mutants into the parental designer yeast. With the presence of 25 mM 3-AT, we performed the liquid assay in 6 replicates as well as the plate assay on these AR mutants . In compAR-LBD contains 12 helices: helix 3, 5, and 11 (red) envelop the ligand-binding pocket (LBP), and loops 1–3 (green) and 11–12 (green)/helix 12 (red) gate access to LBP . Based o600 values of liquid yeast cultures  as the template for a second round of screening, which was again based on EP-PCR in conjunction with designer yeast. This iterative experimental design allowed assessing additional and multipoint LBD mutations that may shed light on the direction of AR gene evolution.The mutation rates of the secondary AR-LBD mutant library based on EP-PCR were 84% for M750L, 86% for K778E, and 83% for E873D, respectively . Once agAR-LBD mutations altering ligand specificity are known drivers of PCa progression, leading to distant metastasis or therapeutic resistance ,58,64–68This yeast reporter system is highly efficient, allowing clonal identification of single mutations generally not possible in mammalian reporter systems. The yeast platform can be used in both solid and liquid media formats, conferring convenience in data visualization and quantitation. Based on our designer yeast, we were able to score and rank responsiveness of AR mutants to distinct compounds. By combining our designer yeast assay with EP-PCR, we demonstrated its potential in high-throughput screening of mutants to steroidal compounds. In addition, this strategy enables simulation of iterative AR natural selection based on sequential artificial evolution screening. Together, our designer yeast platform can simulate AR natural selection and streamline the functional annotation of AR mutations in the public domain.Notably, in a time-frame of roughly 1–2 weeks our system readily scored 19 AR-LBD missense mutations, in which 11 mutants individually validated by re-transformation highly reacted with ligands. Of significance, five verified LBD mutations have been recorded in clinical AR databases, accounting for about 10% cases that were chronicled over a 22-year period. One prominent clinical mutant identified in both initial and second round of screenings using our yeast system, AR-T878A, is a well-known PCa-relevant driver . We alsoWe esteem our designer yeast as a powerful and portable AR-LBD/compound screening module. The yeast system is unique by offering a clean background against complicated mammalian protein–protein interactions and by allowing clonal selection that is generally unachievable in mammalian reporter systems. Although this Y2H system can be biased by the interaction of LBD with a single AR co-activator (SRC-1), it confers high interaction stringency. Moreover, our yeast-based strategy can help bridge the gap between personalized medicine and ever expanding digital bioresources, as exemplified by genomic sequencing and protein structure computation datasets. The application potential of our designer yeast can be realized in combination with additional biological techniques and bioassay systems. With the system we developed in this study, we were able to perform multiple rounds of random AR mutations followed by selection for histidine auxotrophy in the presence of various steroidal compounds mimicking natural evolution of cancer cells under selection pressures by steroid medications. Thus, this system can be adapted to predict the continuous process of cancer development related to the accumulation of AR mutations in response to medical treatments and other clinically relevant challenges. Based on these rationales, we envision the integration of our method into PCa clinical practice and therapeutic references.S1 FigMouse vas deferens protein (MVDP) promoter was used as a negative control for MMTV promoter. Bars indicate mean ± s.d.(TIF)Click here for additional data file.S2 Fig600 values of liquid yeast cultures (without the presence of 3-AT) were measured 21 h post-incubation. Bars indicate mean ± s.d. (n = 2).A preliminary dose-dependent test for (TIF)Click here for additional data file.S3 FigPlate pictures were taken 48 h post-incubation.(TIF)Click here for additional data file.S4 FigPlate pictures were taken 48 h post-incubation.(TIF)Click here for additional data file.S5 FigT878A was a E2/PROG/CPA-responsive AR mutant (n = 4 in liquid yeast assays).(TIF)Click here for additional data file.S6 Fig−8 M DHT, 10−5 M PROG, 10−5 M E2, and 10−5 M CPA. The heatmap represents the OD600 values of liquid yeast cultures measured 21 h post-incubation (without the presence of 3-AT).Distribution of secondary AR-LBD mutant library based on M750L, K778E, and E873D templates, respectively. Again, 94 high-ranking yeast colonies were selected for each ligand, followed by DNA isolation and sequencing to identify additional mutations. Ligands: 10(TIF)Click here for additional data file.S7 FigBars indicate mean ± s.d. (n = 3).(TIF)Click here for additional data file.S1 DataThe R codes as well as the relevant numerical values were described in this .docx file.(DOCX)Click here for additional data file.S2 Data(XLSX)Click here for additional data file.


Artificial intelligence can bring convenience to human life. In the field of sports rehabilitation, the application of artificial intelligence is becoming more and more in-depth. This paper is aimed at studying the prevention and detection of sports rehabilitation in the context of artificial intelligence and proposing a compliance control method for lower limb rehabilitation robots based on artificial neural networks. In this paper, a double closed-loop control system is designed: the outer loop is an adaptive impedance control model based on sEMG feedback, and the purpose is to adjust the predicted desired joint trajectories. In the inner loop, a sliding mode iterative learning controller is designed to suppress periodic disturbance and abnormal jitter and achieve stable tracking of the target trajectory. Finally, the control method is simulated and verified by matlab/simulink, and a statistical experiment is done on the patient's recovery. The experimental results show that the use of artificial intelligence technology can effectively increase the sensitivity of the control system and improve the recovery rate of patients. Compared with the traditional sports rehabilitation control system, the sensitivity is increased by 22.7%, and the patient recovery rate is increased by 10.4%, which is of great significance in the field of sports rehabilitation. In real life, sports rehabilitation is not only for people with sports injuries; it can also help patients with musculoskeletal system injuries, patients after orthopaedic surgery, and even some subhealthy people. Sports rehabilitation is a branch of rehabilitation medicine, and its essence is the integration of “sports” and “medicine.” Sports rehabilitation is a multidisciplinary professional, including equipment rehabilitation therapy, manual rehabilitation therapy, and active exercise of patients to repair sports injuries. Traditional rehabilitation training mainly relies on the manual training of rehabilitation physicians. It not only has low rehabilitation efficiency but also is limited by the clinical experience of rehabilitation physicians in terms of training intensity, training effect, and patients' subjective emotions. Due to the lack of timely and clear understanding of the emotional state of stroke patients, it is easy to make patients feel disgusted in the overall rehabilitation treatment, which is even more unfavorable for rehabilitation treatment. This is also the drawback of traditional rehabilitation treatment.AI is capable of developing artificially constructed human consciousness and thought patterns, and it can replace humans in some jobs. At present, many countries in the world, such as the United States, Japan, and Germany, use artificial intelligence technology to bring convenience to the field of human life. The development level of artificial intelligence also represents the development level of the country to a certain extent. The update and application of artificial intelligence science and technology have brought a profound impact on the development of people and society , 2. WhetThis topic aims at the rehabilitation of limb motor function and extracts the features of motor imagery EEG signals. In-depth research on feature selection and the design and implementation of sports rehabilitation training system can lay a foundation for the application of sports rehabilitation training system. It not only has very important theoretical significance but also has very high application value.C-means (FCM) clustering algorithm that incorporate local spatial neighborhood information into image segmentation ; therefore, the function expression of Sigmoid is:Artificial neurons need data processing from input to output. b1~bn represent the input of the neuron, w1~wn are the weights of each synapse of the neuron, and e neuron . In gene(2) tanh function: the tanh function is an improvement of the Sigmoid function. Compared with the Sigmoid function, the mean value of the tanh function is 0. And in practical applications, the tanh function has better performance than the Sigmoid function, and its function expression is:(3) Relu function: Relu function is a widely used activation function in recent years, and its function expression is:The derivative of the sigmoid function is:(4) Leaky-Relu function: the Leaky-Relu function is to overcome the disadvantage that the Relu function may lead to the failure of neurons when it is used as an activation function. The expression of the Leaky-Relu function is as follows:Compared with the Sigmoid function and the tanh function, the Relu function has the advantages of fast convergence when using the SGD algorithm and does not need to use the exponential function, so the calculation is simple . Howeverβ is a constant with a small value, so that the Leaky-Relu function retains the gradient when the function value is less than 0 without changing the data distribution, thereby avoiding the situation of neuron failure  ∈ RKP1×; here, K = 93.After LCD processing the 22-channel EEG data, 9 ISC components can be obtained. It performs Hjorth feature extraction on these 31 signal data, extracts 3 features for each channel, and then obtains the time-frequency domain feature In order to enable patients to recover their exercise ability better and faster, according to the guidance of the theory of rehabilitation medicine, when the muscle strength of the patient is almost zero in the early stage of rehabilitation, the robot will drive the patient to perform passive training at a certain speed. In the middle of the training, when the patient recovers part of the muscle strength, the robot will assist the patient to maintain a certain speed for assistive training. At the end of the training, the patient is actively training, and the machine does not provide assistance or resistance to increase muscle strength. Therefore, this paper designs three training methods: passive, assisted, and active .Of the three training methods, passive training is relatively simple. The circular motion of the patient driven by the robot at a constant speed can be regarded as position control, with the desired rotational speed as the input. It is a single-input single-output position control system with the actual speed as the output. There are many control methods to achieve this, commonly used are PID control, feedforward plus PD control, and calculation torque method . Their cPID control is as shown in In passive training mode, the rotation speed of the crank is used as the desired input value, and the patient or physician can set the desired rotation speed. After PID control, the actual speed of the crank fluctuates within the desired speed range, so theoretically, the patient can be driven for passive training .n-degree-of-freedom manipulator is:x is the joint angle vector; τ is the joint drive torque vector; M(x) is the coefficient of inertial force; g(x) is the gravity term.PID control is relatively simple, mainly in the determination of PID parameters . In addiτd is the expected driving torque calculated by inverse dynamics; α is the difference between the actual angle of the crank joint and the expected angle; and Lp, Lv are the coefficients of angle difference and speed difference, respectively.Formula  establisx is the joint angle vector; τ is the joint drive torque vector; V is the coefficient of inertial force; g(x) is the gravity term; α is the difference between the actual angle of the crank joint and the expected angle; and Lp, Lv are the coefficients of angle difference and speed difference, respectively.The calculated torque method is similar to the feedforward + PD control algorithm, except that the PD feedback operation is performed before the inverse dynamics calculation. The algorithm of the calculated torque method is shown inMd, Bd, Ld are the inertia matrix, damping matrix, and stiffness matrix; Fd, Fe are the expected and actual forces between the robot end and the environment.The assisted and active training mode is the process in which the patient and the robot work together to help the patient carry out rehabilitation training. When it comes to human-computer interaction, the patient and the machine exchange energy. Compliant control is necessary to ensure patient safety. The compliance control can be classified into the category of force control, and the commonly used force control methods include impedance control, force-position hybrid control, adaptive control, and fuzzy control . ImpedanThere are generally two ways to implement impedance control, one is force-based impedance control, and the other is position-based impedance control. Force-based impedance control is performed in the outer loop by detecting the position of the end of the manipulator, which calculates the theoretical actual contact force according to the robot dynamics model. It then achieves the desired position through an inner loop force controller, the control block diagram shown in The impedance control algorithm adopted in this paper is the position-based impedance control, and an impedance control algorithm is designed . The staY′ is the position correction amount of the outer ring; L−1 is the inverse Laplace transform; l is the crank length; and Md, Nd, Ld are the impedance parameters. In the formula, Y′ is the position correction amount of the outer ring; Yd is the desired position value; and kp, ki, kd are the PID parameters;In the formula, In the experiment, 5 Ag/AgCl electrodes were used to record the EEG signals on the scalp, and the distribution of all channels is shown in The dataset includes four imaginary movements of the left hand, right hand, feet, and tongue. 6 subjects recorded EEG datasets on two different days. Each dataset consists of 6 separate data strings separated by a rest period. Each data string contains 48 experiments, 12 experiments for each type of imaginary movement. So a dataset has 288 experiments.During the experiment, the subjects sat in front of the computer and conducted the experiment according to the computer prompts. An experiment lasts 14 seconds, and the experiment sequence is shown in t = 0, a circle is displayed on the black screen, and at the same time, a short sound will remind the subjects to start the experiment. At t = 3.75 s, there will be an arrow up, down, left, or right  to prompt the subject's imagining task. At t = 6 s, the arrow disappears. There was no feedback during this process, and the subjects performed motor imagery until the cross disappeared at t = 10 s.At During the experiment, the electrode sampling rate was 250 hz, and the signal was processed with a band-pass filter of 0.5 hz-100 hz and a notch filter of 50 hz. The dataset for each subject can be divided into two parts, the dataset train and evaluation, which, respectively, include 288 experiments.In order to remove the artifact interference and improve the signal-to-noise ratio of the signal, it is necessary to filter the EEG signal first before extracting features. In this chapter, according to the characteristics of ERD and ERS, the data in the dataset is filtered at 8-30 Hz to remove interference. According to the literature, the data of 2.5 s-3.5 s is selected for classification processing, and the signals before and after filtering are shown in z with the greatest contribution are selected from the five groups of signals. The LCD time-frequency decomposition is performed on it, and each channel is decomposed to obtain 3 ISC components, a total of 9 ISC components. According to the method, frequency domain features are extracted for these 9 ISC components. Aiming at the problem of large amount of calculation in LCD and high dimension after feature fusion, three channels C3, C4, and CF1 and F2 are fused into feature F, which is sorted by MCFS and then input to the SDRA classifier for training and testing.The original 5 groups of EEG signals and 9 ISC components are integrated, and then, spatial features and time-frequency domain features are extracted for the integrated signals. Finally, the two feature vectors The control strategy of the hand rehabilitation robot designed in this paper is based on active control, and the core of active control is impedance control. The control system recognizes the external input force of the system and outputs the desired motion position to the position controller via the variable impedance control system. The specific process is described in the third part. Now, through the hand rehabilitation platform, the control method of active motion is tested. In theory, the motion control trajectory output by the impedance system designed in this paper is less sensitive to external forces. It focuses more on following the given ideal training trajectory. In order to verify whether the designed variable impedance system can complete the designed trajectory following target, the experiment of the motor following the ideal trajectory is now carried out. In this experiment, the input value of the force sensor is set as a series of random numbers that are automatically generated by the program and vary within a given range. No graphic description is given here, the motor steering controller based on passive motion design is removed, and the output of the motor encoder is collected, as shown in The experimental results show that the peak value of motor one is higher, and the average value of motor one is 22.7% higher than that of motor two, which indicates that the sensitivity of motor one under artificial intelligence intervention is higher than that of motor two. It can be seen that in terms of motor control, the rotation of the motor is composed of a continuous sinusoidal curve. It proves that the impedance control link of the designed active rehabilitation system can be learned through the fuzzy neural network. It adjusts the system impedance to achieve the goal of controlling the motion trajectory to follow the ideal trajectory.In the experiment, training actions rated 1 to 5 were selected for testing. After calculation, the DTW distance and HD distance are obtained, respectively, and then, the confidence level assigned by the system (this paper sets DTW(0.60) : HD(0.40)), the algorithm fusion calculation is performed, and the comprehensive rating of action flow matching is obtained. The experimental results show that the recovery rate of patients under artificial intelligence intervention has been significantly improved, which is 10.4% higher than that of traditional sports rehabilitation training.Although the control system has been verified by Matlab/Simulink simulation in this paper, and good static and dynamic characteristics have been obtained, there is still a lack of experimental data verification in the experiment of the stand-up exercise rehabilitation training process. Next, the control method will be verified by physical experiments, and further work will be done to realize the practical application of the control system faster.In terms of rehabilitation training strategies, although a systematic rehabilitation model has been established, a lot of work is still needed in the construction of patient database software. And the database software construction work needs to be perfected through many experiments.According to the traditional rehabilitation training evaluation method, in the final rehabilitation effect evaluation, the patient's physical feeling during the whole rehabilitation training process, that is, the degree of pain, should be considered.Artificial intelligence technology has been gradually applied to the field of sports rehabilitation because of its imitation, realization, and expansion of human intelligence behavior characteristics. Through a preliminary summary of the application of artificial intelligence in sports rehabilitation scientific research, assessment technology, and treatment technology, the work ideas and scientific research innovation in the field of rehabilitation will be expanded. First, AI provides a better means for sports rehabilitation scientific research. Second, the application of AI makes rehabilitation assessment more intuitive and accurate. Third, the application of AI in sports rehabilitation technology liberates therapists and makes treatment easier. With the continuous improvement and maturity of artificial intelligence, the intelligent direction of sports rehabilitation will become a new development trend in the future.


A total of 27% of the workforce were community service therapists and 61% of therapists earned a production-level salary. Occupational therapy was best (40%) and speech and audiology therapy least (7%) represented. Three percent of therapists worked at primary level, versus eighty percent at secondary level. Forty percent of therapists worked in rural areas. Workforce density per province ranged from 0.71–0.98 per 10,000 population. Overall, results show that the rehabilitation workforce density is low, and that the distribution of therapists between rural and urban settings, and levels of care, is inequitable. Considering the rise in rehabilitation need, prioritisation and strengthening of the rehabilitation workforce capacity is vital to ensure integration across all levels of care and service.The World Health Organisation emphasises the importance of addressing gaps in health systems where rehabilitation services are poorly integrated. In South Africa, regions with the largest disability rates are usually the areas where rehabilitation is least accessible, due to inadequate workforce capacity. The first step towards addressing workforce capacity is to determine current capacity. This paper presents a cross-sectional study to describe rehabilitation workforce data in the public sector of three rural South African provinces. A web-based therapist survey and a telephonic facility survey was conducted. Data were collected regarding total number of therapists per province, age, years employed, qualifications, salary level, profession type, level of care, and rural/urban distribution. Descriptive statistics were conducted, while Chi-squared tests compared professions regarding highest qualification and salary level. Population-adjusted ratios were calculated using national uninsured population statistics. The web-based survey had 639 responses while the telephonic survey reported on 1166 therapists. Results indicated that the mean age of therapists across the respective provinces was 28, 35 and 31 years of age, and the mean employment years in the respective provinces were three, eight and five years. Most of the workforce ( World Health Organisation (WHO) Rehabilitation 2030: A Call for Action emphasises the need to address the gaps in health systems where rehabilitation services are not well integrated, ref. [The ed, ref.  to achieed, ref. ,3,4. Rehed, ref. . Howevered, ref. . It is ted, ref. . Thus, red, ref. ,3.The WHO developed the Rehabilitation in Health Systems: A Guide to Action (‘The Guide’) to assist countries or regions in assessing their baseline rehabilitation capacity . The GuiA rehabilitation workforce that is determined by a population’s needs—and thereby equitably distributed—is a vital component to achieving UHC ,13. In SIdentifying the gaps in rehabilitation workforce capacity data and providing baseline data will assist with the assessment of the rehabilitation workforce , particuThe first step towards improving rehabilitation workforce capacity data is to determine the current rehabilitation workforce capacity, especially in underserved, rural regions. This paper reports on a cross-sectional study to describe the rehabilitation workforce data on the number of therapists, distribution by population, type of therapists, qualification level, and distribution between rural and urban settings, salary levels and levels of care, in the public sector of three rural provinces in SA.A cross-sectional study using a web-based and telephonic survey was conducted between 2020 and 2021. The study was commenced in March 2020 but was halted due to lockdowns and institutional restrictions which barred the continuation of non-COVID related research for at least 6 months in 2020.We designed a web-based survey using a Research Electronic Database Capture (REDCap) form for therapists to provide detailed information see . This weThis study is a sub-study of a project on assessing the capacity of rehabilitation in SA according to WHO’s recommendations in The Guide. This project has been conducted in partnership with the NDoH and WHO’s SA office. A concept note was developed at the start of the project with the NDoH who have provided support throughout this study and the capacity assessment project.REDCap is a secure, web-based software platform designed to support data capture for research studies hosted at Stellenbosch University ,19. REDCEthical approval was obtained from the Stellenbosch University Health Research Ethics Committee (N19/04/048). Permissions were obtained from participating provincial Departments of Health (DoH) and the provincial rehabilitation managers. All participants granted voluntary informed consent to participate in the study.The study was conducted in three of SA’s rural provinces, referred to as P1, P2 and P3. These three provinces have the highest rural population rates  and the The study population was limited to the rehabilitation workforce working at all levels of care  in SA’s DoH public sector. These included audiologists, dually qualified speech and audiology therapists (SAT), occupational therapists (OT), physiotherapists, speech and language therapists (SLT), and physiotherapy or OT assistants and technicians , social media platforms , and personal communication via the DoH rehabilitation and district managers in the participating provinces.The three provincial DoH rehabilitation managers were consulted regarding the most feasible communication strategies to reach therapists (for the web-based survey) and facility managers (for the telephonic survey). One week before commencing data collection in each province, the research team used short video clips via the suggested communication channels to explain the project aims, rationale and how the therapists should complete the survey.Data were collected and managed via the web-based survey (tailored REDCap form) or in PDF format. The survey, accessed via a web link, consisted of two screens. The first screen consisted of seven data fields including informed consent details and personal details. The second screen consisted of 50 data fields which related to employment demographics. Adaptive questioning  was added so that participants were required to complete only 12 data fields.Not all therapists completed the web-based survey. Thus, the telephonic survey was used to obtain accurate data on the number and level of therapists at each facility in the province. The current national public system’s staff database (PERSAL) could not be used due to inaccuracies of the data—the number of posts are often reflected inaccurately or other health professionals are appointed in therapists’ positions . The telAt least one stakeholder meeting was held with facility managers (who were familiar with the rehabilitation workforce information at their facility), district managers, provincial managers, and participating therapists to verify the collected rehabilitation workforce data.To encourage therapists to attend the feedback session, therapists could obtain continuous professional education points for attending the session which provided information and background on the project. The first data validation meeting was face-to-face, but due to COVID-19 restrictions, subsequent validation meetings were conducted online. Data, which excluded personal identifiers, were downloaded from REDCap (web-based therapist survey) into MS Excel and cleaned for analysis. REDCap allows the online creation of reports, where one can select the desired data to download. This allows the researcher to only download relevant data and all personal information can therefore be omitted. Descriptive statistics were calculated and presented using tables and graphs for visualisation. Population ratios (for provinces and districts) were presented using population statistics as reported by Statistics of SA . The ratn = 639/1166). In P1 the response rate was 76% (n = 286/377). P2 had the lowest participation rate of 22% (n = 100/454). P3 had a participation rate of 71% (n = 253/355).The response rate of the web-based therapist survey  was 55% (p < 0.000) in the highest qualification between professions (see n = 16/39). OT also had the highest percentage of master’s degrees . Only one physiotherapist had a doctoral degree, and one OT had a postgraduate diploma.There was a significant difference  per salary level and across all three provinces are shown in p < 0.000) in the salary levels between professions. The largest percentage of community service therapists was observed within the SLT profession (48%), and the lowest within the SAT profession (15%).n = 1166) is shown in n = 252; 40%) of all therapists in the three provinces. SAT contributed the smallest number of therapists .The percentage of professions for each of the three provinces based on the telephonic facility survey  and secondary level (n = 51). At tertiary level, physiotherapy (n = 76) had the largest number of therapists and at primary care OT have the highest number (n = 18). Many of the facilities at secondary level conducted outreach to primary care facilities.The percentage of professions per level of care from the telephonic facility survey is depicted in n = 470) and the other 60% (n = 696) of the therapists worked in urban facilities. Different distribution when comparing urban and rural were noted between the provinces. In P1, 16% (n = 60) versus 57% (n = 257) of the therapists in P2 worked in rural facilities. In P3, the number of therapists working in rural areas was less than in urban areas by 8% (n = 29).The uninsured population (80%) was calculated using the data provided in the 2016 Community Survey . Figure The highest number of profession type per 10,000 uninsured population per provincial district was OT at 0.68 in district nine, while the lowest number of therapists is 0.01 for audiology in district one, two and eight and SLT in district two see .n = 149) therapists.The districts with the higher populations tended to have a larger number of therapists see . For exaWe described the rehabilitation workforce in the public sector of three rural SA provinces. Overall, the rehabilitation workforce capacity of the three provinces is severely lacking in quantity and have large disparities in the workforce distribution between levels of care and across the urban/rural divide. The bulk of the workforce comprised of production level and community service therapists, the rehabilitation workforce was relatively young (high twenties to mid-thirties) and on average, therapists were employed for less than nine years at their current facilities.Population adjusted ratios are routinely reported as a metric to describe the rehabilitation workforce density ,25,26,27We also presented the distribution by type of therapists per population. Two studies conducted in SA on the profile of OTs , and SLTDespite being an upper middle-income country, the ratio of therapists to population in SA compares to lower middle-income countries such as Bangladesh  . The phyThe number of therapists were extremely low in primary care see . SimilarAn inequitable distribution of therapists was found between urban and rural facilities with more than half of the rehabilitation workforce being situated in urban areas see . The recThe NDoH have attempted various strategies such as a compulsory community service year and rural allowance to improve recruitment and retention to rural areas. This has improved the staffing crisis in some areas in the short-term. Khan et al. (2009) reported the willingness of therapists to work in rural areas beyond their community service year when they begin but changed their minds by year-end . Many thNewly qualified therapists are thrown into the deep end and expected to make a difference with minimal or non-existing supervision and support from other professions or management. The mean ages from our study see  show thaThe rehabilitation workforce capacity of the three provinces included in the current study is severely lacking in quantity and have large disparities in the distribution of the workforce between levels of care and across the urban/rural divide. This description of the rehabilitation workforce can be generalised to other rural provinces and are comparable to national figures in SA. Although SA is an upper middle-income country, the rehabilitation workforce capacity is similar to the capacity in LMICs. This is extremely concerning as minimal rehabilitation workforce are available in the areas with the most vulnerable populations. With an increase in rehabilitation need and an inequitable distribution of the rehabilitation workforce, the future of rehabilitation services in the public sector does not look very promising for the most vulnerable persons in our population.About 40% of the therapists did not complete the web-based therapist survey. Therefore, the data on qualification, age, salary level and years worked at their current facility was limited to only those who completed the web-based therapist survey, and this could have introduced bias. The study was limited to quantitative data and did not include the quality or efficiency of the rehabilitation services. This was a cross-sectional study and therefore we were unable to describe the trends over time and the impact of COVID-19 on the rehabilitation workforce capacity. We collected data over one year, as the data collection was disrupted by the COVID-19 restrictions. The data collection in P1 was completed before COVID-19, while the data collection in P2 and P3 were conducted once lockdown levels were eased. This increased time period between data collection in the provinces may have had an impact on the change of the data due to COVID-19 which was not accounted for in this study. The study included three rural provinces and therefore we were unable to compare the data between rural and urban provinces. The data collected was limited to the public sector and therefore excluded the workforce in other sectors such as the private sector or non-governmental organisations. Although it would have been useful to interpret the workforce distribution in terms of the number of people with disabilities in SA, accurate data to base such a discussion on are lacking—i.e., data regarding the precise number and distribution of persons with disability in SA. This lack of data is a result of a major limitation in determining true levels of disability in SA, namely that disability prevalence surveys are usually based on reported disability—often by a proxy informant—which may over- or underestimate the prevalence . There iAs this study was only conducted in three provinces and the overall response rate of the web-based therapist survey was about 40%, not all the demographics of the therapists could be validated. Primary and longitudinal studies should therefore be conducted to develop strategies to enable reliable real-time data. The mean age of the rehabilitation workforce and the percentage of community service therapists suggests that the workforce is young inexperienced. As this is a quantitative study, the quality of the services and competency of the workforce cannot be determined. Qualitative studies should be conducted which aim to understand more about the quality of rehabilitation services, the needs of the population and the competencies of the rehabilitation workforce. Rehabilitation has been excluded from most major policies and guidelines and are therefore not integrated at all levels of care and in rural areas. Research on the cost of rehabilitation services and the rehabilitation workforce should be conducted to assist policy makers and the NDoH in including rehabilitation in policies and planning . The results from this study included only rehabilitation workers in the public health sector. To obtain a clearer understanding of the overall rehabilitation workforce capacity in SA, future research should include the private health sector and other ministries such as the department of education. Further research on a rehabilitation workforce capacity building should also be conducted. This research should be conducted in collaboration with the NDoH involving governance and should include data on policies, disability and rehabilitation, and social welfare.The aim of this study was to describe the rehabilitation workforce in the public sector of three rural provinces in SA. The rehabilitation workforce was described according to the age and number of therapists, years worked at facility, the distribution by population, the type of therapists and qualifications, the distribution between urban and rural, salary levels and levels of care. This study found that there is a low density of rehabilitation workforce and an inequitable distribution of therapists between rural and urban and levels of care, with the lowest number at rural and primary care. The rehabilitation workforce working in these three provinces is relatively young and inexperienced. This means that the population with the greatest need for rehabilitation has the poorest access to rehabilitation services. With the increasing need for rehabilitation, it is vital that the rehabilitation workforce capacity is strengthened and prioritised, ensuring integration at all levels of care and services.


Wildlife rehabilitation centres contribute to the conservation of wildlife by caring for sick, injured and orphaned animals that would not survive in the wild without human help, and releasing healthy animals back into the wild in appropriate habitats. A total of 4388 European hedgehogs, identified as pre-weaned from normally timed litters (NL PRE), post-weaned from normally timed litters (NL POST), pre-weaned from late litters (LL PRE) and post-weaned from late litters (LL POST) were admitted to 27 wildlife rehabilitation centres in the Czech Republic in the period from 2011 to 2020. Where the outcome of rehabilitation care was known, young admitted before natural weaning were associated with a high mortality rate, especially in those from late litters. Among the four groups, the juveniles of the NL POST category experienced the lowest mortality (14%) with the highest release rate (86%). In contrast, LL PRE experienced the highest mortality (46%) with the lowest release rate (54%).Erinaceus europaeus) is in decline. Wildlife rehabilitation centres contribute toward the protection of debilitated hedgehogs, including the young. Based on data from 27 wildlife rehabilitation centres, the mortality rate and the release rate of juvenile hedgehogs were evaluated depending on whether they were from normally timed litters (admitted from April to September) or from late litters (admitted from October to March). A total of 4388 juvenile European hedgehogs were admitted to wildlife rehabilitation centres in the Czech Republic from 2011 to 2020. The number of post-weaned young from late litters admitted (28%) did not differ from the number of pre-weaned young from late litters (29%). Where the outcome was known, young from late litters had the highest mortality rate (46%) in the year of admission. The release rate was the highest in post-weaned young from normally timed litters (86%). Further research should focus on the definition of optimal care and treatment of the underlying causes for admission of juvenile hedgehogs. The reproductive strategy (the timing of litters) of European hedgehogs under the climatic conditions of the Czech Republic affects the chance of survival of young at wildlife rehabilitation centres and likely also in the wild.Previous research from several European countries has indicated that the European hedgehog ( Erinaceus europaeus) is an insectivore that inhabits a large part of Europe [The western European hedgehog  admitted to wildlife rehabilitation centres in the Czech Republic before weaning and after weaning in the years 2011 to 2020, and to determine whether the timing of their birth  influenced their survival chances in care. In addition, interpreting the results in a wider context to discuss how to optimise the conservation effort based on the hand-raising of orphaned, sick or injured juvenile hedgehogs.The aim of this study was to categorise the groups of juvenile western European hedgehogs (Erinaceus europaeus) admitted to wildlife rehabilitation centres in the Czech Republic were obtained from the Ministry of the Environment, which is responsible for the work of wildlife rehabilitation centres and keeps records on the animals for which these facilities care. As these rescue centres are part of the National Network of Rescue Centres, which cooperates with the Ministry of the Environment, the recording system is unified. The data include information on the number of admitted animals, the dates and reasons for admission, and voluntary information on the weight or age of the animal and the place of finding if it is known. These records contained data on the numbers of juvenile European hedgehogs admitted from 2011 to 2020, the reasons for their admission to wildlife rehabilitation centres, and the dates on which these juveniles were admitted to and the outcome, e.g., whether they were released back into the wild or died . A total of 27 wildlife rehabilitation centres in the Czech Republic provided data for the study. Identification of admitted species, including distinguishing between the two native hedgehog species of the Czech Republic (Erinaceus europaeus and E. roumanicus), and recording characteristics of each individual, were the responsibility of the rehabilitation centres’ certified experts.Data on juvenile western European hedgehogs (We included data on reason for admission into care and weight at admission for juvenile European hedgehogs for the purpose of this study. The juvenile hedgehogs were divided by weight at admission into the categories pre-weaned (1–250 g) and post-weaned (251–400 g) young. Furthermore, the juvenile hedgehogs were divided by date of admission into the categories “young from normally timed litters” (young admitted from April to September) and “young from late litters” (young admitted from October to March). This division was based on calculation of the gestation period (5 weeks) and the age of weaning (5–6 weeks) according to Bexton : young fFor the young with known outcome, the proportion of young released after care and young that died or were euthanised during care was calculated to establish the release rate and mortality rate: the proportion of juveniles released and juveniles that died or were euthanised in care compared to the total number of hedgehogs admitted in the given group . Out of the 4388 juvenile hedgehogs registered in the records, only 3441 individuals had information on the outcome of the care . Therefore, the remaining 947 individuals were excluded from the data analyses on survival and duration of time in care. The duration of care at the wildlife rehabilitation centres was analysed for individuals that were subsequently released back into the wild, in the cases where date of admission and date of release were stated in the records. The duration of care was calculated as the number of days between these two dates.p < 0.05 was determined to be statistically significant.Statistical analysis was performed in the statistical program UNISTAT 6.5 for Excel . The data according to the normality test have a non-normal distribution, thus non-parametric tests were used. Spearman’s coefficient was used to assess the trend in the number of young admitted in a given period, and a Fisher’s exact test was used for evaluation of the difference in the numbers of young admitted in individual groups  and for comparison of the numbers of young released and young that died or were euthanised. Kruskal–Wallis ANOVA was used for the assessment of the duration of admission to the wildlife rehabilitation centre. In the tests used, the value of p< 0.001). A significantly lower number (p < 0.001) of NL POST  young were admitted in comparison with all the other groups  in mortality rate and release rate between NL PRE and LL POST.The lowest mortality rate was found in NL POST juveniles , for which the highest release rate was also found (86%) .. In conp < 0.001) than in NL POST and LL POST young  (The length of stay in NL PRE (median 41 days) and LL PRE (median 41 days) young was significantly longer (ctively) .The number of European hedgehogs admitted to wildlife rehabilitation centres has been on the increase in recent years, with their admission to wildlife rehabilitation centres in the UK doubling in the period 2005–2017 . The offErinaceus europaeus) and the northern white-breasted hedgehog (E. roumanicus), which can be challenging to distinguish from each other, as they share a range of similar features. Our study focuses exclusively on Erinaceus europaeus. Our data derives from the records of 27 wildlife rehabilitation centres, where the carers have identified the individuals as European hedgehogs. Even though this categorisation cannot be validated, we acknowledge that all wildlife rescue centre staff in the Czech Republic must have a certificate from the Ministry of the Environment, which also includes an exam on identifying species living in the Czech Republic. In the case of E. europaeus, this includes distinguishing them from E. roumanicus based on morphology.The Czech Republic is inhabited by two species of hedgehogs, the European hedgehog  and LL PRE (29%)). These young are still dependent on their mother’s care. However, every small (<250 g) hedgehog should not necessarily be considered orphaned and in need of care. These results suggest that dependent juvenile hedgehogs are often admitted to wildlife rehabilitation centres regardless of the timing of the litter. The ability to identify juvenile hedgehogs truly in need of human care is important, as they may otherwise be taken to wildlife rehabilitation centres needlessly. It has been shown that the capture of wild animals may itself lead to their death due to causes like capture myopathy or infection transmitted from the other patients ,26. FurtSeveral signs can be recognised in pre-weaned young indicating that they could need care. These include the finding of an isolated juvenile or a litter of juveniles with individuals weighing less than 200 g, being active during the day, vocalising, or having light-coloured and soft spines . Such yop < 0.001) period of time at the centre than young admitted after weaning. Pre-weaned young from both normally timed and late litters spent a median of 41 days at wildlife rehabilitation centres before being released back into the wild. Hedgehog young in the wild are weaned at the age of 5–6 weeks [The demands of hand-rearing pre-weaned hedgehog young are evidently also associated with the fact that young admitted to wildlife rehabilitation centres before weaning spent a significantly longer (–6 weeks . Young ap < 0.001) lower ; the results may also be affected by fewer number of admitted post-weaned hedgehogs form normally timed litters. The smaller number of individuals from late litters released may have been influenced by the fact that the date of their release from the wildlife rehabilitation centre would have fallen in the winter, i.e., during the hibernation period, leaving the registration as “unknown” in the record. Despite research demonstrating that hedgehogs can successfully be released during winter when the conditions are suitable [Unfortunately, not all juvenile hedgehogs admitted to the wildlife rehabilitation centres could be released back into the wild. Some died while in care and some had to be euthanised due to severe injuries or poor prognosis. Age upon admission and the timing of the litter also influenced the outcome: Although more than a 70% of young from normally timed litters admitted were released back into the wild in the same year , the numbers of pre-weaned animals released from late litters were significantly  lower proportion of NL POST hedgehogs admitted than LL POST. We suggest that even though these animals may have the same weight, the juveniles from late litters are considered more at risk by the public because of the approaching winter. This is causing members of the public to regard even large, healthy and independent juvenile hedgehogs as threatened and requiring human care simply because they remain active in the late autumn. The admission of seemingly healthy individuals belonging to the LL POST category could also be explained by the inability of members of the public and even hedgehog carers to distinguish between independent and dependent juvenile hedgehogs. The law in the Czech Republic requires rehabilitation centres to provide education to the public and thus participate in the protection of species in the wild including examples of the work of these centres and information materials.The public plays a large role in the admission of animals to wildlife rehabilitation centres by reporting findings of animals requiring human care to the staff of these centres or by bringing sick, injured or orphaned animals to the centres. Fewer NL POST than NL PRE juvenile hedgehogs were admitted to rescue centres, which may be due to public education stating that only young weighing less than 250 g that are found alone may need help, as opposed to young weighing more than 250 g. The situation may be different for young found in autumn, which raises concerns in people as to whether the juvenile hedgehog will be able to put on the necessary weight needed for hibernation. The results indicated a significantly (The issue of an adequate weight before hibernation is well known, and many wildlife rehabilitation centres, along with other organisations contributing to the protection of European hedgehogs and other wildlife species, issue manuals containing information about how to identify individuals that require human help. Hibernation is a demanding period during which the animal uses a large amount of energy . AccordiWildlife rehabilitation centres contribute towards maintaining populations of wild species of animal by caring for sick, injured or orphaned wildlife. The reproduction of European hedgehogs in the Czech Republic is influenced by climatic conditions, and young born in normally timed and late litters may have different care demands and survival chances. Although juvenile hedgehogs from normally timed litters can be released successfully back into the wild in most cases, the mortality rate is higher in pre-weaned young from late litters at the wildlife rehabilitation centres. As female hedgehogs often give birth to two litters per year in the Czech Republic, and the population of European hedgehogs is in decline, further efforts must be made to improve the care for juvenile hedgehogs, particularly before weaning, to increase the survival, and therefore also the release rate, of these animals.


Парциальная форма синдрома резистентности к андрогенам (СРА) является наиболее сложным вариантом нарушения формирования пола 46,XY  в плане выбора тактики ведения пациента. До настоящего времени не существует четких биохимических критериев, особенно в допубертатном возрасте, позволяющих дифференцировать данное заболевание от других форм НФП 46,XY, и молекулярно-генетическая диагностика парциальной формы СРА играет решающую роль. Между тем, по данным литературы, более чем у 50% пациентов с подозрением на СРА мутации в кодирующей области AR выявить не удается. Нами проведен расширенный анализ гена AR у пациента с клинико-лабораторными признаками СРА и обнаружена глубокая интронная мутация в гене AR (с.2450–42G>A). Данная замена привела к формированию альтернативного сайта сплайсинга и, как следствие, нарушению функции AR. Описанный случай свидетельствует о необходимости углубленного генетического анализа в когорте пациентов с подозрением на СРА при отсутствии у них мутаций в гене AR при использовании стандартных методов молекулярно-генетической диагностики. Xq11–12) и состоит из 8 экзонов. Заболевание является Х-сцепленным и проявляется только при кариотипе 46,XY, тогда как матери пациентов являются носителями мутации и не имеют никаких клинических проявлений. В зависимости от степени нарушения функции рецептора клинически выделяют полную, неполную, или парциальную, и мягкую формы СРА , что Ниже мы описываем случай парциальной формы СРА, обусловленной глубокой интронной мутацией в гене AR (с.245–42G>A), приведшей к формированию альтернативного сайта сплайсинга.Пациент М.: при рождении диагностирована мошоночная форма гипоспадии, двусторонний паховый крипторхизм, в ходе цитогенетического исследования установлен кариотип 46,XY, на основании чего пациент зарегистрирован в мужском паспортном поле. Из анамнеза известно, что брак родителей не близкородственный, семейный анамнез отягощен (дядя по материнской линии оперирован по поводу гипоспадии и гинекомастии) (рис. 1). В допубертатном возрасте проведены оперативные вмешательства: двусторонняя орхипексия и пластика уретры в 3 этапа. С 11-летнего возраста отмечено прогрессирующее развитие грудных желез, перераспределение подкожно-жировой клетчатки по феминному типу. При обследовании в возрасте 13 лет: половое развитие по Таннеру: G2Р2B3, половой член искривлен, длина до 3 см, кавернозные тела развиты слабо, тестикулы в мошонке, D=S ~6–8 мл, в гормональном профиле: лютеинизирующий гормон (ЛГ) — 5,0 Ед/л , фолликулостимулирующий гормон (ФСГ) — 0,9 Ед/л , тестостерон — 17,8 нмоль/л , эстрадиол — 120 пмоль/л (мальчики II ст. по Таннеру 20–100). По данным ультразвукового исследования малого таза: дериваты мюллеровых протоков не визуализировались. При проведении пробы с хорионическим гонадотропином отмечено адекватное повышение андрогенов , что позволило исключить нарушение биосинтеза тестостерона как возможную причину НФП. На основании полученных данных диагностирован «синдром резистентности к андрогенам, парциальная форма». Учитывая мужской пол воспитания, проведена двусторонняя мастэктомия, к терапии добавлены блокаторы ароматазы.Для верификации диагноза проведено секвенирование гена AR по Сэнгеру, однако патологических вариантных замен выявлено не было. При дополнительном молекулярно-генетическом анализе методом высокопроизводительного параллельного секвенирования (IonTorrent) с использованием таргетной панели «Нарушения формирования пола 46,XY» (43 гена) патологически значимых изменений также выявлено не было.Учитывая клинико-лабораторные данные, свидетельствующие о наличии парциальной формы СРА при отсутствии изменений в каких-либо других генах-кандидатах, ассоциированных с НФП 46,XY, предположено наличие варианта нуклеотидной последовательности, влияющего на сплайсинг. Подобные замены по аналогии с другими заболеваниями  могут раJ. Morris в 1953 г. впервые опубликовал описание серии случаев СРА (80 случаев из литературы и 2 собственных наблюдения), когда у пациентов при женском фенотипе имелись тестикулы , и ввел http://www.hgmd.cf.ac.uk/ac/index.php]. Между тем, как отмечают некоторые авторы, несмотря на наличие у пациентов четких клинико-лабораторных данных, предполагающих СРА, идентифицировать мутации при секвенировании кодирующей области гена AR удается не всегда: в ~95% случаев при полной форме и менее чем в 40% случаев при парциальной форме заболевания ..http://wВ литературе имеются единичные описания СРА вследствие глубоких интронных мутаций, для которых доказано влияние на сплайсинг, и обнаружение которых при стандартном методе анализа гена AR невозможно 11–13]. –13. 11] Обращает на себя внимание, что все описанные выше случаи СРА, обусловленные нарушением сплайсинга вследствие глубоких интронных мутаций, приводили к преимущественной экспрессии аберрантного транскрипта, что клинически проявилось развитием полной формы СРА. В нашем случае результаты секвенирования кДНК свидетельствуют о преимущественной экспрессии транскрипта дикого типа, что может объяснять развитие парциальной формы СРА.Важно отметить, что, несмотря на редкость описаний глубоких интронных мутаций как причины возникновения СРА, в 2018 г. H. Ono и соавт. при обследовании семьи с парциальной формой СРА в двух поколениях выявили вариант нуклеотидной последовательности в той же позиции, что и в представляемом нами случае. Авторами также была показана преимущественная экспрессия транскрипта дикого типа в сравнении с мутантным . Таким оПредставленное нами наблюдение и данные литературы свидетельствуют об ограничениях стандартного подхода к молекулярно-генетическому анализу гена AR, при котором проводится секвенирование экзонов и участков интронов в области экзон-интронных стыков. Учитывая, что геномная протяженность гена AR составляет более 186 500 пар нуклеотидных оснований, которые преимущественно занимают интроны, и лишь 2763  соответствуют кодирующей последовательности, вероятность наличия патогенных мутаций глубоко в интронах достаточно высока. Анализ гена AR является основополагающим в диагностике СРА, от результатов которого при парциальной форме заболевания зависит выбор пола воспитания ребенка. Между тем «отрицательный» результат по данным стандартного молекулярно-генетического исследования не может полностью исключить нарушение функции AR. Анализ транскриптов AR, экспрессируемых в фибробластах в доступных андрогензависимых участках кожи, может быть ценным дополнительным методом обследования, который будет способствовать улучшению качества диагностики при НФП 46,XY.Исходя из вышеописанного, можно предположить, что использование более сложных методов молекулярно-генетической диагностики при дообследовании пациентов с клинико-лабораторными данными СРА, но не имеющих генетического подтверждения в ходе использования стандартных методов молекулярно-генетической диагностики позволит выявить большее число глубоких интронных вариантных замен нуклеотидных последовательностей, приводящих к СРА. Возможно, выявленный нами вариант транзиции G в A, являясь более частым, чем трансверзии, может оказаться «горячей» точкой, а не редким вариантом причины СРА.Источники финансирования. Работа выполнена при содействии Фонда поддержки и развития филантропии «КАФ».Конфликт интересов. Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с содержанием настоящей статьи.Участие авторов. Калинченко Н.Ю. — концепция и дизайн исследования, сбор материала, анализ данных, написание текста; Петров В.М. — анализ данных, интерпретация результатов; Панова А.В. — анализ данных, интерпретация результатов; Тюльпаков А.Н. — концепция и дизайн исследования, интерпретация результатов, внесение в рукопись существенной правки с целью повышения научной ценности статьи. Все авторы одобрили финальную версию статьи перед публикацией, выразили согласие нести ответственность за все аспекты работы, подразумевающую надлежащее изучение и решение вопросов, связанных с точностью или добросовестностью любой части работы.Согласие пациента. Добровольное информированное согласие пациента на публикацию в журнале «Проблемы эндокринологии» получено.Благодарности. Выражаем благодарность Фонду поддержки и развития филантропии «КАФ» за помощь в проведении исследования.


Contemporary myocardial infarction (MI) care and management has evolved dramatically since the 1950’s; yet outpatient rehabilitation remains underutilized. Deepening our understanding of the origins and history of cardiac rehabilitation highlights a contemporary shift required for policy and practice related to secondary prevention of coronary disease in light of societal changes as well as medical, digital and surgical advancements. Contemporary “cardiac rehabilitation” began when bed rest and physical inactivity was recommended and commonplace for MI survivors. Today, most patients who survive an MI, undergo reperfusion therapy, a short inpatient stay and are discharged with minimal physical morbidity. Despite this, the majority of modern day programs continue to be structured in the same way they have been for the past 50 years and this model has become incongruent with the contemporary context, especially in the COVID-19 era. This review aims to describe the historical foundations of cardiac rehabilitation to inform solutions and meet the demands of contemporary MI management. Delivering health systems reform to address modernization is current healthcare challenge where a united and interdisciplinary effort is needed. Cardiovascular disease (CVD), including coronary heart disease (CHD) and stroke, is the leading cause of death and disease burden globally . It is eUnderstanding the historical context can inform our understanding of cardiac rehabilitation and its potential in the future. This includes deepening understanding of why current programs are formatted as they are and how this has failed to adapt with changed needs of societies where there has been major changes in culture, language and diversity coupled with a rapid expansion in availability of technology along with major changes in medical and surgical management of CVD in recent years. The aim of this review is to summarize the historical context of cardiac rehabilitation in order to highlight areas for modernization and reform. That is to put in context the timing of changes in acute care and the lack of change in cardiac rehabilitation during the same time period highlighting the subsequent gaps in health services and systems at the present time. The overall timeline is summarized in absolute rest in bed for not less than a month is imperative to allow healing of the infarct and to reduce the risk of embolism….convalescence will therefore be prolonged and the return to ordinary life postponed as long as possible”  and its associated treatment evolved dramatically around the mid-twentieth century. The coronary circulation was first recognized in the early 17th century and angina pectoris first described in the 18th century, but it was not until the late 19th century that further research identified the link between coronary artery occlusion and MI . It was exciting. It was everything that I ever wished to do. It was also very frightening. Although, I had seen it all working in Canada and knew it was safe, the first patient was exercised in front of doctors from the Heart Foundation, the medical directors and physicians from Parramatta Hospital and I was just there with one bike and a little machine.”“Within two months, I had about forty patients and I was just one staff. Then it grew and then I got more staff, more patients. At some stage we had 65 patients a day, just in a session in the evening where we used run the cardiac gymnasium. It was also really a lot of fun; the nursing staff did it in their own time and we used the hospital’s equipment. Sometimes, we had up to 80 patients in an evening, just coming in skipping rope, bench stepping using some of the equipment, calisthenics; all this was done by these cardiac patients.”By the 1970s, a model of structured “rehabilitation” for patients with CHD was progressively introduced around the world. A new area of research and clinical practice had emerged with numerous groups commencing research investigating potential benefits and safety of the group-based approach . Availabindividual instruction by the physician” and the focus was on exercise although several noted the importance of “psychotherapy” and “individual advice” although funding was identified as a barrier  pandemic had a major impact on cardiac rehabilitation delivery around the world. Human transmission of infection with the novel coronavirus was first detected in late 2019 and rapidly spread. At the time of writing, there have been approximately 5.2 million deaths globally from the pandemic . COVID-1Since cardiac rehabilitation programs emerged, there have been enormous changes to both the medical and surgical care of patients with CVD coupled with transformation of societies and technology. Very few patients now need a period of “rehabilitation,” but rather life-long multifaceted prevention is needed to reduce the CVD burden. At the same time, even when offered, only the minority of eligible patients attend  cardiac rehabilitation programs and to meet current and projected expanding need within financial limits, contemporary models of cardiac rehabilitation are being modified so as to better align with other treatments, changing societies and technological advancements. Below, we suggest key recommendations that emerge with consideration of the history of cardiac rehabilitation as preventive cardiology moves forward into the new millennium:1.Implementation of lifelong preventive strategies, rather than time-limited programs, would optimize continuous management and care for patients.2.Building flexibility into cardiac rehabilitation delivery models to improve program reach and equity through for example, home-based programs, cultural and language tailoring, ensuring inclusivity with regard to diversity, cognitive impairment, geographical access etc. .3.Systematic incorporation of cardiac rehabilitation into hospital performance measures, with digital integration such as automatic referral and standardized benchmarking .4.Ensuring programs are focused on comprehensive risk factor management (not only exercise-based) based on individual patient need to optimize personalization of care across all relevant risk factors including psychosocial issues to optimize potential benefit of preventing new events .5.via the telephone and internet which are now widely available, as well as use of mobile applications (apps), tracking sensors, text messaging and so on. These strategies have been evolving but have accelerated in availability as a result of the COVID-19 pandemic. However, robust trial/registry research is needed to continue to ensure effectiveness and usefulness for patients.Scientific evaluation of evidence for and implementation (where effective) of digital health interventions to support secondary prevention. Such strategies include communication 6.Focus on implementation of approaches that are tailored to the needs of LMICs where the CHD burden is greatest to improve access to and engagement with effective secondary prevention. Widespread availability of mobile technology offers a promising pathway to achieving this implementation although evidence-based strategies are needed .7.Universal definition and classification of preventive “rehabilitation”; including cardiology, nursing, allied health, primary care, consumers, policy-makers is needed to demonstrate leadership and champion access and implementation of evidence-based care.8.Advocacy for suitable reimbursement and funding of flexible models of cardiac rehabilitation.9.Although controversial and potentially challenging, organizations and leading stakeholder groups could consider revisiting the term “rehabilitation” and revising to a more inclusive term such as “secondary prevention” or “preventive cardiology.” While this particular term was relevant in the 1970s, it may not be reflective of the full potential of secondary prevention programs in the 21st century.bed rest and physical inactivity were commonplace. Despite undergoing some reform, this traditional model is still followed by the majority of programs around the world which in itself is a major barrier to change. This is despite major changes in medical management and surgical approaches to CHD coupled with different sociocultural norms and technological development globally. Understanding this history enables consideration of opportunities for reform that include greater flexibility, the need for life-long prevention and the potential value of digital health in improving reach and sustainability of programs.During the last 75 years there has been a reversal of inpatient and post-discharge care and treatment guidelines for patients with CHD. This historical overview highlights how modern-day cardiac rehabilitation was born over 50 years ago at a time when JR conceived and draft the manuscript. RG, AO’N, SG, and TB provided the rehabilitation expertise. AB, GJ, and DB gave policy, public health and cardiology input. All authors reviewed multiple versions and the manuscript and approval the final version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Threatened preterm delivery is a serious obstetrical complication and has for decades been prescribed physical activity restrictions (AR). Adherence to the recommended level of physical AR is however unknown. This study aimed to assess the objectively measured different physical positions and activities of pregnant women recommended AR due to threatened preterm delivery complications, compared to a reference group of uncomplicated pregnant women without restrictions, and to explore if admission status influenced adherence to AR.A Danish descriptive, clinical multi-center study included singleton pregnancies between 22–33 gestational weeks admitted to an antenatal ward or during midwife consultations either prescribed AR due to threatened preterm delivery or uncomplicated controls without restrictions. For seven days participants wore two tri-axial accelerometric SENS® monitors. Accelerometric data included time spent in five different positions, activities, and step counts. At inclusion demographic and obstetric information was collected.Seventy-two pregnant women participated; 31% were prescribed strict AR, 15% moderate, 3% light, 8% unspecified, and 43% had no AR. Strict AR participants rested in the supine/lateral position for 17.7 median hours/day (range:9.6–24.0); sat upright 4.9 h/day (0.11–11.7); took 1,520steps/day , and 64% were inpatients. Moderate AR participants rested in the supine/lateral position for 15.1 h/day (11.5–21.6); sat upright 5.6 h/day (2.0–9.3); took 3,310steps/day , and 64% were outpatients. Participants with no AR rested 10.5 h/day (6.3–15.4) in supine/lateral position; sat upright 7.6 h/day (0.1–11.4) and took 9,235steps/day . Compared to no restrictions, participants with strict or moderate AR spent significant more time in physical resting positions and took significant fewer mean steps. Among strict AR admission status did not alter time spent in the physical positions, nor the step count.Overall, participants adhered highly to the recommended AR. However, discriminating between strict and moderate AR recommendations did not alter how physical resting positions and activities were carried out. The admission status did not influence how participants adhered to strict AR. Preterm deliveries are the leading cause of mortality among children under the age of five years. Moreover, it is associated with more than half of long-term morbidity and causes large health-care costs , 2.The prevalence of preterm delivery varies greatly worldwide; in many global regions the rate is more than 10% whereas in the Nordic and Baltic countries the rate is 5–7% . These vIn lack of an effective treatment to prevent or postpone preterm delivery, the clinical practice has been for decades to recommend physical activity restrictions/immobility/bed rest even though the practice has no evidence based documentation –7. LatelDespite the lack of evidence even now when AR is recommended the definition ranges from a few hours of daily rest in a supine or laid back position during the waking hours of the day to rest around the clock except for meals and when having a bath and during toilet visits , 12. TreHowever, neither the effect nor the objective level of AR has been documented , 12–14. Hence, the aim of this study was to assess the objectively measured different physical resting positions and activities of pregnant women recommended different levels of AR due to threatened preterm delivery complications, compared to a reference group of uncomplicated pregnant women without restrictions, and to explore if the admission status influenced adherence to AR.This clinical descriptive study was prospectively performed at three different tertiary Danish hospitals in the Capital and the Zealand regions between February 2019 and October 2020. Yearly the three hospitals take care of between 2500 and 6000 deliveries. In Denmark the rate of preterm deliveries before gestational age 34 is approximately 1.5% and a diagnosis of threatened preterm delivery explains 31% of all antenatal obstetric hospitalisations .p value of less than 0.05. All analyses were performed using SPSS 25 software .The statistical significance was defined as a The study was approved by The Danish Data Protection Agency . The Danish Regional Committee on Biomedical Research Ethics was notified about this study and the committee decided that ethical approval was unnecessary (Notification Request no. 18021398). The respective administrations of the obstetric departments at the three study sites all approved the study. At inclusion all participants gave written informed consent to participate.All methods were carried out in accordance with the study protocol and other relevant guidelines and regulations.In total 72 pregnant women were included; 41(57%) were recommended AR of whom 22(54%) had strict restrictions, 11(27%) moderate, 2(5%) light, and 6(14%) unspecified restrictions, whereas 31 participants (43%) had no restrictions (Table n = 41) during data collection 16(39%) were inpatients, 13(32%) outpatients and 12(29%) were combined in-/outpatients  compared to no AR. Moreover, the intragroup variations of time spent in the inactive, resting positions, when standing upright, when walking and number of steps taken were high both within the different levels of prescribed AR as well as within the group of no AR Fig. .Fig. 2InWomen with no AR were all outpatients and spent 10.54 median hours/day (range: min.6.29-max.15.38) in the supine or lateral resting position; 7.56 h/day (0.05–11.36) sitting upright; stood upright 2.17 h/day (0.98–3.89) and took 9,235 steps/day  ; sat upright 4.92 h/day (0.11–11.69); stood upright 0.44 h/day (0.06–1.13) and took 1,520 steps/day . Among the strict AR 63.6% were inpatients and took 1,155 steps/day  whereas 27.3% were combined in-/outpatients and took 1,803 steps/day  ; sat upright 5.60 h/day (1.99–9.29); stood upright 1.26 h/day (0.27–2.39) and took 3,310 steps/day . Of those with moderate AR 63.6% were outpatients and took 3,944 steps/day , whereas 27.3% were combined in-/outpatients and took 2,112 steps/day  , sitting upright (3.51 (more)/-2.53 (less) mean hours per day, p = 0.006/ p = 0.011), standing upright (-1.28/-0.77 (less) mean hours per day, p < 0.001/ p = 0.003), sporadic gait (-0.84/-0.62 (less) mean hours per day, p < 0.001/ p = 0.014) and walking (-0.89/-0.79 (less) mean hours per day, p 0.001/ p < 0.001). Moreover, the women with strict/moderate AR took -5,040/-4,592 (less) mean steps (p 0.001/ < 0.001) compared to those with no restrictions , when sitting upright (p = 0.492) nor in the number of steps taken (p = 0.188). However, the women stood less time upright (p = 0.016) when recommended strict AR (Table No differences were found between the two groups (strict vs. moderate AR) in the time spent resting in the supine/lateral position (ht p = 0.92 nor inThe duration of time spent in the different physical positions and activities according to admission status is illustrated in Fig. We found as expected that participating women recommended strict and moderate AR spent more time in the physical inactive, resting positions than pregnant women with no restrictions. However, women within the same level of AR performed the restrictions with extensive variability. Moreover, only the time standing upright differed between strict and moderate AR and the admission status did not affect adherence to the recommended level of AR.In our study, inpatients recommended strict AR took 1,155 median steps per day, which was higher than demonstrated in an American pilot intervention study, where 11 participants who were recommended bed rest took only 200 median steps per day, and 11 without restrictions took 837 steps . The AmeOur study demonstrated no significant differences in any of the physical positions / activities or step counts between the strict and moderate activity restricted groups except time spent in the standing upright position, where the strict group stood upright 0.73 less median hours per day than the moderate group. This may question if it makes clinical sense to differentiate between strict and moderate AR. Moreover, participants who were recommended the same level of AR did adhere to the prescription with extensive variations, especially when resting in the supine or lateral position. It may indicate that an accurate dosage of physical positioning and activity is not definite and may be influenced by the clinician’s instructions as well as participants’ individual interpretation. On the other hand, we demonstrated as well a great variation in how uncomplicated pregnant women with no physical AR moved around in their daily lives. This may verify that pregnant women in general perform their daily physical positions and activities with great variations regardless of being recommended AR or not.Being recommended AR is a significant personal intervention –26 henceMoreover, it is essential that healthcare professionals acknowledge that several challenging dimensions of being recommended AR are at stake. In order to reach an intrinsic, meaningful and self-determined experience of the AR and thereby being able to adhere to the recommendation the pregnant woman must be guided and supported individually .There is a lack of data definitively demonstrating that AR improves perinatal outcomes in pregnancies complicated not only by threatened preterm delivery but also in multiple pregnancies, fetal growth restriction, PPROM, or hypertensive diseases of pregnancy , 28, 29.Our study demonstrated that even healthy pregnant women with no AR in some cases spent many more hours in physical inactive positions than were to be expected. It has repeatedly been demonstrated that physical activity in healthy pregnant women reduces the risk of pregnancy related complications such as preterm delivery, preeclampsia, hypertensive disorders, gestational diabetes, and fetal growth restriction , 32–35. Our study contributes with new knowledge about how much time is daily spent in physical resting positions and activities both by women with recommended AR during pregnancy and by women without any restrictions, using chest and knee worn tri-axial accelerometry. This study is to our knowledge the first of its kind in the obstetric field. Other studies have used knee worn tri-axial accelerometry performed in other health care fields to detect changes in physical inactivity during training sessions as well as during different kinds of hospitalizations , 37.Our accelerometric data were validated based on a qualitative audit process with excellent agreement in all tested cases, which was a strength. A limitation was however, the rather small study population. When the accelerometric data were stratified in the different AR groups, the relative low number of observations included in the adjusted linear regression models may have involved some dilution of the data information.Moreover, it is a limitation of this study that the data collection did not discriminate between sleep and awake, supine or laid-back rest and also that the SENS monitors used to collect the accelerometric data have never been validated on a pregnant population.Overall, participants adhered highly to the recommended AR. However, discriminating between strict and moderate AR recommendations did not alter how physical resting positions and activities were carried out. The admission status did not influence how participants adhered to strict AR.