A new man

How far would you go to feel comfortable in your own skin? Would you spend thousands of dollars for muscle damaging chest binders, ongoing rounds of shots or undergo invasive surgery? For Charlie Poulson, a junior in graphic design, none of these are questions

The Partnership Model For Service-Learning Programs: A Step-By-Step Approach

Service-Learning is a hot topic in higher education today, but the importance of streamlining processes for community service will never go out of style. Generally, universities, faculty, communities, and students value the concept of civic engagement. However, it is challenging for educators to provide meaningful service, which offers valuable learning opportunities, while trying to meet academic expectations of rigor and research. The Partnership Model for Service- Learning provides a visual framework for organizing sustainable programs and leads to collective impact. It is a model that “ties it all together”, seamlessly connecting teaching, scholarship, and service. In addition to a step-by-step framework for constructing a service-learning program, this article presents case examples to illustrate the differences between “project-based” and “program-based” pedagogical approaches. Finally, student-perceived impacts of service-learning are quantified, via Likert scale, in the associated areas (Callister and Hobbins-Garbett, 2000), of personal satisfaction, impact on professional development, critical thinking, awareness of unmet community needs, and feelings of preparedness for practice, for both the project-based and program-based case examples.

THE RELATIONSHIP BETWEEN MUSCULOSKELETAL STRENGTH, PHYSIOLOGICAL CHARACTERISTICS, AND KNEE KINESTHESIA FOLLOWING FATIGUING EXERCISE

Fatiguing exercise may result in impaired functional joint stability and increased risk of unintentional injury. While there are several musculoskeletal and physiological characteristics related to fatigue onset, their relationship with proprioceptive changes following fatigue has not been examined. The purpose of this study was to establish the relationship between musculoskeletal and physiological characteristics and changes in proprioception, measured by threshold to detect passive motion (TTDPM), following fatiguing exercise. Twenty, physically active females participated (age: 28.65 ± 5.6 years, height: 165.6 ± 4.3 cm, weight: 61.8 ± 8.0 kg, BMI: 22.5± 2.3 kg/m2, BF: 23.3 ± 5.4%). During Visit 1, subjects completed an exercise history and 24-hour dietary questionnaire, and body composition, TTDPM familiarization, isokinetic knee strength, and maximal oxygen uptake/lactate threshold assessments. During Visit 2, subjects completed TTDPM and isometric knee strength testing prior to and following a fatiguing exercise protocol. Wilcoxon signed rank tests determined TTDPM and isometric knee strength changes from pre- to post- fatigue. Spearman’s rho correlation coefficients determined the relationship between strength and physiological variables with pre- to post-fatigue changes in TTDPM and with pre-fatigue and post-fatigue TTDPM in extension and flexion (α=0.05). No significant differences were demonstrated from pre-fatigue to post-fatigue TTDPM despite a significant decrease in isometric knee flexion strength (P<0.01) and flexion/extension ratio (P<0.05) following fatigue. No significant correlations were observed between strength or physiological variables and changes in TTDPM from pre- to post-fatigue in extension or flexion. Flexion/extension ratio was significantly correlated with pre-fatigue TTDPM in extension (r=-0.231, P<0.05). Peak oxygen uptake was significantly correlated with pre-fatigue (r=-0.500, P<0.01) and post-fatigue (r=-0.520, P<0.05) TTDPM in extension. No significant relationships were demonstrated between musculoskeletal and physiological characteristics and changes in TTDPM following fatigue. The results suggest that highly trained individuals may have better proprioception, and that the high fitness level of subjects in this investigation may have contributed to absence of TTDPM deficits following fatigue despite reaching a high level of perceptual and physiological fatigue. Future studies should consider various subject populations, other musculoskeletal strength characteristics, and different modalities of proprioception to determine the most important contributions to proprioceptive changes following fatigue

Careless Whisper: Speech-to-Text Hallucination Harms

Speech-to-text services aim to transcribe input audio as accurately as possible. They increasingly play a role in everyday life, for example in personal voice assistants or in customer-company interactions. We evaluate Open AI's Whisper, a state-of-the-art automated speech recognition service outperforming industry competitors, as of 2023. While many of Whisper's transcriptions were highly accurate, we find that roughly 1\% of audio transcriptions contained entire hallucinated phrases or sentences which did not exist in any form in the underlying audio. We thematically analyze the Whisper-hallucinated content, finding that 38\% of hallucinations include explicit harms such as perpetuating violence, making up inaccurate associations, or implying false authority. We then study why hallucinations occur by observing the disparities in hallucination rates between speakers with aphasia (who have a lowered ability to express themselves using speech and voice) and a control group. We find that hallucinations disproportionately occur for individuals who speak with longer shares of non-vocal durations -- a common symptom of aphasia. We call on industry practitioners to ameliorate these language-model-based hallucinations in Whisper, and to raise awareness of potential biases amplified by hallucinations in downstream applications of speech-to-text models

Intrasession Test-Retest Reliability of the Cervicocephalic Kinesthetic Sensibility Test used to Measure Cervical Joint Position Sense

INTRODUCTION: Cervical spine injuries and concussion present with similar mechanisms and nearly identical symptoms. Reliable measures of cervical proprioception could help determine if deficits exist. The aim of this study was to determine the intrasession reliability of the Cervicocephalic Kinesthetic Sensibility (CKS) test. Previous literature has only addressed Left and Right Axial Rotation, where this study addresses 3 planes of motion. METHODS: A descriptive, observational design was used to assess intrasession reliability. Seventeen subjects were included in this study (4 males, 13 females), 18-25 years old avg. Age (yrs.) (23.12±1.36), avg. Weight (kgs) (66.89±12.59), avg. Height (cm) (171±11.44). The dependent variables for this study included cervical joint position sense (JPS) error of the cervical spine in degrees (°). Cervical Flexion (CF), Cervical Extension (CE), Right Axial Rotation (RAR), Left Axial Rotation (LAR), Right Side-Bending (RSB) and Left Side-Bending (RSB) were assessed for JPS error. A chair was placed 90cm from the wall. A 40cm target was placed on the wall. The subject wore a helmet with a laser attached and Head Neutral (HN) was established prior to testing. The rater instructed the subject to position themselves in HN, close their eyes and flex their neck to end range of motion, then had them return to HN. The rater marked on the target where the laser landed. This was performed in the same manner for all 6 cervical motions. The intrasession test retest reliability was estimated calculating ICC(2,1) and ICC(2,3), 95% CI and P-values. Statistical significance was set a priori at alpha= 0.05, two-sided. RESULTS: The highest reproducibility for single measures ICC and average measures ICC was found in CF and LSB, CF ICC(2,1) = .404, LSB ICC(2,1) = .496, CF ICC(2,3) = .670, LSB ICC(2,3) = .747. Cervical Extension (CE), Right Axial Rotation (RAR), Left Axial Rotation (LAR) showed very low reproducibility for single measures ICC, however showed more acceptable average measures ICC. CONCLUSION: These results show a wide variability among reliability of the CKS test in 6 different cervical motions. Further evaluation of test-retest reliability is necessary to determine the usefulness of this tool to measure cervical proprioception

Inter-Rater Reliability of Dynamic Exertion Testing (EXiT) Performance Among Healthy Adults.

INTRODUCTION: The Dynamic Exertion Test (EXiT) is a new standardized return to play (RTP) exertion assessment for athletes at medical clearance following a concussion. It incorporates aerobic, multiplanar dynamic, and functional movements, based on exercise prescription guidelines from the American College of Sports Medicine (ACSM), with objective measures that work to challenge all potentially affected systems of a concussed athlete. The purpose of this study is to determine the interrater reliability (IRR) of the EXiT between two raters assessing healthy, non-concussed athletes and to determine the level of systematic bias between the two raters. METHODS: A subgroup of 15 participants (F=5, 33.3%, age: 23.67 ± 4.22 years old) from a larger study were assessed with the EXiT on two visits. Two raters simultaneously scored participants at both visits on the number of errors committed on all dynamic tasks and on time to completion on agility cone tasks. IRR was estimated using intraclass correlation coefficients (ICC) and 95% confidence intervals (CI) for time and Kappa Coefficients and 95% CI were used for errors. Paired t-tests and NcNemar Tests were used to assess for systematic bias between raters’ scores. RESULTS: Time to completion had good IRR (ICCs > 0.759), Arrow Agility at visit 1 had the highest (0.999 [95% CI 0.997-1.0]) and Box Drill Carioca at visit 2 had the lowest (0.759 [95% CI 0.314-0.929]). Fifteen of the 20 tasks showed no statistically significant difference between raters scores. Errors had poor to excellent IRR (p-values: 0.324-1.00) and an observed percent agreement >83.33% for 10 of 14 tasks, Zigzag at visit 1 had the lowest (66.66%). McNemar Test showed no statistically significant difference (p-values > 0.250) for all task errors, but Arrow Agility had the largest difference between raters at both visits (13.33% vs. 40%, 16.66% vs. 41.66%). CONCLUSION: IRR for the EXiT time and errors was good for the majority of tasks. This study was a good first step in evaluating the reliability of the new RTP exertional protocol, the EXiT. Future research should use a larger sample size to evaluate IRR in concussed participants along with intra-rater and test retest reliability

THE EFFECT OF LOADED FATIGUE ON LOADED POSTURAL STABILITY

Military personnel are often required to carry heavy loads for long distances over unpredictable terrain. Additional load carriage, in conjunction with fatigue, has the potential to influence postural control mechanisms which may in turn increase injury risk. The purpose of this study was to determine if a loaded incremental march to fatigue negatively influences loaded postural stability. Loaded postural stability was measured using the NeuroCom Sensory Organization Test (SOT) and kinetic force plate variables (vertical ground reaction forces: SDvGRF, and TotSway) before and after a loaded incremental march to fatigue in 23 physically active men and women (age: 24.1 4.0 years, height: 172.3 11.1 cm, weight: 162.2 38.2 lbs) while subjects were adorned with a weighted vest equating to 30% of their body weight. The SOT consisted of six conditions (C1-C6) aimed to perturb the sensorimotor system, which were performed before and after a loaded fatigue protocol. C1, C2 and C3 challenged the somatosensory system, C4 challenged the visual system, while C5 and C6 challenged the vestibular system. Fatigue was induced with a treadmill march at 4mph with increasing grades of 2% every three minutes until volitional fatigue. After testing for normality, paired sample t-tests or Wilcoxon signed rank tests were conducted to assess pre- to post-fatigue differences. Significant reductions in SOT scores were found in overall composite scores (pre: 82.8 4.7, post: 81.6 5.2, p = 0.010), SDvGRF of C1 (pre: 1.3 0.5, post: 2.0 0.9, p < 0.001), C2 (pre: 1.4 0.6, post: 1.9 1.2, p < 0.001), C3 (pre: 1.4 0.5, post: 2.1 1.8, p = 0.026), and C6 (pre: 2.5 2.2, post: 3.5 3.2, p < 0.001) and TotSway of all conditions. Results suggest that significant changes in loaded postural stability were caused by loaded fatigue. Findings could aid in future postural stability screenings, load carriage training and strategies for injury prevention in the military

Impact of Increased Load Carriage Magnitude on the Dynamic Postural Stability of Men and Women

The impact of load carriage on dynamic postural stability affects the survivability of the Warfighter by influencing performance capabilities and injury incidence. Further, sex may interact with the relationship between load carriage and dynamic postural stability to further compromise survivability. PURPOSE: To investigate the effect of load carriage magnitude on dynamic postural stability of men and women and its relationship to jumping ability. METHODS: 32 subjects (16 men, 16 women) were investigated for maximum jump height and dynamic postural stability. Dynamic postural stability was assessed by subjects jumping a horizontal distance of 40% their height over a 30cm hurdle, landing on one leg on a force plate (sample rate = 1200 Hz). 3 trials were completed for 3 load conditions: +0, +20 and +30% body weight (BW). Dynamic postural stability was determined from ground reaction force data during landings, by calculation of the dynamic postural stability index (DPSI). Maximum jump height was assessed by subjects performing 3 countermovement jumps (sample rate = 1000 Hz). Two-way repeated measures ANOVA were used to compare mean DPSI scores between sexes and conditions (α = 0.05). Pearson’s Correlation Coefficients were used to determine the relationship between jump height and change in DPSI scores between conditions (α = 0.05). RESULTS: Load condition significantly affected DPSI (F = 100.304, p = 0.001). DPSI scores increased between the 0% (0.359 ± 0.041), 20% (0.396 ± 0.034) and 30% (0.420 ± 0.028) BW load conditions. No significant effect of sex on DPSI was found (F = 0.131). No significant sex by load interaction on DPSI was found (F = 0.393). No significant correlations were found between jump height and change in DPSI scores between conditions. CONCLUSION: Increased load was found to negatively affect dynamic postural stability, most likely as a result of modifying the demands of the task. Therefore, the dynamic postural stability of men and women changes comparably in response to increased load carriage magnitude. Future research should focus on the effects of load on dynamic postural stability under higher loads and during more military-specific tasks

Altered transmission of HOX and apoptotic SNPs identify a potential common pathway for clubfoot.

Clubfoot is a common birth defect that affects 135,000 newborns each year worldwide. It is characterized by equinus deformity of one or both feet and hypoplastic calf muscles. Despite numerous study approaches, the cause(s) remains poorly understood although a multifactorial etiology is generally accepted. We considered the HOXA and HOXD gene clusters and insulin-like growth factor binding protein 3 (IGFBP3) as candidate genes because of their important roles in limb and muscle morphogenesis. Twenty SNPs from the HOXA and HOXD gene clusters and 12 SNPs in IGFBP3 were genotyped in a sample composed of non-Hispanic white and Hispanic multiplex and simplex families (discovery samples) and a second sample of non-Hispanic white simplex trios (validation sample). Four SNPs (rs6668, rs2428431, rs3801776, and rs3779456) in the HOXA cluster demonstrated altered transmission in the discovery sample, but only rs3801776, located in the HOXA basal promoter region, showed altered transmission in both the discovery and validation samples (P = 0.004 and 0.028). Interestingly, HOXA9 is expressed in muscle during development. An SNP in IGFBP3, rs13223993, also showed altered transmission (P = 0.003) in the discovery sample. Gene-gene interactions were identified between variants in HOXA, HOXD, and IGFBP3 and with previously associated SNPs in mitochondrial-mediated apoptotic genes. The most significant interactions were found between CASP3 SNPS and variants in HOXA, HOXD, and IGFBP3. These results suggest a biologic model for clubfoot in which perturbation of HOX and apoptotic genes together affect muscle and limb development, which may cause the downstream failure of limb rotation into a plantar grade position

Serial Cytoreductive Surgery and Survival Outcomes in Recurrent Adult-Type Ovarian Granulosa Cell Tumors

BACKGROUND: Few studies have evaluated the role of cytoreductive surgery in patients with recurrent adult granulosa cell tumors of the ovary. Despite a multitude of treatment modalities in the recurrent setting, the optimal management strategy is not known. Cytoreductive surgery offers an attractive option for disease confined to the abdomen/pelvis. However, few studies have evaluated the role of surgery compared with systemic therapy alone following the first recurrence and subsequent disease progressions. OBJECTIVE: This study aimed to determine the impact of secondary, tertiary, and quaternary cytoreductive surgery on survival outcomes in recurrent adult granulosa cell tumors of the ovary. STUDY DESIGN: This is a multicenter, retrospective cohort study evaluating patients with recurrent adult granulosa cell tumors of the ovary enrolled in the MD Anderson Rare Gynecologic Malignancy Registry from 1970 to 2022. Study inclusion criteria consisted of histology-proven recurrent disease, at least 1 documented recurrence, and treatment/treatment planning at the MD Anderson Cancer Center or Lyndon B. Johnson General Hospital. The primary exposure was cytoreductive surgery, and the outcomes of interest were progression-free survival and overall survival. Survival analyses were restricted to eligible patients with resectable disease without medical barriers to surgery at each progression episode. Demographic and clinicopathologic characteristics were summarized using descriptive statistics. Progression-free survival (after first, second, and third progression) and overall survival were estimated with methods of Kaplan and Meier, and were modeled via Cox proportional hazards regression. Multivariable analyses were performed for progression-free survival after first progression and overall survival. RESULTS: Among the 369 patients with adult granulosa cell tumors of the ovary in the registry, 149 patients met the study inclusion criteria. Secondary cytoreductive surgery was associated with a significant improvement in progression-free survival on univariable (hazard ratio, 0.37; 95% confidence interval, 0.17-0.81, P=.01) and multivariable analyses (hazard ratio, 0.42; 95% confidence interval, 0.19-0.92; P=.03). Those who underwent secondary cytoreductive surgery had a significantly improved median overall survival compared with those who did not undergo cytoreductive surgery (181.92 vs 61.56 months, respectively; P=.002). Overall survival benefit remained statistically significant on multivariable analysis (hazard ratio, 0.28; 95% confidence interval, 0.11-0.67; P=.004). Tertiary cytoreductive surgery was similarly associated with a significant improvement in progression-free survival (hazard ratio, 0.43; 95% confidence interval, 0.26-0.70; P=.001). Despite a similar trend, quaternary cytoreductive surgery was not associated with a significant improvement in progression-free survival (hazard ratio, 0.74; 95% confidence interval, 0.42-1.26; P=.27). CONCLUSION: Among those with resectable disease and no medical contraindications to surgery, cytoreductive surgery may have a beneficial impact on progression-free survival and overall survival in patients with recurrent adult granulosa cell tumors of the ovary