Reliability of Precision in Motion Software

Background: There is a current lack of affordable 3-D motion analysis systems available to physical therapists for documenting objective data. Objective: Compare data from inexpensive 3-D motion capture system using the Kinect, to the Codamotion, a traditional active marker, motion analysis system. Determine data reliability. Design: Reliability-method comparison study Methods: Seventeen subjects (9 females, 8 males) were instructed to walk down marked runway, arms across chest while both systems recorded data. Data was collected with Kinect on the same and opposite side as the Coda. Kinect and Coda data were interpolated and normalized for comparison. A program for heel strike detection was written in R for both systems, which determined stride length and stride time. Interclass correlation coefficients (ICC 3,1) were calculated for stride length, stride time, and joint angles for all subjects. Results: All stride length ICC ≥ 0.70 shows acceptable clinical reliability. One of four stride time ICC \u3c 0.70 for opposite leg step 1 likely due to occlusion of test leg by other leg during step. Joint value comparisons show high variability in reliability of Kinect software. Seventy-seven % of the same side knee data and fifteen % of the hip same side data from Kinect is clinically reliable. Limitations: Kinect and Coda use different skeletal models. Conclusions: Kinect software updates are needed to improved accuracy. Kinect system was significantly easier to use than Coda and may eventually be a cheaper alternative to traditional motion analysis systems that could be used by clinicians to monitor patient progress

Make It New

As jazz enters its second century it is reasserting itself as dynamic and relevant. Boston Globe jazz writer and Emerson College professor Bill Beuttler reveals new ways in which jazz is engaging with society through the vivid biographies and music of Jason Moran, Vijay Iyer, Rudresh Mahanthappa, The Bad Plus, Miguel Zenón, Anat Cohen, Robert Glasper, and Esperanza Spalding. These musicians are freely incorporating other genres of music into jazz—from classical (both western and Indian) to popular (hip-hop, Ramp;B, rock, bluegrass, klezmer, Brazilian choro)—and other art forms as well (literature, film, photography, and other visual arts). This new generation of jazz is increasingly more international and is becoming more open to women as instrumentalists and bandleaders. Contemporary jazz is reasserting itself as a force for social change, prompted by developments such as the Black Lives Matter, #MeToo movements, and the election of Donald Trump

Identification of the GDP-N-acetyl-d-perosamine producing enzymes from Escherichia coli O157:H7

AbstractGDP-N-acetyl-d-perosamine is a precursor of the LPS-O-antigen biosynthesis in Escherichia coli O157:H7. Like other GDP-6-deoxyhexoses, GDP-N-acetyl-d-perosamine is supposed to be synthesized via GDP-4-keto-6-deoxy-d-mannose, followed by a transamination- and an acetylation-reaction catalyzed by PerA and PerB. In this study, we have overproduced and purified PerA and PerB from E. coli O157:H7 in E. coli BL21. The recombinant proteins were partly characterized and the final product of the reaction catalyzed by PerB was shown to be GDP-N-acetyl-d-perosamine by chromatography, mass spectrometry, and 1H-NMR. The functional expression of PerB provides another enzymatically defined pathway for the synthesis of GDP-deoxyhexoses, which is needed to further study the corresponding glycosyltransferases in vitro

Risk Factors Associated With Low Back Pain in Golfers: A Systematic Review and Meta-analysis

Context: Low back pain is common in golfers. The risk factors for golf-related low back pain are unclear but may include individual demographic, anthropometric, and practice factors as well as movement characteristics of the golf swing. Objective: The aims of this systematic review were to summarize and synthesize evidence for factors associated with low back pain in recreational and professional golfers. Data Sources: A systematic literature search was conducted using the PubMed, CINAHL, and SPORTDiscus electronic databases through September 2017. Study Selection: Studies were included if they quantified demographic, anthropometric, biomechanical, or practice variables in individuals with and without golf-related low back pain. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 3. Data Extraction: Studies were independently reviewed for inclusion by 2 authors, and the following data were extracted: characterization of low back pain, participant demographics, anthropometrics, biomechanics, strength/flexibility, and practice characteristics. The methodological quality of studies was appraised by 3 authors using a previously published checklist. Where possible, individual and pooled effect sizes of select variables of interest were calculated for differences between golfers with and without pain. Results: The search retrieved 73 articles, 19 of which met the inclusion criteria (12 case-control studies, 5 cross-sectional studies, and 2 prospective longitudinal studies). Methodological quality scores ranged from 12.5% to 100.0%. Pooled analyses demonstrated a significant association between increased age and body mass and golf-related low back pain in cross-sectional/case-control studies. Prospective data indicated that previous history of back pain predicts future episodes of pain. Conclusion: Individual demographic and anthropometric characteristics may be associated with low back pain, but this does not support a relationship between swing characteristics and the development of golf-related pain. Additional high-quality prospective studies are needed to clarify risk factors for back pain in golfers

Effects of Transition from Closed-Book to Open-Book Assessment on Students’ Scores in a Pharmacokinetics Course

Closed-book summative assessment of student learning, common in pharmacy education, is challenging to administer in a remote setting due to the need for costly and intrusive monitoring technology. Therefore, open-book assessments without monitoring have been considered an alternative in remote settings. The present study investigated the effects of the transition from in-person closed-book to remote open-book format on the students’ scores in different assessment categories in a Pharmacokinetics course. The students’ performances in the transition cohort (Transition, n = 96) during the in-person and remote periods were compared with those of an in-person cohort (Control, n = 85) during the same periods. Assessments included take-home assignments, daily quizzes, and progress/final examinations. Whereas the take-home assignments were open-book for cohorts and periods, the quizzes and examinations were open-book only for the Transition cohort during the remote period. Only the quiz/examination questions that were identical for both cohorts were included in the analysis. Statistical analysis by a linear, mixed-effects model indicated that the transition did not have any significant impact on the scores of students in the assignments, which were open-book for both cohorts and both periods. However, there were significant increases in the Transition cohort’s scores (mean ± SE) during the remote open-book period in both quizzes (+8.4 ± 1.9%) and examination (+6.8 ± 1.5%) questions, compared with the Control cohort who had in-person closed-book assessments. These differences amounted to Cohen’s d-effect sizes of 0.61 and 0.59 for the quiz and examination questions, respectively. It is concluded that when the questions are similar, the students’ scores in pharmacokinetic assessments are higher (medium effect size) in a remote open-book format compared with the in-person closed-book format

Evaluation of Step-Down Oral Antibiotic Therapy for Uncomplicated Streptococcal Bloodstream Infections on Clinical Outcomes

Background: Despite the severity and frequency of streptococcal bloodstream infections (BSIs), the effectiveness of oral definitive therapy remains unknown. The objective of this study was to evaluate the clinical outcomes of step-down oral antibiotics for the treatment of uncomplicated streptococcal BSIs. Methods: In this retrospective cohort study, adult patients admitted with uncomplicated streptococcal BSI between June 2015 and June 2017 were included. Patients were excluded if they received \u3c48 h of antibiotic therapy; therapy was started \u3e48 h after first positive culture; had complicated infections of endocarditis, bone and joint infections, or central nervous system infections; Pitt bacteremia score (PBS) ⩾ 4; or failed to respond to effective therapy necessitating continued intravenous (IV) therapy. Patients were grouped by receipt of step-down oral antibiotic therapy (PO group) versus continued IV therapy (IV group). Outcomes included hospital length of stay (LOS), 30-day recurrence of BSI, 30-day readmission, 30-day all-cause mortality, and catheter-related or drug-related adverse events (AEs). Results: Of 244 patients included, 40% received step-down oral therapy (n = 98). Overall, the most common source of BSI was pneumonia (22%), followed by skin and soft tissue infections (SSTI) (18%). Severity of illness measured by intensive care unit (ICU) admission and PBS was similar. The IV group had significantly longer LOS [median 10 (interquartile range [IQR] = 5– 21) versus 5 (4–6) days, p \u3c 0.01] compared with the PO group. BSI recurrence, readmission, all-cause mortality within 30 days, and AEs were similar between the groups (p = ns). Conclusion: In uncomplicated streptococcal BSI, patients treated with step-down oral antibiotic therapy had significantly shorter LOS compared with continued IV therapy without compromise of clinical outcomes

Clinical Application and Feasibility of Utilizing the PEDI-CAT to Assess Activity and Participation Among Children Receiving Physical Therapy Incorporating Hippotherapy

Background Hippotherapy (HPOT) is a physical therapy (PT) treatment tool using equine movement to improve mobility for children with movement impairments. Although research suggests HPOT improves body structure and function, there is limited evidence regarding its impact on activity and participation outcomes in a clinical setting. The Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) may be useful in HPOT settings to highlight changes in activity and participation. Purpose 1) Evaluate the PEDI-CAT’s sensitivity to changes in activity and participation among children receiving PT using HPOT; 2) determine feasibility of administering the PEDI-CAT in a HPOT setting; and 3) examine how PEDI-CAT scores influence clinical decision-making. Methods Participants (N = 34) were children who attended weekly PT using HPOT for 6 months. The PEDI-CAT was completed for all participants by a parent or caregiver at initial treatment (T1) and 6 months later (T2). A linear mixed effects model was used to evaluate changes in scores over time. Team meetings occurred monthly to discuss how PEDI-CAT scores impacted treatment. Results There were significant improvements across 3 PEDI-CAT domains between T1 and T2 for all children with small effect sizes and nonsignificant changes noted within two diagnostic subgroups with small-to-medium effect sizes. The PEDI-CAT was completed by all participants without interrupting treatment flow. PEDI-CAT score reports enriched therapist-client conversations increasing shared decision-making. Conclusion PTs who treat children using HPOT may feasibly use the PEDI-CAT to assess changes in activity level outcomes and to assist clinical decision-making

Classifying Toe Walking Gait Patterns Among Children Diagnosed With Idiopathic Toe Walking Using Wearable Sensors and Machine Learning Algorithms

Idiopathic toe walking (ITW) is a gait abnormality in which children’s toes touch at initial contact and demonstrate limited or no heel contact throughout the gait cycle. Toe walking results in poor balance, increased risk of falling, and developmental delays among children. Identifying toe walking steps during walking can facilitate targeted intervention among children diagnosed with ITW. With recent advances in wearable sensing, communication technologies, and machine learning, new avenues of managing toe walking behavior among children are feasible. In this study, we investigate the capabilities of Machine Learning (ML) algorithms in identifying initial foot contact (heel strike versus toe strike) utilizing wearable body sensors. Thirty-six children (Age 9.4±2.8 years) diagnosed with ITW participated in this study. Six ML algorithms, consisting of Support Vector Machines (SVM), decision tree (DT), random forest (RF), K-nearest neighbors (KNN), Multi-layer Perceptron (MLP), and Gaussian process (GP), could successfully classify initial contact walking patterns among ITW. We found that a simple KNN algorithm resulted in the highest accuracy of 92.92% and an F1-score of 93.20% to differentiate toe walking gait versus best heel strike when using all four body sensors. We also found that toe walking resulted in higher variability in the sacral vertical accelerations among children diagnosed with ITW. Accurate quantification of toe walking steps in clinical applications is critical for assessing rehabilitation progress and designing new interventions for children diagnosed with ITW

A Nonrestrictive Approach to Fluoroquinolone Stewardship at Two Community Hospitals

Background Fluoroquinolones are one of the most prescribed antimicrobials in the United States and have been increasingly used in inpatient and outpatient settings to treat various infectious diseases syndromes. Due to the unwanted collateral effects on antibiotic resistance, poor susceptibility rates among Gram-negative pathogens, and adverse effects, fluoroquinolones are often targeted by hospital antimicrobial stewardship programs to prevent overutilization. This study describes the association of nonrestrictive antimicrobial stewardship interventions at 2 nonacademic community hospitals on levofloxacin utilization, prescribing patterns on alternative antibiotics, and Pseudomonas aeruginosa nonsusceptibility rates to levofloxacin. Methods Nonrestrictive antimicrobial stewardship interventions included monitoring and reporting of fluoroquinolone susceptibility trends to physician groups, performing medication use evaluations of levofloxacin accompanied with prescriber detailing, daily prospective audit and feedback, implementation of beta-lactam-based institutional guidelines for empiric therapy in various infectious disease syndromes, review and adjustment of electronic medical record order sets containing fluoroquinolones, and intensive prescriber education. No preauthorization of levofloxacin was used during this study period. Antibiotic utilization data were collected for the time periods of August 2015 through January 2021. Correlation between levofloxacin and other broad-spectrum antibiotc use was investigated as well as the impact on Pseudomonas aeruginosa levofloxacin nonsusceptibility rates. Results Both hospitals showed an overall downward trend in the prescribing of levofloxacin during the time period of August 2015 to January 2021. There was a significant negative correlation between monthly ceftriaxone and levofloxacin days of therapy for both hospitals (P \u3c .0001). There was a positive correlation between levofloxacin days of therapy and P aeruginosa nonsusceptibility (P \u3c .02 at both hospitals). Conclusions Our results demonstrate that a nonrestrictive approach to fluoroquinolone stewardship interventions had a significant impact on reducing levofloxacin utilization, increasing ceftriaxone utilization, and improving P aeruginosa levofloxacin susceptibility