Good Vibrations: The Impact of Mechanical Focal Vibration on Erector Spinae Morphology and Lumbar Spine Range of Motion

INTRODUCTION: Focal mechanical vibration (FMV) is a type of therapy that involves applying mechanical vibration to a specific body area. It is thought to enhance muscle activation and increase flexibility via the stimulation of muscle spindles. Muscle spindles detect changes in muscle length and trigger reflex contractions in the agonist and reflex relaxation of the antagonist’s muscle via reciprocal inhibition. Additionally, activities paired with FMV may increase lumbar range of motion, decrease pain, and improve lumbar muscle activity in those with low back pain. However, optimal parameters regarding frequency, intensity, and duration of FMV require further investigation. Ultrasound with shear wave elastography (US-SWE) is an emerging technology that may contribute to understanding the mechanism of action associated with FMV and its impact on tissue morphology. The technology quantifies the stiffness or elasticity of soft tissue by measuring the propagation speed of ultrasound-induced shear waves within the tissue. Since muscle stiffness increases with contraction and decreases with relaxation, US-SWE can be used as a surrogate assessment of muscle activation and force. OBJECTIVES: The primary objective of this study is to determine if FMV delivered via Vibracool affects erector spinae muscle stiffness, lumbar spine ROM, and self-report of lumbar stiffness assessed via a Likert Scale. METHODS: The PCOM institutional review board approved this study, and all participants provided informed consent. A convenience sample of three male and seven male students (n=10) was recruited from the PCOM physical therapy department. Participants who self-reported low back stiffness and were healthy participated. Baseline assessment required participants to self-report their perceived low back stiffness via a Likert scale and perform the Schober test to determine lumbar spine ROM, followed by the acquisition of US-SWE images to determine muscle stiffness of the erector spinae in a prone position. A linear transducer was used for US-SWE imaging of bilateral erector spinae musculature, which was placed in the sagittal plane parallel to the most prominent portion of the musculature immediately above the iliac crest, centered on L3 – L5 spinal levels, and manipulated until a clear image of the erector spinae muscle was noted. Three US-SWE images were acquired, and the mean will be used in data analysis. Focal mechanical vibration was then applied via a Vibracool device that delivers constant vibration of 225Hz with an intensity of 7.9 g’s. for 20 minutes with participants in the prone position. All baseline assessments were repeated post-FMV. RESULTS: Descriptive statistics will be reported, and a repeated measures ANOVA will be completed to determine whether there is a statistically significant difference between the means with a level of significance set at p=.05 CONCLUSION: TB

A Provider-driven Approach to Preventative Oral Care in Nursing Home Facilities

Oral care is an essential part of preventative medicine as it minimizes risk for pneumonias and other infections. In nursing home settings, often oral health care is not routinely provided due to a number of issues. A health care system that either owns or contracts nursing home facilities initiated a performance improvement plan to address this patient care concern. The first goal of this project was to reduce the variation in oral care between nursing home facilities within the system. The second goal was 100% of their patients will have one oral health care exam documented in EPIC once a year. Baseline metrics bore out the low number of oral exams routinely performed and a root cause analysis examined the various reasons why nursing home patients do not receive oral care during routine care. A number of countermeasures were implemented to include the creation of a flowsheet for oral exams, automated EPIC reminders to conduct oral exams and a monthly report on oral care exams distributed to providers by the nursing home director. As a result of the interventions, the baseline of 6% in July 2018 was up to 70% in May 2019. It is expected that the goal of 100% will be met by October 2019. In addition, assessment variation between facilities saw a reduction. Some of the next steps include integration of a second oral healthcare assessment per year as a practice standard and continue to assess and reduce variations in assessments between facilities

Board 121: Using Tutor-led Support to Enhance Engineering Student Writing for All

Writing Assignment Tutor Training in STEM (WATTS) is part of a three-year NSF IUSE grant with participants at three institutions. This research project seeks to determine to what extent students in the WATTS project show greater writing improvement than students using writing tutors not trained in WATTS. The team collected baseline, control, and experimental data. Baseline data included reports written by engineering and engineering technology students with no intervention to determine if there were variations in written communication related to student demographics and institutions. Control data included reports written by students who visited tutors with no WATTS training, and experimental data included reports written by students who visited tutors who were WATTS-trained. Reports were evaluated by the research team using a slightly modified version of the American Association of Colleges and Universities (AAC&U) Written Communication VALUE Rubric. Baseline data assessment also provided an opportunity to test the effectiveness of the rubric. This paper presents findings from the analysis of the control and experimental data to determine the impact of WATTS on student writing in lab reports. An aggregate score for each lab report was determined by averaging the reviewer scores. An analysis was run to determine if there was a statistical difference between pre-tutoring lab report scores from the baseline, control, and experimental rubric scores for each criterion and total scores; there was not a statistically significant difference. The research team ran a Wilcoxon signed-rank test to assess the relationship between control and experimental aggregate rubric scores for each criterion. The preliminary analysis of the control and experimental data shows that the WATTS intervention has a positive, statistically significant impact on written communication skills regardless of the campus student demographics. Since WATTS has been shown to be a low-cost, effective intervention to improve engineering and engineering technology students’ written communication skills at these participating campuses, it has potential use for other institutions to positively impact their students’ written communication

Estudio geotécnico con fines de cimentación para tres asociaciones de vivienda en Tacna

La presente investigación cuantitativa tuvo como objetivo principal plantear una adecuada alternativa de cimentación a partir de la realización de estudios geotécnicos mediante los ensayos de laboratorio y métodos geofísicos: refracción sísmica y MASW en las asociaciones de vivienda Los Damnificados del 23 de junio B, Corazón de María y El Manantial, ubicados en el Distrito Coronel Gregorio Albarracín Lanchipa de la ciudad de Tacna. Con los ensayos de refracción sísmica se conoció la estratigrafía del terreno y su ripabilidad, con el ensayo de MASW se encontraron las propiedades dinámicas del suelo y su clasificación según NTE E.030, mientras que los ensayos de laboratorio determinan las propiedades físicas, químicas y mecánicas del suelo. Del ensayo de MASW se obtuvo que el tipo de suelo es S1 y corresponde a un suelo muy rígido, y de la exploración por calicatas se clasificó como grava pobremente graduada (GP). De los resultados se obtuvo un Vs (promedio) de 652.86 m/s, un Ts (promedio) de 0.18 y una 30 capacidad de carga admisible con promedio de 2.1 kg/cm2 por falla local. De este modo, se realizó una microzonificación de la zona con las velocidades de ondas de corte promedio Vs, propiedades dinámicas del suelo y 30 capacidad portante. Finalmente, conociendo las propiedades del suelo se diseñó una zapata aislada cuadrada de 1 m de ancho cimentada a una profundidad de 1.5 m para las tres asociaciones de vivienda

Curvature Corrections to Dynamics of Domain Walls

The most usual procedure for deriving curvature corrections to effective actions for topological defects is subjected to a critical reappraisal. A logically unjustified step (leading to overdetermination) is identified and rectified, taking the standard domain wall case as an illustrative example. Using the appropriately corrected procedure, we obtain a new exact (analytic) expression for the corresponding effective action contribution of quadratic order in the wall width, in terms of the intrinsic Ricci scalar $R$ and the extrinsic curvature scalar $K$. The result is proportional to $cK^2-R$ with the coefficient given by $c\simeq 2$. The resulting form of the ensuing dynamical equations is obtained in terms of the second fundamental form and the Dalembertian of its trace, K. It is argued that this does not invalidate the physical conclusions obtained from the "zero rigidity" ansatz $c=0$ used in previous work.Comment: 19 pages plain TeX, 2 figures include

Board 317: Improving Undergraduate STEM Writing: A Collaboration Between Instructors and Writing Center Directors to Improve Peer-Writing Tutor Feedback

Undergraduate STEM writing skills, especially in engineering fields, need improvement. Yet students in engineering fields often do not value writing skills and underestimate the amount of writing they will do in their careers. University writing centers can be a helpful resource, but peer writing tutors need to be prepared for the differences between writing for the humanities and writing in STEM fields. The Writing Assignment Tutor Training in STEM (WATTS) model is designed to improve tutor confidence and student writing. In this innovative training, the writing center supervisor collaborates with the STEM instructor to create a one-hour tutor-training where the tutors learn about the assignment content, vocabulary, and expectations. This multidisciplinary collaborative project builds on previous investigative work to determine the impact of WATTS on students, tutors, and faculty and to identify its mitigating and moderating effects. Data has been collected and analyzed from pre- and post- training surveys, interviews, and focus groups. In addition, the project studies WATTS effects on student writing pre- and post-tutoring. The team will use these results to develop a replicable, sustainable model for future expansion to other institutions and fields. By systematically collecting data and testing WATTS, the investigators will be able to identify its mitigating and moderating effects on different stakeholders and contribute valuable knowledge to STEM fields. This approach assesses the elements of the model that have the most impact and the extent to which WATTS can be used to increase collaboration between engineering instructors and writing centers. The project enables the investigators to expand WATTS to additional engineering courses, test key factors with more instructors, refine the process, and position WATTS for dissemination to a broad audience. As the cost of higher education rises, institutions are pressured to graduate students in four years and engineering curricula are becoming more complex. WATTS presents an economical, effective method to improve student writing in the discipline. Several factors indicate that it has the potential for broad dissemination and impact and will provide a foundation for a sustainable model for future work, as instructors become trainers for their colleagues, allowing additional ongoing expansion and implementation. WATTS serves as a model for institutions (large or small) to capitalize on existing infrastructure and resources to achieve large-scale improvements to undergraduate STEM writing while increasing interdisciplinary collaboration and institutional support

Preoperative predictions of in-hospital mortality using electronic medical record data

Background: Predicting preoperative in-hospital mortality using readily-available electronic medical record (EMR) data can aid clinicians in accurately and rapidly determining surgical risk. While previous work has shown that the American Society of Anesthesiologists (ASA) Physical Status Classification is a useful, though subjective, feature for predicting surgical outcomes, obtaining this classification requires a clinician to review the patient's medical records. Our goal here is to create an improved risk score using electronic medical records and demonstrate its utility in predicting in-hospital mortality without requiring clinician-derived ASA scores. Methods: Data from 49,513 surgical patients were used to train logistic regression, random forest, and gradient boosted tree classifiers for predicting in-hospital mortality. The features used are readily available before surgery from EMR databases. A gradient boosted tree regression model was trained to impute the ASA Physical Status Classification, and this new, imputed score was included as an additional feature to preoperatively predict in-hospital post-surgical mortality. The preoperative risk prediction was then used as an input feature to a deep neural network (DNN), along with intraoperative features, to predict postoperative in-hospital mortality risk. Performance was measured using the area under the receiver operating characteristic (ROC) curve (AUC). Results: We found that the random forest classifier (AUC 0.921, 95%CI 0.908-0.934) outperforms logistic regression (AUC 0.871, 95%CI 0.841-0.900) and gradient boosted trees (AUC 0.897, 95%CI 0.881-0.912) in predicting in-hospital post-surgical mortality. Using logistic regression, the ASA Physical Status Classification score alone had an AUC of 0.865 (95%CI 0.848-0.882). Adding preoperative features to the ASA Physical Status Classification improved the random forest AUC to 0.929 (95%CI 0.915-0.943). Using only automatically obtained preoperative features with no clinician intervention, we found that the random forest model achieved an AUC of 0.921 (95%CI 0.908-0.934). Integrating the preoperative risk prediction into the DNN for postoperative risk prediction results in an AUC of 0.924 (95%CI 0.905-0.941), and with both a preoperative and postoperative risk score for each patient, we were able to show that the mortality risk changes over time. Conclusions: Features easily extracted from EMR data can be used to preoperatively predict the risk of in-hospital post-surgical mortality in a fully automated fashion, with accuracy comparable to models trained on features that require clinical expertise. This preoperative risk score can then be compared to the postoperative risk score to show that the risk changes, and therefore should be monitored longitudinally over time

Longitudinal community plasma HIV-1 RNA concentrations and incidence of HIV-1 among injecting drug users: prospective cohort study

Objective To examine the relation between plasma HIV-1 RNA concentrations in the community and HIV incidence among injecting drug users