Effect Of Biofeedback Devices In Partial Weight-Bearing Orthopaedic Patients

Partial weight-bearing (PWB) instructions are commonly given to orthopaedic patients. However, the ability of patients to comply with these instructions is poorly defined. Recent advances in technology have created biofeedback devices capable of offering real-time feedback to patients given PWB instructions. These devices could potentially increase patient compliance with PWB instructions following orthopaedic surgery. This thesis was designed to evaluate the effectiveness of modulating partial weight-bearing using the SmartStepTM biofeedback device. Fifty asymptomatic subjects aged 21-72 years were given three educational interventions designed to train them to limit weight-bearing on a lower extremity: verbal instructions, training with a bathroom scale, and training with a biofeedback device. Weight-bearing was measured after each activity to determine the effectiveness of biofeedback as compared to other clinical teaching methods. Additionally, another 14 subjects were given biofeedback training and retention was measured over a 24-hour period to assess retention of biofeedback training. Subjects given only verbal touch down weight-bearing instructions (25lbs) initially bore an average of 61.25± 4.80lbs (average ± standard error). This was reduced to 51.50 ± 4.47lbs after training with a bathroom scale and was further reduced to 30.01 ± 2.33lbs after biofeedback training. Likewise, subjects given verbal partial weight-bearing instructions (75lbs) initially bore an average of 89.06 ± 5.58lbs. There was no improvement with the use of a bathroom scale, with an average of 88.47 ± 4.75lbs. After training with a biofeedback device, weight-bearing improved to an average of 68.11 ± 2.46lbs. Mixed model analysis found age was not a significant predictor of subject compliance. However, higher BMI and male gender were predictive of heavier weight-bearing. Additionally, subjects in the retention study initially bore 20.4 ± 2.12 lbs (average ± standard error) after biofeedback training. Retention tests during the 24 hour period showed no significant difference from the original testing, with 2-4 hour retention of 19.98 ± 4.75 lbs; 6-8 hour retention of 25.07 ± 6.60 lbs; and 24 hour retention of 21.75 ± 4.58 lbs. Biofeedback training leads to superior compliance with touch down and partial weight-bearing instructions as compared to verbal instructions or training with a bathroom scale. Compliance was negatively affected by BMI and male gender, but not age. Additionally, biofeedback training shows retention up to 24-hours. As partial weight-bearing instructions are commonly given to orthopaedic patients, training with such a device may be appropriately considered

Improving Documentation In Shoulder Dystocia

Shoulder dystocia (SD) is difficult to predict and one of the most highly litigated obstetrical emergencies. Consequently, our institution implemented a standardized SD form in order to help facilitate adequate and accurate documentation in cases of SD. Our study aimed to utilize the information recorded in the newly implemented SD form to investigate the demographics of patients, practices, and outcomes in SD cases at Yale-New Haven Hospital (YNHH) and to study the effect of implementing a standardized SD form on medical record documentation practices. We collected 41 discrete data points from the SD form and the medical record in cases of SD occurring at our institution. We identified SD cases beginning in January 2004 and tracked inclusion of delivery information in the SD form and in narrative delivery notes for one year before and four years after implementation. Overall, 152 consecutive cases of SD were included and the presence as well as the mean and standard deviation, or percentage, for each data point was collected and calculated. Elements from the SD form increased significantly in narrative delivery notes after implementation of the form (p=.011). Data elements included at higher rates in the medical record after implementation included estimated prepregnancy maternal weight (13% to 28%, p=.043), total maternal pregnancy weight gain (19% to 36%, p=.033), estimated fetal weight (60% to 77%, p=.025), time of onset of active labor (40% to 65%, p=.004), time of onset of second stage (27% to 52%, p=.003), and time of head delivery (4% to 30%, p=\u3c.001). The demographics of our patient population were comparable to that of others reported in the literature. Our results show that use of a mandatory SD form results in significant improvements in documentation within provider narrative delivery notes and may improve the attention of providers to more complete and accurate charting. Such improvements in documentation may better demonstrate standards of care in the management of SD cases and decrease litigation exposure when events are reviewed

The State of Preschool 2007

Provides data on state-funded pre-K programs for the 2006-2007 school year, such as percentages of children enrolled at different ages, spending per child, and the number of quality standard benchmarks met. Includes state rankings and profiles

Improving Informational Bases of Performance Measurement with Grey Relation Analysis

Performance measurement (PM) needs objective empirical data with causal relevance in order to steer and control financial performance generation. In business practice, there is often a lack of such objective data. A surrogate might be collected subjectively based on data generated by questioning corporate experts. Such an involvement of subjects can rapidly lead to an immense extent of data that (partially) imply incomplete information. To handle this imperfection of data, the Grey systems theory (GST) and especially its element, the Grey relation analysis (GRA), seem to be methodologies able to improve informational bases for PM purposes. Therefore, GRA is able to reveal those performance indicators that considerably influence the corporate financial performance, the key performance indicators. GRA is able to supply valid results with only four data points of a time series. Hence, the GST provides an improvement of the PM framework in situations of incomplete information, which is demonstrated in the following

Residual Malaria Transmission in Select Countries of Asia-Pacific Region: Old Wine in a New Barrel

Background: Despite substantial reductions in malaria burden and improvement in case management, malaria remains a major public health challenge in the Asia-Pacific region. Residual malaria transmission (RMT) is the fraction of total transmission that persists after achievement of full operational coverage with effective insecticide-treated bed nets (ITNs)/long-lasting insecticidal nets (LLINs) and/or indoor residual spray interventions. There is a critical need to standardize and share best practices for entomological, anthropological, and product development investigative protocols to meet the challenges of RMT and elimination goals. Methods: A systematic review was conducted to describe when and where RMT is occurring, while specifically targeting ownership and usage of ITN/LLINs, indoor residual spray application, insecticide susceptibility of vectors, and human and vector biting behavior, with a focus on nighttime activities. Results: Sixty-six publications from 1995 to present met the inclusion criteria for closer review. Associations between local vector control coverage and use with behaviors of human and mosquito vectors varied by locality and circumstance. Consequently, the magnitude of RMT is insufficiently studied and analyzed with sparse estimates of individual exposure in communities, insufficient or incomplete observations of ITN/LLIN use, and the local human population movement into and from high-risk areas. Conclusions: This review identified significant gaps or deficiencies that require urgent attention, namely, developing standardized procedures and methods to estimate risk exposure beyond the peridomestic setting, analytical approaches to measure key human-vector interactions, and seasonal location-specific agricultural or forest use calendars, and establishing the collection of longitudinal human and vector data close in time and location

Digital transformation: from hierarchy to network-based collaboration? The case of the German "Online Access Act"

To unlock the full potential of ICT-related public sector innovation and digital transformation, governments must embrace collaborative working structures and leadership, is commonly argued. However, little is known about the dynamics of such collaborations in contexts of hierarchy, silo cultures, and procedural accountability. A widely voiced but empirically insufficiently substantiated claim is that bringing cross-cutting digital endeavours forward requires more lateral, network-based approaches to governance beyond traditional Weberian ideals. We test this claim by shedding light on three distinct challenges (complexity, risk, and power imbalance) encountered when implementing the specific collaborative case of the German Online Access Act (OAA) and by examining how they have been addressed in institutional design and leadership. Our analysis, which combines desk research and semi-structured expert interviews, reveals that flexible, horizontal approaches are on the rise. Taking a closer look, however, vertical coordination continues to serve as complementary means to problem-solving capability.Dass Regierungen kooperative Arbeitsstrukturen und Führungsformen annehmen müssten, ist eine gängige Forderung, um das Potenzial von IKT-bezogener Innovation und digitaler Transformation im öffentlichen Sektor auszuschöpfen. Bislang ist jedoch wenig über die Dynamik solcher Kooperationen unter Rahmenbedingungen bekannt, die durch Hierarchie, Silokulturen und prozedurale Verantwortlichkeit charakterisiert sind. Auch empirisch nicht ausreichend untermauert ist die weit verbreitete Behauptung, die Förderung bereichs-übergreifender, digitaler Bestrebungen erfordere laterale, netzwerkbasierte Governance-Ansätze, die über die traditionellen Weber'schen Ideale hinausgehen. Wir prüfen diese Annahme, indem wir drei spezifische Herausforderungen (Komplexität, Risikowahrnehmung und Machtasymmetrien), die bei der Umsetzung des deutschen Onlinezugangsgesetz (OZG) aufgetreten sind, näher beleuchten, und untersuchen, wie diesen mit Maßnahmen des institutionellen Designs und Leadership begegnet wurde. Unsere Analyse kombiniert Literaturrecherchen mit semi-strukturierten Experteninterviews und zeigt, dass flexible, horizontale Ansätze an Relevanz gewinnen. Gleichzeitig wird jedoch deutlich, dass vertikale Koordination weiterhin als komplementäres Mittel zur Problemlösung Anwendung findet

Zur Adsorption von CO2 auf NaCl(001)- und KCl(001)-Einkristallspaltflächen : höchstauflösende Polarisations-Fouriertransform-Infrarot-Spektroskopie, Diodenlaserspektroskopie, Beugung langsamer Elektronen und Spektrensimulationen

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Modular aufgebaute Vorformwerkzeuge für das Schmieden von Langteilen

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