Validity and Usability of a Professional Association’s Web-Based Knowledge Translation Portal: American Physical Therapy Association’s PTNow.org

Background: PTNow.org is an evidence-based, on-line portal created by a professional membership association to promote use of evidence in practice and to help decrease unwarranted variation in practice. The site contains synthesis documents designed to promote efficient clinical reasoning. These documents were written and peer-reviewed by teams of content experts and master clinicians. The purpose of this paper is to report on the content and construct validity as well as usability of the site. Methods: Physical therapist participants used clinical summaries (available in 3 formats--as a full summary with hyperlinks, quick takes with hyperlinks, and a portable two-page version) on the PTNow.org site to answer knowledge acquisition and clinical reasoning questions related to four patient scenarios. They also responded to questions about ease of use related to website navigation and about format and completeness of information using a 1-5 Likert scale. Responses were coded to reflect how participants used the site and then were summarized descriptively. Preferences for clinical summary format were analyzed using an analysis of variance (ANOVA) and a Dunnett T3 post hoc analysis. Results: Seventeen participants completed the study. Clinical relevance and completeness ratings by experienced clinicians, which were used as the measure of content validity, ranged from 3.1 to 4.6 on a 5 point scale. Construct validity based on the information on the PTNow.org site was supported for knowledge acquisition questions 66 % of the time and for clinical reasoning questions 40 % of the time. Usability ratings for the full clinical summary were 4.6 (1.2); for the quick takes, 3.5 (.98); and for the portable clinical summary, 4.0 (.45). Participants preferred the full clinical summary over the other two formats (F = 5.908, P = 0.007). One hundred percent of the participants stated that they would recommend the PTNow site to their colleagues. Conclusion: Prelimary evidence supported both content validity and construct validity of knowledge acquisition, and partially supported construct validity of clinical reasoning for the clinical summaries on the PTNow.org site. Usability was supported, with users preferring the full clinical summary over the other two formats. Iterative design is ongoing

Evidence-Based Practice Confidence and Behavior Throughout the Curriculum of Four Physical Therapy Education Programs: A Longitudinal Study

Background Evidence-based practice (EBP) is a foundational process taught in health professional education, yet it is unclear when EBP confidence and skills are obtained. Increases in EBP confidence and behaviors from the start of physical therapy programs to post graduation have been reported in studies that evaluated a single program or used non-valid questionnaires. This study aimed to describe changes in EBP confidence and behavior using validated questionnaires of students from four physical therapy education programs throughout their curriculum and one year post graduation. Methods One hundred and eighty-one students from a potential pool of 269 (67.3%) consented to participate. Students completed the Evidence-Based Practice Confidence (EPIC) Scale and the Evidence-Based Practice Implementation Scale (EBPIS) at 6 timepoints: start of the program, prior to first clinical experience, after first clinical experience, at the end of classroom instruction, graduation, and one year post. Medians (Mdn) and 25th and 75th percentiles (P25, P75) were calculated for 42 (23.2%) students with complete data across all timepoints. Change between timepoints was assessed using Friedman’s test and Wilcoxon signed rank test with a Bonferroni correction for post hoc analysis. Results There were significant changes in EPIC scores (p \u3c 0.001) from enrollment (Mdn 50.0, P25, P75 35.5, 65.9) to prior to first clinical experience (Mdn 65.5, P25, P75 57.3, 72.5) and after the first clinical experience (Mdn 67.3, P25, P75, 58.9, 73.2) to the end of classroom instruction (Mdn 78.6, P25, P75, 72.0, 84.1). Significant increases on the EBPIS (p \u3c 0.01) were only seen from after the first year of training (Mdn 15, P25, P75, 10.0, 22.5) to end of the first clinical experience (Mdn 21.5, P25, P75 12.0, 32.0). Conclusions EBP confidence increased significantly after classroom instruction but remained the same after clinical experiences and at one year post graduation. EBP behavior significantly increased only after the first clinical experience and remained the same through graduation. Confidence and behavior scores were higher than were previously reported in practicing professionals. Ongoing assessment of EBP confidence and behavior may help instructors build appropriate curricula to achieve their outlined EBP objectives

Time since injury limits but does not prevent improvement and maintenance of gains in balance in chronic stroke

[EN] Objective To determine the influence of time since injury on the efficacy and maintenance of gains of rehabilitation of balance after stroke. Method Forty-seven participants were assigned to a least (6-12 months), a moderate (12-24 months), or a most chronic (>24 months) group. Participants trained for 20 one-hour sessions, administered three to five times a week, combining conventional physical therapy and visual feedback-based exercises that trained the ankle and hip strategies. Participants were assessed before, after the intervention, and one month later with a posturography test (Sway Speed and Limits of Stability) and clinical scales. Results In contrast to other subjects, the most chronic participants failed to improve their sway and to maintain the benefits detected in the Limits of Stability after the intervention. Although all the participants improved in those clinical tests that better matched the trained skills, time since injury limited the improvement, and over all, the maintenance of gains. Conclusion Time since injury limits but does not prevent improvement in chronic stages post-stroke, and this effect appears to be more pronounced with maintaining gains. These findings support that training duration and intensity as well as type of therapy may need to be adjusted based on time post-stroke.This work was supported by Universitat Politecnica de Valencia (Grant PAID-10-16).Llorens Rodríguez, R.; Noé, E.; Alcañiz Raya, ML.; Deutsch, JE. (2017). Time since injury limits but does not prevent improvement and maintenance of gains in balance in chronic stroke. Brain Injury. 32(3):303-309. https://doi.org/10.1080/02699052.2017.1418905S303309323Pekna, M., Pekny, M., & Nilsson, M. (2012). Modulation of Neural Plasticity as a Basis for Stroke Rehabilitation. 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Journal of Neurologic Physical Therapy, 29(1), 24-33. doi:10.1097/01.npt.0000282259.81949.0eYang, Y.-R., Wang, R.-Y., Lin, K.-H., Chu, M.-Y., & Chan, R.-C. (2006). Task-oriented progressive resistance strength training improves muscle strength and functional performance in individuals with stroke. Clinical Rehabilitation, 20(10), 860-870. doi:10.1177/0269215506070701Fritz, S. L., Pittman, A. L., Robinson, A. C., Orton, S. C., & Rivers, E. D. (2007). An Intense Intervention for Improving Gait, Balance, and Mobility for Individuals With Chronic Stroke: A Pilot Study. Journal of Neurologic Physical Therapy, 31(2), 71-76. doi:10.1097/npt.0b013e3180674a3cMacko, R. F. (2008). Adaptive physical activity improves mobility function and quality of life in chronic hemiparesis. The Journal of Rehabilitation Research and Development, 45(2), 323-328. doi:10.1682/jrrd.2007.02.0025Lee, S. W., Shin, D. C., & Song, C. H. (2013). The Effects of Visual Feedback Training on Sitting Balance Ability and Visual Perception of Patients with Chronic Stroke. Journal of Physical Therapy Science, 25(5), 635-639. doi:10.1589/jpts.25.635Tsaklis, P. V., Grooten, W. J. A., & Franzén, E. (2012). Effects of Weight-Shift Training on Balance Control and Weight Distribution in Chronic Stroke: A Pilot Study. Topics in Stroke Rehabilitation, 19(1), 23-31. doi:10.1310/tsr1901-23Gil-Gómez, J.-A., Lloréns, R., Alcañiz, M., & Colomer, C. (2011). Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury. Journal of NeuroEngineering and Rehabilitation, 8(1), 30. doi:10.1186/1743-0003-8-30Lloréns, R., Albiol, S., Gil-Gómez, J.-A., Alcañiz, M., Colomer, C., & Noé, E. (2014). Balance rehabilitation using custom-made Wii Balance Board exercises: clinical effectiveness and maintenance of gains in an acquired brain injury population. International Journal on Disability and Human Development, 13(3). doi:10.1515/ijdhd-2014-0323Lloréns, R., Gil-Gómez, J.-A., Alcañiz, M., Colomer, C., & Noé, E. (2014). Improvement in balance using a virtual reality-based stepping exercise: a randomized controlled trial involving individuals with chronic stroke. Clinical Rehabilitation, 29(3), 261-268. doi:10.1177/0269215514543333Lloréns, R., Noé, E., Colomer, C., & Alcañiz, M. (2015). Effectiveness, Usability, and Cost-Benefit of a Virtual Reality–Based Telerehabilitation Program for Balance Recovery After Stroke: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 96(3), 418-425.e2. doi:10.1016/j.apmr.2014.10.019Dromerick, A. W., Edwardson, M. A., Edwards, D. F., Giannetti, M. L., Barth, J., Brady, K. P., … Newport, E. L. (2015). Critical periods after stroke study: translating animal stroke recovery experiments into a clinical trial. 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Infrared Array Camera (IRAC) Observations of Planetary Nebulae

We present the initial results from the Infrared Array Camera (IRAC) imaging survey of planetary nebulae (PNs). The IRAC colors of PNs are red, especially in the 8.0 μm band. Emission in this band is likely due to contributions from two strong H2 lines and a [Ar III] line in that bandpass. IRAC is sensitive to the emission in the halos as well as in the ionized regions that are optically bright. In NGC 246, we have observed an unexpected ring of emission in the 5.8 and 8.0 μm IRAC bands not seen previously at other wavelengths. In NGC 650 and NGC 3132, the 8.0 μm emission is at larger distances from the central star compared to the optical and other IRAC bands, possibly related to the H2 emission in that band and the tendency for the molecular material to exist outside of the ionized zones. In the flocculi of the outer halo of NGC 6543, however, this trend is reversed, with the 8.0 μm emission bright on the inner edges of the structures. This may be related to the emission mechanism, where the H2 is possibly excited in shocks in the NGC 6543 halo, whereas H2 emission is likely fluorescently excited in the UV fields near the central star

Infrared Array Camera (IRAC) Observations of Planetary Nebulae

We present the initial results from the Infrared Array Camera (IRAC) imaging survey of planetary nebulae (PNs). The IRAC colors of PNs are red, especially in the 8.0 μm band. Emission in this band is likely due to contributions from two strong H2 lines and a [Ar III] line in that bandpass. IRAC is sensitive to the emission in the halos as well as in the ionized regions that are optically bright. In NGC 246, we have observed an unexpected ring of emission in the 5.8 and 8.0 μm IRAC bands not seen previously at other wavelengths. In NGC 650 and NGC 3132, the 8.0 μm emission is at larger distances from the central star compared to the optical and other IRAC bands, possibly related to the H2 emission in that band and the tendency for the molecular material to exist outside of the ionized zones. In the flocculi of the outer halo of NGC 6543, however, this trend is reversed, with the 8.0 μm emission bright on the inner edges of the structures. This may be related to the emission mechanism, where the H2 is possibly excited in shocks in the NGC 6543 halo, whereas H2 emission is likely fluorescently excited in the UV fields near the central star

Performance of the infrared array camera (IRAC) for SIRTF during instrument integration and test

The Infrared Array Camera (IRAC) is one of three focal plane instruments in the Space Infrared Telescope Facility (SIRTF). IRAC is a four-channel camera that obtains simultaneous images at 3.6, 4.5, 5.8, and 8 microns. Two adjacent 5.12x5.12 arcmin fields of view in the SIRTF focal plane are viewed by the four channels in pairs (3.6 and 5.8 microns; 4.5 and 8 microns). All four detector arrays in the camera are 256x256 pixels in size, with the two shorter wavelength channels using InSb and the two longer wavelength channels using Si:As IBC detectors. We describe here the results of the instrument functional and calibration tests completed at Ball Aerospace during the integration with the cryogenic telescope assembly, and provide updated estimates of the in-flight sensitivity and performance of IRAC in SIRTF

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio