Reliability of the Myotonometer for Assessment of Posterior Shoulder Tightness

BACKGROUND/PURPOSE: The Myotonometer® is an electronic tissue compliance meter that has been used to quantify the compliance of soft tissues. The Myotonometer® may be a valuable tool to measure the effectiveness of interventions commonly used to increase tissue compliance in individuals with posterior shoulder tightness (PST). Limited data exist on reliability and responsiveness of the Myotonometer® for assessment of soft tissues about the shoulder; therefore, the purpose of this study is to determine the intra- and inter-session reliability and responsiveness of the Myotonometer® in measuring tissue compliance of the posterior shoulder musculature in asymptomatic subjects with PST. METHODS: Fifteen asymptomatic subjects with unilateral shoulder range of motion deficits attended two measurement sessions to assess the compliance of the tissues overlying the posterior deltoid, infraspinatus, and teres musculature. Analyses of reliability and responsiveness were conducted using intra-class correlation coefficients (ICCs) and the determination of minimal detectible change (MDC). RESULTS: Intra-session ICC values ranged from 0.69 to 0.91 for all muscles with MDC never exceeding 1.0 mm. Inter-session ICC values were best for the posterior deltoid, which averaged 0.82, compared to the infraspinatus and the teres complex, which averaged 0.42 and 0.5 respectively. Inter-session MDC ranged from 0.55 to 1.20 mm across all muscles. CONCLUSIONS: Clinicians can reliably detect relatively small changes in tissue compliance within a single treatment session utilizing the Myotonometer®. The Myotonometer® can reliably detect changes between sessions for tissues overlying the posterior deltoid; however, observed change in the infraspinatus and teres musculature must be above 1 mm to achieve meaningful change and account for decreased inter-session reliability. LEVEL OF EVIDENCE: 3

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

BOKO HARAM'S RISE AND THE MULTINATIONAL RESPONSE

Boko Haram’s Islamic insurgency in northeast Nigeria has resulted in tens of thousands of deaths, displaced millions of civilians, and threatened the security and stability of multiple nations. Despite a concerted effort by the militaries of Nigeria, Chad, Niger, and Cameroon, and the 2014 formation of the Multinational Joint Task Force (MNJTF) committed to countering it, Boko Haram has remained remarkably resilient and continues to conduct attacks throughout the region. This thesis aims to understand the conditions that led to Boko Haram’s development as a violent jihadist organization in northeast Nigeria, how Nigeria’s heavy-handed response fueled Boko Haram’s growth, how the nations of the Lake Chad Basin responded to Boko Haram’s rapid expansion, and the successes and challenges of the multinational force built to combat it. Multiple interviews with current and former MNJTF officers provide insight into how the MNJTF plans and conducts counter-Boko Haram operations and the challenges the MNJTF faces. Ultimately, this thesis provides insight into how the MNJTF can help bring an end to Boko Haram’s insurgency and how nations of the Lake Chad Basin can prevent the next Boko Haram-type movement from developing.http://hdl.handle.net/10945/61200Major, United States ArmyLieutenant Colonel, Army, CameroonApproved for public release; distribution is unlimited

Directed Study in Support of SOJTF-A: The Future Utilization of SOF in Afghanistan

Defense Analysis PosterWhat we were asked to do: Develop a set of considerations to support future SOJTF-A planning; A narrative that explains the justice of the shared US-Afghan cause and undermines the Taliban's narrative; develop creative concepts for the future utilization of SOF in AfghanistanSpecial Operations Joint Task Force –Afghanistan (SOJTF-A

Framing the Post-2020 Afghan Environment: Thoughts and Recommendations

This research aims to augment the reader’s strategic appreciation for the post-2020 environment in Afghanistan. As such, the authors consider this a “thought piece” versus a policy prescriptive decision briefing or white paper. The near-term goal is to inform the NATO Special Operations Component Command – Afghanistan/Special Operations Joint Task Force – Afghanistan (NSOCC-A/SOJTF-A) Commander and his staff on crucial variables that may prove consequential in the forthcoming development of a campaign design for the future utilization of Special Operations Forces (SOF) in Afghanistan, while also providing a collection of ‘creative options’ that could be injected into future SOF campaign plans in order to influence the aforementioned variables. For this analysis, the authors consciously present a holistic look at Afghanistan, accounting for variables and circumstances beyond SOJTF-A’s authorities or sphere of influence. The expanded scope was purposefully chosen to present a comprehensive understanding of the environment in which SOJTF-A leadership employs the SOF enterprise.Commander, NSOCC-A/SOJTF-ACommander, NSOCC-A/SOJTF-

ExELS: An exoplanet legacy science proposal for the ESA euclid mission - I. cold exoplanets

The Euclid mission is the second M-class mission of the ESA Cosmic Vision programme, with the principal science goal of studying dark energy through observations of weak lensing and baryon acoustic oscillations. Euclid is also expected to undertake addit