Determining the Efficacy of the Use of Instrument Assisted Soft Tissue Mobilization in Hand Therapy

In collaboration with Brian Chase, CHT, OTR/L of NW Sports Physical Therapy in Tacoma, WA, our research group addressed his question of whether instrument assisted soft tissue mobilization (IASTM) is effective for clients and if so, are certain brands such as Graston Technique (GT) or Astym more effective. Through our careful review of the literature, summarized in a critically appraised topic format, we found that the majority of studies (case reports and experimental studies) found that IASTM treatments improved scores on outcome measures including return to occupation, range of motion, pain, and grip and pinch strength over baseline measurements. However, randomized controlled trials that compared IASTM to other treatments including ultrasound, active movement, acupuncture, and massage therapy generally showed that IASTM is not significantly more effective than other forms of therapy. The existing evidence for IASTM is insufficient to justify and support the use of IASTM in most hand therapy scenarios. To remedy this problem we initiated a translation of knowledge and created a research needs assessment (RNA) highlighting the current gaps in the literature. Through sharing this needs assessment we hope that hand therapy practitioners will be compelled to publish findings that they feel could help fill the research needs that we have outlined. We reached out to the Facebook pages of Hand Therapy and the American Society for Hand Therapists (ASHT) to share our RNA with the intention of receiving critiques and feedback. We then forwarded our RNA to the Research Department of the ASHT and are awaiting further response. Our RNA has also reached the ears of the Graston Technique which resulted in an informative conference call with the Graston Technique’s Director of Strategic Planning, Mike Ploski PT, ATC, OCS, our group members; Kaitlin, Sarah, Yoseph, and Evan, and our research chair, George Tomlin. Based on our research and our identification of gaps in the literature, we recommend that practitioners contribute to the field of research on this topic to provide more evidence for the use of IASTM in practice

Knowledge is power: An analysis of discussions on hacking forums

There remains a lack of understanding on the social factors that influence the behaviours and beliefs of people who have an interest in hacking. This research sought to address that gap by exploring the conversations that take place on hacking forums and subreddits. Text in hacking related threads was collected from these sites over a period of several months. Linguistic Inquiry and Word Count (LIWC) software was used to determine the linguistic characteristics of each forum/ subreddit. Thematic analysis was then conducted on a sub-set of text from each source. The results of the LIWC analysis indicated that there are variations in several psychologically relevant factors between these forums and subreddits, including the degree to which users used language that indicated they were being honest, confident, analytical and emotional. There were several results that were inconsistent with stereotypes of hackers, such as a relative absence of language indicating anger. The thematic analysis identified several themes relating to knowledge, skills acquisition, honesty legality and risk. Overall, this research demonstrates that there exists an established online community of hackers, which are likely to be encountered by any young person who becomes interested in cybersecurity and hacking. These communities may potentially act as an important source of social support and social identity for their members. Understanding the dynamics of these communities may better help us steer people towards legitimate cybersecurity careers, where their passion and skills can be used for societal good

Homogenization via formal multiscale asymptotics and volume averaging: How do the two techniques compare?

A wide variety of techniques have been developed to homogenize transport equations in multiscale and multiphase systems. This has yielded a rich and diverse field, but has also resulted in the emergence of isolated scientific communities and disconnected bodies of literature. Here, our goal is to bridge the gap between formal multiscale asymptotics and the volume averaging theory. We illustrate the methodologies via a simple example application describing a parabolic transport problem and, in so doing, compare their respective advantages/disadvantages from a practical point of view. This paper is also intended as a pedagogical guide and may be viewed as a tutorial for graduate students as we provide historical context, detail subtle points with great care, and reference many fundamental works

Homogenization via formal multiscale asymptotics and volume averaging: How do the two techniques compare?

A wide variety of techniques have been developed to homogenize transport equations in multiscale and multiphase systems. This has yielded a rich and diverse field, but has also resulted in the emergence of isolated scientific communities and disconnected bodies of literature. Here, our goal is to bridge the gap between formal multiscale asymptotics and the volume averaging theory. We illustrate the methodologies via a simple example application describing a parabolic transport problem and, in so doing, compare their respective advantages/disadvantages from a practical point of view. This paper is also intended as a pedagogical guide and may be viewed as a tutorial for graduate students as we provide historical context, detail subtle points with great care, and reference many fundamental works

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Does the Internet Represent a Threat to the Security of Symptom Validity Tests?

Objective: Previous research has shown that there is a variable amount of information on Internet sites about symptom validity tests (SVTs) that threaten the security and validity of these measures. However, this work was conducted a number of years ago (Bauer & McCaffrey, 2006; Ruiz, Drake, Glass, Marcotte, & van Gorp, 2002). Given the continued advances in technology and Internet services, the goal of the present study was to examine the current level of threat to SVT security posed by Internet sites. Methods: Internet searches using Google were performed for two SVTs: Word Memory Test (WMT) and the Computerized Assessment of Response Bias (CARB.) The name of each test was entered into the search engine and the first 25 links were examined. The websites were classified into four levels of test security threat: No Threat, Low Threat, Moderate Threat, or High Threat using criteria consistent with previous research. Results: For the WMT, 24% of the sites were determined to be No Threat, 36% were Low Threat, 28% were Moderate Threat, and 12% were High Threat. For the CARB, 24% of the sites were determined to be No Threat, 20% were Low Threat, 48% were Moderate Threat, and 12% were High Threat. Conclusions: Compared to previous research, these data indicate an alarming increase in the number of Internet sites that contain content that threatens the test security of the SVTs investigated. For the WMT, increases were found at every level of threat severity. For the CARB, a troubling percentage of sites that threatened test security where also found. There were interesting differences between the two measures in terms of the severity of threat. Specifically, 40% of the results were of moderate or high threat for the WMT, while 60% were of moderate or high threat for the CARB